02.07.13
Consultant contract ‘absurdly unambitious’ – PAC
NHS hospital consultants are declining in productivity, despite a new contract increasing pay, the Public Accounts Committee (PAC) has found.
The NHS currently employs around 40,000 consultants, costing £5.6bn in 2011-12. In 2003 the Department for Health introduced a new contract for consultants, increasing the bottom of the pay band by 24% and the top by 28%.
Yet pay progression is not linked to performance and performance management structures and incentives are often not properly aligned to achieve improvements, the report highlighted.
Consultants can refuse to work at evenings and weekends, leading to extra costs to work overtime, and there are shortages of consultants in some geographical areas, leading to reliance on locum doctors.
PAC called the contract a “missed opportunity” to improve performance and provide value for money. It said the DH was not ambitious enough in its scope, and that improvements are essential if we are to avoid another disaster like Mid Staffs.
The committee stated: “We consider the failure by the NHS to implement a proper culture of performance management as a crucial factor in the poor standards of care recently witnessed.”
Committee chair Margaret Hodge MP said: “Many of the improvements envisaged by the Department were achieved but that’s because its objectives were absurdly unambitious.
“This nonsense highlights how badly consultants’ performance is being managed. A proper culture of performance management for consultants and other NHS staff must be implemented if we are to avoid incidents of poor performance.
“Despite the increased pay, there is still a shortage of consultants in some parts of the country, in hospitals in deprived areas and in specialities such as geriatric medicine. This makes some trusts reliant on locum consultants, who provide less continuity of care for patients as well as being more expensive for the NHS.
“The Department must consider measures to attract consultants to such areas and specialities without financially disadvantaging the organisations concerned.”
Gill Bellord, director of employment relations and reward at the NHS Employers organisation, commented: “The PAC report raises some important issues about care for patients which are of increasing concern. It's ten years since this contract was introduced and we have begun to talk to the British Medical Association about changes needed to support the employment of consultants going forward.
“It is time to refresh the contract and the awards for clinical excellence to strengthen performance management and incentivise excellence.”
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