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Press information briefing: the consultant contract

• The Department of Health (DH) and the BMA agreed on the costing of the consultant contract. The BMA received repeated assurances that the contract was fully costed, the funds were available and it would be funded in full.

• There was an unbudgeted overspend of around £90 million (see footnote 1 below) due largely to the DH underestimating how hard consultants worked. This compares to an overall NHS debt of around £1bn and a cost envelope for Agenda for Change (the new contract for nurses and other health care professionals) of at least £950 million, and which was overspent by over £220m. The funding shortfall for the consultant contract in England was compensated for in the PCT funding allocations and tariff for the 2005/6 round and was not, therefore, a reason for financial shortfall.

• Consultants in England are contracted for a basic 40 hour week, compared to 37.5 for most NHS workers. They will earn a basic salary starting at £71,822 going up to £96,831 after they have completed 20 years of NHS service as a consultant. It can take up to 15 years to get to consultant status – so will reach the top of the scale after around 35 years of commitment to the NHS. For most consultants who transferred from the previous contract the basic salary is £80,812.

• The new contract was agreed by the DH to pay consultants for all the hours they agree to work and to ensure that there is accountability for the work agreed in the consultants’ job plan. Most consultants are contracted to work more than the basic 40 hours and are now paid for this extra work at the same hourly rate. Typically this will add 10% to their basic salary for an extra four hours work. However most consultants continue to work unpaid in excess of their contracted hours to varying degrees.

• There are annual job planning and appraisal processes that give both employers and consultants the tools to manage workload and activity, and to ensure that high quality patient care is maintained.

• The new contract has already seen direct benefits for patients. Where trusts implement the contract in partnership with their consultants they can clearly align work patterns to patient activity. For example, it can introduce more effective ways of conducting ward rounds, enable emergency work to be better separated from elective activity or allow a greater presence of senior doctors to ensure patients receive the most appropriate care.

• Within the new contract there is also a supplement to recognise the significant impact of being on-call, around-the-clock, for emergencies. This varies from 1 to 8% of basic salary depending on the number of nights per week and weekends affected.

• A key feature of the contract was defined time for supporting professional activities (SPAs), i.e. those activities underpinning high quality care and development of patient services and without which the NHS would not be able to function. Again, consultants tend to put more time into these activities than is allocated as part of their contract. Recent funding constraints have led to the number of SPA’s being cut which puts at risk the future quality of care.

• As with the old contract, evidence suggests that consultants continue to work many hours in excess of those contracted and paid for, as they will always put the demands of their patients first. This extra unpaid work relies upon the goodwill of consultants and also depends on the attitude of their employers. According to the Royal College of Physicians (see footnote 2 below), 42% of consultants report working greater than 60 hours a week, and a further 23% greater than 50 hours per week. The average working week for those with an NHS component to their contract (including part-time doctors) averaged 59 hours. This compares to the average consultant being paid for around 45 hours work per week. This is backed-up by further independent reports, such as the Kings Fund’s review of the consultant contract and the National Audit Office.

• To encourage and support innovation and excellence there are also clinical excellence awards which consultants can apply for. Over their career approximately half of consultants will receive at least one clinical excellence award which start at £2,850.