The government has signalled its willingness to risk a pre-election run-in with the British Medical Association by publishing proposals for the new consultants' contract.
The shift followed little progress in stalled and ill-tempered talks with doctors' leaders. The proposed contract reinforces the changes outlined in the NHS plan and retains the contentious idea that new consultants should be restricted to working for the NHS for up to the first seven years in post.
Although the government will continue negotiations on the contract with the BMA, relations between the doctors and the Department of Health soured further this week, with Dr Peter Hawker, chair of the consultants' committee, accusing the government of 'megaphone negotiations' and of 'underestimating the very real anger of consultants'.
The government envisages a system of 'phased careers' - in the early years as a consultant the bulk of time would be devoted to clinical care and to the NHS, while later years would allow more flexibility for private sector work.
All consultants would be obliged to agree a formalised job plan with their employer setting out their key objectives and responsibilites in the trust and the sessions they are expected to work - including making more of a contribution to out-of-hours services.
The contract would include new salary scales, with two thresholds linked to the consultant's clinical performance.
New consultants could expect a significantly increased starting salary, and those who commit more of their time to the NHS will be able to expect even greater financial rewards.
Reform of the system of distinction awards and discretionary points, which currently offer bonuses up to£60,000 a year, will also mean that future bonuses depend on clinical performance and commitment to the NHS.
An annual appraisal of performance will be mandatory and the right to take on private practice work will depend on both a satisfactory appraisal and completion of the minimum number of sessions of NHS work.
But Dr Hawker insisted: 'Publishing documents just weeks before the general election is not an acceptable substitute for negotiation. Consultants will be deeply cynical of the government's motives for doing so. '
Though the BMA is keen to reopen negotiations on the contract, it insists that government officials have not been serious about talks. The NHS Confederation is also keen for a rapid resolution to the impasse, though it seems unlikely that will happen before an election.
Confederation chief executive Stephen Thornton immediately branded Dr Hawker's attack 'illtimed and intemperate', and suggested it was more to do with internal politics than a genuine negotiating stance.
'The new contract must enable NHS management to properly manage its staff, including doctors, ' said Mr Thornton.
'The public now expects doctors to be much more accountable than was the case when the existing contract was first negotiated. '
However, he stressed that from the employers' point of view the main issue was not private work but what consultants did in their normal working hours and how this tied in with trusts' priorities.
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