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Fixing pay for consultants in England

Consultants have seen their real-term take-home pay fall by over a third over the last 14 years. We're calling for this to change.

The referendum on the pay offer

 

Thank you to everyone who voted in our referendum on the Government’s pay offer.

 

The results are in and our members voted by a slim majority, 51%, to reject the offer.

 

Find out more about the result and next steps.

Fix pay now and for retirement

After months of hard work by our members and many hours of negotiations, the BMA’s Consultant’s Committee approved a referendum of all consultant BMA members in England on a new pay offer from Government.

Our objective has been to achieve two things – an above inflation pay uplift for this year (2023/2024) and reforms to the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) to fix pay now and for the future.

While this offer does not deliver all that the BMA asked for, significant progress has been made. 

Throughout this dispute, the BMA has been clear that any such credible offer would be put to members for their approval.

We formally put the offer to our members via a referendum that was open between 14 December 2023 and 23 January 2024. 

Pay offer referendum results

Thank you to everyone who voted. The results are in and our members voted by a slim majority, 51%, to reject the offer.

The vote demonstrates that consultants still have considerable concerns about the offer. From the feedback members have given us it was clear that they thought it did not go far enough and as a result they did not have confidence that pay would be restored over future years. They were also concerned both about the fairness of the deal and about potential changes to SPAs.

The results have been discussed by consultants committee today and we have decided not to call strike action at the current time but instead enter discussions with Government to see whether we can secure improvement to address our members' concerns. If, however, that is unsuccessful, consultants in England remain in dispute; as members demonstrated in the ballot before Christmas they remain committed to taking further strike action, should the need arise. We want this dispute resolved, but the ball is in the Government’s court to make a renewed offer that not only delivers for consultants, but crucially, for patients too, by retaining the NHS’s most experienced clinicians.  

The offer

The offer included total investment of 4.95% that would be used to reform our pay scale structure. This would see a reduction in the number of pay points from eight to four and reduce the number of years it takes a consultant to reach the top of the pay scales by five years.

It would have also increased the starting pay for new consultants and secured an increase for the top pay point. This increase would have been in addition to the 6% uplift awarded earlier this year. If these changes would have been accepted they would have been implemented in April 2024 but pay increases backdated to January 2024.  

As part of this investment, funding for new Local Clinical Excellence Awards (LCEAs) would have been moved into basic pay. This would have resulted in this money becoming consolidated, pensionable, and subject to uplifts as determined by the outcome of the DDRB process.

The moving of this money from new LCEAs represented approximately 1.5% of the 4.95%. Therefore, the contractual entitlement to access an annual awards round would have stopped from 1 April 2024. However, there would have been no impact on consolidated, pensionable LCEAs awarded prior to the reforms in 2018. These awards would have also no longer be subject to a renewal process. 

But what would this have meant for your individual pay?

We developed a new tool that allows you to estimate how much additional pay you would have received under the offer in 2023/24 and 2024/25. See what the offer would have likely meant for you.

A bank of frequently asked questions have been developed to help you understand more about the offer.

Read answers to member’s questions and some misconceptions

Case studies
Anaesthetist working less than full time

NB: this is based on 7 year consultant, but working less than full time – 0.6 of full time. This example also has no backdated pay because there is no immediate change to basic pay as a result of the deal in current financial year – 23/24. 

Phoebe is an anaesthetist. She has been working as a consultant for the last 7 years, and has now decided to work less than full time, and is working 6 PAs (60% of full time). She does no on-call. Phoebe is 38. Currently, she is on threshold 5 of the consultant contract pay-scale, so her current pay is £63,234. Her progression anniversary is 1st April, so without the offer she will only progress to the next threshold 6 on 1st April 2025. 

As a result of the offer, she will be moved in the new pay structure to threshold 2, which is paid the same as her current pay. However, she will move to threshold 3 on her progression anniversary on 1st April 2024, a year earlier than she would have progressed to the next threshold without the offer. This means as a result of the offer, her annual pay from April 2024 will be £71,330. Her total earnings are 12.8% higher in 24/25 than they would be without the offer. Over the next 5 years, her total pay will be 7.1% higher than it would be without the offer, and across her lifetime (assuming she continues to work part time and retires at 60), it will be 6.6% higher. 

In addition, her higher pay will lead to a higher value pension when she retires. 

This is in addition to the 6% pay increase already provided for 23/24 as part of the DDRB process.  Taking the offer and the already awarded 23/24 DDRB award, Phoebe will be 13.0% better off in earnings over her lifetime pay as a result of combined pay uplifts in 23/24, compared to 22/23 payscales, if this offer is accepted. 

New radiologist consultant in 2023

NB: this is based on 0 year consultant, but with an additional on-call pay supplement.

Emily is a radiologist. She is a new consultant, as of April 2023. She is currently 32 years old. As she is a new consultant, she is on threshold 1 of the current payscale. This gives her basic pay of £93,666 but she is also required to participate in an on-call rota, which often involves coming in and performing emergency procedures. For this, she also receives a medium frequency (5%) on-call availability supplement and her actual gross pay is currently £98,349 without the offer. 

As a result of the offer, she is moved onto the new payscale at threshold 1, which with her on-call supplement is £104,509 (as the on-call supplement is a percentage of basic pay, the increase in basic pay increases the supplement as well). This will apply from 1st January 2024, but is paid in arrears in April 2024, when she will receive £1,540 backdated pay. In addition, in 24/25 she will continue to remain on threshold 1 of the new payscale – still £104,509. Without the offer, she would move up to threshold 2 of the old payscale as she would have been a consultant for more than a year, but that would mean her pay would only have been £101,429. In total, including the backdated pay, she will be 4.6% better off in 24/25 (not counting the backdated pay, she will be 3.0% better off). 

