Consultants offered 'fees-forservice'

Around a dozen trusts are being targeted to pilot local 'fee-for-service' incentive schemes, rewarding the consultants who do most for NHS patients, as the British Medical Association meets next week to discuss industrial action in opposition to the imposition of the new consultant contract.

The Department of Health finally ruled out any renegotiation of the consultant contract last week. Its new scheme is part of a two-fronted push to introduce new employment arrangements for consultants.

Health secretary Alan Milburn is writing to all consultants and specialist registrars this week, stressing that the new contract is not negotiable and that English trusts are being instructed to implement the deal.

Meanwhile, the DoH has named four strategic health authorities which have one month in which to identify a total of 10 or 12 trusts willing to take part in pilots. The pilots will pay annual bonuses to surgeons, physicians and anaesthetists who improve productivity, access, quality and service development. The money will come from a pot of£130m this year, rising to£250m in 2005.

To receive payments consultants will also have to meet new standards governing the relationship between NHS and private work and new standards of job planning.

If the fee-for-service pilots are a success in trusts where consultants are likely to back the scheme, similar deals will be offered to trusts where consultants are opposed.

NHS human resources director Andrew Foster said he expected more than 50 trusts to implement the contract.

'We have done a lot of work and listened to a lot of people since January. Now we are giving consultants a whole variety of options for rewarding people for the efforts they make at a local level.'

Avon, Gloucester and Wiltshire, North East London, Kent and Medway, and Surrey and Sussex SHAs have been chosen to pilot the incentive scheme.

North East London SHA chief executive Carolyn Regan said she would be meeting the chief executives of the five acute trusts as well as primary care trusts in her area to gauge interest in taking up the incentive schemes.

'We want to produce a deal that works for this area and that includes tackling health inequalities and improving access. We also want to ensure that the scheme benefits teams not just individuals.'

She said she did not anticipate opposition from consultants in her area to the scheme, and she added that relatively short NHS waiting times in north east London indicated consultants were working for the NHS, rather than privately.

The BMA's central consultants' and specialists' committee is due to meet next week to discuss its response. Committee chair Dr Paul Miller said the BMA was 'unhappy' and 'dismayed' that the DoH had decided to implement the contract despite its two-to-one rejection by English consultants.

He said the government's announcement had made industrial action more likely.

'CCSC has already asked negotiators to consider calls from regional committees for industrial action and no doubt the matter will come up again.'