Consultant pay in Scotland: English offer accepted, Government talks and next steps

Many of you will have seen that English Consultants last week agreed a new deal on their pay – and crucially reforms to the pay review body – the DDRB. As a result, I know the key question you will want to know is what does this mean in Scotland, and what has the BMA been doing on your behalf?

As I hope you will be aware from my previous blogs, BMA Scotland had written on a number of occasions to the former Cabinet Secretary regarding meeting to discuss consultant pay.  We then wrote to his replacement, Neil Gray MSP, and recently (27^th March 2024) he did finally meet with myself and Dr Sine Steele (Chair, Scottish Staff and Associate Specialist Committee).

The key focus of our meeting was of course on pay. At that stage we didn’t know the outcome of the English referendum, but as laid out in our pay evidence there has been a continual attrition in consultant pay over many years now thanks to sub-inflationary DDRB pay awards.  Although the Scottish Government has accepted these awards in full each time, the sub-inflationary nature of them has led to marked pay erosion of 25-35% over the past 15 years (depending on the measure of inflation used). You will recall this was one of the key drivers for us leaving the DDRB this year and seeking direct pay discussions with Scottish Government.

Mr Gray and his team say they are committed to the importance of ‘NHS recovery’ (it is even in the name of his role as Cabinet Secretary for NHS Recovery Health and Social Care), but unless we also see recovery in our pay I am not sure how much of an NHS we will have left to recover.  In recent posts I covered the ongoing issues of consultant retention – both the issues for those later in their career and also the wider problem that affects us all by way of ongoing consultant vacancies. There have been some steps in the right direction regarding the first aspect with the introduction of partial retirement last October, however for the second part we desperately need to retain those completing training in Scotland as well as encouraging those that may wish to move to Scotland.  As I highlighted in the meeting with the Cabinet Secretary it is on this latter point that it is so important that Scotland remains an attractive place to work.  You will have seen the recent coverage regarding the impact of vacancies at Emergency Departments in Glasgow and Edinburgh and we all know this is only the tip of the iceberg when it comes to the impact of consultant vacancies.

I therefore took the opportunity to discuss the latest pay offer from UK Government to consultants working in England – which as mentioned above has subsequently been accepted.  In previous years the acceptance of DDRB awards in England had been more piecemeal than here, hence our pay scales were actually at many stages slightly more favourable.  However the new position in England both markedly shortens the pay scales and boosts them.  I was crystal clear with the Cabinet Secretary that in the event the deal was accepted this needs to be taken into account when setting pay levels for consultants in Scotland.  I have received a number of emails from consultants in England who were considering moving to Scotland but put off by the upcoming pay differential (only exacerbated when take-home pay is considered given the swingeing level for Scottish income tax rates compared to the rest of the UK).

One other key part of the offer in England that will directly impact on us in Scotland is the proposed reforms of the DDRB.  These are absolutely crucial for trying to address long term pay erosion and many of the proposed changes (particularly around the ability of DDRB to ‘look back’ at previous pay awards and the involvement of the BMA in the appointment of DDRB members) will be key factors going forward.  I mentioned above that the Scottish Consultants Committee has not submitted evidence to the DDRB this year, following a clear message from consultants in our pay survey.  Scottish Government did however send a remit letter to DDRB that asked for a recommendation for consultants.  We discussed this with Mr Gray and he was clear that although he was keen to have a recommendation from the DDRB as a ‘weathervane’ to guide his thoughts, he absolutely recognised the issues around pay erosion and the consultant pay offer in England and would be fully cognisant of these in the discussions and not constrained by the DDRB recommendation.

The key question is of course, what next?  Mr Gray said he wished to be clear on the funding envelope he would be working with in pay negotiations and said they are currently working through the implications of the UK & Scottish Budgets.  Once these are completed later this Spring he has committed to work with his officials to enter pay negotiations as soon as practicable.  I was clear with him the importance we attach to these discussions and that if these were insufficient we would have no choice but to consider further steps. The longer we go in Scotland without addressing the historical issues with our take home pay and the growing competitive disadvantage we face with our English colleagues, the closer we will be to following the example of our English colleagues and the action they took. The positive is we are now getting the engagement and the talks that are desperately needed (which is of course one of the main aims of any escalated action). We all know that is not enough yet – the ball is in the Government’s court, they know what’s required and we will be holding them to it when they set out their next move as regards this year’s pay award. Should we need to act we’ll need you all to have a say and help guide our course. To do so we need you to make sure your details are up to date. You can do that any time by just logging in to the website or contacting support@bma.org.uk.

In the meantime, please ensure when undertaking any additional extra-contractual work you have read through and make use of our extensive documentation on the consultant rate card.  It is also important for all consultants to ensure they have looked at our consultant handbook and are properly up to speed on basic contractual rights such as ensuring they are appropriately paid when covering for sick and absent colleagues, working bank holidays, etc. – it is something that many people seem to do for free when it is actually additional work that needs to be appropriately recognised.

In the coming weeks and months we’ll need to stick together, work together and stay united to make the improvements we know are need for Scottish consultants. One thing I can promise is this won’t be easy – but I will keep you up to date and do all I can on your behalf.

Dr Alan Robertson is Chair of BMA Scotland’s Consultant Committee