A comparison between the current national contract and the proposed new contractual arrangements to be offered in England, Wales and Scotland
September 2003
Updated 10 October 2003
1 Basic salary scales and pay progression
1.1 Salary scales
The basic salary scales under the four different contracts are set out in Table 1.
Table 1
| Year | Current contract | New – England | New – Wales | New - Scotland |
| 1 | 54, 340 | 65, 035 | 63, 000 | 65, 035 |
| 2 | 58, 295 | 67, 100 |
65, 035 | 67, 100 |
| 3 | 62, 250 | 69, 165 |
68, 440 | 69, 165 |
| 4 | 66, 205 | 71, 230 |
72, 395 | 71, 230 |
| 5 | 70, 715 | 73, 290 |
76, 910 | 73, 295 |
| 6 | 70, 715 |
73, 290 |
79, 485 | 73, 295 |
| 7 | 70, 715 |
73, 290 |
82, 065 | 73, 295 |
| 10 | 70, 715 |
78, 195 |
82, 065 |
78, 200 |
| 15 | 70, 715 |
83, 100 |
82, 065 |
83, 105 |
| 20 | 70, 715 |
88, 000 |
82, 065 |
88, 010 |
Notes
1. Consultants in England on the new contract will be eligible for additional clinical excellence awards from their 2nd year. Those transferring to the new contract will keep any discretionary points or distinction awards held and will be eligible to apply for further clinical excellence awards (see section 12 for further information).
2. A new system for the allocation of current discretionary points and distinction awards funding will be agreed in Scotland in time for April 2004. Until then, the current systems apply.
3. Once reaching the top of the basic salary scale, consultants on the current contract are eligible to apply for discretionary points and distinction awards (see section 12 for further information).
4. From their 10th year, consultants in Wales will be eligible for commitment awards in addition to basic salary (see section 12).
1.2 Pay progression
The current consultant contract’s basic salary scale consists of a 5 point scale through which consultants progress annually on an automatic basis.
Under the terms of the new contract in England there are 8 points on the basic salary scale. The first four thresholds are annual and the remaining three are accessible at 5 year intervals. Progression through pay thresholds is the norm unless the employer demonstrates that the consultant has not made reasonable efforts to fulfil basic criteria such as in job planning and appraisal. Consultants will also be eligible for extra clinical excellence awards payments from their second year of appointment1.
In Wales, the new contract specifies a 7 point salary scale as set out above. Progression through the increments is annual. Additionally, consultants who have reached the maximum of the scale will normally receive commitments awards4 at three year intervals, unless there has been an unsatisfactory job plan review. Consultants in Wales will also be eligible to apply for national clinical excellence awards (see section 12).
In Scotland, the same principles apply as in England, except that the current discretionary points and distinction awards systems will continue to operate until successor schemes have been agreed.
2 Hours of work
2.1 Weekly working hours and number of sessions
Under the current contract, maximum part-time consultants undertake a minimum of 10 notional half days (NHDs) of 3.5 hours flexibly worked. No maximum hours of work are stated for either whole-time or maximum part-time consultants. In practice, consultants usually work well in excess of this minimum commitment (surveys suggesting 47-51 hours) without additional pay.
The standard commitment under the new contracts in England and Scotland consists of 10 programmed activities (PAs) of 4 hours length i.e. a full-time contractual commitment of up to 40 hours per week. However, programmed activities undertaken during premium time are only 3 hours long so consultants working in premium time may therefore work less than 40 hours per week. It should be common for many consultants to have a standard commitment of 38 or 39 hours. A job plan review will take place where a consultant is working in excess of their standard hours and workload will either be reduced or the extra work will be paid as additional PAs.
