Each year, the BMA submits detailed evidence to the Review Body on Doctor's and Dentists' Remuneration (DDRB), on matters relating to pay, recruitment, morale and motivation for doctors' across the UK.
Key points from the 2018/2019 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
What the BMA thinks
Dr Chaand Nagpaul, BMA council chair, said: "Delivering a world-class health service requires a workforce that feels motivated and supported to provide the best possible care for patients.
"However, all doctors have seen a significant fall in real-terms pay since 2008. While the BMA understands the economic constraints facing the health service, years of real-terms cuts to frontline staff pay undermines the excellent work from hardworking doctors and leaves them feeling demoralised and undervalued.
"Doctors should be treated in line with the wider economy where pay settlements run at 60 per cent higher than the current public-sector policy cap, which is why are we recommending that the DDRB uplift the pay of all doctors across the UK in line with the Retail Price Index plus £800 or two per cent, whichever is greater.
"Out of the 10 pay review body occupations doctors have seen the biggest fall in real earnings. Because of this, we are also asking the DDRB to find a way to close the gap that has emerged in doctors’ pay over the long-term. Failure to do so will only exacerbate current recruitment and retention issues facing the profession."
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Find out more
DDRB annual report 2017/2018 - full report
Read the full recommendations from the DDRB on doctors' and dentists' pay in England, Wales and Northern Ireland.
Download DDRB annual pay review report 2017/2018
BMA evidence for 2017/18 pay review
We submitted our evidence to the DDRB for the 2017/18 pay review in September 2016.
Key points in our submission:
The British Medical Association (BMA) is submitting evidence for the whole of the UK, and is seeking a common recommendation for all doctors, though we note an increasing divergence between the four constituent UK nations. We ask that DDRB continues to assert its independence to make a full set of recommendations, irrespective of any remit that a constituent health department might seek to impose.
We are not proposing a specific figure for the 2017/18 pay award, but we argue that doctors should be treated in line with the wider economy, where pay settlements continue to run at higher than the public sector pay policy cap, at around 2% currently.
We do not support targeted recommendations to address location or specialty recruitment issues, and we do not wish DDRB to pursue its suggestion of applying funds to different approaches than pay to alleviating pressures – unless there was a substantial increase to the overall funding availability. We do however note that previous DDRB recommendations around distinction awards in Scotland, GP earnings in Wales, and clinical excellence awards in Northern Ireland, have not been implemented by the respective governments.
The financial distress of the NHS, and the lack of credible plans to increase capacity will further worsen recruitment and retention issues, and create real concerns around the health and wellbeing of the remaining doctors as a result of their increased yet unrecognised workload, and their lack of time and empowerment to be able to contribute to sustainable solutions.
We note the remit letter from England asks DDRB for observations around salaried GPs. We believe there is a significant lack of data currently available around sessional GPs (salaried and locum) on which to base any firm recommendations, for example around pay ranges, and how GPs choose to take a partnership, salaried or locums post. We request that DDRB considers who is able to provide what data with a view to a more in-depth analysis in next year's pay round.
In general, we note there is a lack of data around how doctors choose their career paths, both in terms of specialty and location, but also in terms of choice between a permanent role or locum position. We hypothesise that the increased attractiveness of a locum role reflects the seeming low value and ever-increasing unrecognised workload of permanent positions. The recent moves to advertise Staff, Associate Specialist and Specialty doctor (SAS) roles at the closed Associate Specialist (AS) grade are also a reflection of this recruitment and retention issue.
BMA evidence documents
Download the BMA evidence documents from September 2016
BMA evidence to the DDRB - September 2016 (PDF)
Annex - NHS funding briefing (PDF)
Annex - SRM 2016 workforce briefing (PDF)
Who are the DDRB?
For doctors and dentists holding posts within the NHS on nationally agreed terms and conditions of service, your pay is considered annually by the Doctors' and Dentists' Review Body (DDRB).
The DDRB is an independent body which makes recommendations directly to the Prime Minister and the Secretary of State for Health, and their equivalents in Scotland, Wales and Northern Ireland.
Various parties, including the Departments of Health in England and in Northern Ireland, the Welsh Government, the Scottish Government, NHS England, NHS Employers, and the BMA and BDA send written evidence to the DDRB around September each year. Oral evidence sessions are also held with these parties, which take place between November and February.
The DDRB usually reports to the Prime Minister in February or March the following year and the report is made public with the government's decision a few weeks later, for implementation the following April 1.
Find out more about the DDRB
Find out how doctors' pay is decided