The new 2003 national consultant contract for England - a summary by the BMA’s Central Consultants & Specialists Committee (CCSC)
September 2003
How did we get to where we are?
- Two years of difficult negotiations to revise an old open-ended consultant contract resulted in the June 2002 contract framework;
- Consultants and SpRs in England rejected this offer;
- The BMA consultants committee surveyed members to clarify the key problem areas with the framework and pressed for further negotiations to resolve these;
- The Department of Health consistently refused further negotiations and sought local implementation of its framework plus an alternative “incentives” package;
- Consultants overwhelmingly rejected local implementation and backed the BMA’s push for further national talks;
- In July 2003 the new health secretary agreed to discuss adjustments to key problem areas highlighted by the BMA survey;
- Intensive discussions over the summer resulted in an improved offer in almost all of the key areas.
The following are the key changes to last year’s contract offer:
- There is a clear full time commitment of 40 hours per week (or less if some work is in premium time) - any additional work must be by agreement and paid for;
- No discrimination between new and existing consultants;
- Evening and weekend non-emergency work is now explicitly voluntary;
- Job plans drawn up by agreement, with a clear appeals mechanism;
- The job plan will define the resources needed to deliver agreed objectives;
- A greater proportion of the week, and all of the weekend, attracts premium rates;
- Improved arrangements for part-time and flexible workers;
- Additional two days annual leave per annum (after seven years in post).
Consultants and SpRs will be balloted on whether to accept the new contract in England;
If there is a “yes” vote:
- Existing consultants are offered the option of taking up the new contract or retaining their existing contract. Future consultants and consultants transferring jobs would be offered the new contract;
- Existing consultants wishing to convert to the new contract would need to give a formal commitment and agree a job plan. The commitment would not be legally binding, but conditional upon the consultant being able to agree a job plan. Backdating of salary increase would be as follows:
- - Committing by 31 October 2003 and agreeing a job plan within 3 months allows backdating of new salary to 1 April 2003;
- - Committing before 31 March 2004 and agreeing a job plan within 3 months allows backdating of new salary to 3 months before commitment;
- Backdated pay will normally include additional PAs agreed in the new job plan as well as the on-call availability supplement – further guidance on this will follow;
If a “No” vote:
- Highly likely that the Department of Health would go for local implementation;
- Very unlikely to be any further talks nationally;
- Only realistic chance of achieving an alternative offer would be a sustained confrontation, including industrial action.
What is happening in other parts of the UK?
- Consultants in Scotland are going through a similar process based on the original 2002 framework (which was accepted in Scotland);
- In Northern Ireland discussions are continuing;
- In Wales consultants are being offered a deal based on changes to terms and conditions of their existing contract;
- - Though having some advantages there are a number of new benefits and protections contained in the new English contract that will not be available under the Welsh contract;
- - Despite strong representations to Government the Secretary of State has made it clear that there are no circumstances under which the Welsh offer would be made available in England;
- A detailed comparison of the contracts on offer in the different countries of the UK and the current contract is enclosed.
The BMA’s consultants committee is not recommending how consultants and SpRs should vote. However on considering the whole package as well as the consequences of rejection the CCSC believes that:
- Good progress has been made in the detail of the contract and associated documents in, and beyond, the areas over which consultants expressed their concerns;
- Though imperfect, this offer is a significant improvement on last year’s framework and is the best deal that can be achieved nationally in England;
- Each doctor would need to look at the deal and consider its merits as it applies to them individually.
Summary of the contract
The current contract refers only to minimum commitments; no maximum is defined. Surveys have shown that consultants on average work around 47-51 hours, usually with no extra pay.
The new contract is based on a full-time commitment of 10 programmed activities (PAs) per week, each of 4 hours (3 hours in premium time – see below).
A key feature of the new 2003 package is that this is a clear maximum commitment and includes work done whilst on-call. Depending on the scheduling of work, this could mean a basic commitment below 40 hours, with no requirement to work in excess of this. Any additional work above 10 PAs will be by agreement and paid at the full appropriate rate. In other words, whilst the European Working Time Directive provides a maximum working week of 48 hours, this contract specifies a maximum of 40 hours. Part time consultants are considered below.
