The government's reforms of contracts and pay for NHS staff are designed not just to pay staff more but also to secure changes in working patterns and productivity that translate into benefits for patients. This paper assesses the impact of the new consultant contract in England. Its findings are based on a literature review, discussion with key informants and case studies of five acute NHS trusts. The report shows that there is little evidence, as yet, of benefits having been realised: the scale of the task was underestimated and national guidance not sufficiently clear, leading to considerable variation in approach and outcome between trusts. [Introduction]