CEAs, Consultant's & Junior's Contracts to be Renegotiated

The DDRB today published its long awaited report on the future of clinical excellence awards. Out goes clinical excellence and in comes alignment to organisational objectives. Seemingly having learnt nothing from scandals such as Mid Stafford the DDRB recommendations seek to firmly put Trusts in charge of who is rewarded. The review body also advised giving single year only local awards and to make all awards (including existing ones) non-pensionable. A quick synopsis (subject to change and further analysis is below).

In further not so joyful pre-Christmas news the government also announced its intention for the consultant contract to be renogotiated with the loss of the ability to turn down 24 hour work and the concept of management nominated 'Consultant Principles' who will have an annual supplement to their income which is non pay protected in terms of salary or pension if the consultant was to lose this management conferred status.

Negotiations on all aspects are due to commence in the New Year.

Who'd have guessed that the DDRB is fully appointed by the government and is stacked to the rafters with ex NHS HR directors and management consultants and absolutely no-one with a clinical background. Please post or send me your comments.

Personally my biggest worry is that patient needs are not put at the heart of this but corporate objectives. These two things, as evidence has shown again and again, are not always aligned, with disasterous consequences. When it comes to patient safety, it must not be possible for NHS Trusts to buy the silence or acquiescence of doctors in the way that these proposals if enacted as described would encourage.

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Synopsis on DDRB recommendations on merit awards and remuneration

The report puts forward 16 recommendations as part of its report. I have pasted these below. I have also gone through the long summary at the start of the report and pulled out a number of key points.

1.     The DDRB open by saying that they have looked at consultant pay relative to comparator professions and that the overall level of compensation for consultants is appropriate.

2.     They state that variable award schemes should continue.

3.     However, they are uncomfortable with a number of aspects of the existing awards such as their being consolidated into basic pay, pensionable and held until retirement.

4.     The DDRB believes that both awards and pay should be more closely linked with performance appraisals with awards being made to the highest performing consultants in each employing organisation. This should take place within a United Kingdom-wide framework of common principles and governance.

5.     They argue that awards (local or national) should be non-pensionable. As we know from the ministerial statement, the Government is willing to keep the pensionability of the national awards and is willing to consider options on local awards.

6.     They recommend a thorough review of the basic pay scale, with a view to moving the emphasis towards rewarding performance and encouraging career development, and away from paying for length of service. They argue that near-automatic progression is not typically a feature of the professional roles used as comparators.

7.     They suggest introducing a principal consultant grade, to which experienced, high-performing consultants, who are undertaking larger roles in terms of service delivery, expertise or leadership, could be promoted.

8.     They are critical of the Commitment Awards system in Wales and state that they do not support it.

The principal consultant grade

9.     This would be for a small proportion of consultants, possibly 10 per cent, following a rigorous process for appointment. The initial salary for this grade would take the form of a 10 per cent pay increase on promotion, from any point in the main consultant pay range. The maximum salary for the grade would be £120,000, with any progression within the range based on performance and contribution, at the employer’s discretion. The salary for the principal consultant would be consolidated and pensionable. If principal consultants are moved back into the main consultant grade, their pay would not be protected.

New pay structures

10.  The DDRB propose a new model for consultant career development with some fairly radical changes to the pay structure. They suggest three broad bands:

Levels of award

11.  The DDRB argues that there should be fewer levels of award in a future scheme which they think would reduce the difficulties in assessing the incremental contributions of individual consultants.

12.  They are also concerned that, with the exception of local awards in Northern Ireland and level 9 awards in England, local awards are not subject to any form of review.

13.  They support a much stronger link between local awards and performance appraisals. Under their proposals consultant in future would no longer apply for local awards: employers would make decisions as to which of their consultants were the most deserving in any one year by an assessment of their job performance.

14.  They estimate that 25 per cent of consultants working within each employing organisation would receive local awards. They suggest that there be four levels of award.

15.  Local awards would, in almost all cases, be one-off annual non pensionable lump-sum payments, linked to the annual objective setting cycle.

16.  They stress the importance of all employing organisations having local award schemes in place to recognise the valuable contribution that consultants make towards delivering the objectives of employing organisations.

17.  The DDRB accepts that the fine detail of the new scheme should be negotiated between NHS Employers and the BMA. They suggest that a pan-UK arrangement for a new awards scheme would be possible and advisable.

18.  The DDRB recommends that national awards should be held for a period of up to an absolute maximum of five years with applications via self-nomination, and that it should be the role of the awarding bodies to make an assessment of the applications and to rank them in order

19.  They propose a scheme with four levels of award, of £10,000 per annum, £20,000 per annum, £30,000 per annum and £40,000 per annum, to be awarded to 4 per cent, 3 per cent, 2 per cent and 1 per cent of consultants respectively. The new national schemes would operate in parallel with the new local schemes, so consultants would be eligible to receive payments under both schemes simultaneously.

