Consultant contract negotiations update, a personal view

What seems like a very long time ago we were called to contract talks with the government and employers. Not because the BMA felt that the 2003 contract had run its course but at the behest of our negotiating partners. They felt that changes were needed to facilitate the provision of 7 day services. My hospital and I’m sure yours has had services provided throughout the  week in many areas. You will have all noticed however that the number and range of these services has steadily grown and so too has the amount of work that cannot really be deemed ‘emergency’. You will probably also know that the 2003 contract stipulated that consultants could only be asked to provide ‘routine work’ outside of 7am-7pm, Monday to Friday (this is in section 3 paragraph 6 of the contract, often shortened to S3P6) by agreement. This last word is of course vitally important.

The government have made a policy decision to expand further the amount of work done at the weekends. As seen here 7 day service standards.

Initially it will be enable the new quality standards, i.e. all admissions seen by a consultant within 14 hours (two ward rounds a day for on call consultants), all patients in for example SAU seen twice per day and every hospital in patient seen daily by a consultant unless specifically not needed (it is worth noting that when these standards were suggested by the AORMC they were felt to be aspirational and currently unaffordable). In addition to this work there are waiting list initiatives, Saturday and Sunday convenience clinics, using spare operating lists to foster local service reconfiguration etc. Clearly it can be argued that not all of this represents emergency work.

As a group, consultants have seen their real terms take home pay fall by 30% since 2003 and employers are obviously worried that consultants might use this as a lever to regain some of their lost income, exposing NHS trusts to unpredictable wage bills. The talks were therefore started with the government’s aim that contract changes would render enhanced 7 day services as ‘affordable’ although this very rapidly became cost neutral. Which you may feel is a rather different word.

Why did we agree to talk at all? As I have said, there was not a strong feeling that renegotiation would be in our interest. There were however areas of the contract which it was felt could possibly be improved. The 2003 contract is based around a consultants emergency duty being on call with occasional return to hospital. This is clearly not the pattern experienced by many consultants in 2015/16. Consultants are not well protected from enormous amounts of work performed out of hours. A set of protections against this was felt to be useful. Similarly the present CEA scheme is not supported by all consultants and at the outset of negotiations it seemed we might have the opportunity to work on enhancements to the scheme. The current pay scale is not a good match to the CARE pension that new consultants will have most of the their lifetime pension entitlement based upon.

As one would expect, some of things that we might hope to achieve during a negotiation may not come to pass and likewise some of the things that we would not wish to give away are sought by the other side!

We have had a very able group of negotiators with the support of a professional negotiator so whatever has been achieved is not through lack of expertise, intelligence or trying. There has been a strict timescale imposed by the government and talks were guillotined prior to Christmas.

The current situation is that the negotiation document has gone to government for comment, approval and costing. We hope that government will bear in mind that an agreement which is acceptable to the vast majority of doctors is the only one that will see the kind of contractual change they seek. Usually that will need to be via some sort of benefit to most clinicians. In a cost neutral environment they clearly have a very difficult task on their hands. By the end of the month we will no doubt get to see both the carrots and sticks. We’ll then be touring England and Northern Ireland in our blue satin BMA tour jackets to let you know all about it and vitally hear your views. Until that time consultants up and down the country will of course continue to provide 7 day services where they realistically expect them to make a difference to their patients, all remarkably on their current un-altered 2003 contract. Makes you wonder.

Happy new year.

Mike Henley