Job planning
There is a new system of job planning based on a partnership approach between consultant and clinical manager (see schedule 3 of the terms and conditions). Key features:
- Work done whilst on-call will be included in the job alongside all other clinical commitments;
- The job plan will be by mutual agreement between the clinical manager and the consultant;
- Non-emergency work in the evening and weekends will be entirely voluntary. This includes the regular work of specialties like A&E;
- There is a robust appeals process (see below) if there is no agreement on the job plan;
- Job plans will list all NHS duties as well as the consultant’s objectives and agreed supporting resources;
- New “good practice” guidance sets out in detail how the process will work and the CCSC will be developing separate step-by-step practical advice for consultants on how to job plan;
- These new arrangements are meant to make clear the consultant’s commitment to the NHS and the Department of Health has said that they ‘are emphatically not intended to diminish professionalism or override clinical judgement"
- Adequate recognition must be given for supporting professional activities. This will normally be an average of 2.5 per week, but if more time needs to be devoted to this type of activity, the consultant’s allocation of direct clinical care activities should be reduced to take account of this.
This will consist of 10 programmed activities (PAs), separated into:
1. Direct Clinical Care: work directly relating to the prevention, diagnosis or treatment of illness. It includes emergency work (including whilst on-call), operating sessions including pre- and post-operative care, ward rounds, outpatient activities, clinical diagnostic work, other patient treatment, public health duties, multi-disciplinary meetings about direct patient care and administration directly related to the above (e.g. clinic letters, phone calls etc).
2. Supporting Professional Activities: activities that underpin direct clinical care. This may include participation in training, medical education, continuing professional development, formal teaching, audit, job planning, appraisal, research, clinical management and local clinical governance activities.
3. Additional NHS Responsibilities: special responsibilities – e.g. being a Medical Director, Director of Public Health, Clinical Director or lead clinician, or acting as a Caldicott guardian, clinical audit lead, clinical governance lead, undergraduate dean, postgraduate dean, clinical tutor or regional education adviser. These need to be specifically agreed with the employer.
4. External Duties: duties not included in any of the above and not separate fee paying services or private practice. These are things undertaken as part of the job plan by agreement. These might include trade union duties, acting as an external member of an Advisory Appointments Committee, work for the Royal Colleges or work for the General Medical Council.
On average 7.5 PAs will normally be for “direct clinical care” however this could vary as part of agreeing a job plan. Under the current contract many of the activities currently undertaken in “administration” or “flexible” sessions (such as letters, phone calls etc relating to patient care) would now come under the definition of direct clinical care and fall within the 7.5 PAs for this purpose. Where work falling into the other categories is significantly above or below 2.5 PAs, consultants may agree a different balance of PAs in each area with their employer.
It is recognised that part-time consultants need to devote proportionately more of their time to supporting professional activities. The guidance on part-time working (enclosed) suggests that the ratio should be 2 direct clinical care PAs to 1 supporting activity. Such arrangements would be agreed in the job planning process.
Emergency on-call work
The existing contract makes no specific provision for on-call work. Under the new package, the work is recognised in three ways:
1. Any predictable work done whilst on-call (e.g. ward rounds, operating etc). This should be assessed prospectively and then built as a priority into the direct clinical care PA allocation. It may attract a premium depending on scheduling (for example, if a consultant does a ward round for emergencies on Saturday and Sunday when on-call and these last for 3 hours each, this would equal 2 PAs. If the consultant is on a 1 in 4 rota, this means 0.5 PAs per week of direct clinical care);
2. Unpredictable on-call work (“emergencies”). This should also be assessed prospectively and built into the direct clinical care PA allocation. It is expected that such activities would not exceed 2 PAs per week (1PA until April 2005) on average. If there is more, then such work could, by agreement, either be paid separately or reduced/reallocated through job-plan review;
3. Availability for on call will attract a supplement in addition to any other payments. This will be based on the number of colleagues on a rota and on the complexity of the work when called. Where there is an expectation that consultants will have to return to site immediately when called or provide complex telephone advice, the supplement will be 8% of basic salary for a 1 in 4 rota or more frequent; 5% for 1 in 5 to 1 in 8 rotas; and 3% for 1 in 9 or less frequent. If calls can normally be dealt with by a delayed return to work or simple telephone calls, the supplement rates are 3%, 2% and 1% respectively. For a consultant on a 1 in 4 rota who will normally return to the hospital when called, this means a supplement of between £5,200 and £7,040.
Premium time
- After 7pm and before 7am during the week;
- Any time during the weekend;
- Non-emergency work cannot be scheduled during these times without the agreement of the consultant.
Pay
This will be composed of five elements:
1. Basic Pay;
2. Additional Programmed Activities;
3. On-Call Supplements;
4. Clinical Excellence Award payments;
5. Other fees and allowances.
1. Basic pay scales
Current scale: £54,340 to £70,715
New contract: £65,035 to £88,000
The new basic pay scale is based on 10 PAs (40hrs, or fewer if any premium time PAs).