20.  They believe that a maximum of 10 per cent of all consultants should be in receipt of a national award at any point in time.

Recommendation 1: We recommend that consultants continue to receive reward above their basic pay scales, where appropriate, and are eligible for incentives to reward excellence.

Recommendation 2:

For local award schemes, we recommend that such schemes should operate within a United Kingdom-wide framework of common principles and governance and should include the following:

• all employing organisations should have a local award scheme in place;

• there should be measurable targets linked to both the objectives of the employing organisation and the individual objectives of consultants;

• the system should be transparent, fair and equitable;

• awards should be linked to performance appraisals and should be made only for work that is done over and above job plans;

• awards should not reward activity already remunerated elsewhere, for example through additional Programmed Activities or Supporting Professional Activities, unless the outcomes are significantly above expectations;

• consultants should no longer need to apply for local awards – all would be eligible. employing organisations should make decisions as to which of its consultants were the most deserving in any one year;

• schemes should operate within a competitive environment, to reward a limited percentage of consultants working for an employing organisation within any one year;

• nationally, the parties should agree a cap on the cost of local schemes;

• under the new schemes, local and national awards may be held simultaneously;

• awards should be non-consolidated and non-pensionable;• one-year local awards should be the norm, and the maximum length of local award, in exceptional cases, should be three years, to be paid in annual lump-sums;

• awards in excess of one year should require ‘sign-off’ by the employing organisation Chief executive on an annual basis;

• all existing award holders should have their awards reviewed on a regular basis, the awarding organisation to decide the length of time between reviews (but with a presumption for annual reviews) and with no grace period;

• subject to accrued rights, there should be no pay protection; and

• subject to accrued rights, consultants who retire and return to work should not retain any local award, although they should be eligible for consideration for new local awards alongside other consultants.

Recommendation 3: We recommend that the Health Departments provide annual evidence to DDRB on the level of funding for local award schemes.

Recommendation 4: We recommend that employing organisations publish annual data on the awards made and details of their local award schemes.

Recommendation 5:

For national award schemes, we recommend that such schemes should operate within a United Kingdom-wide framework of common principles and governance and should include the following:

• awards should recognise those consultants with the greatest sustained levels of performance and commitment to the NHS and whose achievements are of national or international significance;

• the system should be transparent, fair and equitable;

• awards should be made only for work that is done over and above job plans;

• awards should not reward activity already remunerated elsewhere, for example through additional Programmed Activities or Supporting Professional Activities, unless the outcomes are significantly above expectations;

• under the new schemes, local and national awards may be held simultaneously;

• all successful national awards should require ‘sign-off’ by the employing organisation Chief executive on an annual basis;

• application for an award should be by self-nomination;• the cost of national awards should continue to be met centrally;

• awards should be non-consolidated and non-pensionable;• awards should be held for a period of up to an absolute maximum of five years, the length of which should be determined by the awarding body at the time of granting the award and should be linked to the sustainability of the achievements;

• the level of the national award should be linked to the impact of the achievements;

 • consultants should be able to apply for a new award at any time;

• subject to accrued rights, there should be no pay protection;

• existing awards that remain subject to review should not include any grace period; and

• subject to accrued rights, consultants who retire and return to work should not retain any national awards, although they should be eligible to apply for a new national award in the same pool as new applicants.

Recommendation 6: We recommend that clinical academics holding honorary NHS contracts continue to have access to any future local and national award schemes alongside NHS consultants.

Recommendation 7: We recommend that payments made under any new award scheme, at national or local level, should be made on a non-pensionable basis.

Recommendation 8: We recommend that existing awards are no longer pensionable for future service, following a suitable transition period, to be determined by the parties.

Recommendation 9: We recommend that, in the light of the changes that we are recommending for the schemes, the awarding bodies should revisit the domains and their weightings, in particular to distinguish elements of the domains with a local focus from those elements with a national focus, while ensuring that work carried out at a local level for the wider NHS is still recognised.

Recommendation 10: We recommend that work undertaken for the Royal Colleges should continue to be recognised through the award schemes, where appropriate.

Recommendation 11: We recommend that public health consultants and Directors of Public Health should continue to be eligible for the award schemes and that, in the light of the forthcoming changes in england to their employment arrangements, the rules and guidance should be amended to ensure their continued inclusion in the schemes.

Recommendation 12: We recommend that, in order to form a balanced committee, the composition of members in the national awards committees should be comprised of an equal ratio (for example 6:6:6) of clinicians (some of whom may be academics), employers and lay members, and that the ultimate decisions on national awards should rest with the national awards committees. We recommend that employer-based awards committees conducting reviews of existing local awards should have a similar constitution to that of the national awards committees.

