Calls for fresh talks as consultants in England reject Government pay offer

26th January 2024

The British Medical Association (BMA) is calling on the Government to discuss making improvements to its latest pay offer after consultants narrowly voted against it.

BMA consultant members in England voted 51.1% against the offer in a referendum held from 14 December to 23 January.

Some 23,544 consultants cast their vote – a turnout of 64.8% – of whom 12,037 voted against and 11,507 (48.9%) for the offer.

Dr Vishal Sharma, BMA consultants committee chair, said: ‘The vote has shown that consultants do not feel the current offer goes far enough to end the current dispute and offer a long-term solution to the recruitment and retention crisis for senior doctors.

‘It backs up conversations we’ve had with colleagues in recent weeks, who felt the changes were insufficient and did not give them confidence that pay erosion would be addressed over the coming years.

‘In addition, they were concerned about the fairness of the offer and how it impacted different groups of doctors. There were also clear concerns about changes to professional development time, and time dedicated to teaching and research.’

With such a slim margin, the BMA has announced it will not immediately resume strike action, instead giving the Government time to improve the offer.

Consultants in England have a mandate to take industrial action until 18 June 2024.

Dr Sharma said: ‘In the coming days we will be further engaging with consultants, and seeking talks with Government to explore whether the concerns expressed by our members during the referendum process can be addressed.’

Responding to the consultants’ vote, health secretary Victoria Atkins said: ‘I hugely value the work of NHS consultants and I am disappointed that after weeks of constructive negotiations the BMA has, by the narrowest of margins, rejected this fair and reasonable offer.

‘I want to build on our progress on waiting lists and for us all to be able to focus our efforts on offering patients the highest quality care. The Government is therefore carefully considering next steps.’

Earlier in January, some 58% of consultant members of the Hospital Consultants and Specialists Association (HCSA) voted against the pay offer.

HCSA president Dr Naru Narayanan also called on the Government to return to the negotiating table after the offer was rejected ‘on a number of points’, including further erosion of Supporting Professional Activities (SPA) time and the overall level of investment and unevenness of the award across the pay scale.

Dr Narayanan said: ‘We have listened to our members and the prospect of changes to SPA time in this offer rang clear alarm bells. They are deeply concerned that the time they need to develop their skills and impart knowledge to trainees has already been eroded beyond a sustainable level. They know first-hand the constant pressure they face from managers to reduce it still further.’

Targeting the suggested investment at specific pay points means ‘many consultants would have missed out on an uplift this year’, he said.

Dr Narayanan added: ‘The Government needs to revisit the investment it is willing to make in our most experienced doctors. This result is a wake-up call. We have observed the Prime Minister’s repeated suggestion that the senior doctors’ pay dispute had been resolved, but the result … shows there is no room for complacency given low morale and years of underinvestment in staffing.

‘We are confident that with a positive approach to further negotiations it is still possible to strike a deal which a majority of consultants will be willing to accept.’

BMA Cymru Wales’ consultants are also being balloted for strike action over the six weeks to 4 March 2024.

The rejection of the Government’s offer by BMA consultant members in England comes as the union’s junior doctors committee in England announced it is to reballot its members for another six months of industrial action.

The current mandate expires at the end of February and the new ballot will run from 7 February to 20 March 2024.

If returned with a ‘yes’ vote, the mandate for strike action in England would be extended to September 2024.

The new ballot will also include approval of Action Short of a Strike (ASOS), which encompasses any other industrial action taken in order to put pressure on the employer in a trade dispute, such as refusing to work overtime, but which does not amount to full walkouts.

In December, HCSA junior doctors in England voted by over 96% in favour of continued strike action over pay until at least June.

Consultant pay reform package agreed in principle with UK Government

27th November 2023

The UK Government, the British Medical Association (BMA) and Hospital Consultants and Specialists Association (HCSA) have reached an agreement in principle on a pay offer that could bring an end to consultant strike action.

The Government is offering a 4.95% investment in pay for this financial year, in addition to the 6% pay uplift already awarded.

The pay reform package would also see a reduction in the number of pay points from eight to four and reduce the number of years it takes a consultant to reach the top of the pay scales by five years.

