Consultants in England have voted YES

In a ballot that closed on 6 July, consultants have voted in favour of industrial action. Of 35,067 eligible members, 18,069 (51.53%) voted:

• Yes - 13,695 (75.81%) 
• No - 4,369 (24.19%)

Thank you to all of you who returned your ballot.

Consultants are demanding better

This result demonstrates the strength of feeling among consultants: we need significant improvements to our working lives and that includes an end to pay erosion. It also sends a clear message to Government that consultants should be better valued, and this means fair pay, more professional time, better valuation of out of hours work and for the endless erosion of our contracts to stop. We hope with a new Government we can make a fresh start and finally make progress after too many months of being stalled and negotiations being too one-sided. We have shown them that we are united in wanting a better deal for consultants now, and in the future, and ensure there remains a consultant workforce within the NHS. Industrial action remains a last resort, and with the mandate for action now lasting 12 months we have plenty of time to negotiate. However, if the Government fails to seize this opportunity to make us a reasonable offer, we can’t rule out calling for strikes. This is a choice that the Government can and must make.

The role and status of consultants is being eroded

With the role of the consultant being ever more demanding, our campaign is about restoring the status of consultants in England. Burnout is increasing for 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 and make the role sustainable, recognising the value of the profession and ensuring that becoming a consultant remains attractive to the next generation of doctors. Our asks include:

• A multi-year pay deal to ensure we make progress against our pay erosion, in the face of repeated failures of DDRB. We can see no reason why the final pay point of a consultant in England is £16,000 lower than that of our colleagues in Wales; this should be corrected immediately.
• 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.
• A minimum level of three contractually guaranteed SPAs unless agreed otherwise, mirroring the situation in Wales.
• Ensuring consultants towards the end of their career are able to recoup lost pension value

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, whilst maintaining pay for 10PAs. For example, consultants in Wales already have a 37.5 hour standard week for 10 PAs, and Agenda for Change staff in Scotland will now be working 36 hours per week. We believe this will help address burnout in consultants and improve retention. No one is going to force consultants to reduce their hours but the current ‘standard’ will be reduced from 40 to 35. Allowing consultants to reduce their hours to a more manageable level when needed. Alternatively, consultants can continue to work their current job plan with the same hours but the value in PAs will need to be adjusted to match the new PA length of 3.5 hours.

Out-of-hours work is felt to be some of the most onerous, as reported by colleagues, and is significantly undervalued. We therefore 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. Presenteeism is not dedication, it’s a warning sign. We must ensure improvements in working conditions reduces burnout rates for the benefit of both ourselves, our future colleagues 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, we must also address the falling quality of our roles. Being some of the most senior doctors, we are expected to 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 3 SPAs, for full time consultants, is necessary. Contractual minima must also apply to those less than full time. 3 SPAs should not be considered to be unrealistic – our colleagues in Wales have 3 SPAs in their contracts already.  There are also 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. SPA time is not a luxury - it’s what makes the job work.

Alongside burnout and presenteeism, we are increasingly seeing the emergence of ‘quiet quitting’ among medical consultants. Quiet quitting is not a lack of professionalism or commitment to patients; rather, it is a protective response to sustained workload pressure, long hours and a system in which additional goodwill is routinely expected but rarely recognised or valued. Consultants are quietly withdrawing their discretionary effort, taking on fewer extra roles, declining leadership or teaching opportunities, and focusing strictly on contractual obligations as a means of preserving their own wellbeing. Quiet quitting represents a serious loss to the NHS: fewer experienced clinicians able to lead services, support trainees or drive improvement, and a system more reliant on a stretched core workforce operating at its limits. Left unaddressed, this risks normalising a level of working that is just about survivable for consultants, rather than sustainable or safe for patients.

Without meaningful action on standard working hours, proper valuation of out of hours work, and the protection and realistic recognition of SPA time within job plans, quiet quitting will become an entrenched survival strategy rather than an early warning sign. Action is essential to retain experienced consultants and to create conditions in which all consultants can contribute fully, sustainably and with professional integrity throughout their careers.

The value of the job

We have been in dispute with the Government since May 2025, when the pay uplift of 4% suggested that Government was attempting to claw back the gains we had achieved through our campaigning. The announcement in March 2026 of an ‘uplift’ of just 3.5%, making negligible progress to reverse our pay erosions and at a time when inflation is again rising, has shown we were right. It demonstrated that the promised reforms to the pay review body (DDRB) have failed to give it any real independence from government. 

Our average pay is still 26% lower in real terms that it was 17 years ago, and on this trajectory pay restoration will not be achieved within your working life as a consultant. Persistent pay erosion is contributing to early retirement, quiet quitting, reduced discretionary effort, and colleagues leaving the profession in the UK and entirely - all factors exacerbating NHS workforce shortages.

Our pay is also diminished in comparison with peers in competing professions. When inflation is omitted, the average UK pay for those in comparator professions (such as those in the professional, scientific and technical sectors) has increased by 80% since 2008, but the average consultants pay only by 30%. 

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

When we re-entered into dispute with Government in May last year, we reintroduced the consultant rate card in England. If 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.  

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.