Consultant pay offer

Answers to member’s questions and some misconceptions about the deal that the Government put to consultants in England.

Location: England
Audience: Consultants
Updated: Thursday 18 January 2024
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Gateways and pay progression

What are the "performance criteria"? 

A simple progression process will be introduced between the consultant and their clinical manager so that progression is achieved where clinical managers are satisfied that certain criteria have been met. The majority of the criteria are already set out in Schedule 15 of the terms and conditions of service. 

A pay progression review meeting will need to be undertaken to ensure that the doctor has met the criteria. Following this, it will be the responsibility of the clinical manager to take the necessary action on the NHS pay system to open the pay point. Joint guidance will be developed to support employers implementing the new system to ensure it is applied fairly and consistently to all consultants, in line with relevant equalities legislation.  

The intention is not to prevent consultants who are achieving expected standards from moving through the pay scale, but simply to ensure consistency of approach and a minimum standard for progression. It is the expectation that consultants will be able to progress through these gateways by meeting the performance criteria and there is no intention to unreasonably restrict pay progression. 

Progression cannot be withheld due to financial or other non-performance related issues. Withholding progression shall not be used as a means to coerce a consultant into agreeing a proposed job plan.   

Consultants should be given the appropriate time and resource to meet the pay progression criteria. 

Where a doctor disputes a decision that they have not met the required criteria to progress to the next pay point, the mediation procedure and the appeal procedure set out in the terms and conditions should be followed. 

Where a criterion has not been achieved for reasons beyond the consultant’s control, the consultant will not be prevented from progressing onto the next pay point if the other criteria have been met.   

Managers will be able to control pay progression?  

The 2003 contract, which the vast majority of consultants are on, includes a schedule which outlines numerous criteria which a consultant has to meet in order to achieve pay progression. If the criteria are met , it is then signed off by the Chief Executive. The current contract states (Schedule 15)  ‘The Chief Executive, informed by the Medical Director’s recommendation, will subsequently decide each year whether the consultant has met the criteria. ‘  

This has been the case for 20 years and cases of withheld pay progression are very rare. Whilst managerial ‘control’ will remain, the past 20 years have demonstrated that consultants are not withheld progression. Also, given the number of pay points will be reduced if the offer comes in, the number of increments will be reduced thereby reducing the number of times that the sign-off process needs to occur. It would be the case that following the review meeting the manager will need to authorise payroll to increase pay to reflect the higher threshold where this applies. Given the reduced number of pay points, this will only happen three times in a consultant’s career. There are extensive safeguards to ensure that this will not be abused.    

Why are you making mandatory training a contractual requirement?  

Under the current consultant contract pay progression is already dependent on the consultant having “made every reasonable effort to meet the time and service commitment in the Job Plan”, which includes SPA for revalidation and, therefore, mandatory training as defined by the trust/medical director. As such, we do not believe that this materially changes the contractual requirement to engage with statutory and mandatory training.  

Why are consultants further up the pay scale being prioritised over those consultants towards the bottom of the scale whose uplift is either smaller or who will see no change? 

It is the case that in the immediate term some consultants will not receive any additional uplift on top of the 6% awarded this year and the pay award we would expect in 2024/2025. However, younger and future consultants will be the biggest beneficiaries of the changes to the pay scale, including fewer pay points and quicker pay progression. Throughout the negotiations a key priority was ensuring a higher starting salary for new consultants – this was secured and sees the salary of a new consultant increase from £93,666 to £99,532. 

Meanwhile, a consultant who is at the end of their third year on the payscale will, from April 2024, earn the same as a consultant with 13 years’ experience earned in March 2023. While a consultant who has completed eight years in April 2024 will be earning the equivalent salary of a consultant with 25 years in March 2023.  

Over the course of their career, a new consultant starting in 2024 will be approximately £180,000 better off under the changes to the pay scales, as set out in this offer.  

Will I suffer significant annual allowance tax charges as a result of these pay rises? 

While annual allowance charges cannot be avoided completely, especially for those nearer the top of the pay scale who typically have higher accrued final salary membership, the changes announced at the budgt in March 2023 following extensive lobbying from the BMA go some way to mitigate this. There is a particularly high opening value uplift (10.1%) applied to the value of your pension in 2023/24 and a moderately high uplift (6.7%) applied in 2024/25. The opening value is uplifted by these figures (in line with the level of CPI from the September of the preceding year) to enable your pension to grow with inflation before it is tested for the annual allowance. In effect, this means that you can receive a larger than “typical pay rise” before it is assessed against the annual allowance. Secondly, following the budget changes, not only has the annual allowance increased to £60,000, some technical changes mean that you can now offset negative growth from your 1995 scheme against positive growth in the 2015 scheme. Aswell as this. The value of inflation applied to the opening value is effectively aligned with the value of inflation used for the revaluation. The net impact of this is that whilst some may have AA charges that can’t be avoided, this is a better time than in recent years to get higher pay rises. There are some additional points on which we are seeking clarification. The timing of any “backpay” is important as this should ideally be paid before March 31st 2024 to ensure that it falls both in the correct pension year for pension growth purposes and to avoid falling in the 2024/25 tax year as this may result in more consultants crossing the taper threshold. We will update you once there is greater clarity on this. 


