NHS consultants are offering poor value for money, the National Audit Office (NAO) has found, with pay awards not matched by improved patient care.
Ministers have been substantially blamed for the failings of the consultant contract, negotiated in 2003, with the NAO claiming the Department of Health (DoH) under-estimated the work consultants do.
The new contract awarded consultants a 27 per cent pay rise, bringing their annual income to £110,000 before private earnings were taken into account.
In response, the government claimed patients would benefit from improved care, with consultants spending more time on each case and moving towards more flexible services.
However, the NAO found the new contracts have failed on both counts, with consultants spending less time with patients and few opportunities for flexible care.
Sir John Bourn, the comptroller and auditor general, said: "Consultants are central to the work of our national health service and deserve to be paid properly for the work that they do.
"However, the new contract was introduced to benefit not only consultants, but patients and the health service in general."
"Although a new contract was needed it is regrettable that the costs are higher than expected and that we are not yet seeing any clear evidence of improvements in productivity or services for patients."
The NAO partly blames the DoH for the failings, claiming the department failed to collect sufficiently accurate evidence on the hours worked by consultants, meaning ministers were unable to calculate the contract accurately.
Costing at least £715 million, the contract has exceeded original estimates by £150 million, the NAO found, also laying the blame on local NHS trust managers.
Furthermore, despite an 11 per cent rise in consultant numbers to 31,999, there has only been a four per cent rise in the number of patients seen.
The Liberal Democrats said the NAO report is further proof of financial mismanagement from the DoH.
Health spokesman Norman Lamb called on the government to take responsibility for the "financial chaos" in the health service.
"Minister are too keen to blame local trusts for the problems in the health service, but they should get their own house in order first," he said.
The DoH has defended itself against charges of incompetence, claiming the new contract rewards doctors for NHS work, improving recruitment and retention.
Reduced working hours in fact mean consultants are working in line with the European Working Time Directive, the DoH added.
Health minister Lord Hunt said: "There is considerable potential for the consultant contract to further improve the management of consultant time and deliver full value for money to the NHS.
"The report shows that, thanks to the consultant contract, trusts have already taken a more proactive approach to job planning linked to organisational and service objectives and affordability."
The British Medical Association (BMA) defended consultants, claiming they were doing more work for the NHS.
Dr Jonathan Fielden, chairman of the BMA's consultants committee, said: "It has never been easy calculating exactly how many hours consultants work for the NHS. It is clear that their workload remains high, is intensely demanding and exceedingly complex.
"NHS consultants have led on delivering reductions in waiting times and strive to introduce new treatments and efficiencies for patients. If trusts are failing to realise the benefits of the contract it is because they have been distracted by the pressure to balance their books and meet political targets."