Ministers are to press ahead with plans to change the way consultants work despite their decision last year to reject a new contract.

Health Secretary Alan Milburn has unveiled a package of measures aimed at rewarding those senior hospital doctors who "do most for NHS patients".

The �250m originally earmarked to pay for the new contract will now be given to NHS trusts.

We will need to go into very careful, serious discussion on these plans Dr Paul Miller, BMA

There will also be a new code of conduct for NHS doctors who work in the private sector.

The British Medical Association criticised some of the measures and said it expected to hold talks with ministers in the next few weeks.

Higher pay

Under the plans, individual trusts will be able to offer the proposed new contract if there is support from consultants.

According to the Department of Health, around 50 trusts - about one in six - have so far expressed an interest in going down this road. However, the BMA said it was sceptical about this figure.

Elsewhere, trusts will be able to use the extra money to introduce a new annual incentive scheme from April.

Consultants will be expected to set individual and team objectives and to meet them before they can receive the extra money.

Mr Milburn said the new code of conduct for consultants carrying out private work will "provide a clear set of standards defining best practice in managing the relationship between NHS and private practice."

The health secretary also announced plans to offer consultants career breaks on full pay in an attempt to stop them leaving the NHS.

Senior hospital doctors who have worked for the NHS for 20 years will be able to apply for paid leave of up to three months from 2005.

A total of 800 consultants will be able to apply for the scheme in the first year. Ministers hope to extend the scheme to younger doctors at a future date.

NHS rewards

Mr Milburn said: "This package is designed to reward those NHS consultants who do most for NHS patients.

"Local NHS employers will be able to choose how best to use the resources I am committing to reward consultants, reform working practices and improve patient services."

The BMA indicated that it would oppose some of the proposals.

Dr Paul Miller, chairman of its consultants committee, said: "We will need to go into very careful, serious discussion on these plans, but I do not believe that annual payments for meeting performance targets are the right way to reward consultants."

He added: "We remain opposed to local implementation of a contract framework that was clearly rejected by consultants in England and we doubt whether it would prove a popular option for consultants."

But NHS managers welcomed the package. Alastair Henderson of the NHS Confederation said: "We believe the NHS will think this is a positive package of measures which should help trusts improve services locally for the benefit of patients and also improve the rewards to consultants for the work they do."

The original contract was rejected by consultants in England and Wales by a margin of almost two to one last year.

It was narrowly backed in Scotland and Northern Ireland and looks set to be introduced there.

But many doctors said the deal would give NHS managers too much power to interfere with their day-to-day work.

They also objected to plans for them to work evenings and weekends without additional pay.