In Wales the basic working week for a full-time consultant consists of 10 sessions with a timetabled value of 3 to 4 hours each, to be programmed so that on average 37.5 hours per week are worked. A consultant could conceivably work up to 41.25 hours per week without extra pay since a job plan review is only triggered if a consultant regularly works an extra session per week. Similarly a job plan review is only triggered if a consultant regularly works one session less. Remuneration for any extra session awarded is paid after the job plan review takes place. This will be at plain time rates for the first 2 years and then at a premium rate of 1.25 rising to 1.5 at 2 year intervals. There is no provision for a premium rate specifically for doing non-emergency work during unsocial hours. For emergency work, the first three hours of work done whilst on-call counts as one session.
2.2 Categories of work
The current contract distinguishes only between work that should be carried out during fixed commitments i.e. regular scheduled NHS activities requiring the use of other NHS resources, and supporting work that can be undertaken flexibly (e.g. administration, audit). Consultants should normally have between 5 and 7 fixed commitments per week in their job plan.
Under the new contracts in England, Wales and Scotland, work to be carried out as part of the consultant’s contractual obligations falls into 4 categories:
- Direct clinical care
- Supporting professional activities
- Additional responsibilities
- Other duties (external)
In England, the average number of direct clinical care PAs for a full-time consultant will typically be 7.5 per week, with the remainder of 2.5 PAs to be devoted to other types of PAs, unless those other types of activities together constitute more than 2.5 PAs. It is important to note that direct clinical care PAs also include all administration related to patient care.
In Wales, a full-time consultant will typically undertake 7 sessions of direct clinical care and 3 sessions of supporting professional activities.
In Scotland, unless otherwise agreed 7.5 PAs of direct clinical care will be undertaken by a full-time consultant with 2.5 PAs of supporting professional activities. As in England, direct clinical care includes all administration related to patient care.
2.3 Standard time and premium time
The current contract makes no differentiation in terms of remuneration for work done during ‘normal’ or unsocial hours.
Under the new contract in England, standard rates of pay will apply to work carried out between 7am and 7pm, Monday to Friday. From April 2004, at all other times, including public holidays, all types of work will be remunerated at a premium rate based on the principle that PAs last only 3 hours, instead of 4. Alternatively, by mutual agreement, a premium pay rate of time and a third will apply to these PAs.
In Wales, the new proposals are not explicit about normal working hours (evenings and weekends are not defined) and there is no set premium rate specifically for doing non-emergency work during unsocial hours. There is however the same provision as in the English contract for emergency on-call work to be recognised by a shorter 3 hour session. There is also the provision that a consultant’s work in excess of the basic commitment is recognised at plain time sessional rates for the first 2 years of doing the work and then at a rate of 1.25 and 1.5 at 2 year intervals. Additional sessions at the request of the employer are remunerated at a rate agreed locally. There are also specific provisions recognising resident on-call (see section 3.3).
In Scotland, the same principles apply as for England except that plain time rates apply between 8am and 8pm, Monday to Friday. PAs worked outside these times will be three hours long instead of four and there will also be a reduction in a consultant’s time-tabled weekly work equivalent to one hour for each PA undertaken during premium time.
2.4 Normal working day
There is no concept of a normal working day in any of the contracts. The timing of all work will be the subject of a mutual agreement between the consultant and the employer during the job planning process.
2.5 Volunteering to work at certain times
Under the current contract there are no periods where it is explicitly the case that working will be entirely voluntary.
The new contract in England specifies that non-emergency work undertaken after 7pm in the evening and at any time at weekends is on a voluntary basis. Non-emergency work for these purposes specifically includes regular programmed work in specialties dealing routinely with emergency cases.
In Wales, work in evenings and weekends is on a voluntary basis. Evenings and weekends are not defined in the Welsh proposals.
In Scotland, non-emergency work undertaken after 7pm in the evening, after 1pm on Saturday and all day on Sunday is on a voluntary basis.
2.6 Extra programmed activities
The current contract allows for temporary additional NHDs to be paid in recognition of work undertaken which is not part of the consultant’s normal contractual duties. These form a separate contract with the employer and are paid at the rate of 1/11th of basic salary (including discretionary points). They are not superannuable. In practice, consultants currently do not often receive temporary additional NHDs for extra clinical work.
