Press release: Consultant contract - NHS Confederation key messages + Q&A
31 Oct 2002
We are disappointed that the contract has been rejected by consultants in England, and Wales. Along with the BMA, we believed it was a good deal for individual consultants, for the NHS, and for patients.
The issues raised by the BMA seem to indicate that consultants have real concerns about being managed. However, to deliver a modern health service which meets the needs of patients, it is essential that the work of doctors is effectively planned and managed. This means it is less possible for doctors to be as independent and autonomous as they've been in the past.
We are committed to working with the profession to find a way to balance doctors traditional demands for autonomy with the increasing need to plan services around patients.
NHS organisations already work on a daily basis with consultants on ways to modernise the NHS. The contract was designed to assist this process ¡V but the no vote won¡¦t stop these joint efforts to deliver a first class service.
Q&A
1. What is the Confederation's reaction to the no vote in England and Wales?
We're disappointed that the contract has not gone through in England and Wales. We think it was a good deal for individual consultants, NHS managers and patients.
We believe the no vote is a missed opportunity to take forward a win-win offer, which would enable consultants NHS work to be properly rewarded, allow managers to more effectively plan services, and provide patients with more convenient care.
2. How do we respond to accusations that the contract would lead to excessive managerial control?
We reject any suggestions that the contract would have led to ¡¥excessive managerial control The NHS and its medical staff have to be accountable for the use of the considerable public resources put into the NHS. What was proposed in the contract was simply for consultants and managers to jointly agree a Job Plan, to more effectively monitor consultants workload, and ensure that services are planned around the needs of patients. The Job Plan would be decided through mutual agreement, and forms part of the normal employment procedures which would be recognized and accepted by all other staff in the NHS or any other employer.
Claims that the contract meant that all consultants would have to work 14 hours a day and all evenings and weekends are simply nonsense. At present, many consultants are working evenings and weekends for nothing. Under the new arrangements, any scheduled work in the evenings or at weekends would be part of a mutually agreed work programme, and would count toward the consultants working week.
3. Did poor relations between doctors and managers lead to the no vote?
Whilst there are no doubt some areas where doctors and managers could work more effectively together, in many trusts the relationship is positive and constructive.
It is also absolutely vital to recognise that doctors themselves are part of the "management" of NHS organisations. The new contract would largely be overseen by medical and clinical directors doctors who are part of the management team. So in many cases the idea that doctors and managers are at loggerheads simply does not make sense.
But we do recognise some of the wider issues that seem to have arisen during the ballot. Doctors concerns about a loss of autonomy and increased management are not just a UK issue but are common in developed healthcare systems across the world. Redesigning health care around patient needs will inevitably make it less possible for doctors to act as entirely independent and autonomous practitioners.
This does not mean managerial interference in the individual clinical decisions made by a doctor or in the personal doctor/patient relationship. But it does imply a need for a managed approach to the organisation and provision of services.
The move to a more managed approach is not going to stop ¡V either in the UK or internationally. If doctors expect to avoid this entirely they are being unrealistic.
What is therefore important is to engage with the profession in defining how relationship between doctors and NHS organisations can best be defined and developed. We have already proposed that work needs to be done to build a new psychological ¡§compact¡¨ between doctors and the NHS and we hope to work with the BMA over the coming months to take this forward.
4. Does this wreck the governments NHS reform plans?
No. NHS organisations already work on a daily basis with consultants on ways to improve and modernise the NHS. This will continue. The contract was a tool to assist this process and would have been helpful for NHS organisations. However, not having the new contract is not going to prevent the NHS improving services for patients.
5. What are the implications of the yes votes in Scotland and Northern Ireland?
We welcome the vote of confidence in the contract in Scotland and Northern Ireland. We hope it will now be implemented in both nations.
6. What should happen now in England?
That really is up to the Government. But it was made very clear during negotiations that there was no room for any further improvement to the package. If consultants have rejected the new contract that is probably where it remains.
The Confederation cannot envisage, and would not support, the reopening of negotiations. NHS employers are quite clear that we can¡¦t simply drop the proposals about job planning and organisation of the working week.
7. Will this affect the negotiations on the GP contract?
No. The BMA and Confederation are working constructively together on the negotiation of a new GP contract, and remain committed to delivering a new contract early in the New Year.
Notes for editors
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Contact details
- Contact Media Relations Manager Joanna Clason on 020 7074 3306 or 07798 571078 or Senior Media Officer Amy Darlington on 020 7074 3304 or 07767 770309. For out of hours media enquiries, please call the Duty Press Officer on 07880 500726.
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