2. Additional Programmed Activities
Any agreed extra work above 40 hours (or fewer if the consultant has premium time PAs) will be paid in addition to the basic salary. Any agreement to take on such work is subject to a notice period and to prospective planning, and not based on ad-hoc arrangements.
Extra PAs are paid at a rate of 1/10th of full time salary, including any discretionary point or local clinical excellence award (see below). Make sure you take any likely extra PAs into account when you work out your new salary - see the ready reckoner.
3. On-Call Supplements
Paid as an additional percentage of basic salary ranging from 1% to 8% based on on-call availability (see above).
4. Clinical Excellence Award Payments (See below)
5. Other fees and allowances
There is currently a range of fees and allowances that consultants receive on top of their basic pay. Fees such as for domiciliary consultations and category 2 work will be paid if the work is done outside of programmed activity or if done during PAs with the employer’s agreement.
Pay progression
- 1st four pay thresholds are awarded at one yearly intervals;
- Next three thresholds awarded at five yearly intervals.
Many existing consultants moving over to the new contract will move up the scale more quickly than this because of the transitional arrangements (see below). Whilst it takes longer to get to the top of the pay scale than at present, the new contract offers a considerably higher salary and therefore pensionable pay (see below).
It will be the norm for consultants to progress through the pay thresholds (this is explicitly stated in the terms and conditions) unless they have demonstrably failed to:
- take part in the appraisal process;
- made reasonable efforts to meet job plan requirements;
- take part in job plan review and set personal objectives;
- make every reasonable effort to meet personal objectives;
- work towards any identified changes linked to the organisation’s objectives;
- take up an extra paid PA (if offered) if they want to work privately (see private work below);
- work in line with the contract’s private practice standards.
Consultants who trained part-time or who have extended training because of dual qualification will also get extra seniority credited where necessary to make sure that they can get to the top of the salary scale before retirement. For example, training extended by two years counts as the equivalent of two years’ seniority as a consultant on first appointment.
Annual pay award
Pay scales would increase by 3.225% in April 2004 and by the same amount in April 2005. Subsequent annual awards decided, as now, by the Doctors and Dentists Review Body (DDRB).
Transitional arrangements
For existing consultants, there are detailed pay transition arrangements (see schedule 13 of the terms of service for full details). This depends on seniority – which is calculated by combining completed years as a consultant plus the point on the salary scale when appointed (1 to 5) plus any additional credited seniority.
Progression along the new scale will be accelerated for consultants with more years' seniority. For example, a consultant with 20 years seniority will move over at £73,290, receive the next salary increment of £78,195 after one year, £83,100 after another two years and £88,000 after one more year. Please consult the terms of service and ready reckoner (www.bma.org.uk) to see how the transitional arrangements will apply.
Pay protection
A small group of consultants’ combined basic pay and on-call supplement would go down in the short term under the new contract. Their pay is protected at current rates until they reach the higher salaries of the new contract. They would also receive the DDRB uplift from April next year.
Maximum part-timers (MPT) and the “10% rule”
- The MPT contract (and therefore the current pay penalty) would be abolished under the new contract;
- The benefit of extra pay for MPT consultants is phased in . On transferring, one third of the difference between old and new rates of pay is added to the old salary. From April 2004, two thirds of the difference is paid and from April 2005 (around 15 months), the full new salary is paid;
- If MPT consultants choose to wait until April 2005 to transfer there would be no phasing so if they took up the contract at that time, they would get the full salary.
These are new payments under the contract:
- Paid on top of basic pay;
- They can be single lump-sum or recurrent payments (normally for up to four years)
- Can be up to 30% of starting salary.
- Replace Distinction Award and Discretionary Point systems;
- More consultants eligible for awards, starting after one year of being a consultant;
- Protection of existing award value;
- 9 Local Awards (£2,617-£31,404) – compared to current 8 (up to £22,680);
- 4 National awards (£31,404 to £67,097).
The CCSC is working with the Department of Health and the ACCEA to produce guidance on the awards process, for example regarding awards panels, scoring systems, criteria, and appeals processes. The scheme will be reviewed after 2 years.
Part time and flexible working
As part of the new package, a separate document (enclosed) has been agreed setting out how the contract applies for part-time and flexible working. In particular, the document clarifies that:
- Existing part-time consultants can choose whether to take up the new contract based on the number of PAs nearest to their current hours or have the number of PAs the same as their current number of notional half days;
- Any rise in work will only be by agreement and will receive extra pay;
- Part-time consultants will need to have pro-rata more supporting professional activities than full-time colleagues. For example, a 6 PA consultant should have 2 supporting PAs;
- Consultants who have trained flexibly and have therefore had longer training should have their pay progression adjusted to make sure that they can reach the top of the pay scale.
