The White Paper (CM 555) Working for Patients DoH, 1989 and its associated Working Paper 7 recommended Regional Health Authorities to devolve everyday management of consultant contracts to Districts, with instructions that, by April 1991, hospital consultants must have job plans which reflect their main duties and responsibilities within the service. Health Circular HC(90)16 represents, in four pages, the outcome of the year-long negotiation between the Ministry and the medical profession's negotiators on the Central Consultants and Specialists Committee (CCSC). Honours are even. Government can claim that the profession's traditional autonomy, already weakened by the Griffiths NHS enquiry in 1983, has been brought further under its iron fist; on the other hand CCSC can justifiably pride itself on the preservation of a flexible professional contract (Havard, 1990). It has succeeded too in modifying the original proposals by winning rights to an appeals mechanism, and, of great importance to those involved in College activities, in preserving the opportunity for consultants to contribute to national and local professional committees within NHS time. The CCSC has also negotiated amendments to Terms and Conditions of Service for Consultants which allow those involved in management activities (UMRs, Clinical Directors, Resource Management Leaders and Audit Co-ordinators) either payment for up to two additional notional half days a week or relinquishment of equivalent clinical work, in which case a colleague may be paid to take this on. These are important concessions and will be welcomed by all consultants.
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