What is agreed and what is not?

A closer look at the proposals

What is agreed?

Under the general outline of a new contract which has been agreed between management and medical organisations, hospital consultants would in future work over an extended day as part of teams under the leadership of a clinical director.

There would also be significant restrictions on private practice although consultants with existing rights to treat fee-paying patients in off-site private hospitals would be able to retain these arrangements if they signed up for the other elements of the deal including the longer hours and team working.

It is generally agreed that there would be three categories of consultant contract in the future, a type A under which doctors would work exclusively in public hospitals, a type B which would permit limited private practice rights in public or co-located hospitals and a type C arrangement which would provide for off-site private practice in "exceptional circumstances".

Consultants with the new contract would work a 37-hour week and be rostered for duty from 8am to 8pm, Monday to Friday.

Consultants would also be present on-site in hospitals on a structured rostered basis for five hours on Saturdays, Sundays and bank holiday Mondays. Outside these hours at weekends, consultants would be available on call at home.

Consultants would also in future work as part of teams under a clinical director.

There would also be a new common waiting list to cover both public and private patients referred to hospitals for non-urgent diagnostic tests in hospitals.

A new central booking registry would be put in place in hospitals to arrange diagnostic outpatient procedures such as X-rays, MRI scans or blood tests. There would be no distinction between access for private and public patients. All would be treated on a first-come first-served basis with any prioritisation being on the basis of medical need.

Consultants with rights to treat private patients in public hospitals would have to see four public patients for every fee-paying patient treated.

What is not agreed?

In the main there is still disagreement over pay, hours of work and private practice rights.

Although the cap of 20 per cent on private practice work in public hospitals is generally agreed, the parties are at odds over how this mechanism should be policed.

Everyone has agreed that some new consultants should in future be allowed to treat patients in off-site private hospitals in "exceptional" circumstances.

However, the definition of "exceptional" circumstances is in dispute.

Medical organisations have also objected to management proposals that there be provision for local arrangements to have consultants rostered in some cases to work for five out of any seven days. There is also disagreement over plans for 24-hour cover in some specialties.

There is also dispute over provisions for appointing the proposed new clinical directors and in relation to new disciplinary procedures.