This guidance should be read in conjunction with our recommendations for agreeing to take on additional work and amending your job plan.
While it's not what we advocate for, we recognise that you may be asked by your employer to work outside your existing contract of employment or agreed job plan. You have the right to decline such work and it is important for your health and wellbeing that you don’t feel pressured to work too many hours.
However, if you do agree to work additional and/or extra-contractual hours, these should be properly remunerated with additional payment for these additional hours. The rates should be negotiated locally and in advance and confirmed in writing.
The national approach
The BMA believes that a nationally agreed rate for out of hours working would be helpful for both employers and doctors.
During the first wave, the BMA approached the DHSC (Department of Health and Social Care) and NHSE (NHS Employers) in order to seek agreement on this.
Unfortunately NHSE and DHSC were not given a mandate by government to agree rates for extra-contractual work and instead suggested that this was left to local agreements.
This led to a variety of different rates being agreed, and on occasion different rates were agreed by different consultants or SAS doctors working within the same trust.
Clearly this is not equitable and consumed unnecessary amounts of discussion time that could have been better utilised caring for patients.
As we are now entering the second wave, we have once again approached NHSE and DHSC to discuss nationally agreed rates for extra-contractual work. We are awaiting a formal response but suspect that they will once again prefer to leave this to local agreements.
Agreeing remuneration locally
To support consultants, SAS doctors and trusts, we have suggested the below framework to be used for discussion locally in agreeing rates for extra contractual work.
Wherever possible and by agreement with the consultant, reallocation of existing PAs (programmed activities) and time off in lieu should be offered rather than simply increasing hours in order to reduce the risk of burnout.
We recognise that simply repurposing your PAs to accommodate temporary COVID-19 working is not always possible and that you may be asked by your
employer to work outside your existing contract of employment or agreed job plan. You have the right to decline such work and it is important for your wellbeing that you don’t feel pressured to work too many hours.
However, if you do agree to work additional and/or extra-contractual hours, these should be properly remunerated with additional payment for these additional hours, with the rates negotiated locally and in advance, confirmed in writing.
We believe that a nationally agreed rate for out of hours working would be helpful for both employers and consultants. Despite our best efforts, NHSE and DHSC were not given a mandate by Government to agree rates for extra-contractual work and instead suggested that this was left to local agreements.
For SAS doctors
We stress that rather than simply offering additional payment, the option of time off in lieu should always be made available.
It is essential that you secure agreement on remuneration for any additional work you undertake in writing in advance.
Table of recommended length of programmed activities
|7am - 7pm||7pm - 11pm||11pm - 7am (for high intensity working)|
|Monday to Friday||3 hours per PA||2 hours per PA||1.5 hours per PA|
|Saturday, Sunday and bank holidays||2 hours per PA||2 hours per PA||1.5 hours per PA|
We consider almost all COVID-19 related work and ‘catch up work’ of high intensity and as such recommend that a fewer number of hours constitute a PA for COVID work. This will help protect against fatigue and burnout.
Remuneration for SAS doctors
Adequate rest and recuperation is are essential and therefore we recommend that wherever possible, SAS doctors who adopt different working patterns are able to take time off in lieu.
The recommendations above are designed to ensure work patterns are safe and those with the highest intensity work patterns and those working a higher proportion in the most antisocial hours will have a shorter working week to compensate for this.
Principles when determining the extra-contractual rate for a PA for consultants
One of the anomalies of the 2003 consultant contract is that consultants with a longer period of service get different rates of pay, even when doing the same role. This is due to the tiered salary scale.
This discriminates against younger consultants and also contributes to the gender pay gap as there is a higher proportion of women at the lower end of the consultant salary scale.
For extra contractual work, it is right to pay consultants at the same rate of pay regardless of their length of service. It would potentially be discriminatory to offer younger consultants in particular a rate of pay that is lower than older consultants for such work.
Extra-contractual work is discretionary and it is appropriate that the overtime rate is paid at a higher rate than the trust pays for work within a standard contract of employment.
This should be the case for all consultants and no consultant should be expected to do overtime at a rate of pay that is at a lower rate for their employer than that paid under their standard contract.
We have calculated the cost of a PA to your employer under the 2003 contract, taking into
account pensionable CEAs (clinical excellence awards), annual and study leave, and other employer-borne costs.
This has been calculated at a minimum of £422 per PA. We believe this should be the minimum standard cost of a PA for extra contractual work for all consultants.
For high intensity extra-contractual work such as that required to support the pandemic, it is essential that the number of hours that constitute a PA are reduced in a
similar manner to those for contracted PAs that are subject to a temporary change in job plan.
Not only does this maintain a consistent approach but again reduces the risk of burnout.
You can view our recommended length of PAs for extra-contractual work.
Shadow on-call rotas
A number of organisations have implemented shadow on-call rotas to cover sickness absence or 'second on' on-call rotas to come in if 'first on' consultants or SAS doctors are busy.
Again, this is a change to your job plan and can only be implemented by mutual agreement.
If agreeing to this change, it is essential that you make clear to your employer in writing that this is a temporary change and that you reserve the right to revert to your pre-existing job plan.
Some trusts have refused to remunerate these shadow rotas rotas beyond the existing frequency and PA rates for predictable emergency and emergency work within the contract. This is not appropriate and in some cases, simply altering the on-call frequency may result in only a modest increase in remuneration (for example, changing from 3% to 5% supplement), despite the impact on the working life of the doctor being very significant.
It needs to be acknowledged that by undertaking a shadow rota, the doctor needs to remain available and that this causes significant restriction on their time.
The BMA recommends that these rotas are paid at a 'standby rate' that applies when you need to be available but not working. The BMA minimum recommended standby rate when not working but available is £50 per hour.
Any time that is subsequently spent undertaking predictable or unpredictable emergency work during the 'standby period' is remunerated at £422 per PA.
If your trust does not agree these rates of pay
You may find yourself unable to agree to work a temporarily requested work pattern or roster, or to take on certain clinical responsibilities during the pandemic, for a variety of reasons.
Declining to accept temporary changes to your working patterns or additional work must be without detriment. It is important to remember that:
- you do not have to agree to change your normal hours
- if you have already changed your hours and wish to revert back, you have a right to do so.