BMA leaders have reacted angrily to what they describe as “unacceptable” below inflation pay rises for doctors working in the NHS.
Doctors’ pay
| Year | Salary rise | |
|---|---|---|
| Consultants | GPs | |
| 2002-3 | 3.8% | — |
| 2003-4 | 14.3% | 18% |
| 2004-5 | 4.5% | 23% |
| 2005-6 | 6.1% (average £109 974) |
10% (average £113 614) |
Source: National Audit Office
Hamish Meldrum, chairman of the BMA, warned of doctors’ “anger and disappointment” at the government’s decision to accept in full the recommendations of the Review Body on Doctors’ and Dentists’ Remuneration for 2008-9.
This was for a 2.2% pay rise for hospital doctors and doctors in training, and a similar amount for GPs. The BMA says that the rise is below the level of inflation, which is 2.5%.
The government has also refused to compensate first year junior doctors for the loss of free accommodation. The BMA had asked that new junior doctors be given between £400 (€500; $800) and £600 a month to meet the extra accommodation costs after changes to the Medical Act 1983, which mean that juniors no longer need to be resident in the hospital in their first year. Trusts have provided free accommodation this year but are expected to start charging juniors from August.
“This is a complex report that we need to study in depth before commenting in detail, but it is clear that the treatment of junior doctors is completely unacceptable,” said Dr Meldrum. “The BMA will now be considering the next steps to ensure first year junior doctors are not left out of pocket.”
A spokesperson for the Department of Health said that the provision of accommodation for junior doctors was a matter for the review board, which had said in its report that changes to the working patterns of junior doctors and new rotas made it unnecessary for them to be “on call.” Free accommodation for junior doctors had not been a necessity for some time, said the board, adding that it was “entirely appropriate that junior doctors are treated in exactly the same way as other NHS staff.”
The deal includes a 2.7% rise in the amount paid to general practices for providing core services, known as the global sum. Taking expenses into account, the department says this equates to a 2.2% rise in earnings.
The protected income, negotiated as part of the 2004 contract, has not increased, however. This means that the estimated average rise in payments to general practices is expected to be about 0.2%.
“Some GPs will receive a small increase in the resources necessary to run their practices, but many will receive nothing at all,” said Dr Meldrum.
“After two years of zero awards, this is a further slap in the face for GPs and a further significant erosion of the deal the government agreed to just four years ago. The subinflation rise of 2.2% for consultants and other salaried hospital doctors is also extremely disappointing and will do little to promote their engagement within the NHS.”
But the health secretary, Alan Johnson, has said that the government would invest up to a further £105m in GP services, an additional 1.5% rise on last year and above the 0.2% rise, providing it was matched by improvements in access for patients, including at weekends or in the evening.
“We want to make sure that GPs work reasonable hours and are fairly rewarded, but this must be matched by further improvements in patient services and access,” said Mr Johnson.
The pay clampdown follows the unexpectedly high costs of implementing new contracts for hospital consultants and GPs.
The National Audit Office estimated that the cost of the new consultant contract in England in 2003-4 was between £649m and £764m.
Its report, Pay Consultation: A New Contract for NHS Consultants in England, published in April 2007, showed that an average consultant’s pay rose 27% from 2002-3 to 2005-6, from £86 746 to £109 974 a year (BMJ 2007;334:865; doi: 10.1136/bmj.39191.670347.DB).
A separate report from the National Audit Office in February this year, NHS Pay Modernisation: New Contracts for General Practice Services in England, showed that the new contractual arrangements for GPs introduced in April 2004 cost the department £1.76bn more than it had originally budgeted for because it underestimated the amount that GPs would earn from the pay for performance scheme, the quality outcomes framework (BMJ 2008;336:465; doi: 10.1136/bmj.39504.525301.4E).
In 2005-6 the annual average pay of a GP partner was £113 614, an increase of 58% since 2002-3. It rose 18% in the first year of the new contract, 23% in the second, and almost 10% in 2005-6.
As a result the pay review board recommended no increase in 2007-8.
The department has also announced a three year deal for nurses, midwives, and allied health professionals of 2.75% in 2008-9, 2.4% in 2009-10, and 2.25% in 2010-1.