Consultants poised for pay sanctions

The doctors' trade union, the British Medical Association, is today expected to approve consultants' plans to impose sanctions against locally determined pay. Across the country hospital consultants are united in opposing ministers' intention to introduce local pay arrangements in the hospital trusts from next April and are shaping up for a serious confrontation with the Government.

While the BMA Council, the profession's ruling body, is uncertain about the timing of such action the consultants' group is clear, and voted last week that action would be taken when Virginia Bottomley, Secretary of State for Health, moves to change the regulations under which consultants are paid.

The consultants' committee has asked the BMA's sanctions working party to work out details of schemes which involve not working unpaid overtime and not co-operating with NHS changes. The sanctions should not affect "patient care" but could lengthen waiting lists.

A sample of opinion from UK hospital trusts yesterday showed a striking uniformity of view, after two years of change and difficulty with the introduction of the new NHS market.

"I hope [sanctions] will not be needed. But the Department of Health and the Treasury must relax their intentions on this ,'' said Dr Basil Hudson, anaesthetist at Derbyshire City General Hospital NHS Trust.

"All shades of opinion are opposed to locally determined pay, whatever the speciality and whatever are consultants' political leanings. One of the great successes of the NHS is that it has ensured medical care of the same highest standards throughout thecountry, whether it was a remote rural hospital or London teaching hospital. It has never been to the financial advantage of doctors to work in one place rather than another."

Dr Ken Taylor, consultant physician at City Hospital NHS Trust, Birmingham, said he believed the dispute could get as far as sanctions. "Performance- related pay is hand-in-hand with local pay negotiation. But it all depends on your branch of medicine. The speciality you work in has never determined the reward you receive. Young doctors in future may choose to work in branches of medicine which are more attractive."

While a surgeon's "output" could be measured, the work of a geriatrician or psychiatrist could not be so easily quantified. "Young doctors are starting their careers these days with heavy debts. This will introduce perverse incentives."

Connie Fozzard, obstetrician and gynaecologist at the Royal Cornwall Hospitals NHS Trust and a BMA negotiator, said: "Four hundred and fifty trusts all doing their own negotiating is very wasteful both for the profession and for managers. The game they are playing is `beat the consultant'.People are breaking down under the stress and they don't give a tuppenny damn."