In England under the new contract, a consultant can agree to take on more than the standard 10 PAs, either when drawing up the job plan or if a job plan review finds that they are working in excess of their job plan and the consultant wishes to continue with the work. Extra PAs will be remunerated at a rate of 1/10th of basic salary salary (plus discretionary points or local clinical excellence awards) and are not superannuable.
There is no requirement for a consultant undertaking private practice to carry out extra work, but if they do not undertake an extra PA if offered, they may risk their pay progression. This does not apply if he or she is already working the equivalent of 11 or more PAs. Any extra PAs worked will always be paid.
In Wales, additional sessions can be contracted for and payments for these will be locally negotiated. Where it is identified at a job plan review that a consultant has been working in excess of their basic commitment, by agreement the work can be continued and additional sessions will be paid at plain time rates for the first two years (see section 2.3).
In Scotland, work undertaken in addition to that specified in the job plan will trigger a job plan review. A decision will be taken as to whether to adjust the job plan to recognise and pay for the extra work or for the work to be reduced, or a combination of both. As in England, consultants who wish to undertake private practice and not risk pay progression must first offer one extra PA to the NHS. This does not apply if the consultant is already working 11PAs or more. Any extra PAs worked will always be paid. Extra PAs will be remunerated at a rate of 1/10th of basic salary (plus discretionary points) and are not superannuable.
3 On-call arrangements
3.1 Recognising work done whilst on-call
The current consultant contract does not specifically set out how on-call work should be recognised, merely stating that on-call rota commitments should be taken into account when drawing up a job plan.
Under the new contract in England & Scotland the number of hours worked whilst on-call is assessed and recognised in the consultant’s weekly direct clinical care PAs. If on-call work takes place during premium time, three hours of work will count as one PA, rather than four.
Similar arrangements apply in Wales, such that emergency work which takes place at regular and predictable times will be programmed into the consultant’s weekly sessions. The first three hours of work done whilst on-call counts as one session.
3.2 On-call availability supplements (also see section 6)
Under the current contract consultants may receive an out of hours intensity supplement (see section 6 below) of up to £2,505 per annum according to how onerous their out of hours and on-call commitment is.
The new contract in England and Scotland instead allows for an availability supplement of up to 8% of basic salary (up to £7,040) to be paid according to a consultant’s frequency of on-call rota and whether or not calls received typically require them to return to the hospital immediately.
In Wales, the existing scheme of out of hours intensity supplements will apply (see section 6), but at enhanced rates of up to £5,760 per annum.
3.3 Resident on-call
There are no provisions under the current contract for recognising resident on-call duties.
The new contract in England states that it will be unusual for consultants to undertake resident on-call duties. A consultant will only be resident on-call by mutual agreement, and local arrangements will apply with regard to remuneration for this commitment.
In Wales, as in England, consultants will be resident on-call only in exceptional circumstances and by agreement. A sessional rate of three times the maximum of the incremental scale will be payable in recognition of this work. One resident on-call session is regarded as a period of four hours.
In Scotland, again, consultants will only be resident on call in exceptional circumstances and by agreement, and local arrangements for remunerating this work will apply.
4 Additional fees
The current terms and conditions set out the types of work that consultants are not expected to undertake as part of their contractual obligation and for which extra fees are paid. These activities include category 2 work and domiciliary visits.
In England under the new contract, such fee-paying work will still be undertaken, but the underlying principle governing this work is that it should not attract double payment. If it causes minimal disruption to a consultant’s programmed activities and the employer agrees, the fee can be retained by the consultant. Otherwise the fee should be remitted to the employer. Fee-paying work can be undertaken outwith programmed activities or during periods of leave, with the fee retained by the consultant.
In Wales, the principles of the new English contract apply.
In Scotland fee-paying work can either be undertaken outside PAs or it can be undertaken during PAs with the agreement of the employer. In both cases the fee is paid to the consultant.
5 Waiting list initiatives
Under the current arrangements, consultants may agree to undertake extra NHS work under a separate contract with their employer and at a rate that is locally agreed.
