United Kingdom Specific
- In the United Kingdom consultant terms & conditions of service are defined in national contract law that first came into force when the NHS was created in 1948
- The common contract evolved via the 1919 Civil Service General Whitley Council Conditions of Service (link to 1983 version)
- The contracts are now devolved and are linked to at the bottom of this page
- In England the contract as of 2015 was agreed in 2003 and provided a model for the devolved states negotiations
The time line below is divided into UK political administrations as these actually have had a major influence on the contract. The colour coding is Green: National/coalition government, Yellow: Liberal, Red: Labour, Blue, Conservative. Often the arguments over the consultant contract were however medico-political. This included initially parity with GPs, a major issue or two between the major conurbation consultants and those in the regions which all but split the BMA and by the 1970s the tensions with the juniors who had adopted a more industrial contract and who were no longer working in ways compatible with the traditional firm structure. Notice the reward the consultants obtained in 1979 and the relative stability that followed after a period where changes in consultant conditions of service correlated rather well with the electoral cycle. Tensions continue to this day.
- 1919 Civil Service National Whitley Council established. This product of First World War attempts to improve the relationship between the civil service and the government was in due course a basis for national terms and conditions. However at this time and prior to the establishment of the NHS many voluntary hospitals expected doctor trainees to work for nothing.
- 1948 National Health Service created with contracts for doctors based on the Whitley Industrial Relations System. As of 2014 the current junior contract still refers to 24 contractual matters, such as annual leave, removal expenses and public holidays as defined by the General Whitley Council (GWC) agreements. A basic salary that covers all duties is contracted. Junior doctors continue the traditional system of being resident on call, indeed many effectively live full time in hospital. Pay of consultants and juniors was based on the reports from the Spens Committee with as a starting point 1939 money.
- 1957 Royal Commission on doctors’ pay announced by government, shaken by the size of the Danckwerts award to GPs, it repudiated Spens
- 1960 Royal Commission recommends Consultant Annual pay of £2,500 rising to £3,900 compared to GP net NHS income of £2,425
- 1961 Joint Working Party on the Medical Staffing Structure in the Hospital Service changes very little
- 1962 Review Body established under the chairmanship of Lord Kindersley to "determine pay by the analysis of data rather than by a power struggle, preventing pay disputes from disrupting the NHS. It would give doctors and dentists a guarantee that their wages would not be arbitrarily depressed for political reasons, and assure the taxpayer that the professionals were not earning too much. It would hear evidence from the professions and the health ministries and take into account changes in the cost of living, earnings in other professions and recruitment. Its proposals, though not binding on the government, should be rejected only for the most compelling reasons"
- 1970 In April the Labour government held up the publication of the doctors' 12th Review Body report and its recommendation of pay increases of 30%. The government referred half the award to the National Board of Prices and Incomes, criticising some of the reasoning. The Chairman of the Review Body, Lord Kindersley, and his fellow members resigned with the BMA applying sanctions. After the 1970 election Edward Heath's Conservative government withdrew the reference, announced a new review body and the BMA sanctions were lifted. The new body could work as it chose and review pay any time, asking for any information it needed.
- 1972 Central Manpower Committee was established
- 1974 Pay bed crisis. Negotiations over a new consultant contract went wrong, and many consultants began to ‘work to contract. Barbara Castle, Secretary of State, and Henry Yellowees, the Chief Medical Officer were effectively bypassed, the later covertly, with Harold Wilson asking a distinguished solicitor, Arnold Goodman, to arbitrate. Two weeks quiet negotiations resulted in a compromise agreement.
- 1979 Labours negotiated consultant contract with minimal pay change abandoned by Conservatives. They quickly decided to increase the income of part-time consultants roughly 10 per cent and to allow whole timers to earn an additional 10 per cent from private practice.
- 1986 Achieving a balance. Proposed to increase the number of consultant posts, restrict the number of training posts and introduce a new career staff grade for doctors who do not wish, or are unable, to progress to the consultant grade. In the end it was the academic doctors who caused the most problems in implementation.
- 1993 European Working Time Directive (EWTD, 93/104/EC)
- 2000 SIMAP judgement brought by Spanish doctors union means that with full implementation of EWTD residence on call no longer viable option for doctors.
- 2003 New Consultant contract for England, quickly followed in Wales (where there was universal take up), Scotland and Northern Ireland
- 2009 Implementation of European Working Time Directive (93/104/EC) and UK Working Time Regulations (WTR) that allowed a maximum of a 48 hour week.
- 2015 Consultant contract renegotiations stall in England
This section applies to the contract as it applies in England only. The contract is being renegotiated in 2016
This section applies to the contract as it applies in Scotland only.
All consultants in Wales transferred to the new contract with the amendments agreed with the Welsh Government in December 2003
This section applies to the contract as it applies in Northern Ireland only.