In England, medical public health consultants may be employed in a number of organisations, including:
- LAs (Local authorities)
- PHE (Public Health England)
- Research organisations
- NHS England
- HEE (Health Education England)
- CCGs (Clinical Commissioning Groups)
- Independent companies
- Voluntary organisations
- Departmental bodies
The majority of medical public health consultants in England are employed by local authorities (we estimate approximately 250-300) and PHE (approximately 350).
This guidance solely refers to medical public health consultants, but public health consultants may have other professional backgrounds and their employment contracts usually follow NHS Agenda for Change terms and conditions.
Local authority employment
The contractual terms of doctors employed in local authorities depend on the individual doctor’s circumstances. If their employment was transferred as a result of the Health and Social Care Act 2012 from the NHS into a LA in April 2013, their TCS (terms and conditions of service) are likely to be different to those who have been directly appointed by the LA since April 2013.
For those who transferred from the NHS, many will remain on protected NHS terms. Some however may have recently accepted TCS that have been harmonised with LA terms.
Most medical consultants who transferred from the NHS remain on the NHS consultant contract. All schedules of the consultant TCS continue to apply. BMA guidance on the contract is available here.
Directors of public health
Like other medical consultants, DsPH (directors of public health) who transferred from the NHS are usually employed on the NHS consultant contract . They receive a pay supplement based on the size of the populations they are responsible for, and they may also receive additional programmed activities in recognition of their work.
Annual pay award
Whilst the NHS consultant annual pay award is subject to the recommendations of the DDRB , LAs determine the pay award for their employees including public health consultants on protected NHS terms. Pay awards will therefore differ from employer to employer.
Access to CEAs (clinical excellence awards)
The national clinical excellence awards scheme recognises and rewards exceptional personal contributions to the NHS by consultants through a cumulative scale of additional payments. Under the transfer agreement, public health consultants continue to be eligible to apply for local and national CEAs . In order to ensure LAs can fulfil their statutory responsibility to enable CEA payments for their public health consultant employees, PHE (Public Health England) administers the scheme on behalf of LAs (as well as for their own staff and for clinical academics with honorary contracts at PHE). The annual application round usually begins in April and closes in June. Further information is available from ACCEA (the Advisory Committee on Clinical Excellence Awards). Once completed by the consultant and the LA employer, the ACCEA application form should be sent directly to PHE.
As part of the transfer agreement, public health staff who transferred to LAs continue to have access to the NHS Pension Scheme. They continue to have access to the NHS Pension Scheme if after the transfer they are compulsorily moved into a new post with their LA. Transferred public health specialists and practitioners, including public health consultants, will also have access to the NHS Pension Scheme if they move jobs voluntarily.
Detailed information is available here and individual advice is available from the BMA’s pensions advisers.
Continuity of service
The extent to which an employee is entitled to certain employment benefits such as sick pay, maternity leave and redundancy pay usually depends upon the length of their continuous service with an employer or within a sector. In the local government sector, legislation allows employers to treat service with other LA employers as continuous service, thereby allowing free movement of staff between employers. Similarly in the NHS, legislation allows employment at different employers to be counted as continuous employment for certain benefits. Unfortunately, for staff moving out of the NHS and into LAs, previous NHS service cannot always be recognised but the LGA (Local Government Association), PHE, the ADPH (Association of Directors of Public Health) and the FPH (Faculty of Public Health) all encourage LA employers to recognise previous NHS service wherever possible.
In many cases continuous service for contractual benefits (e.g. sick pay, occupational maternity pay) can be accommodated, though statutory rights (e.g. right to claim unfair dismissal, redundancy pay) may not. The BMA and other stakeholders has been lobbying government for legislation to be enacted to facilitate the recognition of continuous service and ensure free movement around the public health system since it is now spread across a number of employers including the NHS, PHE and LAs.
The right to remain on protected terms
The transfer of public health functions and responsibilities to local authorities and Public Health England (PHE) took place in April 2013 under a statutory instrument (a Transfer Order) from the Secretary of State for Health. As part of the Order, a staff transfer scheme was agreed, which had the following key features:
i. employees transfer on their existing terms and conditions in place at the time of transfer including any contractual redundancy or severance entitlements
ii. employees’ statutory continuity of employment is protected
iii. access to the NHS pension scheme is retained at the point of transfer for those employees who were eligible for membership of the scheme immediately prior to the transfer
iv. unlike TUPE, employers and employees and their representatives can agree transfer connected changes to terms and conditions, free of TUPE-type restrictions
v. similar to TUPE there are restrictions on making transfer connected changes to terms and conditions through dismissal and re-engagement, but unlike TUPE those restrictions lapse 24 months after the transfer
The 24 month period has now come to an end. The full implications of this for public health staff are currently unclear and will need to be tested through the courts. Some LA employers believe they are freely entitled to move protected staff onto local terms after 1 April 2015, and have begun the process of ‘harmonising’ terms locally. However, there is an argument that irrespective of the 24 month period TUPE (or an equivalent statement of practice known as COSOP) continues to apply, and if correct, this would allow staff to remain on their NHS terms for an unlimited period.
Any changes in the workforce following a transfer must be subject to formal consultation. Members affected by these issues should seek advice from the BMA as soon as they become aware their employer is considering TCS harmonisation.
