Fixing pay for consultants in England

The role and status of being a consultant have been eroded

Consultants in England remain in active dispute with the Government. The pay uplift in 2024 was welcome but failed to come close to restoring fifteen years of pay erosion. Our pay not only remains significantly diminished in comparison with then, but also in comparison with peers in competing professions. Since2008, the average UK pay for those in comparator professions has increased by 80%, but the average consultants pay only by 22%. With the role of the consultant being ever more demanding, our campaign is all about restoring the status of consultants in England.

We remain committed to engaging with the Government; however, progress will require political leadership and meaningful movement on the core issues that members supported in the recent indicative ballot. When we met with the Secretary of State in September to discuss our demands, he frustratingly declined direct negotiations, offering instead meetings with employers and the Department for Health and Social Care. We wrote to him in early October to reiterate the need for progress.

We are calling for changes that reflect the demands and complexity of the consultant role, make the role sustainable, recognise the value of the profession and which ensure that becoming a consultant remains attractive to the next generation of doctors.

The sustainability of the job

Currently, a full-time consultant works ten Programmed Activities (PAs) of four hours duration each, per week. We are calling for these to be reduced to match the working week of other public sector workers. This will need knock-on reductions for how many hours per PA out of hours work is valued at, including weekend, resident on call and overnight work. Action is also needed on minimum counted duration for overnight interruptions.

The quality of the job

In addition to tackling the sustainability of our jobs by transitioning to a shorter standard working week and we must also address the falling quality of our roles. Being some of the most senior doctors, we innovate, redesign services, teach, network, revalidate and reflect on our practice in its fullest breadth. The 2.5 Supporting Activities (SPAs) deemed ‘typical’ in full time job plans have been under sustained attack and in any case are insufficient for the challenging context in which we are expected to lead as consultants. That's why we believe that contractualising SPAs as at least 30% of the Job Plan, for full time consultants, is necessary. Contractual minima must also apply to those less than full time. Changes are also needed to what is regarded as SPA work as employers have sought not only to limit the time available but put ever more work into the category. Not only are these measures practical steps to improve working conditions, they are also vital to retaining talent and maintaining high standards of care.

The value of the job

We are campaigning for meaningful progress to pay restoration through a multi-year pay deal. This would also mean real changes to our pay review body, the DDRB – including who sits on the board – rather than the cosmetic reforms Government have introduced so far.

Consultants should have control over whether we want additional contracted PAs to count towards our pensions, as well as the right to access our pension without needing employer permission.

Staying united for a better future

Our collective efforts over the last two years have led to significant achievements for consultants in England:

A new shortened pay scale and improved pay deal.
Reforms to the pay review body (DDRB) – including changes to its Terms of Reference and a commitment to the pay award being known at the start of the financial year.
A bigger boost to pay for the majority of consultants than delivered by the DDRB for decades.

Pay award 2025 and pension value

The 4% pay uplift for consultants in England announced in May showed the Government has reneged on its pledge to reform the independent pay review body and it undermined years of campaigning. Consultant pay erosion remains at 26% - if we accept this it gives a green light to future governments to reduce the real-terms value of our pay forever more. Furthermore, not addressing the pay erosion that has occurred will have a direct and lasting impact on your pension value – the main route to restore pension value also lies in pay restoration.

When we re-entered into dispute with Government in May following the announcement of 4% pay award, we reintroduced the consultant rate card in England. If the Government does not value us, we must ensure we value ourselves and our own time appropriately, and therefore we encourage you to use the consultant rate card to do so.

Changes to pay

In July 2023 DDRB recommended a sub inflationary pay uplift of 6%, at a time when inflation was much higher. This led to us entering dispute in late 2023. A first offer, in the midst of members’ industrial action, was rejected.

Ongoing action, coupled with direct negotiations with the Government, led to additional increases to pay applied in the successful 2024 pay deal. This deal shortened the pay scale. The resulting uplift received by individuals varied depending on the point of the pay scale they were at. Further industrial action led to increases of between 6% and 19.6%. This showed how effective your action can be.

However, this work is not finished. Neither in terms of the journey towards pay restoration for all as we are still 17 years behind and nor in terms of specific groups at beginning and at the end of the consultant pay scale. It is vital we continue to be ready to fight for fairness if needed.

Pay body reform

The deal we accepted in 2024 stated that the BMA would have a greater role for the BMA in the process of appointing DDRB members. It also included changes to the terms of reference that guide the panel’s recommendations. These include factoring in long-term pay trends as well as the salaries of comparator professions, including those of our international counterparts.

The sum total of these reforms to the DDRB – the first meaningful reforms since 1998 – was intended to equip the pay review body with the independence and scope it needed to determine a fair pay award for consultants.

However, The Government reneged on its pledge to reform the independent pay review body. This included making reference to wider economic factors in its remit letter last year, despite undertakings not to do so.

Resident doctor strike action

The resident doctor committee has voted for renewed strike action, to take place from 14-19 November. We support the resident doctors in their fight and urge you to take the necessary steps to support and protect them. This could be by offering words of solidarity to your residents or, where appropriate, providing additional teaching support to prospective FY1s that will still be shadowing when strikes are taking place.

There is also guidance for consultants working during periods of industrial action by resident doctors, so that you can understand your rights and responsibilities. This includes updated information about the derogation system and a template letter to use should you have concerns about patient safety.