The new contract in England does not affect the current local arrangements in place concerning waiting list initiatives.
In Wales, payments for carrying out extra waiting list initiative work done on trust premises will continue and will command a rate of £500 per session.
In Scotland, where an employer specifically needs to increase consultant activity as a result of waiting times targets, the consultant can voluntarily agree to take on such work under a separate contract. This work will be paid at three times the hourly rate appropriate to point 20 of the seniority scale (£507 at 2003-2004 rates), or twice this rate with equivalent time off in lieu, or at this rate with twice the equivalent time off in lieu.
6 Intensity supplements
Under the current contractual arrangements, all consultants are eligible for a daytime intensity payment of £1,115 per annum (provided they fulfil basic criteria) and many are eligible for out of hours intensity supplements of up to £2,505 per annum according to how onerous their out of hours and on-call commitment is.
Intensity supplements do not apply under the new contract in England, but consultants on on-call rotas will receive an on-call availability supplement of up to £7,040 which recognises the intensity of their on-call commitment.
In Wales, intensity supplements continue to apply but at enhanced national rates of up to £5,760 per annum.
In Scotland, the principles of the new English contract apply.
7 Job planning
Job planning has been a contractual requirement for consultants since 1990. The job plan should set out accurately all NHS commitments, but rarely do job plans reflect a consultant’s actual workload.
The new contract in England sets out a new mandatory and robust system of job planning which is based on a partnership approach between the consultant and his or her clinical manager (who will usually be the clinical director) and will recognise all work done. The job plan is reviewed annually, but if a consultant’s workload changes during the year, an interim job plan review will take place to decide whether this will be resolved in terms of extra remuneration or a reduction towards the agreed level of work in the job plan. The scheduling of non-emergency work in premium time will only be by agreement between the consultant and the clinical manager.
The same basic principles of job planning under the new contract in England apply in Wales.
In Scotland, the principles of the new English contract apply.
8 Part-time consultants and flexible working
The current contract allows for part-time working to be remunerated at a rate of 1/11th of basic whole time salary (including any discretionary points or distinction awards) per NHD. There are no explicit guidelines on flexible programming of work.
A number of important provisions for part-time and flexible working have been agreed as part of the new contract in England. Part-time working is remunerated at a rate of 1/10th of the basic full-time salary per PA. Any on-call availability supplement is paid at the same rate as a full-timer where a part-time consultant participates in an on-call rota on the same basis as a full-time consultant. Part-time consultants should be allocated proportionately more SPAs in their job plan, recognising for example that they need to participate in CPD to the same extent as full-timers. Current part-time consultants can transfer onto the new contract on the basis of the number of PAs nearest to the number of hours that they currently work, or on the same number of PAs as their current NHDs. Any rise in workload will only be by agreement and additional PAs will be paid. The new contract also sets out that there is scope for flexibility in the timing and location of PAs which allows consultants to arrange their routine work outside normal working hours if necessary.
In Wales a broad set of principles governing part-time and flexible working apply. As under the new English contract, the balance between direct clinical care PAs and SPAs is proportionately weighted towards SPAs. There are also the same provisions concerning participation in on-call rotas and flexible working as in the new English contract.
In Scotland, similar principles to the new English contract apply. Part-time consultants will suffer no discrimination in the implementation of the new contract and the job plan will schedule a greater than pro-rata allocation of SPAs.
9 Private practice
9.1 Undertaking private practice
The current contract stipulates that all whole-time and maximum part-time consultants are expected to devote substantially the whole of their professional time to NHS duties. The private practice income of a whole-time consultant cannot exceed 10% of their gross salary for the year. For a penalty of 1/11th of the whole-time salary, maximum part-time consultants can undertake an unrestricted amount of private practice.
