Public sector pay review bodies (2): the health professions
In the second part of our feature on public sector pay review bodies, we look at the recommendations of the NHS Pay Review Body and the Review Body on Doctors' and Dentists' Remuneration; the first part covered the latest pay awards for the police, school teachers, the armed forces and the prison service.On this page:
NHS Agenda for Change workers
Talks on a multi-year agreement
Consultation on the deal
Review Body on Doctors' and Dentists' Remuneration
Reactions to the awards
Table 1: Summary of pay review body awards for Agenda for Change staff and doctors and dentists, 2008
Table 2: Proposed Agenda for Change pay scales
Table 3: Example whole-time salaries for doctors and dentists on main grades
Table 4: Example consultant pay scales.
Key points
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In 2007, the pay awards recommended for staff in the NHS on Agenda for Change pay scales and for doctors and dentists were staged by the government, as were most of the review body awards last year.
The first part of our coverage on pay review bodies looked at the government's continuing determination to control public sector pay. The health departments covering the UK made similar submissions in 2008 to the NHS Pay Review Body (NHSPRB) and the Review Body on Doctors' and Dentists' Remuneration (RBDDR). They said that, of more than £50 billion spent on the paybill for all the pay review bodies each year, the NHSPRB accounted for more than £27 billion and the RBDDR for more than £8 billion. The submissions reiterated the government's belief that the recommendations of these review bodies would be important not only to the delivery of health service policy, but also in terms of their impact on inflation in the wider economy.
The health departments told the NHSPRB: "The government has … concluded that the balance between the interests of staff and those of patients would best be served if the pay of all staff on Agenda for Change contracts was increased by 2%. The government believes that these recommendations are reasonable, affordable and consistent with the need to maintain macro-economic stability through compliance with public sector pay policy."
The RBDDR was told: "The government … recommends that a headline pay award of 1.5% would maintain the balance between the need to deliver continued investment in service improvements, to maintain wider economic stability and to ensure the recruitment, retention and motivation of the salaried medical workforce."
The submissions to both pay review bodies added that because there is no separate budget for pay, recommendations for pay awards higher than those proposed by the departments would mean primary care trusts cutting jobs or services to balance the budget.
NHS Agenda for Change workers
This is the first year that the renamed NHSPRB has made recommendations, following the extension of its remit in July 2007. Previously, the Review Body for Nursing and Other Health Professions covered staff such as nurses, midwives, health visitors and clinical support staff. Other staff on Agenda for Change (external website) terms and conditions - including cleaners, porters and administrative staff - had their pay decided by the Pay Negotiating Council.
The pay award had to be the same for both groups to maintain the Agenda for Change pay structure and its equal value principles. Therefore it was agreed that the staff covered by the Pay Negotiating Council should be included in the remit of the review body to avoid dual negotiations. The remit was also extended to include staff in Northern Ireland.
To reflect these changes, the review body was renamed the NHSPRB. It covers 1.3 million employees paid under Agenda for Change - all NHS staff in the UK, as well as staff in health and social care service organisations in Northern Ireland, except doctors, dentists and very senior managers. Doctors and dentists are covered by the Review Body on Doctors' and Dentists' Remuneration and the senior managers - for the first time - are to be covered by the Senior Salaries Review Body (on the Office of Manpower Economics website).
In its 2008 report (PDF format, 883K) (external website), the NHSPRB expressed its disappointment at the government's decision to stage its recommended 2.5% award in 2007 (see table 1) without any clear explanation as to why this was necessary. It said: "We have yet to see the economic rationale for public sector pay in general, and the pay uplift of our remit group in particular, being capped at 2%. We find this lack of clarity surprising and disappointing, particularly when Scotland, Wales and Northern Ireland felt able to implement the award in full."
The NHSPRB said that, on the evidence it had seen, morale across the NHS in England appeared to have declined over the past year. It was concerned that this could affect service delivery and the ability of the NHS to recruit and retain staff. It also said that Agenda for Change pay scales should not be allowed to get out of line with the wider market. It believed, therefore, that the pay award for 2008 should be above that sought by the health departments.
The NHSPRB's main pay recommendation for 2008 was an increase of 2.75% on Agenda for Change pay rates from 1 April. The same increase will be applied to high-cost-area supplements and to recruitment and retention premia. The NHSPRB believes this recommendation was consistent with the government's inflation target.
The report said: "We consider that the award should be for one year only because that is the basis on which we have received evidence from the parties."
Talks on a multi-year agreement
At the time the NHSPRB was preparing its report for 2008, separate discussions on a possible multi-year agreement were taking place between the Department of Health (DH), NHS Employers (which represents trusts in England), and the two largest health unions: the Royal College of Nursing (RCN) and Unison.
On 7 April 2008, health secretary Alan Johnson announced that the DH had agreed a proposed three-year pay package with NHS Employers, Unison and the RCN. The deal was initially agreed for England, but the health departments in Wales, Scotland and Northern Ireland subsequently also agreed the proposal. The package is subject to consultation by all the unions covered by Agenda for Change.
