BMA update on NHS consultant contract: negotiators answer contract questions

The final discussions between the BMA, NHS Employers and the Department of Health regarding proposed contract changes for consultants in England and Northern Ireland are ongoing.

The BMA currently awaits a final offer from the government.

The union recently held a webcast with members to update them on progress. Here are a selection of questions from members and answers from the BMA’s contract negotiators:

Q: What do the government want to achieve with consultant contract reforms?

We believe that the two key aims are the extension of seven day services and the removal of ‘automatic pay progression’. You have probably heard the PM and Secretary of State talk about seven day services and it has become clear that this is a major policy for the Government. Although most consultants work across seven days, schedule 3 paragraph 6 (the clause in the contract which enables consultants to turn down non-emergency weekend working) appears to have a totemic value for the Government and NHS Employers.

Q: Why did you decide to re-enter negotiations?

Neither the BMA, nor consultants, asked for these negotiations, however the consultants committee decided to re-enter negotiations because the alternative was that changes might be proposed to our contracts in England and we felt that further negotiation was the better option under the circumstances.

Q: I’m at the top of the pay grade and have local CEAs. Will I lose my CEAs and revert to a lower basic salary?

We firmly believe that consultants who have existing awards and have paid pension contributions in good faith should be protected under any new arrangements. We are also concerned that not protecting current CEA holders adequately may force some consultants to consider early retirement. Discussions are ongoing and we will be able advise further once we receive the final package.

Q: National CEAs – will there be any protection?

While not falling within the terms of discussion of the consultants’ contract, the Government have recently indicated that they may look to amend the existing national CEAs scheme. If they were to proceed with this course, they would first have to undertake a public consultation. The BMA would review the details of any proposals and look to robustly represent members’ interests.

Q: I am six years from retirement age and I am concerned about the new contract removing the last pay increment rung which I am due next April. Will this be protected?

Under the BMA proposal those at the top of the pay scale will have their base pay maintained until it exceeds the top of the 2003 pay scale (following the annual uplifts).

Q: What happens if consultants vote against the contract?

If consultants vote against the contract, the BMA will strongly suggest that the Government gets back around the negotiating table to improve the deal. A new contract could be introduced for new appointments relatively easily but for existing contracts it is much more difficult. The ‘fire and rehire’ option that has been mentioned is possible but would be a very risky move by employers and the Government and could seriously destabilise the NHS.

Q: What is the likely timetable for implementation?

Face to face negotiations were completed on 8 December and we had anticipated that there would be a short period of time where the two governments considered where the negotiations had got to before making their offer to us. That process has taken longer as the two governments are collating data and re-analysing the financial implications, and is now not likely to be completed until before the end of January or later. We will keep you posted as soon as we receive the offer.

Q: What is the view for anti-social hours, and for specialities like Emergency Medicine, where a large proportion of the job plan is in antisocial hours?

Both the BMA and the Department of Health agree that those with the most onerous and/or disruptive working patterns should be appropriately remunerated. The negotiations have sought to ensure that such work is better rewarded, particularly in the interests of recruitment and retention. In addition we have sought enhanced safeguards for consultants working on shift rotas. The current proposal has outlined an additional allowance scheme which would rise with the proportion of work done in anti-social hours.

Q: What will happen to plain time vs anti-social time for consultants?

The consultants committee do not believe that Saturday and Sunday are plain time. The current proposals are exploring a combined allowance/hours based approach where the exact definitions are less important.

Q: Can the government impose the contract with a method other than “fire & hire”?

It is worth saying that a variation to the contract can only be agreed if ratified by the BMA in line with the laws surrounding collective bargaining.

There are two ways that a contract could be retroactively altered other than by agreement.

  1. For a Trust to enforce a contract change through process of dismissal and reengagement – i.e. dismissing employees and rehiring them on a different contract.

It is, however, worth saying that, in our discussions with NHS Employers, we do not believe employers have any appetite for trying to change contracts via this method, given that dismissal on this basis always runs the risk of being deemed to be unfair and there are a number of factors that can influence the Tribunals assessment of the same.

  1. Secondly, through the Government introducing primary legislation (i.e. passing a law) to change existing contracts. We also do not believe the Government would pursue this approach but are prepared to resist it in the event that it occurred.

However the government could impose a new contract on new starters or those changing employers.

Q: Is the starting salary of new consultants going to be much reduced?

The lower starting salary was a key ask for the government. We agree that this is a difficult thing to justify, however It is a part of an overall pay package. The package includes faster pay progression. It is expected that the proportion of pay for out-of-hours would be higher than currently. We recognise this is a very difficult area for junior doctors and although other parts of the pay scheme will mitigate the lower starting salary, the membership will still have their say at a referendum of the membership before it was finally agreed.

Q: We are struggling to get SPA time recognised, is this being addressed to allow consultants to be clear of when activities should attract SPA time e.g .educational supervisor, committee work?

We know SPA time has been under pressure for years now. We raised this in the negotiations and believe the final offer will include more contractual protections for SPA time than are currently in place. This is vital for consultants’ working lives and patient care.

Q: Why is the BMA not fighting harder in terms of protecting the rights gained by consultants? Why not join in with the juniors who are doing a much better job!

The juniors face a different offer. The deal that is emerging for consultants will probably be popular with some consultants. It is important that you have your say in a survey so we have a good understanding of what you think of the deal. We cannot reject an offer that hasn’t yet been made!

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