Contract Pay

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BMA demands DDRB recognises the value of doctors

With a real term loss of up to 30% in pay over the last decade, reform of the DDRB is crucial. Read the BMA's 2019 submission to the DDRB.

What is DDRB

BMA 2019 submission of evidence to DDRB

Our submission outlines the key points the DDRB and Governments must understand before taking any decisions which would perpetuate further cuts to doctors’ pay.

Read our submission

Letter to Matt Hancock, Secretary of State for Health and Social Care 

Dr Chaand Nagpaul has written to the Secretary of State for Health and Social Care calling for Government to issue a fair pay award.

Read the letter


BMA statement on the submission of evidence to the DDRB

For several years, the medical profession has been let down by both the DDRB and Governments. Despite ever growing evidence of the impact pay cuts are having on doctors’ morale and the consequent impact this has on the NHS, no attempt has been made to stop the decline in doctors’ living standards.

Ordinarily, the Association spends considerable time and resource producing very detailed evidence to the DDRB. The repeated failure of the DDRB to adhere to its original principles to defend the profession against arbitrary action from Governments – and the continued interference of the Review Body in contractual issues in 2015 during the junior doctor contract negotiations and its more recent recommendations to instigate a new Flexible Pay Premium – have brought us to a situation where there seems to be little point in engaging in the process as we usually do.

This year we have submitted very brief evidence which highlights the key points the DDRB and Governments must understand before taking any decisions which would perpetuate further cuts to doctors’ pay. The NHS is a revered institution and it is entirely reliant on its staff. With unsustainable workloads, the growing demands of an elderly population more likely to suffer from multiple long term health conditions, and resources spread more thinly, reliance on staff is increasing daily. Before the service collapses, we must give its staff a reason to stay. Recognising their efforts through pay is an essential part of that.

  • Since 2008, doctors have experienced the largest drop in earnings of all professions subject to a pay review body, with some groups having seen their pay fall by up to 30 per cent against RPI.
  • When taken together with multiple other financial changes such as increasing tax on pensions as a result of the annual allowance, increased pension contributions, and the soaring mandatory costs of training, the stark nature of the reduction in doctors’ income becomes all too apparent.
  • Insufficient budgeting and a growing elderly population with complex co-morbidities is leading to doctors being asked to work longer hours and more intensely than ever. This would be a stern test under ordinary circumstances, but when coupled with real terms pay cuts, there is likely to be a significant impact on recruitment and retention.
  • Many doctors are on the brink of a breaking point. It is unsurprising that they report low levels of morale and plans to retire early, or give up medicine altogether. The GMC training surveys demonstrate that burnout rates are increasing and that more trainees take time out of training due to the strain of this service provision. This trend has an impact on the current service and is a risk to the recruitment and retention of the future workforce.
  • The DDRB and the Governments must act now if they want to avert this medical workforce crisis, by recognising the value of doctors with an uplift that is at least in line with RPI for 2019, plus a mechanism to start addressing the up to 30 per cent real terms pay cut doctors have experienced since 2008.


Downloadable assets for sharing on social media:

Doctors at breaking point statement

Graph for showing cash vs real pay uplift

Graph for showing GP pay erosion

Graph showing hospital doctor pay erosion


Find out more

  • Call for DDRB reform

    BDA and BMA position statement on reform of the DDRB

    The Review Body on Doctors' and Dentists' Remuneration (DDRB) advises governments in Westminster, Cardiff, Belfast and Edinburgh on rates of pay for doctors and dentists.

    What is DDRB


    The British Dental Association (BDA) is the trade union and professional association for dentists. The British Medical Association (BMA) is the trade union and professional association for doctors.

    The DDRB was established following the recommendation of the Royal Commission on Doctors' and Dentists' Remuneration in 1960. The commission stated that such a body was necessary in order to give the medical and dental professions "some assurance that their standards of living will not be depressed by arbitrary Government action", as well as achieving "the settlement of remuneration without public dispute". The view expressed by the Royal Commission was that this "procedure will in fact, therefore, give the professions a valuable safeguard. Their remuneration will be determined, in practice, by a group of independent persons of standing and authority not committed to the Government's point of view."

    Each year both the BDA and BMA provide evidence to the DDRB as part of the process for determining the annual pay uplift for dentists and doctors.