Under the new contract in England there is no compulsion to undertake extra PAs and no restriction on private practice earnings. However, a consultant undertaking private practice who has declined an extra PA if one is offered may risk their pay progression. This does not apply if he or she is already working the equivalent of 11 or more PAs. Part-time consultants must offer up to one extra PA. Any extra PAs worked will always be paid. The employer may or may not make an offer of extra work and this decision may be dependent upon the employer’s need for the extra work to be done and/or it’s ability to pay for the extra programmed activity. The employer must offer any extra work to all clinically appropriate consultants and if this work is accepted by other consultants there will be no impact upon pay progression for those not undertaking the extra work. If a full-time consultant is already working the equivalent of 11 or more PAs, he or she will not be expected to offer any additional work on top of this.
In Wales, there is no such requirement to offer additional NHS work before undertaking private practice.
In Scotland, similar principles to the new English contract apply.
9.2 Principles governing private practice and NHS work
The current contract offers little guidance on how a consultant’s private practice and NHS work should be managed.
Underpinning the new contract in England is a code of conduct on private practice which sets out standards of best practice in managing private and NHS work. The code’s purpose is to encourage openness and transparency concerning private commitments. At the job plan review, consultants are required to disclose details of their private practice commitments. Consultants are required to observe the code in order to fulfil pay progression and clinical excellence awards eligibility criteria.
The new contract in Wales sets out basic principles that reflect those in the English code. Private work must be disclosed at the job plan review if there are any conflicts between NHS and private commitments.
In Scotland the principles of the code of conduct on private practice in England will apply.
10 Mediation and appeals
Where agreement on a job plan is not reached between the consultant and the employer under the current contract, the consultant may appeal. The appeal panel will be chaired by the Director of Public Health or a senior medical or dental officer of the trust and will also include a lay member and a senior officer of the trust. A medical or dental adviser may also be co-opted to the panel by agreement. The panel will notify the trust board of its decision and the board will make the final decision.
In England under the new contract the matter is first referred to the medical director as mediator who must act under a strict timetable. If the consultant is not satisfied, he or she may lodge a formal appeal to a panel consisting of a chairman nominated by the employing authority, a representative nominated by the consultant and an independent member chosen from a list drawn up by the SHA, BMA and BDA. The appeals panel will make a recommendation to the trust board that will normally be accepted.
In Wales, a disputed job plan or commitment award is initially referred to the medical director who will seek to resolve matters informally. If the matter cannot be resolved, the medical director will convene an appeals panel which will consist of two individuals taken from a panel approved by BMA Wales and Trust HR Directors; one nominated by the consultant and one by the trust chief executive. The decision of the panel will be binding on both parties.
In Scotland, a disagreement on job planning or pay progression may initially be resolved by referral for mediation by the medical director and then if necessary, the divisional chief executive. If the consultant remains unhappy with the outcome, a formal appeal can follow. The appeals panel consists of a chairman nominated by the chief executive, a member nominated by the consultant and a member from a list agreed between the NHS board and the local negotiating committee. The decision of the panel will be binding on both parties.
11 Back pay and transitional arrangements
In England, if a consultant gives a formal commitment by 31 October 2003 to take up the new contract, subject to agreeing a satisfactory job plan within three months, his or her pay under the new arrangements will be backdated to 1 April 2003 (or a later date if the consultant chooses). If a consultant gives the commitment between 31 October 2003 and 31 March 2004, pay will be backdated by three months. The rate of backdating will be according to the prospectively agreed job plan including the number of PAs and the agreed categorisation of on-call availability, but there will be further guidance developed in this area. Consultants giving a commitment from 1 April 2004 will not receive any backdated pay. Assimilation to the new pay scale is dependent upon the consultant’s seniority which is calculated on the basis of number of years of service as an NHS consultant, plus the point on the salary scale when first appointed to the grade (1-5), plus any other agreed years’ service in non-NHS consultant-level posts or in flexible training. Salary protection also applies.
Since the new arrangements in Wales is an amendment to the current terms and conditions of service, there will be no backdating of pay. Consultants will move across to the same point on the new scale and additional arrangements apply in respect of commitment awards, dates of job plan reviews and salary protection.
