BMA tells consultants to stop carrying out non-contractual work unless properly paid

The BMA has published a “rate card” to guide NHS consultants in England on how much to charge their employers for non-contractual work.

It provides three minimum recommended rates, ranging from £150 (€180; $180) to £250 an hour (box 1). It also provides equivalent programmed activities (PAs). The card is valid immediately and will be reviewed again in September.

Non-contractual work is anything outside a consultant’s agreed job plan and includes work relating to waiting list initiatives, weekend clinics, and additional weekend lists (including trauma) and also for covering long term absence and additional shifts, such as in emergency departments.

The BMA’s Consultant Committee is currently reviewing further areas of work, including covering gaps in junior doctor rotas, ward rounds after on-call shifts, and resident on-call duties in premium time (including when consultants are too busy to leave, and working from home to deal with radiology results, for example).

In advice published this week the BMA said that non-contractual work should be agreed between a consultant and their employer and is subject to negotiation over terms, including pay.1

“Consultants are within their rights to negotiate their own rates of pay and are not obliged to undertake this work if they deem the rates of pay to be inadequate,” the advice says. “Local negotiating committees are able to negotiate standardised rates with employers locally. However, even where such agreements are in place this does not override your right to refuse non-contractual work.”

The guidance also provides examples of work not covered under consultants’ standard terms and conditions of service, in addition to basic rates of pay and example responses to employers’ questions.

Vishal Sharma, chair of the Consultants Committee, said consultants did “huge amounts of work outside their contract of employment” and that this was often done for “woefully low rates of pay—rates that do not reflect the skills, experience, and responsibility of a consultant.”

He added, “Enough is enough, and the BMA is now advising all NHS consultants to insist on being paid fairly for any extra contractual work by ensuring that it is paid at the BMA minimum recommended rate and to decline the offer of extra contractual work that doesn’t value them appropriately.”

Mike Henley, a urologist who is a member of the committee and of the BMA council, told The BMJ, “For really obvious extra contractual work—waiting lists, extra lists, extra clinics—we are telling consultants to do it but for the BMA minimum rate. We’ve published a minimum rate card, and we’re encouraging people to do it for that and nothing less.”

Henley said it was difficult to be precise about the proportion of consultant work that fell into the extra-contractual bucket, but he said it was in the region of 20% to 30%. He said that BMA consultant members can expect to get a rate card and backup materials in the post in the next few days, as well as an email.

The catchline with the pack is “value yourself,” he said. “We want consultants to value themselves, because it’s clear to us that if the government isn’t going to isn’t going to value us via the review body (DDRB) then we need to value ourselves.

“We’re a really skilled group, we have a really long training, and we’re in short supply, so there’s certainly a big intrinsic value to that.”