Published: 19/09/2002, Volume II2, No. 5823 Page 14 15
Will consultants accept their new contract? The BMA believes they should and is now telling them why.Mark Gould went to a roadshow to hear the arguments 'T he idea that managers are going to be able to push us around is just not true.' So said the British Medical Association's central consultants and specialists committee member Dr Ed Borman, as he sought to reassure a meeting of over 40 consultants at Kings College Hospital last week that the new consultant contract is worth voting for.
The trouble is that consultants, a single-minded breed, diligent, dedicated to their patients and all working far more hours than the NHS pays them, do not really believe him.
Just a week before the nation's 23,000-odd consultants were due to be balloted on the first ever new contract since the inception of the NHS, the mood among the men and women at Kings College Hospital who attended a BMA contract roadshow was deeply sceptical. Perhaps not cynical, but certainly sceptical. They are worried that the new contract will become a big stick to beat them with.
Dr Borman is a seasoned industrial relations veteran and campaigner with a confident tone.He helped rewrite the junior doctors' contract, which has seen a massive reduction in workload and stress.
He kicked off by asking how many hours the doctors worked.
All worked at least 48 - 53 hours per week, some do unpaid weekend ward rounds. Some work over 70 hours.All were unhappy with the present situation but uncertain about whether the new deal was going to make things better.
Less than half the doctors said they had job plans. 'That is to the managers' benefit because you are working beyond your contracted hours and not getting paid for it.
The new contract will recognise all of the work that you do - ward rounds, on-call, audit, teaching, whatever - and pay you for it.
'However you decide to vote, please ensure that you have a job plan review so that you can get a grip of your workload.'
And then he set out the stark facts. 'We have two options: move to the new contract, or stay on the old one and be undervalued and increasingly exploited and unable to control our own workload.'
But what of other options for gaining leverage? He set them up and shot them down. 'I have no problem with industrial action but I know that I am in a minority of the consultant population.'
The first question from a recently qualified consultant must have cheered Dr Borman. 'I think the contract is rather a good thing, but what about the plans for pay progression? You might have a nice manager one year, but next year it might be handed over to another person.'
He let the question ring to nods of agreement on either side.
Dr Borman was emphatic in his reply, and shared a secret that the Treasury has already accepted that the new contract will cost£600m and bump up the£2bn consultant element of the NHS wage bill by 15 per cent.
'The Treasury has done the sums and the pay progression is fully funded for 95 per cent of people to get the progression up to the next pay scale at the first attempt, with no appeal necessary.'
'How can we be sure that managers will not apply the criteria more rigorously over time?' a locum consultant asked.
Dr Borman replied: 'They probably would like it that way, but we have written into the contractual framework that the only way you can withhold it is for damned good reasons - such as not fulfilling your NHS contract commitment by running off to Harley Street.'
Which brought the meeting around to the core of the government argument - ending what they see as exploitation of the NHS by a small band of consultants making a fortune from private work. The locum consultant came back: 'I find it difficult to pay my mortgage - living in Bromley - yet I can't alter this [under the proposed contract] by doing private work - why have we signed this right away?'
Dr Borman said the government 'fought us all the way - they wanted the seven-year ban [on new consultants doing private work]'. 'BMA lawyers said that there was nothing in European law to stop them. In industry it is written into contracts that you will work for this employer and you can't work for anyone else.
We could have challenged that [in court] and lost.'
Another questioner continued the sceptical theme. 'There will always be a work gap even if we have more money and more staff and they [managers] will renegotiate the definitions of on-call sessions and other elements to something they like - there is not satisfactory protection for us and that is something of great concern.'
Dr Borman ended on a reassuring note. 'The reason that we went for a national deal is that there will not be that kind of flexibility for managers.'