Review body calls for “measured” move to local pay

BMJ 1995; 310 doi: (Published 18 February 1995) Cite this as: BMJ 1995;310:419

The government has accepted the recommendation from the doctors' review body for a move towards local pay determination “in a measured way.” In its report published last week the review body recommends an increase from 1 April of 2.5% for all salaried doctors in the NHS—those working in the hospital service, in public health, and community medicine.

In addition, the review body suggests a system of transitional local pay for consultants in those NHS trusts “willing and able” to introduce local schemes. Under this arrangement consultants will receive a minimum increase of 2.5% and the transitional pay will be limited to the distribution of a further 2.5% of the consultant pay bill (excluding merit awards) in the trust. The review body says that moves to local pay should be tested in different forms for at least another two or three years. “We do not accept that the necessary confidence of doctors and dentists can be obtained through coercing them into accepting rapidly devolved arrangements.” Next year the review body may consider extending the local pay recommendations to junior doctors.

The government has accepted this proposal and has told the BMA that it will not impose an enabling clause that would have allowed trusts to pay doctors what they wish. The leader of the BMA's consultants committee, Mr James Johnson, told the health secretary, Mrs Virginia Bottomley, that his committee will withdraw the threat of sanctions. For the past year the Central Consultants and Specialists Committee and the BMA have campaigned against locally determined pay for all hospital doctors because they believe that it will create hundreds of different health services with different pay levels.

The CCSC was making preparations to insist on treating all patients on the basis of clinical need and thus bypass any two tier system giving priority to the patients of general practice fundholders; consultants were also preparing to give up their goodwill work for the NHS—the work they do over and above their contractual commitment (17 December 1994, p 1660).

The 2.5% increase will mean that consultants' salaries will now range from pounds sterling40 620 to pounds sterling52 440 and the salaries of junior hospitals doctors will range from pounds sterling13 930 to pounds sterling28 730.

The director of the National Association of Health Authorities and Trusts, Mr Philip Hunt, said that he was disappointed that hospitals were not given the same freedom to determine doctors' pay as they have with nurses, but local pay was now “really on the map.”

Nurses have been awarded a 1% increase and have been told that they must negotiate locally to bring increases up to an average of between 1.5% and 3%.

The review body did not accept the Junior Doctors Committee's argument that junior doctors' pay should increase as hours of work fall; it says that the aim of the new deal on junior doctors' hours was to improve working conditions, not to preserve pay. It was concerned, however, about low morale, which it thinks could be improved by better working conditions and by relieving doctors of duties that could be done by other staff. It recommends that the on call rates for house officers and senior house officers should be increased from 50% to 52.5% of base rates.

The average net remuneration for general practitioners will increase by 3% to pounds sterling43 165; there will be no increase in target payments; and there will be a 3.6% reduction in expenses, which have gone down, to pounds sterling21 700. The General Medical Services Committee is disappointed that the review body has deferred recommending a revised fee scale in the hope that further discussions with the Department of Health will resolve the out of hours problem.

The GMSC has already rejected the offer of a fixed payment of pounds sterling2000 per principal for out of hours work and a new night visit fee of pounds sterling9 (28 January, p 211), and the committee's chairman, Dr Ian Bogle, has asked for an urgent meeting with the health secretary in the hope that “she will see the wisdom of agreeing to review our case.”

The BMA says that it is disappointed that the award, which will cost pounds sterling144m or 2.9% of the NHS pay bill, is below the rate of inflation and below the going rate of pay increases across Britain. It notes that the award does not take account of the additional workload falling on NHS doctors, a fact which the secretary of state for health has accepted. Some of the increases for NHS doctors are set out on p 471.—LINDA BEECHAM, BMJ

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