Wait times will not be cut without co-operation of other, less well paid, staff

Published: 20/06/2002, Volume II2, No.5810 Page 20

Almost two years after the government announced its proposal to ban new consultants from working in the private sector for seven years after their appointment, there appears to have been a complete climbdown. The new contract, announced last week, contains no such stricture. And it comes with a 20 per cent pay increase in consultant starting salaries. Yet health secretary Alan Milburn maintains that the deal has gains for both NHS and doctors (news, pages 6-7). The NHS Confederation has welcomed the contract as good for the NHS, consultants and patients. Are they simply putting a brave face on another defeat by the medical lobby?

The core contractual week has been increased and the contract sets out consultants' obligations to the NHS quite precisely. Any new consultant who wants to practise privately must first undertake two extra four-hour sessions for the NHS. If they refuse and take on private work, they will not be entitled to pay increases built into the system.

These are advances on the present situation.

The contract also establishes a working week which includes evenings and weekends.

This could give managers the ability to make more productive use of operating theatres. In theory, they will be able to arrange extra consultant sessions outside the normal working week without having to pay premium rates. But the arrangement is complex and will be time-consuming for managers to administer.

If waiting times for NHS treatment are reduced, patients will be happier and the time consultants spend in the private sector will become less of a political issue. But waiting times are not easily reduced and large increases in productivity require more than consultants being on site for set hours. Mr Milburn's claim that the contract deals 'once and for all with the vexed issue of private practice' is unlikely to be borne out by events.

And the size of the pay increase will do little for relations with other, much more poorly paid, NHS staff. Evening and weekend operating sessions require more than consultant co-operation. Nurses are angered by the size of the pay hike and junior doctors are unhappy with the extension of the working week. Both groups are key to reducing waiting times, which will be the real test of whether the government was right to concede so much to the service's most powerful negotiators. l