The new deal started in 2003

What was the new contract meant to do?

The deal, which over 95% of the 32,000 consultants in England have signed up to, was heralded as a "something for something" arrangement by government.

Consultants have always argued that the hours they put in have not been financially rewarded.

So the deal was designed to give them a pay rise and lead to fewer hours to help meet the European working time directive.

In the first three years, they have received an extra 27%, increasing their NHS pay from �87,000 to �110,000 a year by 2005-6.

Many also earn money from carrying out private work.

The hours consultants worked for the NHS also fell under the contract, from 51.6 per week to 50.2.

In return, consultants agreed to sign up to set job plans brokered by NHS managers which were meant to herald a more patient-friendly service.

These plans were meant to lead to consultants spending a greater proportion of their time with patients and also running more clinics at times suitable to patients, such as evening sessions.

Is more care being provided?

The overall care provided by consultants has increased by 4%. But this does not tell the full story.

Individually, the amount of care provided by consultants has fallen - even though the contract was meant to mean they had more time for patients despite a fall in hours.

The target was for 75%, but consultants only managed 72.6%.

The sole reason the amount of care has increased at all is because more consultants - over 3,000 extra or 11% more - are working in the NHS.

And the NAO said even that increase cannot be put down to the contract as consultant numbers were increasing before it came in.

What do consultants think?

Even though consultants are getting more money for less work, they still are not happy.

A survey by the NAO showed 43% felt their NHS work was not properly valued.

Specialist doctors have reported that they have lost autonomy under the deal.

Detailed job plans are now agreed with NHS trusts and has led to a culture of "clock-watching", some say.

The British Medical Association also reports that "many consultants continue to work many unpaid hours in excess of their contract through their professional dedication to patient care".

What can be done about the problems?

The NAO has urged trusts to pay more attention to job planning.

To achieve this, the watchdog said they should carry out a full assessment of what is needed from consultants in terms of levels of activity and patient outcomes.

Consultants have also been told they must engage more with managers and improve communication.

The government has also been warned that it should make sure it carries out accurate assessments - the NAO said it had underestimated the workload of consultants before the contract began.

This mistake, the NAO said, contributed to the contract costing �150m more than predicted.