Ministers have taken the first step towards imposing a contract deal on medical consultants and junior doctors, HSJ has learned.

The government has asked the independent Review Body on Doctors’ and Dentists’ Remuneration to consider recommending changes to the medical contracts to “better facilitate the delivery of services seven days a week, in a financially sustainable way.”

This could result in substantial proposals from the review body to amend the medical contract terms and conditions.

Any proposed changes could then be unilaterally imposed on the medical workforce by the government.

The government’s request to the review body follows a collapse in negotiations between the British Medical Association and NHS Employers after 18 months of talks.

The BMA has accused the government of refusing to offer safeguards to doctors on the impact of proposed reforms. NHS Employers says such safeguards were under discussion.

In a letter to the review body, health minister Dan Poulter asked it to “make observations” on contractual reform to deliver seven day services as well as examining possible changes to the Clinical Excellence Award Scheme.

He has also requested the body investigates proposals for pay progression linked to responsibility and performance and arrangements in other industries, where seven day services are already provided.

Daniel Poulter

Dan Poulter said the government was ‘disappointed these negotiations have not resulted in agreements’

For junior doctors, the review body has been asked to make recommendations on new contractual arrangements including a new pay system ending “time served incremental progression”; working patterns and how the current pay envelope could be used to increase basic pay, while providing reward for additional work; and supporting services and training over seven days.

Dr Poulter said: “The government is disappointed these negotiations have not resulted in agreements acceptable to all parties.

“I am therefore now asking the [review body] to make observations and recommendations that take into account the work undertaken during the negotiations.

“Patients should be placed right at the heart of everything we do, and the way the NHS organises and manages the workforce should be built around patients and their needs.”

He added that seven day services had the “potential to reduce mortality in the evenings and at weekends, speed up diagnosis and discharge times and reduce the amount of time patients spend in hospital overall.”

The review body has issued a call for evidence which will close on 31 December. It has been asked to report back to ministers in July 2015, after the general election.

Dr Mark Porter, chair of BMA council, said: “After more than a year of negotiations the government has failed to produce any credible evidence on how it will staff and resource a massive expansion of services over seven days in a safe and sustainable way.

“They have also failed to demonstrate how they will protect junior doctors from unsafe and gruelling working patterns that put patient care at risk.

“It comes as no surprise that they have now chosen to refer this issue to the review body.

“It is vital if we are to have a contract that is good for patients, fair for doctors and good for the NHS that the review body listens to the doctors who already care for patients at nights and weekends, about how to make that care better and more consistent.”

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