Most chief executives would cap GPs' pay, abolish clinical excellence awards for consultants and write off historic debts if they had the power.
HSJ's survey of just under 100 chief executives revealed widespread frustration at what chief executives called the 'debacle' of 'criminally costed' pay schemes at a time of budgetary pressures. Much of the criticism was levelled at new contracts for GPs and consultants and Agenda for Change.
Ministers have 'failed to acknowledge that the cause of the financial problems have been the introduction of expensive, uncosted pay reforms which are archaic', one person complained. Another respondent said the contracts have resulted in a 'stronger focus in some clinicians' minds on work for money rather than for improvement and service quality.'
The poll found that 69 per cent of chief executives would cap GPs' pay, with 70 per cent choosing to abolish the clinical excellence awards that replaced merit awards for consultants in 2004. Latest figures show that average pay for GPs reached£106,000 in 2004-05.
In January, health secretary Patricia Hewitt said she would have capped the proportion of profits that GPs could take out of their practices if she had realised they would take such a high share of profits. Since then, talks over next year's GP contract have stalled.
About a quarter of consultants receive clinical excellence awards, allocated by an advisory committee of the Department of Health, which can boost total earnings up to£165,000.
Finance was the key concern among all those polled. More than half - 59 per cent - of chief executives would also write off historic debts. An almost identical number said finance is the biggest challenge facing their organisation.
The findings come as the NHS waits to hear whether the government will agree to abandon the resource accounting and budgeting system under which trusts in deficit pay twice. NHS chief executive David Nicholson has said his decision depends on the service breaking even at year end.
Nearly three-quarters felt that most trusts in heavy debt are not viable in their current form.
Just over half of chief executives in the survey expected their trust to be in surplus by the end of the financial year, while 30 per cent are forecasting debts and 17 per cent predict they will break even.
Over two-thirds believed patient care will suffer as a result of short-term financial decisions.
In 61 per cent of trusts, financial pressures have led to compulsory redundancies in the past financial year. Recruitment freezes are still more common - especially at primary care trusts, of which 85 per cent surveyed are controlling expenditure this way.
Restricting access to some treatments was also widespread, with 73 per cent of PCT leaders reporting this, while 50 per cent said they had delayed operations. At acute trusts, 83 per cent had closed wards.
Top-slicing, reform and national targets are all to blame for the financial squeeze, according to many of those surveyed.
The vast majority of chief executives - 79 per cent - wanted to see an independent board set up to control the running of the NHS. One said: 'Politicians remain short term in their outlook so the perceived desires of the electorate almost always take preference over sensible management.'
Alan Milburn wins popularity contest
Alan Milburn has emerged as the most popular health secretary of the past 10 years among NHS chief executives. HSJ's survey asked chief executives to rate New Labour's health secretaries for their stewardship of the NHS. Mr Milburn was followed by John Reid. Patricia Hewitt came bottom, just behind Frank Dobson.
Several respondents criticised Mr Milburn's successors for their handling of the NHS plan. Mr Milburn got an average score of 5.8 out of 10, while Mr Reid scored 5.1.
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