The consultant contract: marriage or divorce?

Abstract

-At the birth of the new millennium Britain's Labour government published a 10-year plan for modernising the National Health Service (NHS), placing great emphasis on new ways of working. As part of this process, and following extensive negotiation, general practitioners and hospital consultants were offered new contracts in 2003. This process highlighted the issues academic clinicians and managers face in dealing with the tensions inherent in delivering the tripartite mission of teaching, research and clinical service. Following a retrospective review of clinical academic appraisals, this paper considers new strategies for strengthening the relationship across the university and NHS interface and how this novel and strategic approach might be adopted in future health policy. These findings can be helpful for both UK colleagues and for a broader international audience by providing a pragmatic approach to increasing collaboration across the higher education and health service sectors.KEY WORDS: clinical academic medicine, consultant contract, university and health service collaboration Academic medicine is in crisis and is in danger of losing its leadership role. [1][2][3] The root of this problem appears to lie in the challenge of delivering the tripartite mission of clinical service, teaching and research. Unlike Cerberus of Greek mythology, the tripartite mission is not a three-headed monster, but rather an interdependent relationship that underpins a first-class clinical service. Such a service cannot exist without training the doctors and specialists of the future and seeking new pathways of knowledge. Part of the solution to this crisis may be the strengthening of relationships between higher education institutions and their local health service partners. In the UK, the government has embarked on a 10-year programme of modernising the NHS, including the introduction of new contracts for general practitioners and hospital consultants. We believe that this presents a unique opportunity for institutions to work in partnership to deliver the tripartite mission. Excellence in research, learning and teaching underpins a world-class clinical service whether it is developing the future workforce or the translation of basic biomedical research into practice. Value and pressure of the marriageClinical academic staff are employed by universities but their funding may come from diverse sources, including Higher Education Funding Council for England (HEFCE), the NHS, research councils and the medical charities. In many universities, the funding is split between the university and the NHS. Most clinical academics hold a substantive university contract and an honorary NHS contract which requires the two employers to work in partnership. This view was reinforced by the Follett review in 2001. 4 Paradoxically, however, recent policy changes have created an incentive for university and NHS strategies to diverge. The clinical academic is recognised by both parties in the relationship as the pivotal link across this in...