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Fixing pay for consultants in Northern Ireland

Consultants have seen their take-home pay fall by over a third in real terms over the last two decades. Increasing numbers of doctors are choosing to retire or work in other countries where the pay is better. This must change. Our pay needs to be fully restored.

Why we are asking for full pay restoration

For years, consultants here have been working harder and longer, with more complex cases in a much more challenging environment, whilst a crisis built in the health service. Despite the significant additional pressures our pay has remained the same and it no longer reflects the level of responsibility or clinical risk we undertake every day. 

Since 2008/09, our basic pay has experienced real terms (RPI) pay cut of 30.7%.

Colleagues in Ireland under the new Sláintecare contract are paid much higher rates than we are in Northern Ireland and we are already seeing colleagues choosing to work across the border. The government here needs to realise that with increasing consultant vacancies in the Irish health system there is enormous potential for more doctors from Northern ireland choosing to work there with better terms and conditions.

In England consultants have recently accepted a new pay offer leaving us even further behind. Doctors in Wales are also making progress with pay negotiations.

Consultants here have a complex contractual pay system with eight incremental pay rises intended to reflect progressive expertise and increased value in the role. It takes 19 years to reach the top of the pay scale, and this was originally constructed to work with a final salary pension scheme and a retirement age of 60. The new pay scales for consultants in England will see them reach the top of the pay scale in 14 years.

Incremental progression does not mitigate the necessity for the pay scale itself to be uplifted at least in line with inflation. The impact of pay restraint on consultants is cumulative and its effects compound over time as can be seen below.

Consultant pay in Northern Ireland if it had kept up with RPI inflation.

Pay points 2008/09 2022/23 2022/23 if kept up with RPI Difference 23/24 (if given 6% DDRB recommendation)
1 £73,403 £88,799 £129,384 £40,585 £94,127
2 £75,701 £91,581 £133,434 £41,853 £97,076
3 £78,000 £94,362 £137,487 £43,125 £100,024
4 £80,298 £97,141 £141,537 £44,396 £102,969
5 £82,590 £99,913 £145,577 £45,644 £105,908
6 £88,049 £106,520 £155,199 £48,679 £112,911
7 £93,508 £113,124 £164,822 £51,698 £119,911
8 £98,962 £119,723 £174,435 £54,712 £126,906

Consultant (NI) take-home pay and inflation (real value)

The BMA’s calculations show that pay awards for consultants in Northern Ireland from 2008-09 to 2022-23 have delivered a real terms (RPI) pay cut of 30.7%.

CEAs (Clinical Excellence Awards Scheme) and impact on pay

In 2009/10, approximately 50% (686) of the consultant workforce in Northern Ireland held either local or national CEAs, costing in the region of about £14million.

We estimate that by 2019-20 only 300 consultants held awards and we estimate that this would equate to over £26 million in 2020-21. This means many consultants are not being recognised or rewarded for demonstrating excellence in their field of medicine, ultimately benefiting patient care. Collectively consultants are missing out on over £26 million.

We know that because of these real terms decline in our pay, more of us are retiring early, moving overseas, or reducing our hours. It is also making the role of a consultant less and less appealing to prospective consultants, either junior doctors in our own system or those who might want to come and work here. As a result, we continue to see large gaps appearing in the consultant workforce and more pressure on those who remain.

Where we are currently

Following the restoration of the Northern Ireland Assembly in February 2024, the Health Minister said that he intended to apply a pay uplift of 6%, as recommended by the Doctors and Dentists Pay Review Body (DDRB) in 2023, however we are currently still waiting for that to be paid to doctors.

We cannot allow our pay to continue to erode. If we do not take a stand now our pay will continue to decline.

How have we reached this point?

As outlined, due to sub-inflationary pay uplifts, over the last 15 years our pay has steadily eroded to the point where we have now experienced a 30.7% real terms pay cut.

Coupled with this has been a sustained period of political instability in Northern Ireland which has meant decisions to address workforce gaps, and stabilising and transforming the health service have not been taken, adding to the pressures doctors face.

While we have engaged in good faith with the DDRB for the last 15 years, the recommendations they have made around pay have not always been implemented by government. The actual application of the pay award in Northern Ireland has generally been extremely slow and it has taken months for it to be paid. This is unacceptable and out-with what happens in the other nations.

What action have we taken?

Rate card

We introduced a rate card for consultants to guide them in valuing additional work that they undertake outside of their contracted hours.

Indicative ballot

In 2023 we carried out an indicative ballot of consultants in Northern Ireland. 77.7% of respondents said they were willing to take industrial action.


We met with the Permanent Secretary for health and asked for the 2023-24 DDRB uplift of 6% to be applied immediately and to commit to full pay restoration. He was unable to commit to either of these requests. We recently met with officials from the Department of Health who were unable to committee to applying the terms of the English pay offer here, despite money being made available for this through Barnett Consequentials.

We have lobbied local MLAs and have asked them to support full pay restoration. We have asked the Secretary of State to release the funding to enable the recommended DDRB uplift to be paid in the first instance and this was refused.

Keep up to date with our campaign on the BMA NI X (Twitter) and Instagram accounts.