The NHS consultant contract has failed to increase productivity since being introduced in 2003, according to a 10-year study.
Hospital consultants tasted a 27 per cent pay rise during the first three years of the Labour-led employment contract, but the extra money failed to yield a positive impact on consultant output.
Researchers discovered that consultant activity levels slumped between 1999 and 2009, despite the Department of Health anticipating year-on-year productivity gains of around 1.5 per cent after the employment contract was brought in.
The spotlight has fallen on the NHS once again after the coalition government called for productivity improvements and efficiency gains of £20bn by the end of 2014-15 in an attempt to reduce Britain’s deficit.
The decade-long study was the first attempt to explore clinical productivity of hospital consultants over a prolonged period of time, with the findings recently published in the Journal of the Royal Society of Medicine.
Karen Bloor, who led the study for the University of York’s department of health sciences, said: “Our trends are in general consistent with overall trends in NHS productivity, which have been reported as negative until 2008-09, and then slightly increasing.
“An increasing trend in patient episodes but a sharper increase in numbers of hospital consultants gives a plausible explanation for the overall decreasing trend in productivity.”
The basic employment contract for a full-time hospital consultant since 2003 is 10 four-hour sessions each week, with consultants being paid for 11 or 12 sessions to recognise working more than that standard 40 hours a week. Bloor added: “In principle the reward for extra sessions may have increased the consultant time available to NHS managers, but in practice this may simply have provided extra reward for work that many consultants were already doing.”
Professor Bloor concluded: “Claims made that the consultant contract, which resulted in substantial pay increases for hospital specialists in England, would result in increased clinical activity have not materialised. Indeed, in half the specialities studied, a reasonable interpretation of the statistics is that productivity has declined.”
However, chair of the British Medical Association council Dr Mark Porter told HSJ the study did not consider any improvements in quality or the impact of other changes to consultant working practices in the past decade, such as an increase in team working.
The study looked at the number of finished consultant episodes (FCEs) carried out by consultants in five medical and five surgical specialties. However, Dr Porter pointed out many consultants, such as anaesthetists and microbiologists, do not have their name attached to FCEs as they are only involved in a part of the patient pathway.
The government has been considering the recommendations of the Review Body on Doctors and Dentists Remuneration’s report into consultant pay and incentives since July 2011.
Dr Porter, who was involved in negotiating the original contract, told HSJ every contract needed to be “refreshed occasionally” but the “basic shape remains good”.