• New consultant contract to scrap incremental pay structure
  • Base salary will be increased
  • Clinical excellence awards to be reformed

A new contract for medical consultants in the NHS will scrap the “all but automatic” incremental pay structure and replace it with a significantly higher base salary, the Department of Health and Social Care has said.

In its evidence to the Review Body on Doctors’ and Dentists’ Remuneration, the government also revealed plans to make substantial reforms to clinical excellence awards. The document said these would be replaced with locally driven, time limited, non-pensionable payments more closely linked to the objectives of NHS trusts.

The proposals said consultants will lose their right to opt-out of non-emergency work at weekends but no current consultant will have their salary reduced under the reforms.

The deal could be agreed later this year but it will go to a ballot of not just consultants, but speciality doctors and junior doctors at ST3 registrar level and above as well.

Negotiations between the British Medical Association, the Hospital Consultants and Specialists Association, NHS Employers and the DHSC started in 2013 but stalled in 2014 when the BMA walked out of talks.

Since the junior doctors’ strike in 2016, negotiations have progressed slowly but were described as “positive and constructive” in the government’s submission to the DDRB ahead of this year’s annual pay awards.

The discussions have also resulted in legal action against the DHSC by the BMA over whether CEAs are contractual or not. The government denies this and said it would defend its position, however, both sides have applied to the High Court to stay the proceedings until the outcome of the contract negotiations are known.

In its submission, the DHSC said key elements of the new consultant contract include:

  • Replacing the “current 19 year and ‘all but’ automatic incremental pay progression structure with a clearly defined gateway process. This would be linked to newly qualified consultants’ performance and development into the role.”
  • A two point pay structure that “significantly” reduces the time it takes a consultant to reach the top pay scale, leading to a fairer more attractive base pay. The document did not say what the values of these points would be but a figure of £93,000 has been discussed previously.
  • No current consultants’ base pay would be reduced.
  • Consultants will lose their opt-out for non-emergency work on evenings and weekends but there will be “safeguards that prioritise patient and consultant safety and support consultants’ work/life balance”. The DHSC said this will improve weekend care and ensure more support for junior doctors.
  • CEAs will be replaced by local systems that “include making new payments time limited and non-pensionable, so that resources can be focused on the excellent performers of today. Payments would also have a stronger link to the objectives of trusts and include protection for existing award holders.”

The DHSC continued: “A national agreement on consultant contract reform has the potential to support system-wide improvements to patient care, and this remains our favoured outcome.”

But it also warned: “Some employers have worked with staff to make changes to the national terms – for example to remove the ‘opt out’ clause for new starters. In the absence of national agreement, this trend is likely to accelerate as more employers reasonably decide to work with staff locally to change what is an increasingly outdated reward structure.

“In the continued absence of national agreement, it is likely that employers will continue to use available flexibilities to manage the consultant reward package. This includes ensuring they are well placed to support and engage the workforce and to improve patient care.”