Under the new contract there is no compulsion to undertake extra PAs and no restriction on private practice earnings. However one of the NHS pay progression criteria is that consultants should accept an extra paid programmed activity in the NHS, if offered, before doing private work. The following points should be borne in mind:
- If consultants are already working 11 PAs (or equivalent) there is no requirement to undertake any more work;
- 11 PAs could easily be fewer than 44 hours if some work is in premium time;
- A consultant could decline an offer of an extra PA and still work privately, but with risk to NHS pay progression for that year;
- Any additional PAs offered must be offered equitably between all consultants in that speciality; if a colleague takes up those sessions there would be no detriment to pay progression for the other consultants
MPT consultants could alternatively consider seeking a move over to the new contract on a part-time basis. For example, they could become a 9 PA part-timer, offer to do an extra programmed activity and there would be no effect on pay progression. When consultants appointed after 1 January 2004 want to work part-time specifically to do private work, part-time contracts will normally be for no more than 6 PAs (although trusts can agree to more PAs for part-timers locally).
The original framework said that new consultants would have to offer 2 extra PAs before doing private work, in order to meet the pay progression criteria. This different treatment has now gone.
Private practice code of conduct
Alongside, but separate to, the contract and terms of service, a code of conduct has been agreed covering the relationship between private and NHS work. The code stresses the importance of consultants and employers working together in partnership to prevent conflicts of interest between work in the two sectors. A copy of the code is enclosed.
Mediation and appeals
If the consultant cannot agree a job plan or disputes a decision relating to pay progression, there is a process of mediation and appeals set out in the terms of service (schedule 4). The mediation process will normally involve a meeting with the medical director. If that fails to address the problem, there is a formal appeals process.
The membership of the panel is a chairman nominated by the employer, a representative nominated by the consultant and a third independent member from a list approved by the BMA/BDA with the Strategic Health Authority. The consultant can object to the independent member who would then be replaced.
The consultant can present his or her own case or be assisted by a representative. The panel makes a recommendation to the board of the employing organisation.
Superannuation
The new contract does not change the NHS pension scheme which remains “final salary” based on the best of the last 3 years pensionable pay. Therefore, consultants should expect a significantly higher pensionable pay figure – probably in the region of 24% higher than the current figure. Basic pay up to 10 programmed activities is pensionable. As before, additional PAs above the full time commitment will not be pensioned. Clinical excellence awards, on-call availability supplements and separate domiciliary visit fees are pensionable. There is no change to Mental Health Officer status.
Annual leave and other leave
Unchanged, save that from 2005 consultants with seven years service will receive an additional two days annual leave (one extra in 2004).
Disciplinary procedures
The BMA and the Department of Health are developing a new framework for discipline and suspension. Work is on-going but an agreement has been reached over the principles involved in the framework. These are set out in the enclosed joint statement.
Improvements to the Department of Health’s original proposals
The Department of Health (DH) originally published a new model contract and set of terms of service in May. The CCSC had a number of concerns about these documents, many of which have now been addressed through discussions with the Department. For example:
- Under the DH original proposals, new consultants would be treated less favourably: there is now no different treatment;
- The DH proposals did not say that non-emergency evening and weekend working would be voluntary: this is now explicit;
- The DH proposals said that 10 PAs would be the minimum commitment for full time consultants, implying an expectation to work beyond this: it is now clear that agreed work above 10 PAs is voluntary and paid for;
- The DH proposals contained a restrictive confidentiality clause: this has been addressed;
- The DH proposals has unacceptable clauses relating to health assessments: it is now clear that any potential problems will be dealt with by occupational health;
- The DH proposals contained an unacceptable ‘deductions from pay’ clause: this has been changed;
- The DH proposals included a problematic section regarding intellectual property rights: this has been removed;
- The DH proposals had removed entitlements to time off in lieu for work on public holidays: this has been addressed;
- The DH proposals changed rights to carry over of annual leave and notice for leave: these are now the same as current entitlements.
Discussions are continuing as to how locums will be paid under the new arrangements. It has been agreed, though, that locums in post over 6 months will become subject to the job planning process and become entitled to pay progression. It is expected that the arrangements for locums will be resolved in the near future. Information will be posted on the BMA web site at www.bma.org.uk.
Clinical academics
Work is on-going between the BMA’s Medical Academic Staff Committee, the university employers and the relevant Government departments to develop an agreement which translates the 2003 contract for medical academic staff.