- Gareth Iacobucci,
- Abi Rimmer
The BMA has urged ministers to put forward an improved pay offer for consultants in England after its members rejected the government’s offer by a slim margin.
Just over half (51.1%) of BMA consultant members in England voted against the offer in a referendum held from 14 December to 23 January. Some 23 544 consultants voted in total, a turnout of 64.8%. Of these, 11 507 voted for the offer, and 12 037 voted against.
The BMA’s Consultants Committee has rejected the pay offer and urged the government to return to the table. Consultants in England belonging to the Hospital Consultants and Specialists Association had already rejected the offer.1
Why did consultants reject the pay offer?
Vishal Sharma, chair of the BMA Consultants Committee, said the BMA vote showed that consultants didn’t believe that the pay deal offered a long term solution to the recruitment and retention crisis among senior doctors. “It backs up conversations we’ve had with colleagues in recent weeks, who felt the changes were insufficient and did not give them confidence that pay erosion would be addressed over the coming years,” he said.
Consultants were also concerned about the fairness of the offer and how it affected different groups of doctors, Sharma added, as well as changes to professional development time and the time dedicated to teaching and research. “However, with the result so close, the Consultants Committee is giving the government a chance to improve the offer,” he said.
Reacting to the outcome of the BMA referendum, the health and social care secretary, Victoria Atkins, said, “I hugely value the work of NHS consultants, and I am disappointed that after weeks of constructive negotiations the BMA has, by the narrowest of margins, rejected this fair and reasonable offer.
“I want to build on our progress on waiting lists and for us all to be able to focus our efforts on offering patients the highest quality care. The government is therefore carefully considering next steps.”
Will consultants now take further strike action?
Consultants in England currently have a mandate to take industrial action until 18 June 2024.2 The BMA said that its Consultants Committee had decided not to call strike action yet but instead would enter discussions with the government to try to secure improvements to tackle members’ concerns.3
But if that’s unsuccessful, said the BMA, consultants in England remain in dispute and are committed to taking further strike action if needed.
What were consultants being offered?
The offer was for a 4.95% investment in pay for this financial year, in addition to the 6% pay uplift for 2023-24 that was announced by the government last July. Of this investment, 1.5% came from phasing out local clinical excellence awards. If the offer had been accepted the changes would have come into force in January 2024 but paid retrospectively in April.
Under the offer, most consultants would have received an additional uplift of 2.85-12.8%, depending on their pay point. However, consultants in their fifth to eighth year of work wouldn’t have immediately received an additional pay uplift but would have benefited from faster pay progression.
The offer would have seen new consultants start on a salary of £99 532, up 12.6% from their 2022-23 salary of £88 364. The highest paid consultants would have received £131 964 from January 2024, up 10.8% from £119 133 in 2022-23.2
Under that offer the definition of supporting professional activities (SPA) would have expanded to specify work done to support some NHS priorities, such as elective care recovery and delivering the NHS long term workforce plan. The change didn’t permit reallocation of SPAs to direct clinical care.
Speaking to The BMJ last year, Sharma clarified that this wasn’t a contractual change. “There is actually no change to the SPAs within consultants’ contracts,” he said. “I think people thought this was about converting SPA time to direct clinical care, or they thought it was a reduction in SPA time, but none of that is actually true.”4
How have healthcare leaders reacted to the BMA ballot?
Julian Hartley, chief executive of NHS Providers, said that trust leaders would feel “dismayed” by the outcome. He said, “They had hoped the dispute between the government and senior doctors would be resolved, but today’s narrow vote makes clear that a range of concerns still need to be addressed.
“It is reassuring that the BMA Consultants Committee will now seek further talks with the government to resolve outstanding concerns. All parties need to ensure that hard won progress towards an agreement is not lost.”
Matthew Taylor, chief executive of the NHS Confederation, echoed hopes for a resolution to the dispute rather than “more damaging industrial action.”
“Strikes have already led to over 1.3 million cancelled procedures and appointments and cost the NHS in excess of £1bn,” said Taylor. “The NHS relies on its consultant workforce immensely, and these professionals have helped to keep the most life critical services afloat, including over the ongoing winter period and the recent junior doctors’ walkouts.”