Campaigning to restore the value of consultants in 2026

Consultants in England remain in active dispute with the Government.

The pay uplift in 2024 was welcome but failed to come close to restoring fifteen years of pay erosion. Since that award the Government has been clawing back that pay increase in derisory pay ‘uplifts’ and we re-entered dispute with the Government in May 2025 following the pay  review body (DDRB) recommendation of a 4% pay uplift. We’ve urged them to both listen to our concerns and start valuing consultants.

The Secretary of State declined direct negotiations when we met in September, offering instead meetings with NHS Employers and the Department for Health and Social Care, that would not start until March 2026. We’ve been urging a more appropriate and essential response from the Government since, setting a deadline of the end of 2025 to make progress with Government in relation to pay and working conditions, otherwise we would escalate our action to secure what consultants deserve. 

The threat of a ballot for industrial action finally spurred the Government to meet with us in late 2025 and early 2026 to offer more urgent talks. We believe they now understand the very real threat that consultant industrial action poses and that there is a narrow opportunity to engage with us to avoid that outcome.

We remain committed to engaging with the Government; however, progress will require political leadership and meaningful movement on the core issues that we know members support. We cannot allow the gains we previously made to fade, consultants need to be ready for a ballot if we don’t make the progress we need.

The role and status of consultants is being eroded

With the role of the consultant being ever more demanding, our campaign is all about restoring the status of consultants in England. Burnout is increasing in many colleagues due to factors such as volume and intensity of workloads; control and autonomy; recognition and civility; and lack of support.  We are calling for changes that reflect the complexity of the consultant role, to make the role sustainable, to recognise the value of the profession and to ensure that becoming a consultant remains attractive to the next generation of doctors. Our asks include:

• a minimum level of three contractually guaranteed SPAs
• plain time PAs to be no more than 3.5 hours long (and therefore a reduction in the standard full-time working week)
• improved payment for all out of hours work, resident work and recognition for sleep disturbances when on call
• paid compensatory rest
• the right to partial retirement without employer permission or reduction of 10% pensionable pay
• the option for PAs worked above 10 to be pensionable
• agreement to respect the previously agreed reforms of the pay review body process (DDRB) and further steps to ensure it is fit for purpose

Our demands will no doubt resonate with you. Please talk about them with colleagues and also consider signing up as a consultant pay campaigner.

The sustainability of the job

Currently, a full-time consultant works ten Programmed Activities (PAs) of four hours duration each, per week, making a 40-hour week standard for full time. We are calling for these to be reduced to match the working week of other public sector workers of 37.5 hours or less, whilst maintaining pay for 10PAs.  Out of hours work is some of the most onerous colleagues report and is significantly undervalued. We also need knock-on reductions for how many hours per PA out of hours work is valued at, including weekend, resident on call and overnight work. Action is also needed on appropriate recognition for sleep disturbances when on call.

Nearly a quarter of doctors took leave for stress in the last 12 months; 30% are unable to cope with their workload and burnout is a leading cause of colleagues leaving the profession. Presenteeism (being present at work but performing at a reduced level due to illness injury or other reasons) is high in the medical profession, with individuals feeling less able to make complex decisions, less able to take on additional responsibilities and additional worries about quality of care delivered. We must ensure improvements in working conditions reduces burnout rates for the benefit of both ourselves and our patients.

The quality of the job

In addition to tackling the sustainability of our jobs by transitioning to a shorter standard working week and we must also address the falling quality of our roles. Being some of the most senior doctors, we innovate, redesign services, teach, network, revalidate and reflect on our practice in its fullest breadth.

The 2.5 Supporting Activities (SPAs) deemed ‘typical’ in full time job plans have been under sustained attack for years and are insufficient for the challenging context in which we are expected to lead as consultants in the future. That's why we believe that contractualising SPAs as at least 30% of the Job Plan, for full time consultants, is necessary. Contractual minima must also apply to those less than full time. We have seen employers not only limit the time available but put ever more work into the category.

