Pay guidance for occupational physicians

The BMA believes that, as a minimum, doctors working as occupational physicians outside of the NHS should earn a comparable amount to doctors who work in the NHS.

This guidance takes into account the expected seniority and responsibilities of each grade of occupational physician in relation to his/her NHS counterparts. These range from specialty registrars to consultants in receipt of Clinical Excellence Awards. Details of the duties expected of an occupational physician are set out in the attached appendix.

Basic salaries

As mentioned above, the BMA believes that, as a minimum, doctors employed as occupational physicians outside of the NHS should earn an amount comparable to doctors who work in the NHS. The average earnings index also gives a helpful guide to pay awards. Furthermore, we recommend that additional expenses caused by any rise to the consumer price index (CPI) should be taken in to account and that any pay award should at least be commensurate with Senior Managers in employing organisations.

It is also worth noting that the increased costs for self-employed doctors also cover sickness and holiday provision.

Table 1 shows the range of salaries payable to full-time hospital doctors in the NHS at various grades. Occupational physicians and employers may find it useful to refer to this in negotiations.

The table shows the seniority of occupational physician that the BMA believes is equivalent to the corresponding NHS grade. In negotiating a salary, the doctor's experience, qualifications, length of service and responsibilities should be taken into account, as well as the terms and conditions of the NHS contract (see Table 2).

 

Out of hours responsibilities

The above salaries do not include any allowance for any out-of-hours or standby duties that the doctor may be obliged to perform. In the NHS, the allowance for such duties by specialty registrars ranges from 20% to 100% of basic salary, depending on how onerous these duties are. For consultants, additional payments ranging between 1% and 8% of basic full-time salary are payable, depending again on the intensity of these duties.

 

Terms and conditions of service

Apart from salary, doctors and employers need to take into account other terms and conditions of service. A summary of the main terms and conditions of service for NHS doctors is given in Table 2. As with salaries, the Association believes that non-NHS employers should at least match these.

 

Less than full time/sessional employment

If a doctor is employed on a part-time/sessional basis, then pay and entitlement to benefits should be pro-rata to the whole time salaries and benefits outlined above.

 

Table 1 - NHS remuneration ranges in England from April 2015 (£ per annum)

Table 1

NHS Grade	Occupational Physician equivalent	NHS pay range2
Specialty Registrar	Trainee Occupational Physician	£36,461 to £46,208
	Progress through this range should normally take no more than 5 years. This range applies to a doctor who enters specialist training directly after completing basic medical training. A higher rate for doctors who have other qualifications or relevant experience may be appropriate.
Consultant, initial appointment	Occupational Physician	£76, 761 to £86, 369
	Progress through the salary range should normally take no more than 5 years depending on experience, qualifications and responsibilities. Note that within the NHS it is possible for a consultant within this band with additional responsibilities and/or who demonstrates a significant contribution to the specialty/profession can earn up to £102,466.
Experienced Consultant	Senior Occupational Physician	£86,369 to £139,682
	Progress through the salary range should normally take no more than 10 years depending on experience, qualifications and responsibilities. An experienced NHS consultant in a senior position with additional responsibilities and/or who demonstrates a significant contribution to the specialty/profession can earn up to £178,004 a year (with Clinical Excellence Awards).

^{(2) This includes a 1% non-consolidated, non-pensionable lump sum payment for 2015-16 for doctors at the top of their pay scales in England.}

 

Table 2 - Principal features of NHS terms and conditions of service

Table 2

Item	NHS terms and conditions
Hours of work	40 hours per week
Holiday entitlement	6 weeks per annum plus statutory holidays; consultants with 7 or more years of service receive an extra 2 days leave per annum
Study leave and continuing professional development	Recommended levels are up to 30 paid days a year for specialty registrars and 30 paid days over 3 years for consultants; the cost of courses should be reimbursed
Medical Indemnity	NHS doctors are indemnified for their NHS work but must arrange insurance for other work
London Weighting	£2,162 a year from April 2010
2015 section of the NHS Pension Scheme (as at April 2015) Normal pension age linked to state pension age	Career Average Revalued Earnings (CARE) index-linked scheme. Pension calculated as 1/54th of actual revalued earnings for each year of service. Earnings are revalued by CPI + 1.5%. There is no automatic lump sum entitlement in the 2015 section but there is the option of receiving a tax-free lump sum up to HMRC limits by giving up a part of the pension. The employer contribution is 14.3%2 of salary, and employees pay tiered contributions dependent upon their full-time equivalent earnings. As at April 2015 for earnings over £111,377.00 the top tier of contributions is 14.5%. The NHS also includes a 1995 section and 2008 section of the pension scheme with varying pension ages and varying calculations for reckonable pay. Find out more in the pension section.

Self employed doctors

Some employers may choose to meet their requirements for the services of an occupational physician by contracting these out to self-employed physicians.

For some doctors, acting as an occupational physician may represent only a small part of their total work - this applies particularly to general practitioners. An increasing number of specialist Occupational Physician work as self-employed practitioners with a portfolio of clients contracting separately with each one.

If a doctor is working in a self-employed capacity, it is important for both the doctor and the employer to realise that the fees charged must reflect both the loss of benefits which are available to an employee and the overhead costs of running a business, where appropriate. The Association believes that it is reasonable that doctors working in such a capacity can expect that their income, after allowance for the loss of these benefits and the additional costs, should be broadly comparable to that of a similarly qualified and experienced occupational physician who works as an employee (as shown in Table 1).

It is impossible to be prescriptive about how much needs to be included in fees to allow for these costs as this will vary widely according to individual circumstances. However, the Association believes that for a self-employed occupational physician to earn an annual equivalent amount to the NHS salaries shown in Table 1, then their fees should be higher to take account of benefits normally available only to employees and business costs incurred such as:

• contributions by an employer to a pension scheme
• National Insurance
• revalidation and continuous professional development
• professional indemnity insurance
• provision of support staff
• provision of supplies & equipment
• premises, etc.

An increasing number of commercial organisations contract to provide a variety of occupational health advice and support. This may include the services of doctors who may hold a range of qualifications. Their charges will depend on negotiation between the parties concerned. These organisations and doctors who work for them may find this guidance useful in determining appropriate pay scales.

• Download this guidance (PDF)
• Read our updated guide 'The Occupational Physician'
• Contact the BMA Occupational Health Committee secretariat:
  OMC Senior policy advisor, BMA House, Tavistock Square, London WC1H 9JP.
  Email: [email protected]