    However, the view of the BMA and BDA is that the DDRB process has been modified beyond recognition from its original purpose. This has been developing over a number of years, but is now clearly no longer acceptable to the medical and dental professions.

    The BMA and BDA believes it is now time for fundamental reform of the pay review process for doctors and dentists, on the basis of the following principles:

    • Restitution of the DDRB's independence and return to its original purpose.
    • Revision of its terms of reference to narrow the DDRB's focus purely on pay uplifts rather than making recommendations on wider contractual matters.
    • Clear timetables for submission of evidence and publications of the report, and an undertaking that government(s) must not fetter the parameters of the DDRB's recommendations.
    • Re-establishment of the undertaking that government(s) will respect and implement the DDRB's recommendations.
  • Annual pay review briefings 2018/19

    Read our briefings which give an overview of the input we have into the DDRB process.

    Junior doctors briefing

    SAS doctors briefing

    General practitioners briefing

    Consultants briefing

  • Government pay review for England 2018/19

    On 24 July the Government announced its pay deal for doctors in Engand and, in doing so, ignored recommendations from the DDRB:

    • Junior doctors will receive just 2% increase
    • SAS doctors will receive just 3% increase
    • Consultants will receive just 1.5% increase, plus 0.5% related to clinical excellence awards
    • GPs will receive just 2%, plus potentially a further 1% related to contract negotiations

    These increases come into effect in October 2018 (with the exception of the GP increase) and will not be backdated to April 2018.

    Read our statement

    Read our letter


    Results of DDRB survey

    Following the Government announcement on 24 July 2018 on the annual pay review for England, we surveyed our members.

    The survey was sent by email on Monday 30 July and closed on Saturday 4 August. The overall response number was 12,717.

    Read more about the results


    What the BMA thinks

    BBMA representative body chair, Anthea MowatAnthea Mowat, BMA representative body chair, said: "It is truly astonishing that the UK Government has chosen to ignore the already insufficient recommendations of its own independent pay review body and to then compound the misery that this will cause for thousands of our hard-working members and their families by refusing to backdate what will be an inadequate pay uplift.

    “Just last week the new Secretary of State for Health and Social Care talked about how ‘heart-breaking’ it was to see how ‘under-valued’ NHS staff feel. Considering those words, doctors in England will rightly feel both anger and disappointment that sentiment has not been matched with action.

    “While the long overdue recognition of SAS doctors is positive, it is unacceptable that the policy of inflicting a real-terms pay cut on the majority of doctors will continue. Since 2008, doctors have experienced the largest drop in earnings of all professions subject to pay review bodies, with consultants seeing a 19 per cent fall in pay, junior doctors 21 per cent and GPs 20 per cent. The effective pay uplift this year for some doctors will be as little as 0.75%, which will be widely seen as derisory.

    “At a time when the NHS faces severe shortages of doctors across all specialties, it beggars belief that the ministers have failed to recognise the contribution declining pay has had on the ability to recruit and retain doctors and the significant damage to morale.

    “Today’s announcement, coming at a time when understaffed and under-resourced hospitals and primary care services are having to manage unprecedented levels of patient demand, will only make a bad situation much worse and the BMA will be considering its next steps in response."

    Read the news story

  • Government pay review for Scotland and Wales 2018/19

    Government pay review for Scotland 2018/19

    The Scottish Government announced its pay award for doctors in Scotland at the following rates:

    • 3% increase to the national salary scales for all doctors who earn below £80,000 (full-time equivalent)
    • 3% increase to medical practice staff pay and an uplift of 3% for non-staff expenses
    • £1,600 for medical staff earning above £80,000 (full-time equivalent)
    • 3% for all junior doctors
    • 3% for all Specialty Doctors and Associate Specialists who earn below £80,000 (full-time equivalent)
    • 3% for all salaried General Medical Practitioners who earn below £80,000 (full-time equivalent)
    • Distinction Awards and Discretionary Points remain frozen

    These changes will be backdated to 1 April 2018.

