The NAO claims the NHS must make savings of up to £20 billion by 2014 and as consultants play a vital role within the NHS, managing them more effectively will help to make some of those savings.
Last year the average basic salary of the NHS's 40,294 consultants was £84,000, found the NAO. Pay for senior consultants rose by a maximum of 28% after changes in 2003 designed to lift productivity and career development: about 97% of the 40,000 consultants now working in the health service are still employed under its terms.
But extra pay from what the NHS terms "additional work" - plus annual bonuses called clinical service awards - boosts the pay of most to six figures. Almost two-thirds (63%) earn over £100,000, the audit office said. Some hospital consultants are being paid up to £200 an hour for overtime, although the contract also allows them to refuse out-of-hours work.
Even though the report concludes that "value for money" has not been "fully achieved", and there are still "significant gaps" with many trusts not managing consultants effectively.
Around a fifth of trusts either do not benchmark clinical outcomes for consultants in the same specialty area or do so less than once a year. And less than a third of trusts stated that pay progression for all or most consultants either depended on achieving objectives set out in job plans or achieving objectives from appraisals.
The NAO has outlined certain recommendations:
- Trusts should ensure consultants are engaged in meeting trusts objectives and held account for their performance.
- Trusts should ensure that clinical managers have the right skills and support to get the best out of consultants.
- The Department and NHS Commissioning Board should work with trusts to improve the quality and use of information to better understand and improve consultant performance.
- The Department and trusts should ensure that consultant's financial rewards reflect performance.
Dean Royles, director of the NHS Employers organisation, welcomed the reports recognition that employers have made progress and said it is time to look further into doctor's contracts.
Royles said: "The National Audit Office has rightly recognised the positive progress employers have made in managing the work and pay of consultants since the consultants' contact was first introduced.
"This has been a significant achievement not only because of the complexity inherent in doctors' work, but because employers have also increased the number of NHS consultants working in the NHS by almost 70% since contract negotiations began in 2000.
"NHS Employers is currently in discussions with the British Medical Association and others about how any future consultant contract can further support the ability of employers and consultants to deliver the best care for patients while also providing a fair and responsive system of reward and career progression.
"In the current tight financial climate it is absolutely right that we take a fresh look at the consultant contract to get best value for patients and taxpayers."
Royles added: "There is a compelling case for change. Junior doctors' pay arrangements, seven day consultant care and clinical excellence awards are all other areas where we need to focus to modernise and improve the medical workforce and the care our patients receive."
