Please note that the rate card has a limited lifespan. Due to current economic conditions, the BMA will update these rates from time to time.
Please note that the rate card and this guide do not apply to Waiting List Initiative (WLI) work under Paragraphs 2.36–39 of the Amendment to the National Consultant Contract in Wales (the Amendment), or for exceptional resident on call work covered under paragraph 3.8 of the Amendment (see below).
The rate card and the references to negotiation in the guide below do not apply in those circumstances.
What you will learn from this guide
All work outside the agreed job plan (non-contractual) 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 and are not obliged to undertake this work if they deem the rates of pay to be inadequate. Local Negotiating Committees (LNCs) are able to negotiate standardised rates with employers locally. However, even where such local agreements are in place, this does not mean you have to accept an offer of non-contractual work.
To ensure you are informed of your rights when it comes to non-contractual activity, this guide will provide you with:
- examples of non-contractual work, i.e. work which is not covered under the consultants' standard terms and conditions of service
- basic rates of pay
- example responses to employer questions
Examples of non-contractual work
The following are general examples of non-contractual work where the performance of and the rate of pay (or sessional allowance or time off in lieu attached to it) need to be agreed by you and your employer.
Examples of work which may not be covered by contractual requirements and/or other types of work that are regularly undertaken by consultants, over and above their standard contracted work and constitute non-contractual work:
- Weekend clinics
- Extra lists at the weekend (including trauma lists)
- Covering long term absence due to sickness
- Additional shifts (e.g., in emergency departments)
- Ward rounds (including post-on call ward rounds) outside of 9am to 5pm, Monday to Friday
The above list is not exhaustive.
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.
The guidance below addresses the steps to take in relation to non-contractual work that has been incorporated into your 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]
Specific examples of additional work (including non-contractual work)
As a further detailed example, we have highlighted several ways a particular type of additional work may be delivered and the different steps you can take for each one. This is not exhaustive.
If you no longer wish to work above 10 sessions, you are required to give at least 3 months’ notice before ceasing additional sessions above 10 as part of a mutually agreed job plan (for example, a 12-session job plan).
Additional sessions above 10 can be stopped with notice as the national contract for full-time consultants is for 10 sessions. The same applies to those working less-than-full-time for any sessions worked over their contracted amount.
Once you have given notice to stop additional sessions, it is open to you and your NHS employer to renegotiate the terms. You can offer to undertake the work for a better rate of pay.
Many consultants who work in acute specialties will not undertake ‘catch-up work’ or WLIs but will be frequently asked to undertake additional hours.
This is often requested at short notice, either as 'locum hours' (though this name is misleading) or being asked to provide additional clinical cover on their days off.
Again, there is no contractual obligation for consultants to agree to undertake this additional work. The exception to this would be where unforeseen short-term cover is required to deputise for absent consultant or associate specialist colleagues during the working day and delivering this is 'practicable' for the consultant in question. In practice, 72 hours' notice is sufficient for an employer to make alternative arrangements and, provided this notice is given, it should not be considered 'unforeseen short-term cover'.
In all other instances, consultants should consider whether the rate offered by their NHS employer is suitable and, if not, seek to agree a new rate.
We would consider that consultants working less than full-time (LTFT) undertaking non-contractual work should be entitled to the same rates as their full-time colleagues for work conducted over and above their contract.
Some employers argue that, for those on LTFT contracts, any sessions of additional work up to the 10 of a full-time contract should be paid at standard contractual rates, but we do not consider this should be the case.
These are both covered by existing contractual provisions within the Amendment and the rates set out in the rate card do not therefore apply.
The Amendment provides that WLI work is voluntary, however, and provides a rate of pay (the annex referenced in paragraph 2.39), currently valued at £679 per session (3.75 hours). Although you are not required by contract to undertake WLI work, if you do undertake it, the terms are pre-agreed in your employment contract. WLI is not a form of non-contractual work in the sense we are using in this guidance.
In exceptional circumstances where you are requested and agree to be immediately available i.e., resident on call e.g. to cover unexpected absence of a junior doctor between 5pm and 9am on weekdays and across the entirety of a weekend, Paragraph 3.8 of the Amendment will apply. You will be remunerated at three times the sessional payment at Point 6 of the Consultant salary scale, excluding commitment awards and Clinical Excellence/Impact Awards. In such circumstances, there will be an agreed compensatory rest period the following day.
The rates of pay for WLI work and exceptional resident on call work under paragraph 3.8 are already agreed, so the rate card and this guidance on negotiating rates do not apply.