New appointments to LAs
Terms and conditions and pay
The BMA position is that in order to ensure LA public health teams are staffed adequately and salaries are competitive with those available elsewhere in the health sector, medical public health consultants working in LAs should be employed on NHS equivalent terms and conditions. However, LAs are not obliged to offer NHS pay and TCS to newly appointed public health consultants, and have different approaches towards the packages they are prepared to offer. Some are flexible and will be prepared to negotiate in order to attract and secure the best candidates, others less so.
To ensure fairness and to guard against equal pay claims, LAs use job evaluation systems to grade all roles within the organisation. Since medical roles are rare in LAs, the BMA suspects that job evaluation systems do not always result in fair grading for public health consultant posts. Often, posts are advertised at a salary and grade that is not comparable with NHS TCS. Joint BMA and Faculty guidance on job evaluation for public health consultants is available here.
When applying for jobs, consultants should request information about contractual matters and pay in advance so that they can make a decision about the suitability of the post should they be offered it. Clarification on the likelihood of the continuing payment of any CEAs should be requested. We are aware that in rare circumstances, employers may make final decisions about appointments based on each candidate’s salary requirements, and offer posts based on affordability rather than suitability for a job. Contentious guidance from the LGA, ADPH, PHE and FPH indicates that this is appropriate practice, which the BMA disputes. Members should seek advice from the BMA on the pay and conditions they are being offered and always ensure contracts are checked by the BMA before they are agreed.
To maintain national standards in the recruitment of medical consultants, AACs (Advisory Appointments Committees) should always be used in the appointment of public health consultants. The Faculty of Public Health has a statutory role in the appointment process and further details are available here. Guidance on the appointment of public health consultants and DsPH is also available. When applying for jobs, consultants should confirm with the employer that an AAC is being used. If an AAC is not used, the post will not be recognised by PHE as an official consultant post, which has implications for the appointee’s eligibility for CEAs amongst other things.
Collective bargaining and BMA support
The BMA is able, in the case of most LAs, to provide representative services and take part in collective bargaining processes on behalf of BMA members. In the rare occasions where LAs do not recognise that the BMA has a formal role in collective bargaining, local BMA staff can still offer advice and representative services to individuals. Advice is available through contacting the BMA .
Consultants and registrars looking to apply for new roles in LAs will shortly be able to attend a BMA training course to help them navigate the LA approach to consultant appointments, which will equip them to negotiate a fair package of pay and benefits.
Appraisal and revalidation for public health consultants employed in LAs
BMA advice on appraisal and revalidation for consultants is available here. From 1 April 2013 (the date of the beginning of the first revalidation cycle for all doctors) PHE is the designated body for public health consultants working in LAs. All doctors with a prescribed connection to PHE should have received a letter from the GMC indicating their first revalidation date. PHE has a network of advisers trained in appraisal and revalidation whom consultants working in LAs can contact. For more information about the appraisal and revalidation process, PHE can be contacted here. There is also detailed advice available through NHS Networks.
Public Health England
PHE was established on 1 April 2013 under the Health and Social Care Act 2012, and staff from over 70 separate organisations, but primarily from the former Health Protection Agency, were brought together under a single employer.
PHE employs medical staff across all parts of its business. Doctors are employed in management roles as well as more public-facing posts.
Terms and conditions
As part of the transfer agreement, all medical staff within a “ring-fence” of posts considered to be NHS-facing were employed on terms that are “analogous” to the NHS consultant contract, though this position is to be reviewed before the end of 2015. At the point of transfer, PHE indicated an intention "to keep the TCS applying to this group of posts aligned with terms in the NHS".
Further detailed advice about the transfer is available here. New appointments are also made on the NHS consultant contract. For any medical staff outwith the clinical ring-fence, or where medical staff voluntarily move into a ‘generalist’ post, PHE TCS will apply (though we are currently unaware of any medical staff having been appointed on PHE TCS).
Annual pay award
In line with consultants employed in the NHS, PHE consultants will receive the annual DDRB award as implemented in the NHS.
Access to CEAs
For consultants who transferred into PHE, CEAs in payment will continue to be paid. Doctors may apply for new CEAs through PHE in the usual way. Further information is available from ACCEA (the Advisory Committee on Clinical Excellence Awards) here.
PHE consultants continue to have access to the NHS pension scheme.
Continuity of service
Previous NHS service will be counted as continuous for PHE benefits for posts within PHE’s ‘clinical ring fence’. As PHE is a civil service employer, any employee’s previous civil service will also be counted. As above , the counting of previous NHS and PHE service for contractual and statutory benefits for staff moving into roles in LAs is still unclear.
Appraisal and revalidation in PHE
PHE is the designated body for all medical staff employed there. BMA advice on appraisal and revalidation for consultants is available here.
Collective bargaining and BMA support
PHE has a Local Negotiating Committee which is recognised and supported by the BMA. Individual advice on contractual matters is available to BMA members in the usual way.
A small number of public health consultants are employed directly by NHS England. The NHS consultant contract should be used for all NHS England consultant appointments.
Clinical Commissioning Groups
Staff who, as part of the 2013 changes, transferred into direct CCG employment should have moved into their new role on protected terms. However, CCGs have flexibility to offer their own TCS to any new appointments after April 2013. The BMA strongly advises that all consultant appointments should be made on the NHS consultant contract.
There is no guidance or requirement for specific employment terms to be offered in other organisations, but we would advise members to propose to their new employer that the NHS consultant contract should be used as the model.
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