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.
We are in the process of finalising the rate card guidance for those on the 2002 terms and conditions, and we will inform members on these contracts when we have finalised this.
What you will learn from this guide
All locum work, this being work not on your work schedule, needs to be agreed between the junior doctor and the employer and is subject to negotiation over terms, including pay.
The BMA would advise that junior doctors 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. This rate card and guidance sets out the minimum rate at which the BMA would advise a junior doctor to work a locum shift for an NHS Trust. This rate card and guidance does not apply to private work.
To ensure you are informed of your rights when it comes to locum activity, this guide will provide you with:
- description of work not covered under the terms and conditions of service of your substantive contract
- the minimum advised rates
- example responses to employer questions
We plan to update this at least annually in April based on RPI to ensure it keeps up with the rates of inflation. We will notify you if there are any changes in advance of this April date.
As a junior doctor, you can carry out additional activity over and above the standard commitment set out in your work schedule or rota up to a maximum average of 48 hours per week (or up to 56 hours per week if you have opted out of the WTR). We would emphasise to you that you should only take on further shifts where you feel it is safe to work and to monitor your working hours to ensure you are not impacting your physical and mental health.
Further to this, if you are working under the 2016 TCS, you are required to ensure that any additional hours of work do not breach any of the safety and rest requirements set out in Schedule 3 of the junior doctor TCS.
Doctors working under the 2016 terms and conditions
Your terms and conditions include this clause:
Schedule 1, para 4:
"A doctor will be prepared to perform duties in occasional emergencies and unforeseen circumstances (for example short-term sickness cover), if they are able and safe to do so, where the employer has had less than 48 hours’ notice, and the duty is for less than 48 hours’ duration of cover. Commitments arising in such circumstances are, however, exceptional and the doctor should not be required or expected to undertake work of this kind for prolonged periods or on a regular basis."
This is the contractual clause relevant to providing cover for other doctors, either in addition to working your own work schedule or by agreeing to amend your agreed contractual working pattern.
There are no definitions of the following words in your contract but the following could be considered in order to understand this clause:
You don’t have any other commitments, responsibilities or immovable plans. You are free and able to assist.
Covering a shift will not result in you knowingly breaching any of the rota rules:
- you will have 11 hours rest between any two shifts
- you will not work more than 7 consecutive day
- your average weekly working hours shouldn’t be more than 48 hours (unless you have signed a WTR opt out in which case you can work up to 56 hours per week on average) but never more than 72 hours during any consecutive period of 168 hours.
If you are not safe because you will knowingly beach any of these rules, then the GMC could deem that you were not competent to work. This is important if there were to be any complaint against your registration during that shift.
You may also not feel safe because – you don’t feel confident to work in an area or without additional support, if the staffing levels are known to be unsafe and you don’t feel competent or you feel otherwise too tired/unsafe to work an additional shift/ on call. You are responsible for determining in your professional judgement whether you are safe ‘to work’. It may well be that the service needs to consider asking a consultant to act down if there are safety concerns about the level of cover.
A general request should only go out if the gap is unforeseen, unpredictable and last minute, if the gap has been ongoing or known to exist by the Trust for longer than 48 hours, it is a Trust's management responsibility to resolve this gap; the minimum of 48 hours provides sufficient time to advertise for a locum shift or make other arrangements.
Asking for last minute cover should only occur when all other options have failed. Have they exhausted all other options?
Requests shouldn’t be a regular occurrence, if they are other staffing models may need to be considered. If there is no other alternative for staff sickness other than continuously relying on the same group to provide cover, other options need to be considered perhaps via the JDF or LNC.
Finally, you are not obliged to provide cover and although you may be asked to do so and can mutually agree to do so, you can also agree the rate of pay that would enable you either to work (and reasonably cover your costs and incentivise you) or decline to cover. There can be no repercussions on you for refusing to cover due to your own assessment of whether you feel safe and able to do so, this could be victimisation. You should never be coerced or bullied into providing cover and you should never be instructed to do so.