Why has the LCEA funding been repurposed in this package? 

We know that the previous practice of equal distribution of LCEAs, which seemed to be the overwhelming preference of our members, was about to end, with trusts increasingly introducing competitive rounds.

What is more, previous LCEA funding was not pensionable. We therefore believe that redeploying existing LCEA funding pay into basic pay, thus making it consolidated and pensionable, was the most equitable and fair solution for the consultant body.

At the same time, consolidated LCEAs awarded prior to reform in 2018 will be retained and these awards shall remain pensionable and consolidated. The value of these awards will be frozen. The review process for these awards will be removed.

Funding released through the future attrition of consolidated LCEAs will not be reinvested.

The reason for consolidated CEAs remaining in payment is that consultants will have paid pension contributions and in many cases annual allowance tax on them and almost certainly have a legal right to retain them (the BMA brought a legal challenge in 2015 when the government tried to remove them which was ultimately settled out of court).

The renewal process was scrapped as there was no new LCEA scheme to recycle the money into. The BMA was concerned that trusts would undertake aggressive renewals processes in order to generate a financial saving. 

Rate card

So if there is no rate card, what is the guarantee that extra work is properly remunerated? 

The purpose of the rate card has always been to inform consultants of their rights and empower them to value their extracontractual time appropriately. We believe that this educational exercise over the last year has been successful and there is nothing stopping individual consultants to demand to be appropriately remunerated for their work.  

What is more, we reserve the right to re-introduce the BMA rate card for consultants if there is a future industrial dispute. We are also very conscious that some groups of employers collaborate on arrangements for securing extra contractual consultant work. Where this is happening, there is an expectation that this should be done in consultation with those employers’ Joint Local Negotiating Committees. 


Will SPA time be used for Direct Clinical Care (DCC)? 

Categorically no. The offer package includes a clause that “with agreement between consultant and their employer, additional SPA time beyond the minimum level which is required for revalidation and appraisal may be allocated to work to support NHS priorities, such as urgent and emergency care; elective recovery; delivery of the Long Term Workforce Plan and the major conditions strategy.” This simply reiterates things that can already happen under the existing SPA provisions. The clause explicitly states that “this does not permit reallocation for SPA to Direct Clinical Care”. Following the announcement, there has been some confusion on this and we have additionally received written confirmation of the above by DHSC, including that the current proposal does not change the current contractual provision in relation to SPA time. Similarly, the explanatory wording on the NHS Employers website has been revised for absolute clarity.  

Will training of Medical Associate Professionals (MAPs, PAs, AAs etc) built into jon plans and SPA time? 

There is nothing in the offer that would mean consultants have to train or supervise MAPs any more than is already required. There is no contractual change to SPAs and job plans need to be mutually agreed between employers and consultants. For most consultants training or supervising colleagues, including MAPs, is already a contractual requirement.  


Is the DDRB reform meaningful and will it ensure that the pay erosion consultants have experience will be reversed?

For years, the BMA, and specifically the BMA’s consultant committee, has been concerned about the degree of political interference and subsequent lack of independence with the current pay review process. Indeed, we believe that the DDRB is responsible for overseeing the real terms pay erosion we have experienced over the last 15 years, and the only way to ensure that we are never in this situation again is through meaningful DDRB reform.

An extended record of all our concerns and what we set out to achieve through in negotiations is available.

As part of the offer, the Government has agreed to making a number of changes to address some but not all of these points. If the offer is accepted, the Government will work with the BMA to implement the changes set out below in time for the 2025/26 year. Whilst the BMA’s Consultants Committee would ideally have agreed to jointly commission the DDRB to look back at the fall in real terms pay since 2008, it became clear during negotiations that the Government would not be willing to revisit or re-evaluate past decisions. The changes secured here do, however, deliver multiple changes which the BMA has been seeking for some time and give significantly more confidence that a reformed body and process will be less likely to oversee some of the mistakes of the past.

Of particular note is the section on remit letters and terms of reference. Removing references to inflation targets is important, and ensuring that consultant pay is compared to what is happening with consultant pay in other relevant countries and professions should help maintain appropriate levels of consultant pay.

We also fully intend to make a lot of these changes more robust during the implementation stage by setting out very detailed role specifications for the members of the Review Body.

Ultimately, as with any reform, the outputs will need to be constantly reviewed and assessed and if, at any point, we believe the Review Body or the Government is failing to honour the intention of the reforms, we reserve the right to go back to the negotiating table and if needed re enter a formal dispute.