Consultant non-contractual work

This page provides guidance on undertaking non-contractual work as a consultant in England.

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What you will learn from this guide

All non-contractual work needs to be agreed between the consultant and the employer and is subject to negotiation over terms.

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, with the express agreement of members, to negotiate standardised rates with employers locally. However, even where such agreements are in place this does not override your right to refuse 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 work not covered under the consultants' standard T&C's of service
  • example responses to employer questions

In Wales

Please note that we have a separate guide which sets out rights and suggested pay rates for engaging in non-contractual work for NHS employers as a consultant in Wales.

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Examples of non-contractual work

The following are general examples of non-contractual activity where the performance of and the rate of pay (or PA 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:

  1. Catch-up work such as waiting list initiatives (WLIs) and similar
  2. Weekend clinics
  3. Extra lists at the weekend (including trauma lists)
  4. Covering long term absence due to sickness
  5. Additional shifts (e.g., in emergency departments)

The above list is not exhaustive. There are other types of work that are regularly undertaken by consultants, over and above their standard contracted work and constitutes extra-contractual work or overtime.

This includes activity such as:

  • ward rounds (including post-on call ward rounds) in premium time (time outside of 7am-7pm Monday to Friday)
  • providing cover for foreseeable junior doctor colleague absences
  • programmed resident on-call in premium
  • periods of on-call in premium time which necessitate a consultant in practice to be resident whilst 'on call'.

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 sets out the steps to take in relation to extra-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 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. In this case, we have used arrangements around waiting list initiatives as a specific example.  


Sessions offered as waiting list initiatives (WLIs) or similar

Use the rate card and write to your employer to give notice, usually three months, to cease this type of work

You will then need to offer and agree a new rate with your employer. This can either be submitted as an individual or as a group to your clinical lead/clinical director. We are developing a template letter to help with this. 

The model contract states that you should typically have 2.5 PAs of Supporting Professional Activity (SPA). It is essential that in seeking to cease your additional PA activity, you should not be reducing your SPA time. Nor should you be obliged to drop activities that were not associated with the Additional Programmed Activities (APA) when it was originally agreed. Job planning is a negotiation and we would urge you to review our guidance on how to approach these meetings.

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Additional work above 10 PAs included into job plan

Mutually agreed job plans with above 10 PAs will require at least 3 month's notice to cease this work

If you have agreed a job plan with additional activity above your standard 10 PA contract (for example, an 11 PA job plan with a session at the weekend) you will need to give three months' notice of your intention to cease doing this work.

Additional PAs above 10 can be stopped with notice as the national contract for full-time consultants is for 10 PAs (though the same applies to those working less than full-time for any PAs worked over and above their contracted amount).

Of course, the work will still need to be done and you are within your rights to be available to undertake the work at a new agreed rate in the future.

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Additional work in private practice

Where a consultant wishes to undertake private practice, their employer has the right to first offer them an additional Programmed Activity over and above their standard commitment.

A full-time consultant delivering 11 PAs will already be fulfilling these obligations. If, however, a consultant declines to undertake that additional PA, and no other consultant in their department is willing to take it up instead, an employer is able to defer that consultant's pay progression for the year in question, if they proceed to undertake private practice. In view of the current tax implications of pensionable pay increasing suddenly, that may not be an issue in the short term. Positions will of course vary.

Additionally, if you decline this additional session but someone else in the department picks up the extra work, again you will suffer no detriment.

If you are already doing an additional session beyond your standard contracted amount and you wish to stop, simply write to your employer to give your notice to cease doing this work, unless acceptable rates are negotiated.

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Additional hours for acute specialties

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) added onto the end of a scheduled shift, or being asked to provide additional clinical cover on their days off.

Again, there is no obligation for consultants to agree to undertake this additional work, save for in instances where unforeseen short-term cover is required and delivering it is 'practicable' for the consultant in question. In practice, 72 hours' notice is sufficient for an employer to make alternative arrangements and would not be considered 'unforeseen short-term cover'.

In all other instances, consultants should consider whether the rate offered by their NHS / HSCNI employer is suitable and, if not, seek to agree a new rate.

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NHS Pressures Waiting List
Additional hours for those working less than full-time (LTFT)

Consultants working less than full-time (LTFT) undertaking extra-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 must be paid at standard contractual rates, but this is not the case.

Any work beyond your standard contracted amount is, by definition, extra-contractual and if your employer wishes to secure your agreement to undertake it, they will need to offer a rate that you think appropriate.

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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. Employers should 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.

Until new rates of pay can be mutually agreed, the decision to cease undertaking such work should not place a consultant in conflict with their obligations under the GMC's Good Medical Practice.


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