You can agree to swap a day to night or a day to weekend if this is mutually agreeable but you will need to be sure that you are at the very least receiving the additional enhancements for working unsocial hours. Equally, you may agree a locum rate or a different rate of pay for any extra contractual work.
BMA junior doctor minimum hourly locum rate card - valid until April 2024
|Weekday: 8am - 5pm||Weekday: 5pm - 8am||Weekend: 8am - 5pm||Weekend: 5pm - 8am|
Non-resident on-call rate: We would note that the availability rate for those not called in should be at least 50% of the rates set out above. If you are called in, you should then receive the rate for your shift on top of the availability rate.
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. These are to inform your employer that you will be setting rates for any ad hoc work that you are not already delivering
The conversation between a junior doctor and their Trust
We would emphasise that these advisory rates fairly represent the minimum of what a junior doctor is worth for these roles. What you would be asking for is to be fairly paid for the shift you would be working.
We would though stress that you must have the conversation and negotiate with the Trust before accepting the shift. You are unable to retrospectively agree a rate for a shift you have already agreed to work.
When you have the conversation with the Trust, be clear on what rate is being offered, whilst highlighting the advisory rate you are willing to work to, noting that this is exactly what you are worth and what would nationally be considered worthwhile for this shift as a minimum.
We would encourage you to highlight that, for this shift, you would accept the shift on the condition of the shift being paid at least the rate recommended by the BMA.
It is important that you are clear when discussing this with the Trust, and that you have this agreement in writing.
What is a doctor worth?
Junior doctors' skills and work have been undervalued for too long.
These rates are already being paid by some employers across the UK. These rates have been calculated based on data collected from Trusts, and to reflect the fairest rate that, at a minimum, a junior doctor should receive for these shifts.
Considering the huge responsibility and onerousness of undertaking clinical work through the night on-site, we believe this represents a reasonable rate of pay for locum work.
What you can do
Carefully consider whether the rates of pay offered by your employer are worth the loss of your free time, and whether they represent the realistic market value of your training and skills. We believe this should be at least the BMA minimum recommended rates. There may be circumstances in which your work would be worth more. We would encourage you to view these rates as the minimum attributable and for you to negotiate where you feel appropriate above these rates.
We would emphasise to all junior doctors that this is not only about each individual being fairly paid for their work, but for the collective and each junior doctor’s colleagues. We would emphasise that this is for your fellow staff to ensure everyone is fairly valued. We would ask junior doctors not to sell yourselves or others short.
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 junior doctors. Therefore, the decision to do so should not give rise to detriment to the patients currently in a junior doctor’s care.
Until new rates of pay can be mutually agreed, the decision to cease undertaking such work should not place a junior doctor in conflict with their obligations under the GMC's Good Medical Practice.
Example responses to employer questions
Below are some responses you may hear from your employers when negotiating rates for locum work and answers you may want to consider.
You cannot hold the department to ransom
This work is locum, and I have the choice to value my time appropriately. I am following the BMA minimum rate and charging £X. It is my right to earn appropriate rates for additional work I do outside of my contract. I would like to help my employer by doing extra work. However, I am not required to undertake the work and will not do so unless the BMA minimum is paid.
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 and using this as a threat for me to work extra in my own time is harassment. I continue to deliver everything expected of me as required under my contract and Good Medical Practice. Whether or not I undertake additional locum work is my choice. I have also given my employer the required notice. I will be reporting the threatened GMC referral to the BMA for its consideration.
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 have a responsibility to provide a 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 extra contractual it’s a matter for personal choice.
You’re just being greedy
This is not about being greedy but appropriately valuing the risk and responsibilities I am voluntarily undertaking in these locum shifts, and ensuring that the value I bring to the service is recognised.
You’re already well paid
Our pay has fallen significantly, particularly compared with other professionally accountable comparators in other safety critical roles and industries. Junior doctor pay has done markedly worse compared to other staff groups in the health service, who themselves have also performed worse than others in the public sector.
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 subsidize 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
What I do outside my contract is a personal choice and plenty of other professionals decline extra work if the remuneration is not appropriate.