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Letter to Mr David Moss, Programme Director of NHS Pay Reform

8 January 2004

Mr David Moss, Programme Director of NHS Pay Reform, wrote to all SHA Chief Executives and Consultant Contract Leads on 19 December 2003 setting out his views on the key responsibilities of SHAs in overseeing delivery of consultant contract, some further advice on costings and his ideas on the extent to which local agreements could differ from the national consultant contract.

The CCSC had very serious concerns about the content of Mr Moss's letter and wrote to him in the strongest terms, refuting many of the statements he made. Below is the letter from Dr Paul Miller of 8 January 2004.

Dear David

I am writing further to your letter of 19 December 2003 to Strategic Health Authority chief executives on the consultant contract. I have serious concerns about some of the content of the letter and set out my comments below. More generally, I am very unhappy that such a letter has been issued to the service without any discussion with, or even notification to the CCSC, particularly given that the Department of Health and CCIT purport to want to maintain a constructive relationship on contract implementation.

Costings
You make reference to the CCIT’s advice on costing assumptions and say that trusts should be ‘using them as a benchmark’. Further, the same paragraph goes on to draw reference to a need for 11 programmed activities to be seen as ‘an average and not a norm’. We believe that this is an entirely inappropriate and inflexible approach to contract implementation. The number of PAs will surely depend on the nature and workload requirements of individual jobs within individual trusts. Implying that all trusts are required to contract for an average of 11 PAs is unacceptable and constrains the ability of trusts to contract for the number of PAs appropriate to provide its services. We would commend to you the following extract from CCIT’s advice to which you refer:

‘The assumptions are not made on an SHA, trust or departmental basis and must not be interpreted in such a way. Job planning is the proper process whereby an individual consultant engages with the employer in a fair assessment and prospective description of that consultant’s work. The assessment should not set out to reflect UK wide averages or norms or assumptions.’

• Disapplying the unpredictable emergency work limits: strictly speaking, there is no limit to the number of PAs for unpredictable work after March 2005, as the contract does allow for more than two to be paid.
• Category 2 fees: the contract clearly does allow for consultants to retain fees for category 2 done in NHS time, with the agreement of the employer, if there is minimal disruption. Alternatively, ‘time shifting’ is an option, as recognised by the CCIT’s own example job plans.
• Availability supplements: it is helpful for trusts and LNCs to confirm how they will interpret, rather than redefine, the definitions.
• Resident on-call work: the contract is clear that the rates of remuneration for resident on-call should be set locally. Schedule 8, paragraph 4 states: ‘Where unusually a consultant is asked to be resident at the hospital or other place of work during his or her on-call period, appropriate arrangements may be agreed locally.’
• Recruitment and retention: the contract clearly does allow for premia to be 30% or salary. We accept that there should be consultations with the Strategic Health Authority.
• Backpay for retired consultants: as the CCIT FAQs indicate, consultants retiring before agreeing a job plan but making reasonable efforts to do so should be entitled to backpay.