Managing NHS hospital consultants

By 2011/12 around 40,000 hospital consultants were employed at a cost to the NHS of £5.6 billion, 97% of whom were on the 2003 contract. Of the expected benefits that could be measured, all have been either fully or partly achieved. Consultants’ private practice work has not increased, pay progression has slowed and 97% now have a job plan setting out their objectives, although 16% of these have not been reviewed in the last 12 months. While indicators show that consultant productivity has continued to fall, the rate of decline has slowed. The consultant participation rate has also increased although it remains unclear to what extent this has resulted in consultants doing more actual work for the NHS. More could be done to achieve better value for money, says the NAO, by fully realising the benefits set out in the Department’s business case. Despite, for example, the contract providing a clear structure for paying for additional work at contractual rates, most Trusts still use locally agreed rates of pay for additional work outside job plans. Pay progression is also the norm and not linked to consultant performance. The contract significantly increased the cost of employing consultants. Between 2002/03 and 2003/04, total earnings per full-time consultant increased by 12% in real terms, with a 24% increase in the bottom of the consultants’ pay band and a 28% increase in the top. Commenting on the figures, Amyas Morse, head of the National Audit Office, said: “NHS consultants play a key role in the NHS. Given the size of the pay increase given to consultants under the 2003 contract, it is reasonable to expect Trusts to have made more progress in improving how consultants are managed and realising the expected benefits of the contract. Trusts need to get consultants strongly involved in achieving the Trusts’ objectives as well as their own clinical goals.”