Reforming the Consultant Contract – the
journey so far
Reforming the Consultant Contract
– the case for change
Workforce Developments
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•
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The Temple Report, which argued for more consultant presence out of
hours to better support trainees
The Doctors and Dentists Review Body Report on Clinical Excellence
Awards
Parallel reforms to Agenda for Change to help sustainability and affordability
Challenges to the notion of long scales of time-served incremental
progression.
Reforming the Consultant Contract
– the case for change
Supporting Seven Day Services
− NHS England’s report on 7 day services
− The Academy of Medical Royal Colleges standards for 7 day consultant
presence
−
NHS England’s Commissioning Standards.
Reforming the Consultant Contract
– the case for change
System Reform
•
The Francis Report
“The core values expressed in the NHS Constitution should be given priority of place and
the overriding value should be that patients are put first, and everything done by the NHS
and everyone associated with it should be informed by this ethos”
•
Simon Stevens Five Year Forward View
“Over the next several years, NHS employers and staff and their representatives will
need to consider how working patterns and pay and terms and conditions can best
evolve to fully reward high performance, support job and service redesign, and
encourage recruitment and retention in parts of the country and in occupations where
vacancies are high”
Time series of medical and dental staff numbers
(full-time equivalents) in England
60,000
Number of staff (full-time equivalent)
50,000
40,000
30,000
20,000
10,000
0
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
GPs
30,084
31,021
31,901
33,384
33,730
34,043
36,085
35,243
35,319
35,871
36,294
Consultants
26,341
28,141
29,613
30,619
31,430
32,679
34,654
35,781
36,965
38,197
39,014
Other doctors
9,517
9,666
9,661
9,934
10,053
10,609
10,729
10,459
10,436
10,441
10,228
Doctors in postgraduate
36,402
40,654
43,295
45,422
46,051
48,298
51,216
51,397
51,993
52,262
training
Source: Health and Social Care Information Centre, NHS Hospital & Community Health Service (HCHS) and General Practice workforce as at 30
53,399
Reforming the Consultant Contract
– a contract for the future
The key characteristics of any future contract are that it should
•
Be cost neutral
•
Meet the needs of patients, be fair to doctors and affordable for employers
•
Provide for highest quality of excellence and professionalism
•
Support the wider aims of the NHS.
Reforming the Consultant Contract
– preliminary negotiations
•
•
•
•
•
Initial negotiations with the BMA resulted in some broad areas of
agreement, including
Recognition that patients deserved the same quality of care over the whole
week
That this would entail changes to traditional working patterns, including more
senior clinical staff at weekends and evenings and the resources needed to
help them deliver that care
That this presented a significant affordability challenge
Modelling would be required to ensure that a new contract would be cost
neutral
Change would need to be accompanied by adequate safeguards to protect
the health and well being of doctors and patient care.
Reforming the Consultant Contract
– the employers’ side offer
Safeguarding the core contract
•
The retention of a negotiated national framework and the BMA’s role in
collective bargaining
•
a maximum 40-hour contract, unless extended by mutual agreement. No
requirement for the majority of consultants to be contracted for more hours
than they are currently contracted for
•
no changes to any of the core contractual entitlements – redundancy,
maternity, sick pay, leave entitlements, requests for flexible working etc.
Reforming the Consultant Contract
– the employers’ side offer
Safeguarding pay
• retention of the current lifetime earnings potential
• accelerated access to higher pay - consultants will be able to access higher
levels of pay earlier in their career than is possible under the current pay
scales, as long as they meet all necessary access criteria
• the introduction of a fairer way to reward consultants who work frequent and
intense shift patterns
• continued access to a national clinical excellence award (CEA) scheme, by
competitive application
• transitional arrangements that provide protection to existing pensionable pay
• the introduction of a pay structure which is better suited to a Career Average
Revalued Earnings (CARE) scheme
• local clinical excellence awards to be incorporated into the consultants’
contract as part of revised performance payments structure.
Reforming the Consultant Contract
– the employers’ side offer
Safeguarding health and well-being and supporting professionalism
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•
•
•
•
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jointly agreed safeguards (set out in the contract and supported by jointly
agreed guidance), to ensure consultants are provided appropriate protections
where service changes are necessary to deliver seven-day services
a commitment to move towards consultant-led services which will require a
growth in the consultant workforce
greater emphasis on clinical engagement when determining service delivery
priorities with a duty to consult being placed on employers
a strengthened job planning process at the heart of the process for
determining the appropriate clinical activity to support local service delivery
A limit on the number of weekends that consultants will need to be available
for work, without mutual agreement
Protection of an environment where education, training, innovation and
research by both NHS and academics can flourish.
Revised pay framework
Performance related pay
Additional responsibilities
working patterns allowance
Base pay: spot rate
New consultants
Gateway
criteria
Experienced consultants
Reforming the Consultant Contract
– the BMA response
In the BMA’s own words, they could not continue with negotiations because
of “unreasonable demands from the government that could undermine
patient safety”.
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•
•
•
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Patient welfare would be put at risk by employers demands
Priority should be given to urgent and emergency care
Data and modelling on future pay proposals was wholly inadequate to allow
their members to make an informed decision
There was an underlying lack of trust in the Government based previous
experiences on pay and pensions
Employers failed to move beyond broad statements of intent in respect of
safeguards contingent on removal of schedule 3 paragraph 6.
What happens next?
− Ministerial remit to DDRB asking for ‘observations’ on
consultant contract reform to support 7 day services
− Employer evidence submitted on 23 December 2014
with the publication of DDRB report expected July 2015
for consideration by Government, post election.
Reforming the Consultant Contract
– not standing still
Possible options for employers to help meet current challenges
•
Offering locally amended terms to new starters
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The development of local terms based on a national template
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Use of CCT holders in ‘other than consultant’ roles.
Maximising the flexibilities of the
current contract
− Improving the quality of job planning so that all consultants have patient
focused, outcomes based job plans designed to meet the needs of
employers, consultants and patients
− Ensuring regular review of job plans so that they are up to date and relevant
− Ensuring that the criteria for pay progression are met. While pay
progression is the norm for most consultants it is not necessarily automatic
and depends, for example on participation in job planning and appraisal
− Strengthening appraisal and performance review processes
− Reviewing Additional Programmed Activities.
Meeting the challenge together
“Employee engagement will be absolutely crucial for the NHS over the coming
years. Trusts which effectively engage their workforce have more satisfied staff,
better clinical outcomes and are more efficient. If services are to be improved
within a tight budget, trusts will have to unlock the immense potential creativity
and innovation of their employees. And when change happens, staff need to be
right at the heart of decision-making.”
Meeting the Challenge@ Successful Employee Engagement in the NHS –
Involvement and Participation Association (IPA) April 2014.
Keeping informed and asking us
questions
Doctors' contract talks - Q&As
www.nhsemployers.org/your-workforce/pay-andreward/national-negotiations/doctors-contracttalks-qandas
Contact us at:
doctorsanddentists@nhsemployers.org
@NHSE_Bill