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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 November 24; 335(7629): 1063.
PMCID: PMC2094174

Consultant contract has not resulted in any increased productivity

Consultants in England are now being paid on average 27% more than they were three years ago but are working fewer hours and are less productive, says a highly critical report published by MPs.

Doctors' leaders, however, have rejected much of what the report says, claiming that criticism of consultants and their pay is “unfair and relentless.”

The parliamentary Committee of Public Accounts' report into the new consultants' contract, published this week, says that it has been a costly failure so far and that its introduction in 2003 has cost £150m (€210m; $310m) more than the government estimated. It says that most of the contract's aims had failed to materialise.

The Department of Health agreed a new national contract for NHS consultants in England in October 2003 after three years of negotiations with staff and managers' representatives. It was the first major revision of the consultant contract for more than 50 years.

The committee's report says the Department of Health intended that the new contract would give consultants better pay and boost their NHS work while also allowing employers to have greater control and management of their consultants' workload and giving patients a more flexible and responsive service.

However, say the MPs, implementation of the contract was rushed, and many of the intended benefits have not materialised.

Over the first three years of the contract the health department allocated an additional £715m to NHS trusts to fund the contract—£150m more than the amount that was originally estimated as needed.

The report says that although consultants' pay has, on average, increased from £86 746 to £109 974—a 27% rise rather than the 15% the government predicted—and the number of hours they work has fallen, as yet no measurable improvements in productivity have been achieved.achieved.

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Although the number of consultants working in the NHS rose from 28 750 in October 2003 to 31 990 by September 2005, intended benefits have not been realised, such as:

  • The proportion of time that consultants spend on direct clinical care is less than the intended 75%
  • The contract has not been used to extend and develop new services for patients
  • NHS managers still do not have any more control over consultants' work.

Edward Leigh, chairman of the committee, said that consultants should be doing more to “justify their big jump in pay” by giving more support to the redesign of services and by changing their working culture.

“Anyone who is puzzled how large quantities of money can be poured into the NHS to so little effect should examine the example of the new contract for consultants,” said Mr Leigh.

“The plain fact is that the Department of Health greatly increased consultants' salaries without securing any extra productivity from them. Worse than that, their productivity has actually decreased, with consultants spending less time working for the NHS and each one carrying out less activity.”

Jonathan Fielden, chairman of the BMA's Central Consultants and Specialists Committee, reacted angrily, saying: “The chairman of the Committee of Public Accounts shows a complete lack of understanding about how consultants work. He ignores the vast efforts that consultants have made to reduce waiting times and improve patient care and fails to appreciate the enormous pressure that hospital trusts have been under to meet government targets.

“The relentless criticism of consultants and their pay is unreasonable and uncalled for, when the vast majority are going the extra mile to ensure patients get the best possible care. Our most senior doctors are worth every penny.”


Pay Modernisation: A New Contract for NHS Consultants in England is available at

Articles from The BMJ are provided here courtesy of BMJ Group