Recommendation 13: We recommend that, in order to obtain value for money from the consultants’ award schemes, there should be a stronger link to performance with improved links to measures of activity, quality of patient care, patient feedback, cost and a clear definition of excellence for each discipline. We recommend that the Royal Colleges and equivalent bodies define excellence for their disciplines.

Recommendation 14: We recommend that the parties give consideration to how some of the funding released from existing national awards is redistributed to employing organisations to add to the funding for the new local schemes and implementation of the new principal consultant grade.

Recommendation 15: We recommend that award holders should not be able to hold awards simultaneously on the old and new schemes, and that it should be implicit in accepting an award under the new schemes, or moving into our proposed new principal consultant grade, that individuals must relinquish any awards under the current or previous schemes.

Recommendation 16: We recommend that the parties consider carefully ways in which award holders could be encouraged to move from the old schemes for national and local awards to the new, while respecting accrued rights.

Doctor's Comments on Pensions

I've cut and pasted a couple of comments out of the pensions survey. I may add further over the next few days, they are of course anonymous:

1. The main issue for me is equality - if doctors' pensions are being changed in this way - the same should happen to all public sector pensions (including MPs and judges)

2. Doctors have always been treated very badly by successive Governments. Like many my age, as a junior doctor I worked a 1 in 3, frequently working a 100 hour plus week, only to receive 1/3 of the hourly rate for the majority of that time. Unlike politician we do not have access to public funds with which to buy (and previously maintain and furnish) lucrative second homes in the capital to supplement our pensions.

3. More stress should be put on how hard we work, how we are not over paid ( many of us have not reached the high salaries mentioned in the media for instance!) and that we have earned a right to be comfortable in our old age. I also think it is unsafe to have doctors who may not be able or have the interest anymore to have to work beyond the agreed 60 years. In psychiatry consultants used to be able to retire at 55 due to the stress of the job and the increased morbidity associated. When I retire at 68 ( if I live that long) it is unlikely I will get that many years out of it given my health etc. It all seems so unfair, yet everyone thinks we are all wealthy individuals when we are often the main bread winner just trying to bring up our families like everyone else in tough times.

4. An elderly doctor is more likely to make mistakes- go on sick leave etc which will be more detrimental to the system. Then there will be measures in the future reducing sick pay etc-

5. very unfair as done this exercise in the past.. stressful work with sacrificing of nights and weekends (oncall versus .MP/Judges/Teacher/Police) we are a soft target because we will not any patients be harmed..

6. I do not agree with any industrial action. Industrial action will receive very little support from the general public, who rightly or wrongly see the medical profession as well-paid, in secure employment and with comparatively robust pension arrangements. Without public support the Government will not come under any pressure to re-negotiate - as demonstrated by the response to the last day of action.

7. To make emergency only action bite hard it will be essential to string a number of days action together - why not a whole week. Trying to maintain public support is pointless so we should abandon all such attempts

8. There remains a significant fear amongst junior staff that any form of industrial action on their part will adversely effect their future careers as many consultants do not support any firm of strike. During the last day of action I and several of my colleagues were told by our consultants there would be serious consequences to our taking part. What can you do to reassure those of us in training?

Feel free to chime in below!

We Need Your Help!

Dear Colleagues

I have recently been elected chair of the Trent Consultants Committee and I need your views. The most pressing current issues are pensions and imposed changes to local terms and conditions. This letter is primarily regarding the unilaterally enforced changes to the NHS pension scheme by the government. A scheme which, you will probably know, was re-negotiated only 4 years ago. This ‘sustainable’ scheme was described by the Public Accounts Committee as being ‘good value for money’ as recently as May last year.

The total cost of UK public sector pensions is currently only 1.5% of GDP. Even if there are no changes to the public sector schemes, Hutton’s report concludes that this will increase to 1.9% before falling back to 1.4%. To put this into context, it is the same as government spending on religion and leisure. The savings we agreed to NHS pensions in 2008 will save the treasury £67 billion by 2060.

After the last industrial action, local surveys showed that as many as 80% of consultants had changed their work day to fit in with industrial action. In most cases it represented changes from routine cases to urgent. The industrial action was however regarded as overly complicated and difficult to measure / take, particularly for junior doctors. In one local survey, seventy percent of doctors said that they would be willing to take on call only type industrial action if the governments pension offer was not improved.

Industrial action was suspended in the summer for further talks with the government but these have failed to improve on the original offer.

Wherever you are on the current scheme you will be affected by changes in contributions. Doctors will pay 10 (yes ten) times more for the same pension as a judge. Doctors will pay contributions of 14.9% for a 54ths accrual scheme, MPs for example pay 7.7% for the same type of scheme or 13.75% for a much more generous 40ths scheme. The imposed loss of the final salary scheme would of course hugely decrease the impact of clinical excellence awards on pension income.