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 Cymru Wales 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 Cymru Wales 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.
Work covered:
Non-contractual work, e.g.
- Weekend clinics
- Additional weekend lists inc. trauma lists
- Covering long-term absence
- Additional shifts inc. Emergency Department, etc
Rates:
- Weekday: 9am - 5pm, £161 per hour
- Weekday: 5pm - 9pm, £215 per hour
- Weekend: 9am - 9pm, £215 per hour
- Overnight: 9pm - 9am, £269 per hour
Must include travel, pre/post op, admin time as needed.
*Waiting List Initiative sessions are paid in accordance with paragraphs 2.36-2.39 of the Amendment to the National Consultant Contract in Wales (the Amendment) at the rate of £679 per session.
*Exceptionally where a consultant agrees to be immediately available i.e. resident on-call e.g. to cover a junior doctor absence, payment will be in line with paragraph 3.8 of the Amendment.
Consultant minimum non-contractual rate card
Work covered:
Non-contractual work, e.g.
- Weekend clinics
- Additional weekend lists inc. trauma lists
- Covering long term absence
- Additional shifts inc. Emergency Department, etc
Rates:
- Weekday: 9am - 5pm, 2.5 hours = 1 session
- Weekday: 5pm - 9pm, 2 hours = 1 session
- Weekend: 9am - 9pm, 1.5 hours = 1 session
- Overnight: 9pm - 9am, 1.25 hours = 1 session
Must include travel, pre/post op, admin time as needed.
Consultant minimum rate card for sessions
Additional rates
-
Non-resident on-call: £108/hr* paid when available but not working. For any time spent working during this period, the hourly rate, as specified within the rate card, will apply.
* This figure will be varied from time to time in line with inflation as per the other values in the rate card.
What is a doctor worth?
NHS doctors' skills and work have been undervalued for too long.
The BMA Cymru Wales recommended minimum rates are already being paid in some parts of the UK, except for the overnight rate. We have based the overnight rate on the bottom end of the normal rate expected for a lawyer, accountant or management consultant during daytime hours. Your hospital will be paying people in these professions at these rates already, as will the NHS in general.
Considering the huge responsibility and onerousness of undertaking clinical work through the night on-site, we believe these represent reasonable rates of pay for non-contractual work.
What you can do
Carefully consider whether the rates of pay offered by your NHS employer are acceptable to you, and whether they represent the realistic market value of your training and skills. We believe this should be at least the BMA Cymru Wales minimum recommended rates.
For non-contractual work that is job planned, you may wish to give formal notice that such work will cease after three months from the date of notice, unless a suitable rate can be agreed.
We have produced a template letter that you can edit to address your own circumstances, as well as a pdf that you or multiple colleagues can complete, sign and send to your employer.
This non-contractual work should not be simply timetabled into job plans at standard contractual rates.
We are in the process of producing separate template letters for those who wish to give notice that they will cease forms of non-contractual work that they are already delivering unless new rates can be agreed.
Professional obligations
The clinical and professional responsibility you have for your patients does not mean that you must provide services over and above those for which you are contracted, or that you cannot give reasonable notice to cease doing such additional services.
Indeed, the overall responsibility for maintaining clinical services lies with the employer and not individual consultants. If you are giving notice to discontinue non-contractual work your employer can reasonably be expected to make alternative arrangements for the provision of care by the end of the three-month notice period, which you can provide, before the work ceases to be undertaken.
Therefore, the decision to do so should not give rise to detriment to the patients currently in a consultant's care or raise any issue in terms of the consultant’s professional obligations.
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, and I have the choice to value my time appropriately. I am following the BMA minima and charging £X (or X sessions). The average consultant take-home pay is down nearly 35% compared to inflation since 2008/09, and it is my right to charge 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 to undertake, and I should not be made to feel guilty about not undertaking, extra work in my own time for inadequate rates of pay.
This is a GMC matter
I do not agree. I confirm that I will 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. I have given adequate notice to my employer of discontinuing to enable them to make alternative arrangements. I am also available to take on work for reasonable rates.
You are taking money from other staff
The funding of the Welsh health service is a matter of political choice for the Welsh 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 Welsh Government has a responsibility to provide a Welsh 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
Our take home pay has fallen by nearly 35% in real terms since 2008/09; correcting for that in part 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 whose pay has performed worse than others in the public sector.
There is a financial crisis
We cannot expect NHS staff to subsidise the service with their own pay.
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
Plenty of other professionals decline extra work if the remuneration is not appropriate.
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