It would also increase the starting pay for new consultants and secure an increase for the top pay point.

The consultant contract will also be amended to enable consultants to access enhanced shared parental leave arrangements. At present, these are available for all other NHS staff but denied to consultants.

‘While this offer does not deliver all that the BMA has asked for, significant progress has been made,‘ the BMA said.

The terms will be put to BMA and HCSA members via a referendum that will likely open in mid-December and run until late January 2024.

If accepted these changes will be implemented in April 2024 and pay increases backdated to January 2024.

No further strike action will be called while members are being consulted.  

If the offer is accepted, the BMA has agreed to call an end to strike action and to stop promoting the extra-contractual rate card for consultants in England.

However, a re-ballot on industrial action remains open and, if passed, would enable consultants to call further strikes in 2024 if the offer is rejected, the BMA said.

As part of the pay investment, funding for new Local Clinical Excellence Awards (LCEAs) will be moved into basic pay, meaning this money will become consolidated, pensionable, and subject to uplifts.

These uplifts will be determined by the outcome of the Review Body on Doctors and Dentists Remuneration (DDRB) process, the workings of which the Government has committed to overhauling.

This review, in conjunction with the BMA, will examine the appointments of members to the DDRB, the timing of the round, remit letters and terms of reference, and the data provided to the body on which it bases its recommendations, with changes to be implemented for the 2025/26 pay year, the Government said.

Responding to the proposed DDRB overhaul, the BMA said: ‘For far too long has the DDRB’s independence been eroded by successive Government’s looking to sway its decisions or setting its remit. Under the reform we have secured this should be less likely in the future.‘

Commenting on the consultant pay reform package, health secretary Victoria Atkins said: ‘I hugely value the work of NHS consultants and am pleased that we have been able to make this fair and reasonable offer after weeks of constructive negotiations. 

‘If accepted, it will modernise pay structures, directly addressing gender pay issues in the NHS. It will also enhance consultants’ parental leave options.

‘Putting an end to this strike action will support our efforts to bring down waiting lists and offer patients the highest quality care.’

Dr Vishal Sharma, BMA consultants committee chair, said: ‘We are pleased that after a month of intense talks and more than six months of strike action we never wanted to take, we have now got an offer we can put to members.

‘It is a huge shame that it has needed consultants to take industrial action to get the Government to this point when we called for talks many months ago.

‘The 4.95% investment and much-needed changes to the pay scale system comes after we successfully persuaded the Government to reform the punitive pension taxation laws earlier this year, and we also now have commitments to reforming the pay review process, which has been a key ask from the profession throughout our dispute.

‘Only by restoring the independence of this process can we hope to restore consultant pay over the coming years.’

Dr Naru Narayanan, HCSA president, said: ’Today’s announcement follows weeks of intense negotiations. Yet, while it has benefits for consultants, our executive expressed concerns about some parts of the package, including around changes to pay progression and [supporting professional activities] time.

’In coming days we shall do our utmost to educate our consultant members on the changes so they can make their own informed decision. Whatever that decision is, we shall be led by our members.

’While the ballot is open HCSA has agreed to pause strikes by consultants, but the mandate members have given us for industrial action will remain in place.’

Also responding to the pay offer, Sir Julian Hartley, chief executive of NHS Providers said: ‘This development is a vital step towards the Government and unions resolving the industrial dispute with consultants in the NHS.

‘Industrial action has caused unprecedented disruption in the last year. Over 50 strike days have led to 1.2 million appointments for planned care being pushed back and cost the NHS an estimated £1.4bn through lost income and staff cover.

‘Trust leaders will be hugely relieved that consultants won’t be striking over Christmas given that demand for care is always higher in winter. But we’re not out of the woods yet. The deal needs to be put to a vote by union members and we won’t know the result until January.

‘It’s essential we now see similar progress with junior doctors and SAS doctors to bring an end to all industrial action across the NHS.‘

Earlier this month, the new health secretary said she was ‘committed to getting around the table’ to resolve disputes around pay that led to NHS strikes.

