What you will learn from this guide

This guidance is designed to remind SAS doctors employed in the NHS of their rights when asked by their employer to deliver additional work that is not covered by their obligations under their employment contract and is not part of their agreed job plan. The BMA refers to such work as 'non-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.

Rates of pay for non-contractual work can be negotiated either individually or raised via representative structures such as Local Negotiating Committees (LNCs). You are generally entitled to refuse to undertake this work altogether.

To ensure you are informed of your rights when it comes to non-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 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 Cymru Wales 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 Cymru Wales 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.

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. A key principle is that the BMA believes people should receive the same pay for the same work.

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.

What you can do

Carefully consider whether the rates of pay offered by your NHS employer for non-contractual work are acceptable to you, and whether they represent the realistic market value of your training and skills. We believe this should be at least the BMA Cymru Wales minimum recommended rates.

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 are setting your own rates for any non-contractual work that you are not already delivering.

• Template letter (Word document)
• Template letter (PDF)

What non-contractual work looks like

There are several ways that non-contractual work may be delivered.

Sessions 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. If you have exhausted all options and you are unable to reach an agreement, you could raise this 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.

Additional work above 10 sessions 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 session contract (for example, an 11 session job plan with a session at the weekend) you will need to give three months' notice of ceasing doing this work.

Additional sessions above 10 can be stopped with notice as the nationally agreed contractual commitment for full-time SAS doctors is 10 sessions (though the same applies to those working less than full-time for any sessions 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 'locum hours', added onto the end of a scheduled shift, or by 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 acceptable to them and, if it is 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 non-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 sessions of additional work up to the 10 of a full-time contract must be paid at standard contractual rates, but we do not consider this should be the case.

By definition, any work beyond your agreed contractual commitment (including any agreed additional sessions that may form part of your job plan) is non-contractual. If your employer wishes to secure your agreement to undertake such non-contractual work, 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 non-contractual work 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 period of notice. Therefore, giving notice of three months to discontinue additional sessions should be sufficient.