I just thought I should share this with the list:

I read out most of the new consultant contract proposals to a handful of 
non-medical friends of mine at a recent BBQ (yes, do pity me!). I lied a bit 
in telling them what it was (more of that later). These friends are all in 
their late 30s to early 40s and are a building contractor, an accountant, a 
solicitor and two insurance execs. 4 are UK-born, one a recent arrival from 
South Africa. They have all been well-informed by myself and our common 
medical friends over the years and they know quite a bit about what A&E and 
the NHS are all about.

They made a few interesting observations. I admit that on a few points they 
only commented after I specifically asked for an opinion, but I put no words 
in their mouths:
- The language was "ominous" - it sounded as if the government was trying to 
"take over" and control the profession. Some suggestion of an
"attempt to POLICE the profession".
- Very vague language when it came to any commitments other than the
consultants' ones. My solicitor friend said that it was so vague it was 
could not actually be used as a basis for negotiations.
- Who are the "employers"? Were there any guidelines as to who was entitled 
to be deciding on a consultant's next pay rise other than that they would be 
office-dwellers?
- "Where is the bit about A&E?" - A literal quote. My mates thought this was 
written for surgeons.
- They will be counting how many patients you see and paying you 
accordingly. There is no currently implementable system to audit ANY
OTHER aspect of A&E work except its mere quantity. So the only goals
you could prove you have met are numbers... Who will be deciding on
these targets?
- Sounds like consultant on-call duties will be eliminated in A&E
departments with SpRs on call - the section on on-call duties states that 
this would happen if consultants are "rarely" called upon to come in.
- That section also limits the budget to be spent on on-call pay as a
proportion (3.48%) of total consultant pay bill. This means that if this is 
insufficient, the next step would be to to use preferentially those 
consultants who are on a lower pay level to do on-call work, thus
reducing the bill by creating a lower rank of consultant. This could be
made to happen through a management decision, regardless of any
opinion consultants have on how this will affect their interrelationships.
- What happens to SpRs who, when it comes time for them to switch to a 
consultant post next year, are above the £63,000 initial level?
- Many and repeated concerns expressed over how pay raises will be used as a 
leash to tame consultants into just slogging for the NHS and not
having anywhere near enough time for any non-clinical activities. No
wonder the juniors want to vote on this, they said. They will be getting 
zero training now if their consultants have to chase numbers.
- How can they ignore pensions? Who would be dumb enough to even look at a 
contract without pension details, especially nowadays, with everyone trying 
to find ways of avoiding paying what they had promised in terms of pensions.
- "Is private work illegal? They make it sound like a crime..."
- "Looks like doctors are never going to be finished with exams" -
referring to how each year consultants would have to jump through a
hoop of approval to just get paid their dues.
- "Watch out for stress levels"

I am cutting the list of points I noted at the time. There were a few more, 
but I don't wish to make this e-mail too long. My lie? I told my friends 
that this was the government's initial suggestion only. They were all 
assuming that this was the point we will BEGIN to negotiate from. When I 
told them this was the supposed outcome, they could not believe it.

But this possibly explains why they could not see anything positive here at 
all. They actually doubted whether we should even begin to negotiate with 
such a basis unless firmer language was used on the "employer's" side.

The only positive point noted, by accident, was that there will be many
jobs created by this. For each consultant's annual assessment, many
person-hours will need to be spent (I have personally added to this list)
- by someone to audit their performance figures and data
- by someone to collect that data and/or create systems for collecting it
- by someone to confirm that this is correctly collected
- by the conslutant, who will also collect the information to ensure he/she 
is not being cheated
- by others who will report/spy on consultant's performance
- by as many people who would then have to sit and debate this each year 
with each consultant over as many hours as it takes (and it would have to be 
a significant number of people to avoid personal bias)
- by those who will review the inevitable appeals - likely to be near 100% 
of those who are refused a raise
- by those who will have to porcess the mountains of paperwork

(Personally, I expect there would also be MANY resignations and transfers 
resulting from pay raise refusals as well as legal actions very early on for 
unfair discrimination)

They could not believe this was something MY elected representatives
were actually prepared to admit to. We got some paper (after the BBQ) and 
did the math and they were actually laughing! The misleading way in
which figures were presented was so deceitful, they said, that it would not 
be considered legal in any of their fields to put it down on paper. There 
was an obvious attempt to "hide" the fact that a junior consultant grade was 
being created, using, among other means, the working hour directives.

BTW, the BBQ was good...

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