Proposals to enable the NHS to deliver seven day services have been unveiled by NHS Employers. It includes an overhaul of medical contracts and how much staff are paid for weekend and evening work.
In its evidence to the NHS pay review bodies NHS Employers outlines proposals to axe medical consultants’ right to opt out of non-emergency evening and weekend work, and automatic pay progression.
It also includes plans to cut the amount paid to non-medical staff for working evenings and weekends, which NHS Employers estimated costs the health service around £1.4bn, excluding payments for on-call and ambulance staff which bring the total to £1.8bn.
The government asked the Review Body on Doctors’ and Dentists’ Remuneration and the separate, non-medical NHS Pay Review Body to review how contracts could be changed to better deliver a seven day service in October after the British Medical Association walked away from talks.
Non-medical trade unions are also in an ongoing pay dispute with the government over its decision to reject proposals for a 1 per cent pay rise for all NHS staff.
Both review bodies are expected to publish their conclusions later this year, after the general election. These could form the basis on any imposed deal or future negotiations.
According to the documents, seen by HSJ, consultants would be subject to a new pay structure progressing from a salary of £70,000 a year to £93,000 after five years with no automatic progression. As they gain experience this would increase to £107,000 with additional amounts available dependent on their role, responsibility and out of hours work.
Under the scheme, consultants would retain their existing 40 hour week and be expected to work no more than 13 weekends a year, although this would be guidance only – something the BMA believes does not go far enough to protect its members.
The national clinical excellence awards scheme would also be scrapped and replaced with local non-pensionable awards.
Junior doctors would see an increase in their basic pay but would lose automatic pay progression in favour of a system based on their level of responsibility. Trainees would be paid on the basis of an hourly rate with those working Sundays or night shifts receiving more.
Employers claim the contract would include limits such as a maximum of four consecutive night shifts, five consecutive long days over 10 hours, and a maximum number of average hours.
For Agenda for Change staff, where approximately 45 per cent receive some form of unsocial hours pay, NHS Employers suggest a range of models to cut the total cost.
These include extending normal hours to 10pm on Monday-Friday, saving £90m. Extending this to Saturdays could save £290m, while the proposal said also including Sunday would save £770m.
Alternatively, the document suggests paying only Saturday and evening rates or reducing rates by half and paying them only after 10pm across seven days saving a total of £1.1bn
It does not include any assessment of the impact the changes would have on recruitment or retention of staff.
Danny Mortimer, chief executive of NHS Employers, said: “Our default setting as an organisation working on behalf of employers is to negotiate a way forward. There is no alternative to negotiation. Walking away doesn’t move a better contract for junior doctors forward and doesn’t move reform of the consultant contract to provide consistent seven day services forward. Our commitment is to sit down and negotiate.”
Paul Flynn, chair of the BMA’s consultants committee, said employers failed to provide detailed modelling of what changes would cost individual members, adding: “We were committed to try and reach a negotiated settlement on this but that can’t be in the absence of data; you can’t ask our members to sign up to something blind. It has to be realistic and not with guns held to heads.
“You won’t get consultants to vote for this unless they see some advantage in it.”
Sara Gorton, deputy head of health for union Unison, told HSJ there was a lack of detail around what the government and employers wanted to achieve.
She said: “It’s a confused message. There is definitely an opportunity to look at what services are needed and for us to work together on costing that, looking at different workforce and skills models that will enable us to do it and instead they just seem to be saying we need to do everything the same for cheaper.”