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We are three months away from the deadline set for contract negotiations for consultants in England and Northern Ireland. Since discussions began last October, they have focused on two key issues - the provision of seven-day services and pay progression.
With seven-day services, you will be aware of the growing political pressure for more NHS services to be available during evenings and weekends. But the coverage of this issue is often unrealistic and ignores fundamental issues about workforce capacity.
The BMA believes that acute, urgent and emergency NHS care should be of the same high standard throughout the week. BMA council chair Mark Porter has spoken of a ‘calendar lottery’, where the standards of care can vary depending on the day, and time of day, that patients are treated.
You may well be, or know, one of the many consultants who have already led innovative changes in services to help reduce unacceptable variations in care.
But what the successful examples of service change demonstrate is that the work-life balance and health of consultants has to be protected, or the possible benefits to patient safety and outcomes from greater consultant cover could be negated.
So this has been a priority in our negotiations. Were section 3 paragraph 6 of the current contract (which allows consultants to decline non-emergency work) to be removed, it would be vital to enshrine a set of appropriate safeguards in a new contract.
These could include maximum limits on weekend and evening working, assurances around the working time regulations and a commitment to prioritising emergency care over elective procedures.
Some trusts are already trying to introduce more seven-day services, with varying degrees of clinical evidence, support from medical staff and eventual outcomes. This makes it all the more important for this issue to be the subject of national negotiations, and for our members to be protected by a national contract.
The other key issue has been the consultant pay structure. The government wishes to end ‘automatic’ pay progression across the public sector. Although consultant pay progression is not currently automatic, the vast majority of consultants progress through each pay point without delay, and the government thinks the pay system should change. We need any replacement to be fair, and to recognise and reward the contribution that consultants make to the NHS.
It’s certainly a complex area, but we are exploring a number of possible systems that could replace the current one.
Clearly, we are negotiating in a completely different environment to previous negotiations. The Treasury has been clear from the start that there can be no new money, and this had made the talks very difficult. We are working in an environment where, although funding is more protected than in some public services, it has failed to keep pace with the rising demand for services. We have all seen the consequences of this in the increasing intensity of our work.
We have made some progress and we want the talks to succeed because we believe there are overriding benefits in having a national consultant contract. In our extensive consultation, you have told us you also think a national contract is very important, although we agree that it cannot come at any cost.
While the negotiations continue, and whatever the outcome may be, the BMA is continuing to work hard locally and nationally to protect and represent your interests. In a letter we have sent to all consultants in England and Northern Ireland this week, you will see details of our local structures, and now is an excellent time to make contact with them.
The thousands of you who have already given their views are helping to shape and inform our negotiations and I would urge everyone to get involved. Do continue to share your views and discuss issues on BMA Communities, keep up to date with the latest news and information or email us.
Tom Kane is acting chair of the BMA consultants committee
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