Pay review says doctors should lose weekend opt-out

The Review Body on Doctors’ and Dentists’ Remuneration has supported health secretary Jeremy Hunt’s call today for individual consultants to work across a seven day service but also called for doctors to be offered contractual safeguards to prevent exploitation.

It said: “In our view, the current ‘opt-out’ clause in the consultant contract is not an appropriate provision in an NHS which aspires to continue to improve patient care with genuinely seven day services.”

The report, published this morning, endorsed proposed changes by NHS Employers to consultant contracts as part of a broader package of contractual reform.

The report also recommends:

• mandatory contractual safeguards on working and resting hours, with “specific reference” to measures set out in current working time legislation;
• pay progression should be linked to achievement of excellence and not time served, which will be judged by employers during annual appraisals;
• any model for rewarding unsocial working hours be guided by the needs of patients;
• an allowance for undertaking specific additional roles; and
• reform of clinical excellence awards.

The recommendations follow a decision by the British Medical Association to walk away from negotiations with NHS Employers last year when the trade union claimed employers were trying to remove safeguards on working hours that would risk patient safety.

The review body said: “We feel that early removal of the ‘opt-out’ clause by negotiation, agreement of contractual safeguards and confirmation of the unsocial hours premia could be done relatively quickly and then piloted.”

It adds that any new consultant contract should support patient care at weekends, either through direct consultant presence or the supervision of junior doctors “as a point of principle”.

The body also supported proposals for reform of junior doctor contracts. It said: “We consider that there is a sound basis for negotiation of the junior doctors’ contract, and make recommendations that we hope the parties will find helpful, in order to progress to negotiated agreement quickly.”

It added: “Junior doctors and consultants are at differing stages on the same career path and their contracts should not be viewed in isolation. We regard the proposed new contracts as having the potential, over time, to smooth the transition from being a junior doctor to a consultant. They would also better reflect the changing NHS, in which both sets of doctors will work.”

A separate review published today, by the independent NHS Pay Review Body, which covers more than 1 million staff on the Agenda for Change contract, also said the case for adopting seven day working practices was “compelling”. It said negotiations over future reform should not delay seven day services.

Agenda for Change unions have agreed to further talks with the government following last year’s pay dispute.

The review body said: “This is an area where all parties are in agreement, and this common desire to improve patient care provides a positive basis in which to frame further discussions. It is clear that, where a case can be made on the grounds of clinical need and improvements to service, staff are generally willing to support and help enable the change to seven day services.”

However, it concludes: “How quickly and uniformly seven day services are required to be in place will inevitably have to be traded off against affordability.

“If the priority is affordability, for example, then the slower and less uniform the pace of change. We note that the costs of seven day services are principally in employing more staff, including consultants.”