Doctors will also be forced to work until 68/69 to receive a full pension. This applies even to doctors with only 15 years until the current retirement date. Each year a doctor leaves before 68/69 will cost 5% of their pension. A doctor aged 45 will be approximately £300,000 worse off in terms of their pension if they retire at 60 as is their current right. Of course police and firemen will be able to retire at 60 without cost, why not doctors working in the stressful front line of UK medicine?

The industrial action last autumn in support of public sector pensions has already brought some improvement in the pensions offer for those within 15 years of retirement and index linking has been improved from just CPI to CPI + 1.5%. Industrial action has already worked and may well work further if determined action is taken.

The UK wide Consultants Committee felt strongly that the changes in the NHS Pensions bill which is currently before parliament is unacceptable and has called upon BMA council to provide a strike ballot for secondary care doctors in England and Wales (BMA Scotland has request council to organise its own ballot). We feel strongly that there should be fairness across the public sector schemes and that the governments actions are an opportunist grab from a group of staff who have already modernised their scheme.

It might be that you feel that all of this is quite fair or outrageous. If the latter you may be asking what can I do? Here are a few practical things you can do now.

Whatever your views we would like to hear them in a short survey at http://www.surveymonkey.com/s/pensionswhatnext
I’d like more people to join the debate. Our next meeting is an open one, you are welcome to join us at the next Consultants Committee meeting (date and location below). We can only accommodate a certain number of people so please email LCarr@bma.org.uk if you wish to attend.
For those who want to keep in touch locally there is a blog set up at http://trentspecialists.blogspot.co.uk/ it is possible to subscribe to posts so that you will be emailed when anything new is added
You can even follow the committee on twitter @trentconsultant (yes I know). Visit https://twitter.com/trentconsultant. The BMA can be followed at  @TheBMA or https://twitter.com/TheBMA
Write to your MP using this BMA tool http://bma.org.uk/working-for-change/negotiating-for-the-profession/pensions-unfairness/lobby-mp
Email me directly with your thoughts (keep it clean, remember I’m a real person) mhenley@urol.info
Look out for the ballot later in the year


Our aim on the committee is to represent the views of doctors in the Trent region. Please don’t hesitate to get in touch, I look forward to hearing from you, particularly if you wish to get involved.

Please forward this to all of your colleagues.

Kind regards

Mike Henley
Chair Trent Consultants Committee

Next Meeting Trent Consultants Committee
29th November 2012. Alfreton Golf Club, Wingfield Road, Alfreton, DE55 7LH.  A buffet of sandwiches and drinks will be served from 6.30 pm.

Trent Consultants Committee Report (unconfirmed)

The Trent regional consultants meeting was held on 27th September 2012 and discussed the follows.

Election of Officers: Mike Henley (Urologist Derby) elected chairman. David Shipstone (Urologist Chesterfield) elected secretary.

Job Planning:
A very similar picture around the region. Usual pressures on SPA time. Some units where still paying a blanket 2.5SPAs as per contract, others were paying 2.5 only with negotiation. The contract is reasonably clear on this, if a doctor can demonstrate that they are performing SPA work up to 2.5 SPAs there is an expectation it should be paid for. Like all other areas of the contract it is reasonable to have associated outcome measures with SPA time.

Revalidation Preparations:
These are of course occurring all around the region. At the moment there are a plethora of systems. The committee was concerned that arrangements should be similar at all hospitals as the sequelae are so serious and therefore the requirements of MSF/360 etc. in different units should be similar.

Local Pay and T&Cs:
The committee was agreed that these would be counter productive both economically and also in terms of recruiting and retaining excellent medical staff within the regions. The committee agreed with the BMA intention to work with all health unions to reject this threat.

Pensions Industrial Action:
The committee noted that the Scottish BMA had announced its intention to ballot secondary care doctors on emergency cover only industrial action. UK council has a requirement from the BMA annual meeting to do the same in the UK. Council has decided to continue negotiations (none meaningful at the moment) while at the same time prepare to take a further ballot of secondary care doctors on emergency only action later in the year.

All members of the committee felt that the recent industrial action was a poor model and had been hard to take. They also expressed concern regarding the very great difficulties that juniors had in showing their support. The committee members felt that it was with very deep regret that further industrial action was being considered but that the current pension deal had only recently been renegotiated and declared good value for money only just over a year ago. It was also felt iniquitous that many other members of public sector pension schemes were due to have better pensions than doctors despite very much lower contributions.

Next national consultants committee meeting is on Thursday the 4th October. Next meeting of Trent consultants committee 29.11.12

The committee agreed to explore the possibility of an open BMA meeting, possibly for 29.11.12 and also to attempt to arrange a meeting with some or one of the local members of parliament.

Don’t hesitate to get in touch should you wish to comment.