What you will learn from this guide

All non-contractual work outside the agreed job plan needs to be additionally agreed between the SAS doctor and the employer and is subject to negotiation over terms, including pay. SAS doctors are within their rights to negotiate their own rates of pay for non-contractual work and importantly are not obliged to undertake this work if they deem the rates of pay to be inadequate.

This guide provides you with:

• examples of non-contractual work, i.e. work which is not covered under the SAS doctor's agreed job plan
• suggested rates of pay for non-contractual work
• example responses to employer questions

Waiting List Initiative work (WLI)

Work which the employer identifies as needed to address national or local waiting list targets is defined as ad hoc Waiting List Initiative (WLI) work.

If you are on the 2022 SD or Specialist contract then WLI work is covered by these contracts and will be paid at an agreed rate of twice the hourly rate for the top of the SD or Specialist payscale as appropriate. Therefore in this case, the rate card rates will not apply.

If however you are on the 2008 SD or Associate Specialist contract then this work is not covered by the provisions in those contracts and the rate card rates do apply.

Examples of non-contractual work

The following are general examples of non-contractual work where the performance of the work and the rate of pay/PA allowance/time off in lieu attached to it must be agreed by you and your employer in advance.

Examples of work which may fall outside of direct contractual requirements:

1. Additional clinics (eg covering for absent colleagues)
2. Extra lists at the weekend (including trauma lists)
3. Covering long term absence due to sickness
4. Additional shifts or additional on-call (e.g., in emergency departments or ICU)
5. Ward rounds, post-on call ward rounds or ward cover outside of 7am to 7pm, Monday to Friday, and excluding those that are job planned for Saturday 9am to 1pm by agreement
6. Acting down for junior colleagues where there is no resident on-call policy agreed.
7. Cover for vacancies or rota gaps
   
   

Please note: If you are on the 2022 SD or Specialist contracts then you are expected to provide cover for unexpected absence for the first 72 hours (Schedule 3 paragraph 4) and the rates for this work are as set out in the contract (Schedule 10, paragraph 23). A doctor is expected to be flexible and to cooperate with reasonable employer requests to provide short-term cover for the unexpected absence of their usual colleagues, where it is safe and practicable, and the doctor is competent to do so. In this instance the rate card will not apply.

This list is not exhaustive. There are other types of work that are undertaken by SAS doctors over and above their standard contracted work and constitute non-contractual work/overtime to which the rate card rates would be applicable.

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.

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]

What is a SAS doctor worth?

The decision to do non-contractual work rests with the doctor. It is entirely up to the individual to decide firstly if they are willing to do the work and secondly whether the rate of pay offered by their NHS employer is enough recompense for them for their commitment to undertake this additional work.

There is wide variation around Scotland in the remuneration for this work and, in order to achieve uniformity, fairness and consistency, we have produced a BMA rate card. This can be used to help you consider the value of your work and whether the rate your employer is offering is appropriate, fair, and how this compares with what is paid elsewhere in your service.

Doctors' skills, knowledge, work and health have been undervalued for too long. The rates on the card are increasingly being paid by NHS employers elsewhere in the UK. Considering the huge responsibility and onerousness of undertaking additional clinical work, we believe this represents a reasonable rate of pay for non-contractual work.

The current rates can be found below and these rates will be reviewed and updated regularly.

Additional non-contractual hours for those working less than full-time (LTFT)

SAS doctors working less than full-time (LTFT) who undertake non-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 should be paid at standard contractual rates, but this is not the case.

Any work beyond your agreed contractual commitment is, by definition, non-contractual and if your employer wishes to secure your agreement to undertake it, the remuneration should represent your value, and may reflect the rate card rates. For further advice or support please contact our employment advisors at [email protected]

Professional obligations

The clinical and professional responsibility consultants have for their patients does not mean that are required to provide services over and above those for which they are contracted. Indeed, the overall responsibility for maintaining clinical services lies with the employer and not individual doctor.

That said, in emergency situations arising at the place of work there may be a duty, implied from Good Medical Practice, to intervene even if action is not strictly required by the terms of the contract. The difference, however, is between such situations and where a doctor is required to act on a planned or regular basis, or where the doctor is asked to intervene because of a colleague taking industrial action.

What you can do

You will need to carefully consider whether the rates of pay offered by your NHS employer are acceptable to you, whether they 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 decline the work unless a suitable rate is paid.

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 so I am not obliged to do it. If I agree to do it, I can value my time appropriately. My rate reflects the BMA rate card so I am charging £X (or X PAs). The average specialty doctor or AS take-home pay is down nearly 24% compared to inflation since 2008/09, and it is not unreasonable to earn 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 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 to the GMC to make me work extra in my own time is inappropriate. I 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.

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 has a responsibility to staff and fund the 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 money

Being non-contractual it’s a matter for personal choice.

You’re just being greedy

My pay should reflect the value of my training, skills and experience. Take home pay for SAS doctors has fallen by nearly 24% in real terms since 2008/09; seeking appropriate redress for this work is not being greedy.

You’re already well paid

Our pay has fallen compared with comparators and the private sector (our true comparators).

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 subsidise the service.

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.

BMA minimum rate card

The decision to take on non-contractual work (such as waiting list initiatives) rests entirely with you.

You are not legally required to take on non-contractual work which your NHS employer offers you. If you are interested in taking on non-contractual work, you can set a rate for your work that you think appropriately reflects the value of your time. This is the case regardless of whether you work full-time or less than full-time.

There is wide variation around the country in the amount paid for this work. In order to help achieve uniformity, fairness and consistency, we have developed a BMA Scotland minimum rate card. 

We recommend that all NHS SAS doctors reflect on whether the rates they are currently being paid for non-contractual work are fair and acceptable. The BMA Scotland recommended minimum rates, set out on the rate card, are what the BMA considers to be the minimum fair rates of pay for NHS SAS doctors performing non-contractual work. They are a guide to help you consider what rates you are prepared to accept.

Please note: Rates for Waiting List Initiative work are covered by the 2022 Specialty Doctor and Specialist contracts and the rate card is not applicable. However for those on the 2008 SD or AS contracts, there are no contractual WLI rates and therefore the rate card rates would be applicable for doctors who remain on the 2008 contracts.