Milburn says no to talks as consultants reject pay deal

The deep dissatisfaction of senior doctors in the health service was exposed yesterday by a resounding vote to reject a contract that would have given consultants pay rises of up to 25 per cent.

Resentment at loss of professional autonomy, growing managerial control and a service perceived to be driven by political diktat rather than clinical need led to the collapse of what other groups in the profession had seen as a generous deal. Proposed restrictions on private practice also angered consultants. Those wishing to work privately were required to offer their services to their NHS trusts for the first four hours beyond the normal working week, paid at standard rates. Consultants qualified in the past seven years would have to offer eight hours' work.

The British Medical Association, which backed the deal, badly misread the hostile mood among its 28,000 senior members, and the consultants' leader and chief negotiator, Peter Hawker, resigned yesterday.

Consultants in England and Wales rejected the deal by a margin of two to one, but in Scotland and Northern Ireland, where staffing and resources are more generous and workload pressures less intense, it was narrowly accepted. The new contract may now be implemented in those countries. Consultants had been promised they could remain with the old contract rather than switching to the new one.

The result causes a new headache for the Government, which has pinned its future on cutting hospital waiting times and modernising the health service. Better planning of consultants' time and more flexible services for patients set out in the new contract were key to achieving that.

Alan Milburn, the Health Secretary, declared the result "disappointing" yesterday but insisted there was no alternative. "It took two years of tough negotiation to get to this point. I always said it was the only contract on offer. There can be no renegotiation. There can be no more resources. There can be no veto on reform."

He said the extra resources set aside to increase consultants' pay – worth an estimated 15 per cent on the pay bill or £310m over three years – would be used to "better reward NHS doctors who do most for the NHS". He added: "We will bring forward plans to do so shortly."

No details were available but speculation centred on the possibility that NHS trust managers would negotiate local deals with consultants, in line with the Government's commitment to devolve power. The chairman of one trust said yesterday: "This ought to spell the end of centrally negotiated contracts. The only people it benefits are the BMA and the Health Department."

Gill Morgan, chief executive of the NHS Confederation, representing managers, said: "To deliver a modern health service which meets the needs of patients, it is essential the work of doctors is effectively planned and managed. This means it is less possible for doctors to be as independent and autonomous as in the past."

Derek Machin, acting chairman of the Central Consultants and Specialists Com- mittee, said he would seek urgent talks with Mr Milburn. He said: "We would be opposed to any piecemeal introduction of the contract. It would be very unwise if the Government went down that road."