In England, medical public health consultants may be employed in a number of organisations, including:
- Local Authorities (LAs)
- Public Health England (PHE)
- Universities
- Research organisations
- NHS England
- Health Education England (HEE)
- Clinical Commissioning Groups (CCGs)
- Independent companies
- Non-governmental Organisations (NGOs)
- Voluntary organisations
- Departmental bodies
The majority of medical public health consultants in England are employed by local authorities (we estimate approximately 250-300) and PHE (approximately 350).
Local authority employment
The contractual terms of doctors employed in local authorities depend on the individual doctor’s circumstances. If their employment was transferred as a result of the Health and Social Care Act 2012 from the NHS into a LA in April 2013, their terms and conditions of service (TCS) are likely to be different to those who have been directly appointed by the LA since April 2013.
Transferred staff
Of those who transferred from the NHS in 2013, many will remain on protected NHS terms, unless they have recently accepted terms and conditions of service that have been harmonised with Local Authority contracts.
Most medical consultants who transferred from the NHS remain on the NHS consultant contract. All schedules of the consultant terms and conditions of service continue to apply. Read BMA guidance on the consultant contract.
Directors of Public Health who transferred from the NHS are also usually employed on the NHS consultant contract. They will also receive a pay supplement based on the size of the populations they are responsible for, and they may also receive additional programmed activities (APAs) in recognition of their work.
Annual pay award
Whilst the NHS consultant annual pay award is subject to the recommendations of the DDRB , LAs determine the pay award for their employees including public health consultants on protected NHS terms. Pay awards will therefore differ from employer to employer.
Access to Clinical Excellence Awards (CEAs)
Clinical Excellence Awards (CEAs) recognise and reward exceptional personal contributions to the NHS by consultants through a scale of awards payments. Under the transfer agreement, public health consultants continue to be eligible to apply for local and national CEAs.
In order to ensure LAs can fulfil their statutory responsibility to enable CEA payments for their public health consultant employees, PHE administers the local scheme on behalf of LAs as well as for their own staff and for clinical academics with honorary contracts at PHE.
Further information on the national CEA scheme can be found on the Advisory Committee for Clinical Excellence Awards’ (ACCEA) website.
Pension scheme
As part of the transfer agreement, public health staff who transferred to LAs continue to have access to the NHS Pension Scheme. They will also continue to have access to the NHS Pension Scheme if, after the transfer, they are compulsorily moved into a new post with their LA.
Detailed information is available here and individual advice is available from the BMA’s pensions advisers.
Appraisal and revalidation
PHE is the designated body for public health consultants working in LAs. PHE has a network of advisers trained in appraisal and revalidation whom consultants working in LAs can contact. For more information about the appraisal and revalidation process, email PHE.
Continuity of service
The extent to which an employee is entitled to certain employment benefits such as sick pay, maternity leave and redundancy pay usually depends upon the length of their continuous service with an employer or within a sector. Unfortunately, for staff moving out of the NHS and into LAs, previous NHS service cannot always be recognised.
However, the LGA (Local Government Association), PHE, the ADPH (Association of Directors of Public Health) and the FPH (Faculty of Public Health) all encourage LA employers to recognise previous NHS service wherever possible.
The BMA has been lobbying government to facilitate the recognition of continuous service and ensure free movement across the various employers in the public health system.
The right to remain on protected terms
We know that some LA employers have sought to put public health consultants who transferred onto different contractual terms which are aligned with those offered to other LA staff – a process often called ‘harmonising’. The BMA’s position is that, as part of the 2013 transfer processes, such staff should be able to remain on their NHS terms for an unlimited period.
Any changes in the workforce following a transfer must be subject to formal consultation. Members affected by these issues should seek advice from the BMA as soon as they become aware their employer is considering TCS harmonisation.
New appointments to LAs
In order to ensure LA public health teams are adequately staffed and salaries are competitive with those available elsewhere in the health sector, medical public health consultants working in LAs should be employed on NHS equivalent terms and conditions of service (TCS). However, LAs are not obliged to offer NHS pay and TCS to newly appointed public health consultants. Employers may have different approaches towards the packages they are prepared to offer but may be flexible and prepared to negotiate in order to attract and secure the best candidates.
LAs should use job evaluation systems to grade all roles within the organisation to ensure fairness. Since medical roles are rare in LAs, we have concerns that job evaluation systems do not always result in fair grading for public health consultant posts. Often, posts are advertised at a salary and grade that is not comparable with NHS TCS. Joint BMA and Faculty of Public Health (FPH) guidance on job evaluation for public health consultants is available here.
When applying for jobs, consultants should request information about contractual matters and pay in advance so that they can make a decision about the suitability of the post. Clarification on the likelihood of the continuing payment of any CEAs should be requested. Members should seek advice from the BMA on the pay and conditions they are being offered and always ensure contracts are checked by the BMA before they are agreed.
Public Health England (PHE)
PHE was established on 1 April 2013 under the Health and Social Care Act 2012, and staff from over 70 separate organisations - primarily from the former Health Protection Agency - were brought together under a single employer.
PHE employs medical staff across all parts of its business. Doctors are employed in management roles as well as more public-facing posts.
Terms and conditions
As part of the transfer agreement, all medical staff within a “ring-fence” of posts considered to be NHS-facing were employed on terms and conditions of service (TCS) that are analogous to the NHS consultant contract. For staff within that ring-fence, their pay and TCS should remain aligned with the national NHS contract.
Annual pay award
In line with consultants employed in the NHS, PHE consultants will receive annual pay uplifts in line with those recommended by the DDRB and implemented by the Government.
Access to Clinical Excellence Awards (CEAs)
Clinical Excellence Awards (CEAs) recognise and reward exceptional personal contributions to the NHS by consultants through a scale of awards payments.
For consultants who transferred into PHE, CEAs in payment will continue to be paid, subject to PHE CEA policy. Consultants may apply for new local awards through PHE’s Local CEA scheme.
Further information on the national CEA scheme can be found on the Advisory Committee for Clinical Excellence Awards’ (ACCEA) website.
Pension scheme
PHE consultants continue to have access to the NHS pension scheme.
Continuity of service
For posts within PHE’s ‘clinical ring fence’, previous NHS service will be counted as ‘continuous service’ for employer benefits. As PHE is a civil service employer, any employee’s previous civil service will also be counted.
Appraisal and revalidation in PHE
PHE is the designated body for all medical staff employed there. BMA advice on appraisal and revalidation for consultants is available.
Collective bargaining and BMA support
PHE has a Local Negotiating Committee which is recognised and supported by the BMA. Individual advice on contractual matters is available to BMA members in the usual way.
NHS England
A small number of public health consultants are employed directly by NHS England. The NHS consultant contract should be used for all NHS England consultant appointments.
Clinical Commissioning Groups
Staff who, as part of the 2013 changes, transferred into direct CCG employment should have moved into their new role on protected terms. However, CCGs have flexibility to offer their own TCS to any new appointments after April 2013. The BMA strongly advises that all consultant appointments should be made on the NHS consultant contract.
Other employers
There is no guidance or requirement for specific employment terms to be offered in other organisations, but we would advise members to propose to their new employer that the NHS consultant contract should be used as the model.