News / Hunt signals contract changes to achieve seven-day services

He pledged to reform the consultant contract to remove the weekend opt-out for newly qualified consultants. He hoped consultants on the existing contract will switch to the new one.

Senior doctors will be able to keep their current contract, though consultants who continue to exercise the opt-out will no longer receive ‘off-contract payments’, he added.

Mr Hunt aims to move quickly. He put a six-week deadline on negotiations with the British Medical Association on the new contract, but insisted if no deal was agreed by that time he was ready to impose a new contract. In a wide-ranging speech on the future of the health service, he said the lack of a full seven-day service led to 6,000 avoidable deaths every year.

‘This is not about increasing the total number of hours worked every week by any individual doctor. Doctors already work extremely hard, and their hours should always be within safe limits. But we will reform the consultant contract to remove the opt-out from weekend working for newly qualified hospital doctors.

‘No doctors currently in service will be forced to move onto the new contracts, although we will end extortionate off-contract payments for those who continue to exercise their weekend opt-out. Every weekend swathes of doctors go in to the hospital to see their patients, driven by professionalism and goodwill, but in many cases with no thanks or recognition. The aim is to acknowledge that professionalism by putting their contributions on a formalised footing through a more patient and professionally orientated contract. As a result of these changes, by the end of the parliament I expect the majority of hospital doctors to be on seven-day contracts.’

Mr Hunt was speaking as the Doctors’ and Dentists’ Pay Review Body (DDRB) published a report on contract reform to support seven-day services. The findings apply to consultants and junior doctors in England and Northern Ireland as well as juniors in Wales.

The report said the case for seven-day services was compelling. The removal of the consultant opt-out was ‘important and significant’ as it was not appropriate in a system seeking to operate 24/7. However, this should be accompanied by several other changes, including safeguards on hours, pay progression linked to achievement of excellence and separate payment for working unsocial hours. It added that early removal of the opt-out and confirmation of unsocial hours premia could be achieved quickly and then piloted.

The BMA insisted it fully backed seven-day services. But its council chair Mark Porter said: ‘Doctors care for patients and understand their needs, and have been clear in their support for more seven-day hospital services. We have repeatedly called on the government to outline how they will fund and staff them. And yet we are still are no closer to finding out how the health secretary will pay for more weekend care or how he will ensure there isn’t a reduction in mid-week services?

The costs were not limited to extra doctors, but would include additional nurses, porters, diagnostic and admin staff among others.

‘It is positive that the DDRB has recognised the potential impact of these proposals on the working lives of doctors and that one size will not fit all, and we hope that the government does the same,’ Dr Porter added.

In a separate report, the NHS Pay Review Body concluded agenda for change (AFC) was not a contractual barrier to the introduction of seven-day services in the NHS. The report, on barriers and enablers in AFC for delivering healthcare seven days a week in a financially sustainable way, called for greater understanding of the cost implications of the initiative.

The report, which focuses on England, Northern Ireland and Wales, said there was some scope for adjustments in unsocial hours payments. However, it did not find sufficient evidence to support wholesale changes in unsocial hours definitions and premia without changes in the wider AFC system.

Northern Ireland health minister Simon Hamilton welcomed the debate on implementing seven-day services. ‘What is sometimes referred to as out of hours is in fact the majority of the week. What I want to see is us moving progressively towards a seven-day NHS in Northern Ireland, one where patients and people don't notice a difference between a weekday and a weekend,’ he said.