I was interested in your balanced report on consultants' contracts ('On the line', pages 20-22,

11 February). The NHS Consultants' Association is not a negotiating organisation. Its role is to lobby in support of the NHS whenever and however possible.

We have struggled to develop ideas for a new consultant contract which would provide good value for the NHS and raise morale among consultants.

There are several underlying principles. First, doctors are professionals, should act professionally and can reasonably expect to be treated professionally. This includes the necessity of discussing workload and working practices on a regular basis, but we are concerned that a so-called 'workload-sensitive' contract would create division and conflict between specialties and individual consultants. The present contract has achieved a great deal. Doctors choose their careers on interests and abilities, rather than the potential for financial reward. A national contract also means there has been no financial advantage, in terms of NHS work, in the choice of where to work as a consultant. These factors have resulted in an NHS which has high-quality doctors in all specialties in all parts of the country.

We believe in financial recognition for consultants who choose to spend all their time in the NHS. Consultants who undertake private practice must recognise that it is reasonable for their employers to ask how this might affect their NHS work.

With all its flaws, the traditional consultant contract does have advantages and, although change is now overdue, it would be a shame if these were forgotten. Current thinking seems to be that a new contract will solve many, unrelated, problems in the NHS, particularly waiting lists. Little evidence supports this. Some doctors' leaders feel there is an opportunity for a significant increase in consultants' income. This also seems unlikely. We will continue to urge caution to both sides in negotiations as there is a real possibility of major conflict which would benefit neither patients nor the NHS as a whole.

Guy Routh

Chair

NHS Consultants' Association