Top doctors' deal 'poor value'
Changes to the contract for hospital consultants, which saw a sharp rise in pay for senior physicians, do not facilitate around-the-clock care for patients, MPs have said.
Productivity of hospital specialists has "continued to decline" since the introduction of the consultant contract in 2003, according to the Public Accounts Committee.
The deal, which increased the senior physicians' pay by 24% to 28%, was designed to lift productivity and career development but MPs said it means that many specialists can refuse to work at evenings and weekends and some hospitals pay up to £200 an hour for work done out-of-hours.
Around 97% of senior hospital doctors are signed up to the contract, but MPs said that it is "poor value for money to the taxpayer".
The MPs said that consultants' performance is being "badly managed" and warned that improved monitoring is "essential" to avoid another care scandal such as the one seen at Mid Staffordshire NHS Foundation Trust.
MPs said that the contract was a "missed opportunity" to deliver a change in consultant performance. Their report added: "The NHS needs to be more focused on delivering the best possible care for patients, but the performance management structures and incentives for consultants are often not properly aligned to achieve this."
While they welcomed the publication of surgical outcomes league tables, they said that "performance information remains poor and is not transparent". In February, Health Minister Dan Poulter said medical contracts were "long overdue" for change and that the Government was starting discussions to "get the best value" from consultant pay.
Committee chairwoman Margaret Hodge said: "A new contract which increased consultants' pay by between 24% and 28% failed to halt a continuing decline in productivity... A proper culture of performance management for consultants and other NHS staff must be implemented if we are to avoid incidents of poor performance.
"Despite the increased pay, there is still a shortage of consultants in some parts of the country, in hospitals in deprived areas and in specialities such as geriatric medicine. This makes some trusts reliant on locum consultants, who provide less continuity of care for patients as well as being more expensive for the NHS. The department must consider measures to attract consultants to such areas and specialities without financially disadvantaging the organisations concerned."
Consultants account for 4% of NHS staff but their pay amounts to 13% of all NHS employment costs. The 40,000 consultants working in the health service were paid £5.6 billion in 2011/12, according to the committee's report.