Christopher Hawgood

Hospital consultants accept NHS pay deal

Health secretary scores victory as specialist doctors avert first strike in 30 years by swing in favour of deal raising starting salary to £65,035

John Carvel, social affairs editor The Guardian
(Tuesday October 21, 2003)

Hospital consultants in England have voted decisively in favour of the government's offer of a new national contract, raising basic salaries by about 15% and providing lucrative rewards for overtime that was previously unpaid.

The deal was accepted by over 60% of consultants and by 55% of specialist registrars in a ballot by the British Medical Association, it was announced yesterday. The result has averted the threat of mass resignations from the NHS that could have disrupted health service reforms and damaged Labour's re-election chances.

Under the new terms, the basic salary of a newly qualified NHS consultant will be raised to £65,035. At the top of the scale consultants will be able to earn basic pay of £88,000 plus clinical excellence awards worth up to £64,000 for the best clinicians providing the most commitment to NHS work.

They will be free to supplement this income from private practice as long as they offer at least four hours a week of paid overtime for the NHS.

Last year the BMA rejected a similar contract by a majority of nearly two to one. Many consultants feared it would lead to loss of clinical independence.

When Alan Milburn, the former health secretary, tried to impose the deal through negotiations at each NHS trust, the BMA threatened industrial action for the first time in 30 years. It said consultants might withdraw overtime and move into barrister-style chambers outside NHS control.

The new deal is a vindication of John Reid, the health secretary, who decided after taking over from Mr Milburn in June to reopen negotiations.

Under the final terms, they will not be obliged to do non-emergency work in evenings or weekends. If they agree to do so, they will be paid a 33% premium on the hourly rate.

The government has amended plans to make newly qualified consultants do eight hours' overtime a week for the NHS to gain the right to do private work. All consultants will have to offer four hours NHS overtime before working privately.

Dr Reid said: "This is a very good result for the NHS and more importantly for NHS patients." It followed pay increases for GPs, nurses and other staff in return for changes in working practice. "All 1.3 million NHS staff have signed up to new ways of working that will enable us to deliver an even better service for NHS patients," he added.

The pay offer will be backdated to April, but to gain the full benefit consultants must commit to it by the end of this month. They can remain on the old contract if they prefer.

Nizam Mamode, the BMA's chief negotiator, said the deal will encourage consultants to stay in the NHS. "We can make it work on the ground. We have moved from a 66% no vote last year to 60% yes. That's a pretty massive swing. There will be teething troubles, but this will benefit consultants and the NHS as a whole," he said.

Separate negotiations have been carried out in Scotland, Wales and Northern Ireland. The result of the Scottish ballot is due later this week while consultants in Wales will vote on their deal next month. Negotiations in Northern Ireland have not been concluded.

The Conservative shadow health secretary Liam Fox said: "I welcome the stability this result represents. There can now be no excuse for the government's failure to deliver on its health pledges."

Liberal Democrat health spokesman Paul Burstow said: "An agreement may have been reached on this contract, but doctors will still find their work distorted by political targets, which stop them from treating the sickest quickest."

The new contract

· Consultants' average lifetime earnings will rise by 15%, with the biggest benefit going to those at the start or end of their careers.

· The extra cost to the NHS in 2003-04 will be £135m.

· Basic pay for a newly qualified consultant will rise from £54,340 to £65,035 (19.7%).

· The top of the scale will rise from £70,715 to £88,000 (24.4%), but there will still be bonuses worth up to £64,000.

· NHS consultants wishing to do private work will first have to offer four hours paid overtime to the NHS.

· All non-emergency work at evenings and weekends will be by agreement only.

· Work before 7am or after 7pm on weekdays will be paid at time and a third.

· Payment progression will depend on job plans to be agreed with managers.

· Final salary pensions will increase by 24%.

Questions & Answers: the consultant contract

After months of bargaining, hospital doctors in England have voted in favour of a new contract, the British Medical Association has announced today. We explain the background

SocietyGuardian.co.uk (Monday October 20, 2003)

Who are NHS consultants?
Consultants are highly trained senior doctors, many of them working in hospitals. Consultants are normally appointed in their early to mid-30s, having completed at least 15 years of medical training (including 10 years of service in the NHS as senior house officer and then specialist registrar). The UK has around 26,000 consultants, of which 20% are women.

What is the consultant contract?
The contract is the national framework that governs the working conditions and salary grades of consultants. It dates back to 1948, when then health secretary and architect of the NHS, Aneurin Bevan, created it as a way of attracting senior hospital doctors to join the nascent health service. The Department of Health drew up a new contract last year following negotiations with the British Medical Association (BMA), which consultants in England rejected by two to one. But the deal has just been renegotiated.

