What you will learn from this guide

All non-contractual work outside the agreed job plan needs to be additionally agreed between the consultant and the employer and is subject to negotiation over terms, including pay. Consultants are within their rights to negotiate their own rates of pay for non-contractual work and importantly are not obliged to undertake this work if they deem the rates of pay to be inadequate.

This guide provides you with:

• examples of non-contractual work, i.e. work which is not covered under the consultant’s agreed job plan
• suggested rates of pay for non-contractual work
• example responses to employer questions

Resident on-call (RoC) policies

Local Negotiating Committees (LNCs) are able to negotiate standardised rates with employers locally for resident on call (RoC). In line with paragraph 4.9.1 of the Scottish consultant contract, where LNCs have negotiated rates for RoC, those rates will apply and the rate card will not be applicable. However, even where such local agreements are in place, this does not override your right to refuse non-contractual work.

Rates of pay for Waiting List Initiative work (WLI)

Section 4.5 of the Scottish consultant contract describes the arrangements for work which the employer identifies as needed to address national or local waiting list targets (WLI work) as ad hoc.

• The contract provides that you are not required to undertake WLI work, but if you do agree to do this then the terms are already agreed within the contract.
• The contract provides that pay for WLI work is set at 3 times the hourly rate for point 20 of the consultant pay scale (or an equivalent mixture of pay and time off in lieu).
• The rates of pay for WLI work are therefore already agreed and covered by existing contractual provisions, so the rates set out in the rate card will not apply.

Examples of non-contractual work

The following are general examples of non-contractual work where the performance of the work and the rate of pay/PA allowance/time off in lieu attached to it must be agreed by you and your employer in advance.

Examples of work which may fall outside of direct contractual requirements:

1. Additional clinics (eg covering for absent colleagues)
2. Extra lists at the weekend (including trauma lists)
3. Covering long term absence due to sickness
4. Additional shifts or additional on-call (e.g., in emergency departments or ICU)
5. Ward rounds, post-on call ward rounds or ward cover outside of 8am to 8pm, Monday to Friday, and excluding those that are job planned for Saturday 9am to 1pm by agreement
6. Acting down for junior colleagues where there is no resident on-call policy agreed
7. Cover for vacancies or rota gaps

This list is not exhaustive. There are other types of work that are undertaken by consultants over and above their standard contracted work and constitute non-contractual work/overtime to which the rate card rates would be applicable.

It is important not to refuse to do, or to demand extra payment for, work that is currently part of your negotiated and agreed job plan.

If you are in any doubt about the status of a particular activity in your job plan, please contact our employment advisors at [email protected]

What is a consultant worth?

The decision to do non-contractual work rests with the consultant. It is entirely up to the individual to decide firstly if they are willing to do the work and secondly whether the rate of pay offered by their NHS employer is enough recompense for them for their commitment to undertake this additional work.

There is wide variation around Scotland in the remuneration for this work and, in order to achieve uniformity, fairness and consistency, we have produced a BMA rate card. This can be used to help you consider the value of your work and whether the rate your employer is offering is appropriate, fair, and how this compares with what is paid elsewhere in your service.

Doctors' skills, knowledge, work and health have been undervalued for too long. The rates on the card are increasingly being paid by NHS employers elsewhere in the UK. Considering the huge responsibility and onerousness of undertaking additional clinical work, we believe this represents a reasonable rate of pay for non-contractual work.

The current rates can be found below and these rates will be reviewed and updated regularly.

Additional non-contractual hours for those working less than full-time (LTFT)

Consultants working less than full-time (LTFT) who undertake non-contractual work are entitled to the same overtime rates as their full-time colleagues for work conducted over and above their contract.
Some employers argue that, for those on LTFT contracts, any PAs of additional work up to the 10 of a full-time contract should be paid at standard contractual rates, but this is not the case.

Any work beyond your agreed contractual commitment is, by definition, non-contractual and if your employer wishes to secure your agreement to undertake it, the remuneration should represent your value, and may reflect the rate card rates. For further advice or support please contact our employment advisors at [email protected]

Professional obligations

The clinical and professional responsibility consultants have for their patients does not mean that are required to provide services over and above those for which they are contracted. Indeed, the overall responsibility for maintaining clinical services lies with the employer and not individual consultants.

BMA minimum rate card

The decision to work additional hours or other activity beyond the standard contract rests entirely with the consultant.

There is wide variation around the country in the amount paid for non-contractual work. In order to achieve uniformity, fairness and consistency, we have developed a BMA Scotland minimum rate card.

The BMA recommends that all NHS consultants reflect on whether the rates they are paid for non-contractual work are fair and acceptable. The BMA Scotland recommended rates, set out on the rate card, are what the BMA considers to be the minimum fair rates of pay for NHS consultants performing non-contractual work. They are a guide to help you consider what rates you are prepared to accept.

• Download consultant rate card
• Download wallet-size printable rate card

What can you do

You will need to carefully consider whether the rates of pay offered by your NHS employer are acceptable to you, whether they are worth the loss of your free time and whether they represent the realistic market value of your training and skills. If not, then you may wish decline the work unless a suitable rate is paid.

Example responses to employer questions

Below are some responses you may hear from your employers when negotiating rates for non-contractual work and answers you may want to consider.

You cannot hold the department to ransom

This work is non-contractual so I am not obliged to do it. If I agree to do it, I can value my time appropriately. My rate reflects the BMA rate card so I am charging £X (or X PAs). The average consultant take-home pay is down nearly 35% compared to inflation since 2008/09, and it is not unreasonable to earn appropriate rates for additional work I do outside of my contract. I would like to help my employer by doing extra work, but if they are not paying a fair rate, I am not required to undertake the work.

You have a responsibility to the patients

I take that responsibility very seriously and will continue to fulfil all aspects of my contract and continue to deliver excellent care. However, I cannot be forced or made to feel guilty about not undertaking extra work in my own time for inadequate rates of pay.

This is a GMC matter

It is not a matter for the GMC and indeed threatening referral to the GMC to make me work extra in my own time is inappropriate. I continue to deliver everything expected of me as required under my contract and Good Medical Practice. Whether or not I undertake additional non-contractual work is my choice.

You are taking money from other staff

The funding of the health service is a matter of political choice for the government. I am only asking to be paid fairly for work I undertake that is outside of my contract.

You are taking money from patients

The government has a responsibility to staff and fund the health service, it is not the responsibility of individuals. Part of that responsibility is to pay staff enough to motivate them. It’s a political choice.

Your colleagues are agreeing to less

Being non-contractual it’s a matter for personal choice.

You’re just being greedy

My pay should reflect the value of my training, skills and experience. Take home pay for consultants has fallen by nearly 35% in real terms since 2008/09; seeking appropriate redress for this work is not being greedy.

You’re already well paid

Our pay has fallen compared with comparators and the private sector (our true comparators); consultant pay has done markedly worse even compared to other staff in the NHS.

There is a financial crisis

It’s not fair that the public sector is expected to pay for every financial crisis when others in the economy do not. We cannot expect NHS staff to subsidise the service.

It is not in our budget

It is not my responsibility to ensure that sufficient budget is allocated to adequately pay doctors to provide the service.

It’s not professional

What I do outside my contract is a personal choice and plenty of other professionals decline extra work if the remuneration is not appropriate.

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