Contract reform

Group of hospital staff

We have been working with the British Medical Association (BMA) for a number of years, and since 2017 with the HCSA, to negotiate new contracts for consultants.  

This web page provides the background to the negotiations and progress made to date. 

A new reward system for consultants

Employers and doctors have a great opportunity to design an attractive reward system for NHS consultants in England. We need the views of CEOs and senior NHS managers to influence the biggest change to the consultant contract since 2003. See more information and give your views

Contract reform for consultants

NHS Employers received a mandate from the Department of Health to reform the consultants’ contract in October 2013. These negotiations with the British Medical Association (BMA) were around possible changes to the 2003 consultant contract.

The heads of terms and subsequent negotiations were a result of exploratory discussions between the BMA and employers following publication of a report by the Doctors' and Dentists' Review Body (DDRB), which recommended substantial changes to the clinical excellence awards (CEA) scheme as well as changes to the consultant pay scale which would link pay progression more closely to current performance than to time served. These discussions also reflected the debate on seven-day services and how the consultant contract could, in future, facilitate the provision of seven-day services for the benefit of patients, while at the same time remaining fair to consultants.

In December 2014, we submitted evidence to the DDRB and in July 2015, the DDRB made a number of observations on the consultants' contract.

In September 2015, the BMA agreed to re-enter formal negotiations on the reform of the consultants' contract. These talks have been constructive but have not yet concluded. As part of these talks, the parties agreed new local clinical excellence award arrangements from 1 April 2018. We are working with the BMA and the HCSA with the aim of publishing a new contract in due course.

Key themes

The key themes discussed during the negotiations process have focused on the following areas.

Removal of Schedule 3 paragraph 6 – the right to refuse non-emergency work out of hours

Replacement of Schedule 3 paragraph 6 with new contractual safeguards around prioritisation of workload, frequency of weekend working, contractual hours, provision of appropriate facilities in out of hours periods, occupational health and organising cover to ensure continuity of care.

Revised pay structure

Introduction of an amended two point pay scale that will enable consultants to progress from a ‘development’ point to a ‘rate for the job’ after an average of five years. This will provide access to higher earnings (base pay) much earlier in a consultant’s career and is more beneficial in terms of pension accrual in a career average pension scheme.

New performance scheme

Local clinical excellence awards have been replaced with new local performance payments that are linked to performance assessment. Awards are now a contractual entitlement with ring fenced funding. Awards are now time limited, non-consolidated and non-pensionable.

Reward for work undertaken out of hours

Following initial discussions we have deferred negotiating any changes to unsocial hours until we have more accurate data, which would be needed to model the costs of such changes.

Engagement activities

We will maintain a programme of engagement activities with employer networks and reference groups throughout the negotiation period to test emerging proposals to ensure that any changes to the contractual terms and conditions and supporting implementation arrangements are fit for purpose.

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