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.
What you will learn from this guide
This guidance is designed to remind employed SAS doctors of their rights, when asked by their employer to deliver work that is over and above their standard contract and agreed job plan ('extra-contractual work').
This is work that requires you to enter into a specific, separate agreement to undertake the same and for which you are entitled to be paid separately to your usual contractual pay.
These rates of pay can be negotiated either individually or via representative structures. You are always entitled to refuse to undertake this work altogether.
To ensure you are informed of your rights when it comes to extra-contractual activity, this guide will provide you with:
- the BMA SAS minimum rate card
- two sets of rates and the situations they apply to
- next steps required to secure those rates
BMA minimum rate card
The decision to work overtime or additional hours and other activity, beyond the standard contract (such as waiting list initiatives) rests entirely with you.
You are not obliged to agree to any work beyond your standard contract and agreed job plan. You can therefore set a rate that you think appropriately reflects the value of your time. This is the case regardless of whether you work full-time (10 PAs) or less than full-time.
There is wide variation across England in the amount paid for this work. In order to achieve uniformity, fairness and consistency, we have developed a BMA minimum rate card.
This rate card is designed to help you consider the value of your time and the rates on which you will agree to deliver extra-contractual work to your employer.
We are advising all NHS SAS doctors to ensure that such extra-contractual work is paid at the BMA minimum recommended rate and to decline the offer of extra-contractual work that doesn't value them appropriately.
There are two sets of rates:
- rates for autonomous work
- rates for supervised work
We explain these two terms, and the situations in which they apply, in more detail below. The key principle is that people should receive the same pay for the same work.
This is equivalent to senior SAS or consultant activity and includes additional (i.e., extra-contractual):
- admin work such as validation notes;
- operating sessions, including pre-operative and post-operative care;
- ward rounds;
- outpatient activities;
- clinical diagnostic work;
- other patient treatment;
- public health duties;
- multi-disciplinary meetings about direct patient care;
- patient administration linked to clinical work (primarily, but not limited to, notes, letters and referrals);
- providing longer term cover for autonomous SAS doctors for on-calls where not done on a prospective basis
Autonomous SAS minimum extra-contractual rate card
Weekday: 7am-7pm*, £188/hr
Weekday: 7pm-11pm, £250/hr
Weekend: 7am-11pm, £250/hr
Overnight: 11pm-7am, £313/hr
Must include travel, pre/post op/admin time as per standard practice.
*This is extra-contractual work and therefore the definition of 'Out of hours' specified in the 2021 SAS contracts does not apply.
The supervised SAS rates apply where the work involves delivering care on rotas or in settings in which their work is supervised.
This includes Specialty Doctors whose work is overseen by a senior SAS or consultant colleague.
Examples include:
- providing additional intermediate tier on-call
- additional assistance in theatre or clinics for procedures
- assisting additional operating sessions
When acting up to cover a colleague and not being supervised, the autonomous SAS rates will apply.
Supervised SAS minimum extra-contractual rate card
Weekday: 7am-7pm*, £133/hr
Weekday: 7pm-11pm, £175/hr
Weekend: 7am-11pm, £175/hr
Overnight: 11pm-7am, £219/hr
Must include travel, pre/post-op/admin time as per standard practice.
*This is extra-contractual work and therefore the definition of 'Out of hours' specified in the 2021 SAS contracts does not apply.
Please note that the rate card has a limited lifespan. Due to current economic conditions, with inflation increasing and a lack of cost-of-living increases recommended by the DDRB, the BMA will update these rates from time to time.
Additional rates
Non-resident on-call:
- Supervised working - £89/hr paid when available but not working.
- Autonomous working - £125/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.
What you can do
Carefully consider whether the rates of pay offered by your NHS employer 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 to decline the work unless a suitable rate is paid.
We have produced a template letter that you can edit to inform your employer that you will be setting rates for any ad hoc work that you are not already delivering.
Dr Diary helps you to track your activities and steer your job plan.
Get alerted when you are working outside of your job plan by running the weekly comparison report and use the SAS rate card for any extra-contractual hours.
New to Dr Diary? Download on Android or iOS. Available to BMA members.
What extra-contractual work looks like
There are several ways that extra-contractual work may be delivered.
Sessions/PAs offered as waiting list initiatives (WLIs) or similar
This relates to work that is offered and agreed on an ad hoc basis, and where a separate agreement is entered into each time the work is offered and taken on.
If you are unhappy with the rates your employer is offering or paying for this kind of work and you wish to renegotiate the terms, you will need to offer and try to agree a new rate with your employer.
The offer can either be submitted as an individual or as a group to your clinical lead or clinical director, or alternatively via your Local Negotiating Committee (LNC). The LNC is the body in the hospital which is supported by the BMA to negotiate local terms and conditions of service. If you cannot reach agreement in your department then your LNC may take on the negotiation.
Additional work above 10 PAs included in job plan
This relates to work that is regular and has been agreed on a longer-term basis. In this situation, if you have agreed a job plan with additional activity over and 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 nationally agreed contractual commitment for full-time SAS doctors is 10 PAs (though the same applies to those working less than full-time for any PAs worked over and above their contractual commitment). 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.
Additional hours for acute specialties
Many SAS doctors who work in acute specialties will not undertake 'catch-up work' or WLIs but will be frequently asked to undertake additional hours, often at very short notice, either as what is misleadingly termed as 'locum hours', 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 SAS doctors to agree to undertake this additional work, except in instances where unforeseen short-term cover is required and delivering it is 'practical' for the SAS doctor in question. However, where this is the case, such cover should be for no longer than 72 hours, after which point the employer should have made alternative arrangements, whether by engaging a locum or securing agreement from substantive staff to continue providing cover.
In all other instances, SAS doctors should consider whether the rate offered by their NHS employer is appropriate and, if not, seek to agree a new rate.
Additional hours for those working less than full-time (LTFT)
SAS doctors who work less than full-time (LTFT) and who are asked to undertake extra-contractual work are entitled to the same rates of pay as their full-time colleagues.
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 contractual commitment 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 is acceptable to you.
Professional obligations
The clinical and professional responsibility you have for your patients' care does not mean that you are required to provide services over and above your contractual commitment, including those listed above.
It is open to SAS doctors to give reasonable notice to cease undertaking such additional services where a mutually acceptable rate of pay has not been agreed.
It is the employer's obligation to make appropriate provision for the care of patients and they should be capable of putting this in place within a three month's period of notice. Therefore, giving notice of three months to discontinue extra-contractual work should be sufficient.