In Scotland, the new contract will be available from 1 April 2004. Any consultant in post before 1 April 2004 and who commits to the new contract before 1 April 2004 will be entitled to full pay, including agreed extra PAs and the on-call supplement, backdated to 1 April 2003, or the date of taking up the post if later. Other consultants will not benefit from accelerated pay progression or back pay. The same assimilation arrangements regarding seniority in England apply in Scotland except that they will no longer apply after April 2008.
12 Discretionary points, distinction awards and new clinical excellence awards
Currently eight discretionary points of £2,835 each and three distinction awards of up to £67,180 can be achieved in addition to basic salary. Discretionary points are awarded by trusts to consultants under nationally agreed criteria with a minimum of 0.35 discretionary points awarded per eligible consultant every year. Distinction awards are awarded centrally by a national awards committee after regional sifting of applications. The scheme is designed to reward consultants who have contributed to the NHS over and above that which is normally expected. The number of new awards to be made each year is recommended by the pay review body.
Consultants transferring to the new contract in England will retain any discretionary points or distinction awards they hold. When they come to apply for further awards, the new scheme of clinical excellence awards (CEAs) will apply. Designed to be fair and transparent and based on clear evidence it comprises local and national elements with the lower value awards (£2,617 to £31,404) made by trust committees and the higher value awards (£31,404 to £67,097) decided by a new Advisory Committee on Clinical Excellence Awards (ACCEA). In contrast to the current arrangements, all awards under the new scheme will be determined according to a common rationale and objectives. The funding of the scheme will be at least the same as current levels and although local awards are slightly lower than the current value of discretionary points, this is balanced out because of earlier eligibility (after one year as a consultant).
In Wales, consultants who have reached the maximum of the scale and who have completed 3 more years service (i.e. in their tenth year) will be eligible to receive commitments awards which increase at three year intervals, subject to the completion of a satisfactory job plan review. Each award is worth £2,835 per year and it will take consultants 31 years to reach the top of the commitment award scale. In addition, consultants will also be eligible to apply for the higher awards available under the new clinical excellence awards scheme to be implemented in England. The exact details of how the arrangements in Wales will tie-in with the CEA scheme are still to be agreed.
Discretionary points and distinction awards schemes in Scotland are to be replaced replaced by 1 April 2004 with new arrangements, but it has been agreed that the outcome of these negotiations will be on the basis of no detriment to existing awards holders. Consultants transferring to the new contract in Scotland will retain any discretionary points or distinction awards they hold. The current discretionary point and distinction awards systems will apply in the meantime.
13 Pensions arrangements
Consultants’ pensions under the existing contract are based on a final salary scheme with consultants making a contribution of 6% of superannuable income. Superannuable income includes basic salary, distinction awards, discretionary points, intensity supplements, domiciliary visits fees and London weighting. Category two fees, waiting list initiative payments, expenses, temporary additional NHDs and NHDs beyond whole-time or maximum part-time are not superannuable.
The new contract in England does not affect the final salary pensions scheme. However, the consultants retiring at the top of the scale will benefit from a 24% increase in their pension. Pensionable pay includes basic salary, discretionary points, distinction awards and CEAs, on-call availability supplements, London weighting and domiciliary visits fees payable to the consultant. Non-pensionable pay includes expenses, recruitment/retention premia, and payments for additional PAs.
In Wales again, the final salary scheme remains unchanged. Superannuable pay is defined as basic salary, commitment awards, CEAs and out of hours intensity supplements.
In Scotland, basic salary, on-call availability supplements, discretionary points, distinction awards and fees payable to the consultant for domiciliary visits are superannuable. As in England, the new contract does not affect the final salary pensions scheme.
14 Implementation
In England existing consultants would be offered the new contract which they could choose to either accept or to remain on their current contract. New consultants would be offered only the new contract.
In Wales the agreement would be an amendment to current terms and conditions of service and would therefore be binding on all consultants whether or not they voted for the changes.
In Scotland, consultants would have the same choices as in England.