Doctors' leaders are urging the health secretary, Alan Milburn, to enter into fresh talks over the proposed new contract for consultants amid fears that it could be implemented in parts of the United Kingdom despite the fact that most doctors rejected it.
Nearly two thirds of the United Kingdom's consultants and 84% of specialist registrars voted against the contract. However, Mr Milburn is believed to be preparing an alternative deal for consultants with incentive payments for those who spend most time working in the NHS. This time, he insists, there will be no further negotiation with the BMA and no further opposition to reform of the health service.
“We have got to find a better way to sharpen incentives so the doctors who do most for the NHS, get the best outcomes and standards for their patients, and help deliver the biggest contribution to waiting times get the best rewards. That is what we will now be considering,” he said. “I always said it was the only contract on offer. There can be no renegotiation. There can be no more resources. There can be no veto on reform.” It is thought that Mr Milburn is considering the introduction of a new “subconsultant” grade of hospital doctor.
Dr Derek Machin, who became acting chairman of the BMA's consultants committee after Peter Hawker resigned following the consultants' rejection of the contract, said that Mr Milburn had “completely missed the point” on why the proposed contract had been rejected. Consultants were not concerned about the money on offer, he insisted, but about the extra pressure to meet targets and work some of their contracted time in the evenings and at the weekends.
A breakdown of the ballot showed that 66% of doctors in England and Wales were against the new contract, whereas 59% of consultants in Scotland and 54% in Northern Ireland supported it. The reason for the differences was largely to do with the distance from Whitehall, believes Mr Machin, with doctors in England and Wales under greatest pressure to meet performance targets. (See pp 1047 and 1120.)
