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BMA ‘acting like football agents’ inflating extra shift pay, say trust chiefs

Published on: 20 Sep 2022

A row has broken out between trust bosses and the British Medical Association over the doctors’ union’s campaign to drive up consultants’ hourly pay rates for extra shifts, HSJ has learned.

The British Medical Association says its “rate card”, published over the summer, outlines the “minimum” hourly pay consultants should receive for additional work, like waiting list initiatives and weekend shifts.

The card says consultants should be paid a minimum of £250 per hour for overnight work; £200 per hour for weekend days and week day evenings; and £150 per hour for additional work on weekdays.

Trust bosses have reacted angrily to the amounts requested. One senior figure said the “optics are very poor” while another chief accused the BMA of “acting like football agents” trying to inflate their clients’ pay.

A senior figure familiar with negotiations told HSJ: “I think it’s misjudged. The optics of people on six figure salaries asking for many, many multiples of their hourly rate, when many of their colleagues are doing the same but for time and half or double time, especially during a ‘cost of living’ crisis, are very poor.”

But the BMA hit back, accusing trust leaders of “overworking and undervaluing” their consultants; working to suppress their pay; and arguing that “rates of pay [currently offered] do not adequately reflect the skills, experience and responsibility of consultants”.

The medical union also highlighted that real terms pay for an average consultant had fallen 34.9 per cent since 2008-9, even before another real terms pay cut this year was factored in.

BMA consultants committee chair Vishal Sharma told HSJ: “With the NHS as overstretched and understaffed as it is, NHS trusts are repeatedly asking consultants to do more and more work on top of their normal working hours, which as well as regular overtime at standard rates of pay often includes many unpaid hours of work on top of that.

“Consultants have had enough of being overworked, underpaid and undervalued in this way.”

A ‘very mixed’ picture across the country

One respected hospital boss who had spoken to a number of colleagues on the matter said the picture across the system was “very mixed”. This view was supported by the NHS Confederation.

At one end of the spectrum, there was a trust CEO who told HSJ the rate card represented “the biggest threat to [my trust’s] elective recovery”, while another hospital CEO branded it an “absolute hostage situation”.

Other trusts in different parts of England, however, reported their consultants had not made any demands for more money despite the rate card being widely publicised among consultant bodies.

HSJ also understands no consultants have yet refused to take on additional shifts as a result of this latest pay row.

The move is widely viewed by NHS bosses as the BMA trying to leverage the elective work to push the government into giving them a better pay award, following a decade of largely poor pay settlements for senior doctors.

But many chiefs expressed frustrated with the BMA for publishing the card in the first place.

One trust chief executive, whose consultants had not asked for more money, said: “The BMA appear to be operating like football agents and pushing up the rates based on their own egos rather than their members wishes.”

Waiting list initiative  pay rates vary substantially across England but several CEOs from different regions told HSJ the BMA’s rate represented a significantly uplift on what they were currently paying, and what they can ultimately afford.

One chief cited their rates as a comparison, which were a weekday rate of £125/hour, rising to around £170 on weekends – significantly less than the BMA’s minimum guide.

Trust bosses ‘minded’ not to meet BMA demands

NHS Employers chief Danny Mortimer said: “The unilateral intervention of the main medical trade union to seek to push out the premium even further ahead of that already paid has been met with concern by our members.

“The overwhelming majority are not minded to agree to the BMA’s demands, not least because of the much lower overtime rates available to other staff groups.”

However, Mr Mortimer added: “Our members do however absolutely recognise the substantive and very real concerns of senior doctors about the potential impact of pension growth and taxation.

“The government acted four years ago to alter annual allowance taxation, and we believe that abandoning its application to public sector pensions would be a sensible long term action.

“In the short-term… action must be immediately taken to avoid the present high levels of inflation impacting on assumptions of pension growth.”

BMA: rate card based on rates already offered

BMA consultants committee chair Vishal Sharma added: “The BMA’s rate card has been developed to [ensure] NHS trusts adopt a fairer and more consistent approach to overtime pay.

“The rate card has been based on rates already offered in parts of the country to reflect the market value of consultants’ work.

“As well as suggesting rates of pay for extra work, the rate card has been specifically designed to address high levels of burnout by ensuring that consultants who take on this additional work can instead receive time off in lieu.”

He continued: “For too long the NHS has run on the goodwill of its staff and it must stop. This government must realise that it needs to properly pay all healthcare workers for the valuable, often life-saving work that they do.

“This includes fair payment for contracted hours and for all the additional hours that doctors work. Retaining the current workforce must be the immediate priority and we need to see tangible plans from the Government to improve consultants’ pay and conditions.

“In the meantime, consultants will continue to negotiate fair rates of pay, consistent across the country, for the care and treatment they provide beyond their working week - just as any other worker would do.”