There are increasing challenges to gaining time for external duties, such as work with Royal Colleges and other organisations vital to the functioning of the healthcare sector, the long-term consequences to both medical education and wider quality improvement in these roles is not recognised. Not only are the measures we seek practical steps to improve working conditions; they are also vital to retaining talent and maintaining high standards of care.

The value of the job

Our pay not only remains significantly diminished in comparison to 2008, but also in comparison with peers in competing professions. Since 2008, ignoring inflation, the average UK pay for those in comparator professions has increased by 80%, but the average consultants pay only by 30%. 

Despite commitments to reform, the DDRB remains subject to government influence and has not delivered meaningful change. We continue to demand genuine DDRB reform to ensure pay recommendations are independent and fair, with a reformed and functional DDRB the only way to avoid long-term dispute with recurrent industrial action. This would also mean real changes to, the DDRB – including who sits on the board – rather than the cosmetic reforms Government have introduced so far.

We have yet to see if the DDRB is capable of resisting the constraints of government, therefore we are campaigning for meaningful progress to pay restoration through a multi-year pay deal. 
Not addressing the pay erosion that has occurred will have a direct and lasting impact on your pension value – the main route to restore pension value also lies in pay restoration. Additionally, consultants should have control and choice over whether we want additional contracted PAs to count towards our pensions, as well as the right to access our pension without needing employer permission.

Staying united for a better future

Our collective efforts over the last two years have led to significant achievements for consultants in England:

• A new shortened pay scale and improved pay deal.
• Reforms to the pay review body (DDRB) – including changes to its Terms of Reference and a commitment to the pay award being known at the start of the financial year.
• A bigger boost to pay for the majority of consultants than delivered by the DDRB for decades.

Pay award 2025 and pension value

The 4% pay uplift for consultants in England announced in May showed the Government has reneged on its pledge to reform the independent pay review body and it undermined years of campaigning. Consultant pay erosion remains at 26% - if we accept this it gives a green light to future governments to reduce the real-terms value of our pay forever more. Furthermore, not addressing the pay erosion that has occurred will have a direct and lasting impact on your pension value – the main route to restore pension value also lies in pay restoration. 

When we re-entered into dispute with Government in May following the announcement of 4% pay award, we reintroduced the consultant rate card in England. If the Government does not value us, we must ensure we value ourselves and our own time appropriately, and therefore we encourage you to use the consultant rate card to do so. 

Pay body reform agreed in 2024

The deal we accepted in 2024 stated that the BMA would have a greater role for the BMA in the process of appointing DDRB members. It also included changes to the terms of reference that guide the panel’s recommendations. These include factoring in long-term pay trends as well as the salaries of comparator professions, including those of our international counterparts. 

The sum total of these reforms to the DDRB – the first meaningful reforms since 1998 – was intended to equip the pay review body with the independence and scope it needed to determine a fair pay award for consultants. 

However, The Government reneged on its pledge to reform the independent pay review body. This included making reference to wider economic factors in its remit letter last year, despite undertakings not to do so. 

Pay reform in 2023

In July 2023 DDRB recommended a sub inflationary pay uplift of 6%, at a time when inflation was much higher. This led to us entering dispute in late 2023. A first offer, in the midst of members’ industrial action, was rejected. 

Ongoing action, coupled with direct negotiations with the Government, led to additional increases to pay applied in the successful 2024 pay deal. This deal shortened the pay scale. The resulting uplift received by individuals varied depending on the point of the pay scale they were at. Further industrial action led to increases of between 6% and 19.6%. This showed how effective your action can be. 

However, this work is not finished. Neither in terms of the journey towards pay restoration for all as we are still 17 years behind and nor in terms of specific groups at beginning and at the end of the consultant pay scale. It is vital we continue to be ready to fight for fairness if needed.