Doctors’ contracts fit for the 21st century

The Government has today published two independent reports about doctors’ contracts.

The reports commissioned by the Government highlight the need to change doctors’ current contracts, both for consultants and for junior doctors, to make them fit for purpose to support the modern NHS. The changes will promote higher quality medical education and research, motivate doctors to achieve excellent results for patients and ensure that contracts remain fair, affordable and fit for the future.

The Government is also keen to ensure that the terms and conditions for clinical academics remain competitive so that the NHS continues to attract and retain these staff, who make a crucial contribution to the UK economy and medical science.

Using these reports, the Government will look at medical pay as a whole, including the £5.5 billion spent annually on consultants’ pay and the £3 billion spent on the pay of doctors in training, so that it can offer national terms and conditions that are affordable and fit for purpose. This will help support the continuing growth in the number of doctors in the NHS.

The Government has therefore accepted the main recommendations and observations expressed in the independent reports as a basis for discussion, and will now begin active engagement with the medical profession and NHS Employers about how to take things forward.

Health Minister Dr Dan Poulter said:

“These independent reports give us a once-in-a-generation opportunity to work with medical colleagues to take a holistic view of how doctors should be trained, educated and rewarded for their life-saving work.  This means making sure we have the right rewards to encourage hospital doctors of all specialities to continue to provide the very best care for their patients.

“Clinical contracts must support high quality training, and change in this area is long overdue. Reviewing the contract will ensure that doctors have the right training and rewards to look after patients from the moment they are newly qualified until the day they retire as an experienced consultant.

“The Government accepts the majority of recommendations and observations in the independent reports as a basis for discussion and will work with the medical profession to achieve the best outcome for doctors and patients.”

Report from NHS Employers on junior doctors’ contracts

A report on the junior doctors’ contract commissioned from NHS Employers by the Government, has found that the current contract works against the interests of doctors and patients and needs reform. The current junior doctors’ contract was introduced in 2000 as a response to the introduction of the European Working Time Directive into medicine.

However there have been significant ongoing concerns expressed by senior medical professionals about the new junior doctors’ contract being too rigid, and not fit for purpose in terms of ensuring either proper continuity of care for patients, or the training needs of the doctors who will become tomorrow’s consultants.

This report highlights the need for:

• More flexible working patterns and better training. In 2010, the Temple Review found that the current contract did not support the best training for junior doctors, as the set working patterns in the current junior doctors’ contract (and consultants way of working) make it difficult for juniors to take full advantage of training opportunities.

• A single contract for trainees so that all trainees have the same fair conditions, regardless of whether they are training as a hospital doctor, GP speciality trainee or dental trainee.

• More support for doctors’ work/life balance, including recommending that changes are made so that junior doctors are given more notice before they need to move cities or areas for their training rotations.

The Doctors and Dentists Review Board report on consultant contracts and clinical excellence

The Doctors and Dentists Review Board (DDRB), an independent expert pay review body, has recommended changes to consultant contracts and clinical excellence awards so that they better recognise current excellence in providing high quality patient care, medical teaching and research.

Consultants are currently eligible to receive national or local clinical excellence awards for outstanding clinical excellence, ranging up to £75,000 per annum.  These awards are pensionable, in addition to a doctor’s regular salary, and currently payment continues until a doctor retires.

Recommendations accepted by the Government include:

• Rewards for clinical excellence should be linked to performance including patient feedback.

• Rewards for clinical excellence should be capped nationally at £40,000 and locally at £35,000.

• They should reward current excellence, not past performance –awards should be awarded for no more than five years nationally and normally one year locally.

• A new “principal consultant” grade should be introduced, paid between £100,000 to £120,000, to reward very senior and outstanding doctors (capped at 10 per cent of consultants across the country).

• Progression through the current consultant grade (£74,000 to £100,000) should be based on performance and contribution rather than time served –  with progression to the top of the scale at the employer’s discretion, recognising each doctor’s increasing skills and performance in providing high quality patient care.

• Awards should also continue to recognise excellence in medical education, teaching and research – including work to support the Royal Colleges and NHS system improvement.

The reports published today, and the Government’s response, will be followed by further discussions with the medical profession. All four UK administrations will work with the BMA and NHS Employers over the coming months to ensure heads of agreement on the changes is reached by the Spring. Following agreement more detailed discussions will take place next year.

Notes to Editors:

1. For more information please call the Department of Health press office on 0207 210 5282.
2. The number of consultants has risen from 29,000 to 40,000 since the current contract started in 2003, and medical training numbers have increased from 15,000 to 39,000.
3. The report also recommends that the rewards should no longer be pensionable. The Government does not fully accept these recommendations as the recent pension reforms means that pensionable rewards could be affordable as part of an overall agreement.
4. The Clinical Excellence Awards Scheme recognises and rewards NHS consultants and academic GPs who perform over and above the standard expected of their role. It is managed and overseen by the Advisory Committee on Clinical Excellence Awards (ACCEA). National level clinical excellence awards reward NHS consultants for their contribution at a national level.
5. The NHS Employers report on junior doctors’ contracts can be found on the Department of Health website.
6. The DDRB report is available on the Office of Manpower Economics website.