The three-year deal covers all NHS Agenda for Change staff, and incorporated the NHSPRB recommendation for a 2.75% increase on all pay points and allowances in the first year, 2008/09 (see table 2).
In the second year of the deal, 2009/10, pay points and allowances will increase by 2.4%. In addition, the lowest point will be removed from band 1 (see table 2), and the top point of band 5 will increase by 0.33%.
In the final year of the deal, 2010/11, a 2.25% increase will be applied to pay points above point 14, with points below this receiving a flat-rate increase of £420. The length of band 5 will be reduced and the remaining points adjusted within the band. The top point will again be increased by 0.33%.
Throughout the period of the deal, the NHSPRB will monitor the situation. If it finds evidence of a "significant and material change in recruitment and retention and wider economic and labour market conditions" it will be able to request a remit from the secretary of state to review the agreement.
The parties also agreed to hold talks during the period of the deal on proposals to reduce the number of incremental pay points, starting with bands 6 and 7, and on reducing the number of hours in the working week.
Including basic pay increases and the structural changes, the deal is worth 7.99% over the three-year period.
Consultation on the deal
While the RCN, one of the unions that brokered the proposed deal, was positive about the outcome, some of the other unions were less enthusiastic. Unison's health conference voted to ballot its members, and it has not made a recommendation on whether or not they should accept the proposed deal.
Unite, the Royal College of Midwives, the Chartered Society of Physiotherapy, the Society of Radiographers, the Society of Chiropodists and Podiatrists, the British Orthoptic Society, the British Dietetic Association and the Federation of Clinical Scientists issued a joint statement (on external website): "We would accept the NHS Pay Review Body's recommendation of 2.75% on NHS staff pay for 2008/9 because of our commitment to the independent pay review body process. However, the proposed offer of 2.4% and 2.25% for years two and three after the PRB recommendation gives us great cause for concern as the current uncertain economic situation leads us to believe that it would not meet our members' expectations and would represent a real terms pay cut for our members."
The GMB said: "GMB members are likely to be disappointed that the offer falls below the headline inflation rate." However, it said it was pleased that the offer this year would not be staged if it was accepted by members.
NHS chief executive David Nicholson has warned in a letter to NHS stakeholders that the award for 2008 could be staged if the three-year package is not accepted. He said: "The government reserves the right to review its response to the pay review body recommendations and decide whether to accept, stage or abate them in the context of a one-year settlement."
The unions are consulting their members on the proposed three-year deal.
Review Body on Doctors' and Dentists' Remuneration
The RBDDR covers around 183,000 doctors and dentists in the UK. These include consultants, general medical practitioners, general dental practitioners, salaried dentists and doctors and dentists in training. In July 2007, its remit was extended to cover staff working in Northern Ireland.
On 7 April 2008, the government announced that it accepted in full the recommendations in the RBDDR report (PDF format, 664K) (on the Office of Manpower Economics website).
The review body said in its 2008 report that it regretted that the recommendations in its previous report had not been implemented in full. The 2007 award was staged in England and Wales, although in Scotland the uplift was paid in full.
It believed this had damaged the morale of doctors and dentists. It found that morale had also been affected by the widely publicised problems in the medical training application service. However, it said there was no serious cause for concern about recruitment and retention.
In comparison with other professions, it found that the pay ranges for its remit groups were favourable, although for doctors and dentists in training this was the case only when the out-of-hours supplement was taken into account.
The health departments had again made an argument that the pay of independent contractor general medical practitioners should remain at its current level, in addition to suggesting a headline increase for other groups of 1.5%.
In contrast, the British Medical Association (BMA) had asked for increases between 3.6% and 4.3% for the groups it represents. The British Dental Association was looking for a 7% increase. NHS Employers said it believed 2% would be affordable.
The RBDDR was not convinced that this was the maximum that could be afforded. It also questioned the government's argument that low pay increases were necessary to meet the government's inflation target, although it accepted the need to control public spending. It said it believed its recommendations were for a "fair and reasonable uplift", which balanced the need to recruit, retain and motivate doctors and dentists with the funds available and the government's 2% consumer prices index inflation target.
It recommended that all salaried members of the remit group should receive the same basic increase of 2.2%. The awards for independent contractor general medical practitioners and general dental practitioners were considered separately (see below).
The RBDDR expressed the view that its role in the remuneration of independent contractor general medical practitioners should be reviewed because it was "unclear and unsatisfactory". This group works under the general medical services contract, of which some elements are agreed by negotiation. The review body said it believed it should either be able to make recommendations on the net income for this group, or have the group removed from its remit. It felt it could make recommendations for 2008 only on certain elements of the contract, because separate negotiations were taking place between the BMA and the government.
The review body recommendations for each group are as follows (see also table 3):
- Consultants. Most consultants are on a new contract, agreed in October 2003; fewer than 13% are on the old contract. The RBDDR recommended a 2.2% uplift on both pre- and post-2003 consultant salary scales (see table 4). A range of financial rewards is also available to consultants for exceptional achievements and contributions to patient care. These include discretionary points, distinction awards, commitment awards and clinical excellence awards. The value of these awards was also increased by 2.2% in line with the main uplift.
