10 Things You (and your customers) ought to know about the Consultant’s Contract – (Part 5 CONTRACT FACTS 31-39)

31. Consultants Contract: Hospital Consultants also have the bane of their life trying to sort and organise their contract. There are many differences not just in structure of the consultants contract but also in the essence of what the implications are. The consultants contract doesn’t have any points nor does it have any prizes. Begs the question – what exactly is in the consultants contract?

THINK POINT PF: The consultants contract is more along the lines of an ‘employment’ contract. It’s more about salary, working hours, on-call and training rather than the new GMS contract which is much, much more than that.

32. Who implements the consultants contract?: The consultants contract was initially pushed nationally by the government. This didn’t work – so the consultants contract needs to be ‘agreed locally’.

THINK POINT PF: This is not good news. The government didn’t get their way. They were unable to push the small print. So what they are now doing is saying ‘agree locally’. What this means is that some poor soul (usually the medical director) now has to push this contract locally in their own hospital trust. This person is not Mr/Mrs Popular right now. They will be facing the brunt of any reprisals, disagreement, discord and anti-contract feeling that may exist.

33. So what is in the consultants contract?: A significant imperative is a much stricter definition of the contractual commitments for the consultant. For example, core contract of 10 sessions is highlighted with fixed sessions to include on-call, all clinical work, teaching & audit!

THINK POINT PF: Consultants will be earning higher salaries (mean starting jump from £55000 to over £80 000) but will be working hard! Any extra work will be remunerated as ‘additional sessions’. However annual job plan review will be linked to appraisal and subsequent adherence to the new contract.

34. Key Points on the Consultants Contract: A significant imperative is a much stricter definition of the contractual commitments for the consultant. For example, core contract of 10 sessions is highlighted with fixed sessions to include on-call, all clinical work, teaching & audit!

• Overall increase in consultants pay
• Consultants expected to be on site when scheduled for NHS duties
• Strict adherence to contract replaces the 10% limit on private practice
• Significant change in working patterns and on-call site residency and accommodation
• Average 48 hr working time directive not to be exceeded
• 5 yearly career development review to allow portfolio career & less on-call later on
• Incremental pay for professional performance rather than short term bonuses
• Provision for sabbaticals, CPD leave and assessor duties
• Increase availability for part-time & flexible working hours
• Measures to retain consultants who seek early retirement

35. So what’s being contested?: Varied grading of consultants (ie junior consultant & senior consultant) has been rejected outright. On-call payments are being thrashed out (the Paris Test) Enforced reduction in private work (significant politics!). Also the way in which consultants receive merit points & discretionary points to their salary is being reviewed and amended.

THINK POINT PF: The Medical Director of the Trust has a significant job here! Some understanding of this conveyed to the medical director will be received compassionately right now. This task is a lonely one and everyone can seem against them. Your rep-friendliness and ability to influence one of the key medical members may pay off later in life! Everyone will be asking for higher on-call (see Paris Test) and working around private clinic commitments. Leave cover & rotas are very hot topics indeed. Also very contentious – the backpay the consultants are demanding for increased salary!

36. What about on-call?: This is interesting. It’s probably the most contentious part of the consultants’ contract currently being implanted. The Paris Test refers to on-call payment scales based on ‘whether or not on call involves visiting the hospital’.

THINK POINT PF: If you really want some sparks to fly at your lunch meeting or a hospital KOL evening seminar bring up the Paris Test! Sure way to get things into a ‘heated debate’ it goes something like this. Consultants receive a % increase on their salary for doing on-call. However, this can range from 4% – 10% + this depends on 2 main factors – how frequent is your on-call rota & when you do get called, do you have to come in. Regarding the rota – a minimum set of 1 in 5 defines criteria for higher payment. However, the wording is ‘rota’ and not ‘cover!’ So most consultants may be down for 1 in 5 rota but due to cover, leave, sickness, etc, end up covering 1 in 4 or even 1 in 3! Well – the contract says – tough. It’s what you are down for the rota not cover! Not friendly! Also – some consultants will be on 2 separate rotas – where each rota is more than 1 in 5 but together leads to very frequent on-call. Yet again – tough.

37. But what about the Paris Test itself?

THINK POINT PF: If you are a consultant on-call do you ‘usually’ have to visit the hospital site. Now – what does this mean? More common than not? (ie over 50% of the time) All the time? Some of the time? Relatively frequently? Hence the Paris Test asks whether or not you could manage the problem from Paris !!! Or – would you have to be on-site!! As you can see – it’s open to perceptions and believe me, these perceptions are being put directly to the medical director demanding ‘higher scales’ of on-call payment. What’s more – the medical director cannot just award based on the each and every argument. For the government has allowed only for 40% of all consultants to claim the ‘busy on-call’ and the rest to take ‘lower scale’!! So the chief executive will not accept the whole of the consultants’ staff to receive ‘higher grade on-call’ remunerations!! I would not want to be the medical director who has to set these limitations… Furthermore – there is room for manoeuvre in the Paris Test which asks ‘does your on-call involve complex telephone conversations’!!! What does that mean? I suspect all consultants will say their on-call involves this!! And hence demand higher scale remunerations!!

38. So what will happen to on-call as a result of this?: Firstly we will see a lot of toys being thrown out of the pram. Secondly – those physicians that are awarded higher scales will probably do what they currently do. But what about those consultants who are forced to accept ‘lower scale’ % for on-call because they do not meet the Paris Test criteria?

THINK POINT PF: Well – it’s obvious. If they do not get the higher pay for complex calls & visiting on site you can be guaranteed 1 thing. They won’t come in to hospital and won’t spend time on the telephone. The Trust can’t have it both ways. I do hope that if I ever have to go to hospital and the junior phones the consultant on-call, that he/she is getting paid a higher scale. Otherwise, not only will they not come in to see me… they may not answer the phone…

39. Views from Questionnaires: Whilst questionnaires are only snapshots at certain time frames they do make for interesting previews. This one is from 195 specialist registrars prospective to be consultants, anonymously responding to set questions.

THINK POINT PF: I have picked out some interesting ones. For example, whilst 70% said they were prepared to be resident on-call consultants (remember extra pay comes in) over ? would not accept the 7-year ban on private practice (initially proposed by the government). In fact over 80% stated they would be prepared to take some form of industrial action when original government proposals were put to them!! Many still feel that the starting salary is not high enough and would want to seek alternative ways of working (retire from NHS and set up ‘chambers’ who would set sessional fees to work. Bit like a GP saying rather than work a full day week with all the politics of the PCT, NICE and NSF, they will forget being a practice partner and do 1-2 days a week locum/oncall – where they could earn far more, with far less hassles!! What a way to run the NHS!

OMAR ALI is the Formulary Development Pharmacist for Surrey and Sussex Healthcare NHS Trust and is a PCT Formulary Adviser to 2 PCTs. He is a lecturer on the MSc on Pharmacy Practice at Portsmouth University and is also an adviser to three Drugs and Therapeutics Committees in the South of England. Omar is a National Speaker in the UK (cardiovascular, diabetes, mental health) and is an Executive Board Member for the National Obesity Forum. He can be reached directly on ‘alipha@aol.com’