Lingering hopes for a new national contract for senior hospital doctors were quashed last week by the government's insistence on the implementation of locally negotiated pay deals.
Health Secretary Alan Milburn has written to all consultants and specialist registrars in England, advising them that there will be no national renegotiation of the consultant contract, which almost two thirds of them rejected last October.
Instead, NHS trusts in England will be given the option of either implementing the rejected contract locally or introducing locally designed incentive schemes in the form of annual bonuses for consultants “who do the most work for NHS patients.”
To attract the bonus, consultants will have to meet locally agreed performance targets on productivity, access, quality, and service development. They will also have to meet new standards on the amount of time spent in private practice and on job planning. Trusts will have to decide by June this year how they intend to reward their consultants.
An additional “fee for service” scheme, scheduled to start shortly and to run for a year, will be piloted for surgeons and other procedure based specialties in a dozen trusts in the south of England. If successful, it will be extended to other sectors of the NHS.
The government has also reassured consultants that they will not be forced to carry out routine work at evenings and weekends—one of the major stumbling blocks to acceptance of the original contract.
Dr Paul Miller, chairman of the BMA's consultants committee, welcomed this “significant concession” but sharply criticised the government's unilateral stance.
“We are keen to see the NHS reform and modernise, but it is difficult to see how we can continue to work with the department if this is the way they intend to operate,” said Dr Miller.
The negotiating team has called off scheduled pay talks with the government and is considering calls for industrial action from its regional representatives.
Family doctors in the United Kingdom also learned last week that they will be permanently guaranteed a minimum basic income in return for basic quality standards under the terms of the new GP contract.
Fears that practices would be worse off financially had threatened to derail acceptance of the new contract.
The terms of a minimum practice income guarantee were spelled out in a joint letter by the contract negotiators, the BMA's General Practitioners Committee, and the NHS Confederation.
GPs will also be able boost their overall practice income through seniority payments and by offering enhanced services through the quality and outcomes framework.
GPs will not be balloted on the new contract until after mid-May, but if accepted, the deal will mean a cash injection of £6.8bn ($10.6bn; a9.8bn) for primary care services.
The GP negotiators also announced that a special task group would be set up in July to report on their handling of the previous income calculations, for which they had been roundly criticised.