Reid goes 'extra mile' for consultant compromise

The government and British Medical Association have staved off an industrial showdown in England with a compromise deal on the consultant contract.

The deal has yet to be agreed by the BMA's consultants committee and may yet go to ballot.

Hailed by both sides as the best deal available, it was thrashed out during 13 days of 'tough' talks between Department of Health officials, led by health minister John Hutton, and the BMA's negotiating team.

If accepted, the new national contract will see consultants working a 40-hour week, with the NHS having first call on their first four hours of overtime. They would be committed to spending three-quarters of their time on direct clinical work.

The BMA's consultants committee will meet in August to consider whether to put it to a membership ballot, possibly in early September. A 'yes' vote before the end of September would trigger pay rises of 15-24 per cent, backdated to 1 April 2003.

At the end of a tense day of negotiation last week, health secretary John Reid admitted that he had 'gone the extra mile or two to achieve a sensible solution'.

Concessions to the BMA included:

Non-emergency weekend and evening work is voluntary.

More money for evening and weekend work.

A new appeals mechanism to resolve disputes over job plans and pay progression.

Clarification of what constitutes 'appropriate management control'.

No distinction between newly appointed and established consultants.

On the thorny issue of managerial control - one of the sticking points that led to the rejection of the last contract in December 2002 - Mr Reid said both sides had accepted the need to balance corporate management of a huge organisation with the decisions of experts at a local level.

Nizam Mamode, head of the BMA's negotiating team, added: 'The new arrangements are emphatically not intended to diminish professionalism or override clinical judgement. Our concerns about managerial control have been met.'

Neither Mr Reid nor the BMA was able to say whether the new contract would produce more work for the NHS and less for private practice, saying it depended on what hospitals provided and doctors chose to do.

But Mr Mamode admitted the insistence on giving the NHS the first four hours of overtime was a possible sticking point. 'Our people will be unhappy with that, ' he said.

Andrew Foster, director of human resources in the NHS, said the deal represented the breakthrough managers had been looking for. 'It will improve the relationship between doctors and managers, ' he said.Managers now should be preparing to introduce the new national contract. Asked about the consequences of another 'no' vote, he said: 'That is a good question. I am not bloody well doing this a third time.'

However, BMA committee member Dr Richard Rawlins was not prepared to predict a 'yes' vote - especially on the three-person appeal panel. Its chair will be nominated by the trust board, a second member will represent the consultant, and a third member will be chosen from a list approved by the strategic health authority and BMA. Although its recommendations will normally be accepted, the trust board retains the right to make the final decision. Dr Rawlins said: 'I do not think it is independent to say the trust has the last word.'

The agreement reached is being referred to as a 'heads of agreement'. More negotiations will be required to settle the detailed terms and conditions for both full and part-time consultants, as well as outstanding issues such a re-writing the disciplinary procedures.

Country matters: Wales achieves deal; further steps in Scotland and Northern ireland

The British Medical Association and Welsh Assembly have struck a deal on the consultants'contract - rejected by 70 per cent last year - but with differences to England.

The standard Welsh working week will be 37.5 hours - compared to 40 in England.Consultants will be expected to give their first session of overtime to the NHS - and to do it for free.

There are also differences on pay, pay progression and discretionary awards.Pay increases will not be backdated to April but effective from December 2003.

There are also significant differences on job planning. In Wales, the BMA and Welsh Assembly intend to introduce 'indicative numbers' into job plans.

Stephen Redmond, NHS director of human resurces in Wales, said this might outline 'the number of patients an orthopaedic consultant needs to see in clinic or the number of operations they need to carry out'.

Bro Morgannwg and North West Wales trusts are to start pilot schemes running until the end of September. If an evaluation is followed by a positive ballot on 18 October, the new contract could be implemented in December.

Meanwhile, BMA Scotland has called a special meeting of its consultants and specialist registrars on 15 August over the breakdown in talks with the Scottish Executive. In Northern Ireland, the BMA is holding its first exploratory meeting with the health department to discuss the contract in the province.