Rebuilding public health across the UK

Pay restoration, ending pay disparities, and rebuilding the profession: the public health medicine committee gives an overview of its work and vision

Location: England Northern Ireland Wales
Published: Monday 10 June 2024
public health covid

As we approach the BMA’s ARM (annual representative meeting) and a general election shortly afterwards, your public health medicine committee is sending a clear message: public health is in crisis and needs to be rebuilt. We cannot address the problems facing our NHS without that strong foundation of public health.

Across the UK, there are not enough public health specialists. We face a shortfall of at least 750 consultants, unfilled vacancies, too few training posts, and falls in the number of GMC-registered public health specialists.

Pay erosion has contributed to this, and we’ve already seen effective industrial action by public health physicians across the UK for pay restoration. However, public health also faces marked pay disparities (often tens of thousands of pounds in annual basic pay) based on registration type, nation and employer. These disparities have also exacerbated existing gender, ethnicity and disability pay gaps.

The effects have been stark in England, with many medics in recent years leaving local authority work – where there is no collective bargaining – for organisations like UKHSA, where medical and dental contracts are available. This deprives our public health workforces of the diversity of background they need to thrive. The Infected Blood Inquiry spells out the dire consequences of leaving areas isolated and without access to medically qualified public health specialists. We need them embedded throughout, with strong central coordination.

Public health investment and stability is required across the UK.

We’ve recently seen unpopular reorganisations in Northern Ireland and Wales but, again, it is in England where we have seen the most damaging real-terms funding cuts and fragmentation, severely compromising the effectiveness, integrity and independence of public health there.

The public health grant has fallen by 28% despite calls for restoration, and there are huge concerns about the latest restructure for OHID (the Office for Health Improvement and Disparities). Currently, the new consultant pay offer in England is not being funded outside the NHS, leading to the threat of public health redundancies in academia and government.

Your public health medicine committee has been working on this. We’ve gathered data, highlighted the problems, worked with partners such as the Faculty of Public Health, and are lobbying both local government – via the National Joint Council – and national government through the public health minister. A new government will present new opportunities to make progress too.

At this ARM, we are asking delegates to endorse our latest proposals, as expressed in motion 15 of the agenda, building on our existing policies. BMA priorities must be:

  • Pay restoration for all public health consultants and registrars across the UK, with full funding of pay awards for all the relevant employers.
  • All public health consultants and registrars across the UK to be employed on medical and dental terms and conditions where appropriate, regardless of employer.
  • UKHSA, OHID and relevant parts of NHS England being brought back into the NHS as part of a single, independent public health agency.
  • Collective bargaining for public health consultants in English local authorities.
  • Redress existing pay disparities between medical and non-medical public health specialists, both for consultants and registrars, through contractual harmonisation.

You’ll be able to find out more about our work this session, including a briefing on pay, in our annual report. In February, our conference tasked us with new policy in the next session on rallying our membership, rebuilding our profession and promoting the role of the public health specialist, so watch this space. Together, we can all rebuild public health.

By the public health medicine executive committee 2023-24. Find out more about the committee