    Read our statement


    Government pay review for Wales 2018/19

    The Welsh Government announced its pay award for doctors in Wales at the following rates:

    • A two per cent base increase for salaried doctors (including Clinical Excellence Awards) and dentists, salaried General Medical Practitioners (GMPs) and independent contractor GMPs (net of expenses)
    • An increase in the GMPs trainers' grant and rate for GMP appraisers of two per cent
    • An additional two per cent for independent contractor GMPs (net of expenses), salaried GMPs and to the GMP trainers' grant and the GMP appraisers' rate
    • An additional 1.5% for SAS doctors

    These changes will be backdated to 1 April 2018.

    Read our statement


  • BMA evidence for 2018/19 pay review

    Key points from the 2018/19 BMA submission of evidence to the DDRB

    The main recommendations from our submission include:

    • The BMA is very concerned about the ability of the DDRB to serve its original purpose. We urge the DDRB to reassert its independence and not be constrained by the Government's continuing reluctance to properly fund the NHS. It is vital that the DDRB's recommendations are made on the basis of the evidence considered, otherwise the confidence of the profession in the process may be irrevocably broken.
    • Year after year of below inflation increases have equated to significant real terms cuts in doctors' pay and the decrease in the value of sterling in the aftermath of the UK's referendum decision to leave the European Union has increased these inflationary pressures, accelerating the decline in doctors' living standards.
    • In addition, doctors' capped pay awards of 1 per cent were about 60 per cent less than in the wider economy. Out of the 10 pay review body occupations, doctors have seen the biggest fall (-22.5 per cent) in median real gross hourly earnings, confirming that the pay awards recommended by the DDRB over the past decade have led to significant real terms reductions in doctors' earnings, with the resultant negative implications on morale and living standards. We believe that doctors should be treated in line with the wider economy and we therefore ask for a recommendation to uplift the pay of all doctors across the UK in line with the Retail Price Index (RPI), plus £800 or 2 per cent (whichever is greater).
    • Further financial changes, such as reduction in CEA spending, increased cost of training, rise in indemnity fees, tax on pensions, GP expenses not rising with inflation and increased pensions contributions, deepen the impact on doctors remuneration. We therefore ask for the DDRB to explore a mechanism to address the real terms cuts in doctors' pay over the long term.
    • The decline in doctors pay had a damaging impact on the morale of frontline NHS staff at a time when understaffed and under-resourced hospitals and primary care services are having to manage unprecedent levels of patient demand. This has contributed to a workforce crisis in the NHS and has had a detrimental effect on its ability to recruit and retain doctors.
    • Data on the current state of recruitment into pre and post graduate medical education and training show a further worsening of an ongoing, established trend of fewer people choosing medicine as a career and many more leaving the health service.
    • Our position is that the ongoing recruitment crisis can only be addressed through comprehensive workforce planning and appropriate remuneration across the board. We do not support targeted recommendations to address location or specialty recruitment issues and we do not want the DDRB to consider developing a new mechanism for enabling targeted pay solutions.
    • We have consistently highlighted the shortfall in NHS funding across all four nation of the UK, which has come at the expense of patient care and doctors' wellbeing, with sustained cuts over the best part of the decade exhausting genuine efficiencies. The UK has been spending less on health as a proportion of GDP than the average of the 10 leading European countries. This difference in the proportion of the national income committed to spending on health, demonstrates that the sharp decline in doctors' pay and the resources available to the NHS is not a necessity based on the size of the economy but a political choice and we are calling on the UK and devolved governments to match or exceed the average spend of other comparable European countries on health and social scare.
    • We reiterate that it is very challenging to measure productivity in the NHS. The BMA has looked at methods by which productivity for doctors could be measured, but there are some serious problems with potentials ways of measuring productivity that we think make them inappropriate as a basis for pay.
    • We ask the DDRB to note and raise with national governments the lack of comparable earnings data for the devolved nations and we express our dissatisfaction with the lack of reliable and comprehensive evidence on rota gaps and vacancies across four nations.
    • We ask the DDRB to make a recommendation on GP expenses in England as outlined in the GP expenses in England section. We do not ask for a recommendation on GP expenses in the devolved nations; these will be negotiated directly with the devolved governments.

    Read our full submission report (PDF)


    DDRB and junior doctors

    With regards to junior doctors, the DDRB asked for and discussed our views on a number of issues. The oral evidence for junior doctors was delivered by Jeeves Wijesuriya, chair of the junior doctors committee.

    Read the oral evidence for junior doctors