Over a five year period, she will be 1.2% better off under the new payscale. Over a ten year period, she will be 3.1% better off. And over her lifetime earnings, she will be 5.3% better off, assuming she retires at 60.  

In addition, her higher pay will lead to a higher value pension when she retires. 

This is in addition to the 6% pay increase already provided for 23/24 as part of the DDRB process.  Taking the offer and the already awarded 23/24 DDRB award, Emily will be 11.6% better off in earnings over her lifetime, as a result of combined pay uplifts in 23/24, compared to 22/23 payscales, if this offer is accepted. 

Psychiatrist completed 14 years as a consultant

NB: this is simply a write-up of the consultant 14 years in the table 

Ahmed is a psychiatrist who has completed 14 years as a consultant. He is currently 45 years old. He works full time, on 10 PAs per week. Currently he does no on-call. Currently, without the offer, he is on at threshold 7 of the payscale, earning £119,323 per year.  

As a result of the offer, he will be moved onto the new payscale at threshold 4, which means he will earn £131,964 per year in basic pay, which will apply from the 1st January 2024. He will receive a backdated pay award of £3,160 in his April 2024 pay packet. In total, including the backpay and his higher salary under the offer, he will earn an additional £15,801 in 2024/25, an increase of 13.2%. In addition, this is likely to be further increased as a result of the 2024/25 DDRB pay award – although future pay awards as a result of a reformed DDRB are not included in this analysis. 

Not taking into account future pay awards, over the next 5 years, his pay will be £56,247 or 9.3% higher as a result of the offer than it would have been without the offer. Across a 10 year period, it will be £84,662 higher or 6.9% higher. Over his lifetime, assuming he retires at 60 and continues to work full time until then, he will be £107,394 better off as a result of the offer in terms of pay, or 6.2% better off. In addition, his higher pay will lead to a higher value pension when he retires.  

This is in addition to the 6% pay increase already provided for 23/24 as part of the DDRB process. Taking the offer and the already awarded 23/24 DDRB award, Ahmed will be 12.5% better off in earnings over his lifetime1 as a result of combined pay uplifts in 23/24, compared to 22/23 payscales, if this offer is accepted. 

Consultant eye specialist 36740 8

Re-ballot on industrial action

The consultants’ re-ballot on industrial action ran from 6 November 2023 until 18 December 2023 and the results are as follows:

  • Turnout: 60.42%
  • Number entitled to vote: 35,653
  • Number of votes cast in the ballot: 21,543
  • Number of YES votes: 19,278 (89.51%)
  • Number of NO votes: 2,259 (10.49%)
  • Number of spoiled or otherwise invalid voting papers returned: 6

This result is a clear and emphatic demonstration of the strength of consultant feeling - it sends a clear message that consultants remain determined to fix pay now and for the future.  

Thank you again to all our members who voted for delivering such a firm yes result. 

SPA time

Following the announcement and some confusion around the SPA (supporting professional activities) element of the offer, BMA reps have been in touch with DHSC and NHS Employers, who have written to us to confirm what is meant. They also agreed to correct the explanatory wording on the NHS Employers website.

This new wording makes clear that SPA time cannot be converted into DCC PAs, as set out in the original offer document presented by the Government to us, among other clarifications.

The NHS Employers website now specifically states that SPA time cannot be used for direct patient care as follows:

“From 2024, by agreement between consultant and their employer, additional SPA time beyond that minimum level which is required for revalidation and appraisal, may be allocated to service improvement/quality improvement work to support NHS priorities such as:

  • urgent and emergency care
  • elective recovery
  • delivery of the NHS Long Term Workforce Plan
  • major conditions strategy

However, this does not permit reallocation of SPA to direct clinical care.”

How we got here

Pay
Declining pay

Since 2008/09 the real terms take-home pay of consultants in England has been cut by 35% and that is before the impact of this year’s soaring inflation.

This results in a huge loss of earnings during a consultant’s working life. It also impacts the value of their pension and massively reduces their income throughout retirement. 

Working in the NHS over the last fifteen years has become more challenging, more stressful, and more demanding. There is absolutely no justification for the consultants of today being valued less than they were in the recent past. As it stands, consultants are effectively expected to work until May without pay every year. 

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Your finances
Fix pay now and for the future

It’s essential that it’s fixed for the future and that we never find ourselves in this situation again

One way to achieve this is through reforming the broken doctors’ pay review body (DDRB), on whose watch that shocking decline has been allowed to happen.

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Voting Card
First ballot results

How consultants and public health consultants voted in the first ballot.

Consultants

Our consultant members voted overwhelmingly in favour of industrial action.

  • Turnout: 71.08%
  • Number entitled to vote: 33,915
  • Number of votes cast in the ballot: 24,106 
  • Number of YES votes: 20,741 (86.08%)
  • Number of NO votes: 3,354 (13.92%)
  • Number of spoiled or otherwise invalid voting papers returned: 11

Public health consultants ballot results

In the public health consultant ballot the turnout of 38% was below the 50% threshold for industrial action required by the Government’s anti-trade union laws.

  • Number entitled to vote: 96
  • Number of votes cast in the ballot: 37 
  • Number of YES votes: 32 (86.49%)
  • Number of NO votes: 5 (13.51%)
  • Number of spoiled or otherwise invalid voting papers returned: 0
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