In July, the Government announced a 6% pay rise for doctors saying this was a ‘final’ offer which ‘no amount of strikes’ would change.

A version of this article was originally published by our sister publication Pulse.

UK Government and BMA agree to talks over consultants pay dispute

19th October 2023

The UK Government has agreed to meet with the British Medical Association (BMA) Consultants Committee in the hope to find a resolution to the current consultants pay dispute.

The Committee received an invitation to talk with the Department for Health and Social Care following a letter from the BMA requesting the resumption of negotiations and indicating they would pause consultant strikes.

These will be the first formal talks the Committee has had with the Government since May.

Dr Vishal Sharma, chair of the BMA Consultants Committee, said: ‘The BMA Consultants Committee has been clear that reform of the broken pay review process is essential to resolving this dispute and that the reformed pay review body is to make truly independent recommendations on pay in order to correct for the losses that consultants have experienced that have resulted in the current workforce crisis.

‘We will be expecting to discuss and explore other solutions in the forthcoming talks.

‘It is good to see the Government is willing to come to the table and it is vital that they commit to serious negotiations with a view to bringing this avoidable dispute to a conclusion.’

In a series of posts on X (formerly Twitter), the Consultants Committee added: ’We will enter these negotiations positively and will fight hard to achieve the best possible outcome. We are clear that we will simply not talk for the sake of talking and the Government must also negotiate in good faith.

’The government has until 3 November to present us with a credible offer but if they fail to do so, we will not only announce further dates for industrial action but on 6 November will open a re-ballot to ensure we can continue taking industrial action going forward.’

After months of walkouts, consultants and junior doctors organised a joint strike for three full days at the beginning of this month, with ‘Christmas Day’-level cover.

And NHS England bosses had urged the Government to urgently resume talks with doctors ahead of winter.

NHS England chair Richard Meddings gave the stark warning that winter pressures will be ‘impossible to manage’ if also impacted by strikes, while chief executive Amanda Pritchard noted talks between the Government and doctors cannot resume ‘soon enough’.

In a formal warning letter, NHS England told the BMA that ‘cumulative’ impact of doctor strikes were causing ‘significant disruption and risk to patients’.

A version of this article was originally published by our sister publication Pulse.

Consultants now effectively working four months of the year for free, says BMA

16th May 2023

A ballot for industrial action by consultants in England has opened after pay talks with the Government broke down, the BMA has announced.

The Government’s final pay offer represented a real-terms pay cut, the BMA noted, which would continue the downward trend seen over the past 15 years. Indeed, even before taking inflation into account, consultants’ take-home pay has declined by 35% since 2008/9.

‘As a result of this, consultants are now effectively working four months of the year for free,’ said Dr Vishal Sharma, chair of the BMA consultants committee. He added that they had been left with ‘no option but to proceed with the ballot for industrial action‘.

While Dr Sharma acknowledged the constructive manner in which the talks were approached by Government officials, he highlighted that ‘ultimately the Government made a political choice to cut our pay again this year and unless we can secure a commitment that the Government will take the necessary steps to restore our pay over the long term, we simply cannot accept an offer that sees our pay fall even further.’

The ballot, which opened on Monday, will remain open until 27 June 2023. In the meantime, the BMA is urging the Government to return to talks and put forward a ‘reasonable offer’.

This comes after a consultative ballot in February 2023 saw 17,000 BMA-member NHS consultants in England voting for strike action. Turnout was 61% and 86% voted in favour of strike action. While not a legal mandate for strike action, the BMA stressed this ’emphatic result’ and the apparent ‘strength of the anger amongst England’s senior doctors’.

‘Consultants are not worth a third less than they were 15 years ago,’ Dr Sharma continued. ‘With elective waiting lists standing at 7.3 million, we cannot afford to lose any more highly experienced clinicians who are leaving or taking breaks from the NHS due to pay erosion. NHS patients deserve better than an understaffed health service, and NHS staff deserve better than a Government which does not recognise their worth at a time of global shortages of skilled healthcare professionals.’

If consultants do vote in favour of a walk out, it will be the first time since 1975 that senior doctors will have taken such action.