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 (referred to as 'extra-contractual work' or ‘non-contractual work’).
All extra-contractual work requires a separate agreement between you and the employer, for which you are entitled to be paid separately to your usual contractual pay.
Extra-contractual pay is subject to negotiation over terms, including pay. These rates of pay can be negotiated either individually or via representative structures:
- You are within your rights to negotiate your own rates of pay and are not obliged to undertake this work if you deem the rates of pay to be inadequate.
- Local negotiating committees (LNCs) are bodies in each hospital which are supported by the BMA to negotiate local terms and conditions and standardised rates with employers locally. However, even where such agreements are in place this does not override your right to refuse non-contractual work.
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 – including the different sets of rates and the situations they apply to
- Next steps of what you can do to secure those rates - including examples of negotiating non-contractual work and FAQs for negotiating rates
- Example responses to employer questions
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.
The BMA is now 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.
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.
Non-resident on-call (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.)
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.
Non-resident on-call (supervised working): £89/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.
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 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 BMA via our employment advice form.
What you can do
You can use the rate card anytime you are asked to do extra work beyond your job plan – like the examples given on this page.
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 we encourage you to negotiate to increase the rate using this guidance, which is informed by what we have seen work with other doctors using the rate card.
If a suitable rate is not offered, then we are asking NHS SAS doctors to decline the work unless a fair rate is paid.
For extra-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. This non-contractual work should not be simply timetabled into job plans at standard contractual rates.
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.
Specific examples of negotiating non-contractual work
We have highlighted several ways a particular type of additional work may be delivered and the different steps you can take for each one. Click on the arrow for each of the below sections to find out more.
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 you will need to write to your employer to give notice.
You will then need to offer and agree to a new rate with your employer that you determine fairly rewards you for your work. This can either be submitted as an individual or as a group to your clinical lead/clinical director, or alternatively via your Local Negotiating Committee (LNC). If you cannot reach agreement in your department then your LNC may take on the negotiation.
This relates to work that is regular and has been agreed on a longer-term basis.
Mutually agreed job plans with above 10 PAs will require at least 3 months’ notice to cease this work. 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 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.
Your terms and conditions state that you should have a minimum of one SPA (though some SAS doctors will have more agreed at a local level). It is essential that in seeking to cease your additional programmed activities (APA), you should not be reducing your SPA time, nor should you be obliged to drop activities that were not associated with the 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.
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.
This is often at very 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 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.
SAS doctors who work less than full-time (LTFT) undertaking extra-contractual work are entitled to the same rates of pay 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 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 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 SAS doctors. 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, giving notice of three months to discontinue extra-contractual work should be sufficient.
Until new rates of pay can be mutually agreed, the decision to cease undertaking such work should not place a SAS doctor in conflict with their obligations under the GMC's Good Medical Practice.
Negotiating your rates in practice – FAQs
The rate card can be used whenever you are asked to do extra work beyond your job plan. For example, if your rota co-ordinator, manager or clinical lead suggests you do something which isn't in your job plan. This might be a Saturday clinic or an extra theatre list on a Friday afternoon.
You could have the discussion at the point when they ask you either on email or in a conversation. Or you could say that you need thinking time and reply by email. Email can be a useful tool as it creates a paper trail of the rates and the conversations. For example, we sometimes have queries from members who are promised one thing verbally and then find the payment is much less.
The LNC negotiates on behalf of the doctors in the Trust, but collective negotiations are only as good as the members who influence them. Remember we are the BMA and we work together to improve terms and conditions for our members.
If you believe agreed rates are below what you are willing to work with, you are not beholden to agree to them (and can instead push to agree a deal for you, as an individual). If you manage to secure a preferred rate, this could in fact be used to help others (by setting a precedent). You as an individual are best placed to know your own value and have the power to advocate for its recognition.
You have a few options for taking action:
- You don’t need to wait for the next LNC meeting – you can contact LNC members for support. Find your LNC>
- You can speak to colleagues within your department. Senior doctors can negotiate together at a team or department level.
- You can ask your manager or your rota co-ordinator directly, and negotiate an individual rate.
For example, in the Trent region, SAS doctors in orthopaedics worked together with their consultant colleagues to agree that no one would work below the rate card – and this has led to success. In Yorkshire, doctors similarly banded together and refused to work unless they used the rate card.
At University Hospitals Sussex, consultants and autonomous SAS doctors secured higher rates after their trust attempted to introduce lower rates. A strong response from members was key to this success>
Remember that you can stay professional and collaborative, but still stand your ground: you do not have to agree to do work that is not in your contract.
You could:
- say ‘I do want to do the work. However, I don't believe that your offered rate recognises my value.’
- give a deadline for an increase in rates or notify that you will stop doing this work from that point if no increase is proposed by management.
- say ‘my time is worth more than this.’
- say that other organisations have paid higher rates.
- ask if there an escalation policy for rates.
- ask about time off in lieu of payment.
There should be no immigration obligations to perform extra-contractual work that falls outside the role and weekly working hours in your employment contract and Certificate of Sponsorship, nor should there be any visa implications to not agreeing to extra contractual work.
You should in any case be mindful of any visa requirements for a minimum earnings threshold that may be affected by industrial action, but we expect the vast majority of SAS doctors will have met this threshold unless working under exceptionally limited circumstances. If you have any other immigration concerns, you can email a BMA immigration adviser through our contact page.
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.
Consultants in the department are not demanding these rates, why are you?
I am charging a rate that I have determined appropriately rewards me for my time and work. There is a BMA rate card for consultants too and individuals can determine whether the rates they are paid offer appropriate reward for the work.
You have a responsibility to the patients
And 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 extra-contractual work is my choice. I have also given my employer the required notice.
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 already well paid
Our take home pay has fallen by nearly 25% in real terms since 2008/09. SAS doctors are an essential part of the NHS and deserve to have this erosion corrected. We are just seeking fair pay for this work.
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.
