Trusts reluctant to pilot fees-for-service

The four strategic health authorities picked to test a new fee-for-service incentive scheme for consultants have told HSJ they are still officially in talks with trusts to identify which of them might pilot the scheme.

Their deadline - for finding a total of 12 trusts willing to implement the scheme to reward consultants for more NHS work - has been extended by the government.

Asked to name a trust in its region that had signed up to the scheme, a spokesperson for Avon, Gloucestershire and Wiltshire SHA, one of the four SHAs involved, said: 'We are still in active discussion with a number of acute trusts about the incentive scheme.'

A spokesperson for Kent and Medway SHA said: 'Discussions are still going on.'

British Medical Association central consultants' and specialists' committee deputy chair Dr Nizam Mamode last week told a BMA emergency meeting of local negotiating committees that 'not one single trust has expressed an interest in the incentive scheme'.

And consultant Dr Andrew Hobart said that when North East London SHA, another of the SHAs designated to introduce the scheme, had asked Newham Healthcare trust, where he works, to introduce the scheme, it had been rejected as 'a complete shambles'.

Dr Guy Routh, the medical director of Gloucestershire Hospitals trust, which lies within Avon, Gloucestershire and Wiltshire SHA, said the trust would be offering the new contract, rather than the incentive scheme, to consultants.

The CCSC emergency meeting discussed its response to government's attempts to introduce both the new contract locally and the fee-for-service scheme.

A template for the new contract was released by the Department of Health only the night before the meeting. It contained a number of concessions for doctors, including a promise not to insist on evening and weekend work and the provision of an 'honest broker' to mediate where consultants disputed their job plan with managers.

Dr Routh said: 'Nothing was happening locally because we didn't know what was being offered until we saw the model contract and the terms and conditions.'

The BMA has now called on consultants to vote on local implementation of the contract, with the hope they will reject it and demand a renegotiation.

Dr Routh said consultants in his trust who did not want a new contract would have the option of staying on the old deal. 'We will not push the issue. If they all say 'no' to the new contract, we would have to go back to the DoH and say we have pushed this as far as we can but can't do any more, ' he added.

A number of trusts thought to be leading the way on local implementation told HSJ they had made little progress.

A spokesperson for Sheffield Teaching Hospitals trust said:

'The medical director laughed when I asked him and said: 'I do not think we are further forward than any other trust.'' NHS Confederation policy director Alistair Henderson said the fact the template for the new contract had removed some of the consultants' concerns meant it would be acceptable for doctors to agree on a local basis.

'It is a very good deal and I think consultants should get into detailed negotiations with managers, ' he said.

'I am unsure as to what extent the consultants are anti the contract, and how much all this is born of general anger and frustration with the government.'

lThe BMA GPs' committee was due to meet today to consider voting on the GP contract proposals.

Mike Farrar, who is leading the negotiations for the NHS Confederation, said negotiators had responded to doctors' concerns about the contract.