Contract cash allocated to PCTs

The government is set to clash with consultants by announcing that there will be no new national contract - and that the£300m originally earmarked to fund a national deal has already been allocated to primary care trusts.

The news that the PCT allocations announced last month include the consultants' cash will surprise PCTs. Primary care organisations were unaware of it this week.

But the move, which follows rejection of the proposed national consultant contract and accompanying three-year pay deal in a British Medical Association ballot last November, is likely to provoke consultants' anger. The BMA has already said it would 'oppose' piecemeal introduction of the rejected contract.

The timing of the announcement had not been finalised as HSJ went to press. The end of national negotiations with the consultants is particularly sensitive for the government, with the Agenda for Change pay proposals for non-medical NHS staff also due for release and a background of firefighters' strikes.

A senior HSJ source said forthcoming guidance would 'encourage those trusts that feel they have a majority of consultants who support the contract to go ahead [with local implementation]'.

Where such support did not exist, trusts could make their own 'local deals with consultants, incentivising improved access, quality and so on'.

The process would be driven by PCTs' requirements negotiated with trusts in local delivery plans.

'The notion is that incentive schemes agreed locally would be linked to the priorities set in the priorities planning framework, ' the source said.

Given that the national consultant contract had not been implemented, 'the money is still there and it is now down to PCTs, strategic health authorities and trusts to decide what to do with it'.

It is believed that allocating the money to PCTs rather than directly to acute trusts could help trusts withstand pressure from consultants to hand over the cash. It would also ensure greater PCT influence over secondary care access.

NHS Confederation human resources policy manager Alastair Henderson said there was 'logic' in the move. 'Having the money at one remove means there will have to be negotiation and that will help ensure the money can be used for improvement.'

National PCT development programme head Barbara Hakin said money in PCT allocations would be welcome 'because PCTs have given the responsibility to ensure patients get the complete range of services, including access to secondary care.'

NHS Alliance chair Dr Michael Dixon agreed the scheme would be 'logical' as 'PCTs are now the paymasters for the local health economy'. But National Association of Primary Care chair Dr Peter Smith called for clarity about what was in the PCT allocations. 'It is extraordinary that the allocations have come out and people haven't been made aware of what's in it. PCTs are being given more and more responsibilities and then being told [the funding] is all in the unified budget. This is another one.'

And he warned: 'I have suspicions that [the consultants' money] will go into overspends.

That would be dreadful. I hope PCTs will use it creatively to deliver services in new ways.'

The consultant contract shake-up will follow this week's announcement of an agreement between the government and royal colleges on a programme to review the way doctors are trained.

The memorandum of understanding agreed by the Academy of Medical Royal Colleges and the Department of Health aims to modernise doctors' training, streamlining the inspection of training sites by royal colleges and reviewing the length of medical training. The royal colleges will also be involved in establishing and running a post-graduate medical education and training board.