Why does the government want a new contract?
For decades politicians have wanted to renegotiate the consultant contract because in many ways it ran counter to the principles of the NHS. Bevan admitted that in drawing up the 1948 contract he had "stuffed their [consultants'] mouths with gold" That "gold" was an NHS salary; the right to continue private practice in NHS pay beds; and a lucrative merit bonus system (awarded in secret by doctors to each other). While this effectively "bought off" consultant opposition to the NHS, it also institutionalised a two-tier system of access (the rich could always pay to jump NHS waiting lists) and allowed unscrupulous consultants to artificially lengthen waiting lists in order to create a demand for their private work. Ministers hoped that the 2002 deal requiring doctors to do non-emergency work during evenings or weekends would drive down waiting lists and remove much of the demand for private treatment.

Why was the contract not renegotiated before?
The late Barbara Castle tried while health secretary in 1974 to phase out NHS pay beds but failed in the face of consultant industrial action. The Conservatives introduced "job plans" in 1990 to enable managers to keep track of consultants' private practice - but these had little effect and were often ignored.

Why was the 2002 deal rejected?
Consultants in Scotland and Wales accepted the deal that pledged to raise their NHS pay by 19% over three years. But no-voters in England believed that the proposed contract gave NHS managers "unreasonable" control over their working practices and would distort clinical priorities - forcing consultants to focus on cutting waiting lists at the expense of needier cases. The contract gave clear rules on private practice - consultants would not have been allowed to do private work during their NHS contracted hours. And pay rises would no longer be automatic - doctors would have to meet performance targets set out in agreed job plans. Critics said consultants were merely protecting outdated arrangements that allow some senior hospital doctors to protect lucrative private work at the expense of NHS patients.

How did the no vote affect the BMA?
The association's credibility - both in the eyes of ministers and the medical profession - was severely shaken. When the no vote was announced last October, the then consultants' leader Peter Hawker, who had described the contract as "a good deal ... fair to consultants, and fair to the NHS", resigned. His successor, Paul Miller, widely considered a maverick, took a more hardline approach with the government, which initially attempted to implement the rejected deal on a trust by trust basis. The dispute between consultants and the government was further inflamed by the former health secretary, Alan Milburn's insistence that there would be no further talks about the contract. The BMA responded by warning that 7,000 consultants would quit if ministers continued to refuse to renegotiate. It also threatened to sue Mr Milburn because many doctors are still working in excess of the legal limit of 48 hours a week in defiance of European employment law. It advised consultants to begin a work-to-rule against the unpaid overtime that is required by the NHS to meet the government's waiting-list targets.

Why did the BMA recommend the 2002 deal?
It offered consultants more money, and set down clear guidelines on how much time they should spend working for the NHS. After qualifying, consultants would - as of April 2003 - earn a minimum £63,000, roughly £10,000 more than at present. The maximum salary grades would have risen by £17,000 to £85,000. There would have been extra cash for on-call duties. The new contract also put a 40-hour limit on the basic consultant working week; the BMA had complained that most consultants were overworked - that they regularly put in a 50-hour week for the NHS.

What can NHS consultants earn from private practice?
Anything from a small fortune to pocket money, depending on speciality and predisposition. The average net annual private practice income for an NHS plastic surgeon is £75,000 (1999 figures). Orthopaedic surgeons rake in an average of £58,000 a year from private practice. The least lucrative speciality is pathology (£7,572). The very top surgeons can earn upwards of £250,000 on top of their NHS work.

How was the dispute resolved?
The health secretary, John Reid, has agreed a compromise deal with the BMA. Under the revised contract, consultants will keep their right to treat private patients if they have first offered four hours' overtime to the NHS. Doctors will no longer be obliged to do non-emergency work during evenings or weekends. But to protect the interests of NHS patients, the deal now includes a requirement that all consultants would normally devote three-quarters of their time to direct patient care.

How will all this affect patients?
The revised contract explicitly makes clear that the NHS patient came first and that the NHS always had first call on a consultant's time. In theory, this would have lead to shorter waiting times for NHS patients, more "face-to-face" sessions with patients and an increase in the time consultants spend on clinical care.

What was consultants' response to the revised contract?
Sixty percent of hospital doctors in England - 60.7% of consultants and 55.4% of specialist registrars - have voted in favour of the revised contract.

What happens next?
The BMA will now send guidance on the implementation of the new deal to all consultants in England. The results of separate ballots in Scotland and Wales will be announced on October 24, November 12 respectively. A date for the ballot in Northern Ireland has yet to be set.