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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 May 5; 334(7600): 919.
PMCID: PMC1865470

Government will not know for years whether consultants' contract has paid off

The government has admitted that it will have to wait years before it discovers whether there are real productivity gains from the new consultants' contract.

NHS leaders also told the House of Commons Committee of Public Accounts last week that lessons had been learnt from mistakes made when the contract was introduced, such as not piloting it before implementation. They were giving evidence as part of the committee's inquiry into the consultants' contract.

The session was prompted by the publication earlier this month of a report from the government's spending watchdog, the National Audit Office (BMJ 2007;334:865, 28 Apr doi: 10.1136/bmj.39191.670347.DB).

Edward Leigh, the Conservative MP for Gainsborough and the committee's chairman, said that that report had been damning, and he asked why the contract cost £715m (€1.1bn; $1.4bn) in the first three years—£150m more than estimated—“without any discernable increase in productivity.”

Giving evidence, David Nicholson, chief executive of the NHS, said that the negotiations over the contract were complex and that the Department of Health had underestimated the cost.

“I don't accept that it's a mess,” he said. “This was a new contract that we tried to implement over a relatively short space of time. The key thing about it is the potential it gives local management to connect consultant workload with what patients need.”

“It is too early to tell yet whether we are going to get many of the productivity gains that we wanted,” he said. “This is a long term solution to something that has been going on for many years.”

He said that lessons had been learned from the process of preparing the contract, and these lessons had helped in finalising Agenda for Change, the NHS pay system for most other NHS staff.

Mr Nicholson said that, with hindsight, it would have been “more helpful” to have piloted the new consultants' contract, as was done with Agenda for Change, but said: “We couldn't agree that with the BMA.”

Andrew Foster, chief executive of Wrightington, Wigan and Leigh NHS Trust and former director of workforce at the health department, also gave evidence. He said, “At the time, the negotiators for the BMA were under considerable pressure from their own members to get the contract and get it quickly. They didn't want any delays.”

Mr Leigh said that despite receiving a 25% pay rise consultants were still not happy and viewed the contract as having introduced a “clock watching mentality” to their work.

Mr Nicholson said, “The medical staff are moving from a situation where they had great power in the system, and we are changing that—and that is a very painful thing for a professional group to go through but [one that is] necessary.”

Mr Leigh said he was sure the select committee's report from this inquiry would be as damning as that produced by the National Audit Office.


The National Audit Office's report can be seen at the publications section of

Articles from The BMJ are provided here courtesy of BMJ Publishing Group