Prime M i n i s t e r DOCTORS' AMD DENTISTS' REVIEW BODY: WHS CONSULTANT CONTRACT In my minute of 22 Jup© about the proposals which the consultants*
leaders have put t o me f o r amending t h e i r present form of c o n t r a c t , I s a i d t h a t , a f t e r d i s c u s s i n g the matter w i t h NHS management, I would b r i n g formal
to colleagues.
proposals
I have now had discussions w i t h management; and the proposals
^
put t o me on behalf of the p r o f e s s i o n have been f o r m a l l y endorsed by t h e i r Annual Representative
Meeting.
The purpose of t h i s minute i s t o seek colleagues' agreement t o open negotiations w i t h the p r o f e s s i o n , on the basis that the proposals are acceptable
2.
i n principle. 1
The present contract draws a sharp d i s t i n c t i o n between 'whole-time and 'maximum part-time' consultants.
private practice.
The former are forbidden t o take on any The l a t t e r are expected t o devote ' s u b s t a n t i a l l y ' the whole of t h e i r p r o f e s s i o n a l time t o the NHS but, i n r e t u r n f o r the r i g h t t o do p r i v a t e p r a c t i c e and a degree of f l e x i b i l i t y i n t h e i r working arrangements, are paid at only nine-elevenths
5.
of^the whole-timer's r a t e . The p r o f e s s i o n regard the "new c o n t r a c t " which they agreed w i t h our predecessors as dead, and they now see t h e i r b a s i c o b j e c t i v e as securing a f r e e r f i e l d of choice f o r consultants.
More s p e c i f i c a l l y , they seek t o reduce the f i n a n c i a l 'penalty' which maximum part-time consultants s u f f e r as the p r i c e of being e n t i t l e d t o do p r i v a t e p r a c t i c e , and t o o f f e r a corresponding i n c e n t i v e t o whole-timers by a l l o w i n g them ( f o r the f i r s t time) to undertake a l i m i t e d amount of p r i v a t e work.
i.
Their main proposals a r e : that maximum part-timers should i n future be paid
ten-elevenths
of s a l a r y f o r the r i g h t t o undertake p r i v a t e p r a c t i c e , as being a r e a l i s t i c estimate of the c o n t r i b u t i o n which these consultants make to the NHS; ii.
that whole-timers who so wish should be able t o u n d e r t a k e a l i m i t e d amount of p r i v a t e p r a c t i c e , on the basis that gross p r i v a t e earnings should not exceed 10 per cent of basic NHS remuneration; iii.
that the concept of a part-timer who works only nine s p e c i f i e d sessions, and i s paid accordingly, should be reintroduced.
was withdrawn by the l a s t Government).
~~—
(The p r o v i s i o n 4.
Discussion with NHS management has confirmed the view I expressed i n my e a r l i e r minute that arrangements on these l i n e s would be t o our advantage. They would encourage p r i v a t e p r a c t i c e , they would be much l e s s c o s t l y t o p u b l i c funds than the contract which the consultants have r e j e c t e d would have been, and the profession's leaders assure me that they w i l l lead t o the improved morale among h o s p i t a l doctors which we so badly need.
Regional Health A u t h o r i t y Chairmen welcome the r e j e c t i o n of the ' i n d u s t r i a l ' type of contract o f f e r e d to consultants by our predecessors.
They have i n d i c a t e d some matters where we s h a l l need t o be c a r e f u l i n the d e t a i l e d working out of the new proposals, and they would l i k e t o see, i f p o s s i b l e , some f u r t h e r measure of encouragement f o r whole-time consultants, e s p e c i a l l y those who have no opportunity f o r p r i v a t e p r a c t i c e , together perhaps w i t h c e r t a i n minor concessions from the p r o f e s s i o n i n r e t u r n f o r Government agreement t o the package they are seeking.
I attach great weight t o the Chairmen's views and s h a l l c e r t a i n l y ensure that the NHS i s involved i n the d e t a i l e d discussions w i t h the p r o f e s s i o n .
But the key f a c t o r f o r the present i s that NHS management does not b e l i e v e that the proposals would unacceptably
reduce the e x i s t i n g commitment of consultants t o the NHS or otherwise damage the s e r v i c e , and share my b e l i e f i n the importance of these measures as a means of winning the confidence and co-operation of the doctors. Their support w i l l be an important f a c t o r i n d e a l i n g with c r i t i c i s m from the Opposition, which w i l l no doubt concentrate the boost which the proposals w i l l give t o p r i v a t e p r a c t i c e and the extent t o which i t may not be p o s s i b l e t o enable a l l consultants t o b e n e f i t equally from the 'package'. 5.
The l i k e l y a d d i t i o n a l cost of changes t o the contract - mainly a r i s i n g from paying maximum part-timers a t ten-elevenths of the whole-time r a t e ­
would be about £6-7 m i l l i o n i n a f u l l year (as against the £21.8 m i l l i o n which would have been needed t o implement the Review Body's recommendations f o r the new consultant c o n t r a c t , which were approved by E Committee).
The Chief Secretary has s a i d that he sees no o b j e c t i o n i n p r i n c i p l e , p r o v i d e d that the cost i s contained w i t h i n e x i s t i n g cash l i m i t s as the cost of the new contract would have been. ^I^wollltl »5 6ontent w i t h t h i s .
The 1979-80 cost would i n f a c t be u n l i k e l y to exceed £3-4 m i l l i o n , and might w e l l be l e s s , because new arrangements could not take e f f e c t u n t i l l a t e i n the year (or even, depending on the speed a t which discussions proceeded, the beginning of the next f i n a n c i a l y e a r ) . 6.
As I mentioned i n my minute of 18 June, the consultants a l s o want to
•improve' the Review Body.
I s h a l l ensure that colleagues are consulted at an
e a r l y stage on any proposals which the two professions may
decide to put to
but t h i s issue i s l i k e l y to be handled i n considerably slower time.
me,
For the
present, I simply seek confirmation that colleagues are content f o r me to inform
the consultants that t h e i r proposals (as i n paragraph 3 above) are acceptable i n
p r i n c i p l e to us, so that d e t a i l e d negotiations can get under
7.
I am copying t h i s minute to members of E Committee, the S e c r e t a r i e s of
State f o r Defence, Scotland and Wales and S i r John Hunt.
IO J u l y
1979
Department of Health and S o c i a l S e c u r i t y London SE1 way.