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Introduction
Following the rejection in the referendum of consultants of their proposed new contract by a majority of about 2:1, the CCSC sent a questionnaire to all consultants in England which sought information on the possible reasons for this rejection. A total of 10,908 completed surveys were received and this report presents the key findings. Appended to this report are frequency and percentage counts relating to some questions. To see some of the main points of interest click on the blue box link above.
How respondents voted in referendum
64% Percentages quoted throughout are based on total valid responses to a question. of respondents said they voted against the contract, 31% in favour of it and 5% said they did not vote. Although the ratio of those who voted against to those who voted for (64:31) is fairly close to that in the referendum (66:34), it should be noted that only 5% of the survey respondents said they did not vote in the referendum, whereas the referendum turnout was estimated to be 74% (UK wide). The results show that consultants of longer standing are more likely to have voted for the new contract than those newly appointed.
Attitude to aspects of the framework agreement
Respondents were asked to indicate their satisfaction with various aspects of the proposed new contract – summaries of some of the responses are appended. Areas where consultants were satisfied included:
Recognition of additional work through programmed activities (70:30)
Time sensitive as opposed to open-ended nature of contract (68:32)
New system of job planning (57:43)
Working week of 10 four-hour sessions (56:44)
There was some variation according to specialty. Areas where consultants were dissatisfied included:
Capacity for management control over pay progression (14:86)
Capacity for management control over working patterns (17:83)
Different treatment of newly appointed consultants (19:81)
Further to this question, respondents were also asked to write in any aspects of the new contract not listed with which they were dissatisfied or conversely, with which they were satisfied. Not surprisingly, the number of unfavourable comments out-numbered favourable ones by about 4 to 1. As far as the unfavourable comments are concerned, many of them in fact reiterated or reinforced aspects listed in the question. For example, the fear of managerial control over clinical activity was often mentioned. Areas which were not listed in the main question which were mentioned included:
- a perception that part-timers would be disadvantaged under the new arrangements. Linked to this was a complaint that time spent in training grades (which may be by necessity longer for these doctors) was not recognised in the proposed salary progression
- lack of clarity of pension arrangements
- no improvement in study leave
- the fact that consultants with many years experience would not automatically go to the top of the scale
- adverse effect on ability to carry out private practice
As to other aspects with which respondents were satisfied, mentioned most often was probably the abolition of the 10% rule & maximum part-time contracts. Other aspects mentioned were:
- the higher pay rates under the new contract
- continuation of the final salary pension scheme
- the very fact that it was an attempt to replace the existing contract!
The results show that well over two thirds (70%) of respondents thought that, under the existing contract, trying to meet government targets or managerial directives distorted their clinical priorities inappropriately. 64% thought that the proposed new contract would have made the situation worse, and 26% that it would have made no difference.
Current workload and income
The survey shows that for those with whole-time and maximum part-time contracts, the majority (77%) currently work more than 50 hours a week for the NHS and nearly half (46%) work more than 60 hours per week. Only 3% currently work less than 40 hours per week for the NHS.
The majority of respondents (71%) had no half days per week with no NHS commitment in compensation for time spent on-call, whilst 16% had 1 half day per week and 13% had 2 or more half days. The lack of time per week without NHS commitment is particularly high for those in public health (99%), psychiatry (96%), geriatrics (95%) and pathology (93%), compared with A&E (31%) and anaesthetics (48%). The majority (71%) said that their current out of hours duties were not recognised or rewarded in some way. Respondents who said that they received no weekday sessions in recognition for on-call duties carried out were asked if they received compensation in some other way, and if so, to write in what form this took. By far the most common other methods of compensation for out of hours work are through intensity payments or by payment for an additional session(s).
16% stated that their present rota commitment for out of hours duties was 1:5, 13% 1:4, 13% 1:6 and 11% 1:8. 18% had a rota commitment for out of hours duties of 1:10 or above.
Around 30% of respondents stated that their post was allocated to Band 1-(low intensity) for out-of-hours duties,30% were in a Band 2 (medium intensity) post and 28% said they were in a Band 3 (high intensity) post. 9% stated that their allocation was yet to be determined. Those in psychiatry, ophthalmology or public health are more likely to be allocated to Band 1, those in anaesthetics or geriatrics are more likely to be allocated to Band 2 and those in obs & gynae, paediatrics or A&E to be in a Band 3 post. 31% of respondents in the dental specialties stated that they had no out-of-hours responsibilities and more than 10% of those in medicine, psychiatry or ophthalmology had yet to be allocated a band.
Distinction awards & discretionary points
The majority of respondents (86%) do not receive a distinction award but half of respondents do receive discretionary points. The majority of respondents 84.9% who receive discretionary points, receive between 1 and 4 points.
HPERU
28.2.03