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Consultants' contract attacked

22/11/2007

A new contract for NHS consultants to increase their salaries was rushed through and has failed to achieve extra productivity, MPs claim today.

According to the public accounts committee (PAC), the contract has yet to bring about the intended benefits.

In its report the committee of MPs says the Department of Health (DoH) "pushed to get the contract in place at all costs" and left many NHS managers in the dark about what was expected from the agreement.

Since 2003 the government has spent £150 million in funding the new contract but the PAC says although consultants' pay has increased by more than a quarter (27 per cent) from £86,746 to £109,974 and their working hours improved, as yet there have been no measurable improvements in productivity.

The DoH agreed the new contract, the first major revision of working terms for consultants in 50 years, to increase pay and recognition of NHS work.

It was hoped that the new agreement would reward those consultants who made the biggest contribution to NHS work and reduce the average number of hours worked per consultant in exchange for increased productivity.

Since its implementation the DoH has increased the number of consultants working in the NHS from 28,750 in October 2003 to 31,990 by September 2005.

But the PAC said the number of hours consultants work in private practice has neither increased or decreased significantly.

"Anyone who is puzzled how large quantities of money can be poured into the NHS to so little effect should examine the example of the new contract for consultants," said PAC chairman Edward Leigh.

"The plain fact is that the DoH greatly increased consultants' salaries (on average by over a quarter) without securing any extra productivity from them. Worse than that their productivity has actually decreased, with consultants spending less time working for the NHS and each one carrying out less activity."

The British Medical Association (BMA), which worked with the DoH to agree the deal, has robustly defended consultants' NHS work and described the "relentless criticism" of consultants and their pay as "unreasonable".

Dr Jonathan Fielden, chairman of the BMA's consultants committee, said that under the old contract "consultants worked well above what they were paid to do" and accused the PAC of ignoring "the vast efforts that consultants have made to reduce waiting times and improve patient care".

Dr Mark Porter, deputy chairman and lead negotiator for the BMA's consultants committee, added: "The government underestimated how hard consultants work for the NHS.

"Consultants' workload remains high, intensive and complex, and productivity is difficult to measure. The report has made fundamental errors in its understanding of the consultant contract and uses crude measures that focus on fast throughput instead of quality."