- Salaried general medical practitioners. The salary range for this group was increased by 2.2%.
- Salaried primary dental care services. 2.2% increase on all grades.
- Independent contractor general medical practitioners. The review body said it felt able to make recommendations only in respect of the global sum element of the contract for this group of doctors. It recommended an increase in the global sum of 2.7% which, after taking into account practice expenses, gives an increase in income in line with the general uplift of 2.2%. However, because the review body recommended that this should be offset by reducing the correction factor payments, it acknowledged that most practices would not receive any increase in payments as a result of the increase in the global sum, and that expenditure under the global sum would increase by approximately 0.2%.
- General dental practitioners. The RBDDR recommended an increase in the gross earnings base of 3.4% for dental practitioners in England and Wales, intended to give an increase in income of 2.2% after taking account of increased expenses. The same increase was applied in Scotland and Northern Ireland to gross fees, commitment payments and sessional fees for taking part in emergency dental services.
- Doctors and dentists in training. A 2.2% increase was applied to salary scales for doctors and dentists in training. Most junior doctors receive banding supplements, which are designed to recognise out-of-hours commitment. These banding rates remain unchanged. The review body was not persuaded by the BMA's submission that first-year junior doctors should be compensated for the loss of free accommodation, which has resulted from the removal of the requirement for these doctors to be resident at their place of work. It said it did not intend to revisit this issue.
- Staff and associate specialists/non-consultant career grade doctors and dentists. A 2.2% increase was applied to the national salary scales for this group, which includes senior clinical medical officers and doctors in community hospitals. While the RBDDR report was being prepared, this group was in discussions over the introduction of a new contract, and the review body recommended the same increase to the new scales that were being proposed. The new contract - for specialty doctors and associate specialists (2008) - has now been agreed.
The review body decided to leave London weighting unchanged at £2,162 for non-resident staff and £602 per year for resident staff.
Reactions to the awards
Although the British Dental Association (external website) welcomed the fact that the review body had taken on board its concerns about the levels of expenses facing dentists, Susie Sanderson, chair of the executive board, said: "Dentists in general practice will … be extremely disappointed by the level of increase recommended."
Hamish Meldrum, chairman of the BMA, (external website) described the pay rises for the medical profession as "unacceptable". On the loss of free accommodation for junior doctors, he said: "It is clear that the treatment of junior doctors is completely unacceptable. This will further outrage a group that has already suffered enough."
He added: "Some GPs will receive a small increase in the resources necessary to run their practices, but many will receive nothing at all. After two years of zero awards this is a further slap in the face for GPs …The sub-inflation rise of 2.2% for consultants and other salaried hospital doctors is also extremely disappointing."
The BMA has questioned the legality of the recommendation to reduce the correction factor payments to GPs.
This article was written by Rachel Sharp, researcher/writer, Pay and Benefits Bulletin.
Table 1: Summary of pay review body awards for Agenda for Change staff and doctors and dentists, 2008 |
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Group (nos. covered) |
2008 pay award |
Previous increase |
NHS Pay Review Body - all staff paid under Agenda for Change in the NHS in the UK (1.3 million) |
A three-year pay package has been proposed for staff covered by the new NHS Pay Review Body, covering the period 1 April 2008 to 31 March 2011. The deal incorporates the 2.75% increase for 2008-09 proposed by the pay review body, with headline awards of 2.4% in 2009-10 and 2.25% in 2010-11. The package will be subject to consultation of members of all the trade unions covered by Agenda for Change. |
In 2007 the pay for NHS workers was determined by the Review Body for Nursing and Other Health Professions and the NHS Pay Negotiating Council. The review body's recommended 2.5% increase was staged in England, with 1.5% paid from 1 April 2007 and 1% from 1 November 2007. Staff on pay points 1 to 7 received a flat-rate increase of £400, also paid in stages. The main award was paid in full from 1 April 2007 in Scotland, Wales and Northern Ireland. The staged offer was also paid to staff covered by the Pay Negotiating Council. |
Review Body on Doctors' and Dentists' Remuneration - doctors and dentists in the UK (183,000) |
The government has accepted in full the recommendations of the Review Body on Doctors' and Dentists' Remuneration. These include a 2.2% increase to national salary scales for hospital doctors and dentists and to the top and bottom of the pay scales for salaried general medical practitioners. A 2.7% increase has been applied to the "global sum" funding for GP practices, which the review body says equates to a 2.2% increase after taking into account expenses. A 3.4% increase in the gross earnings base under the new contract for general dental practitioners in England and Wales, and increases of 3.4% to gross fees, commitment payments and sessional fees for those in Scotland and Northern Ireland, will result in a 2.2% increase in income. |
In 2007, doctors and dentists covered by the pay review body in England and Wales who were awarded a pay increase worth more than 1.5% received a 1.5% increase from 1 April 2007 and the balance from 1 November 2007. Scotland paid the award in full from 1 April 2007. The awards included an increase of £1,000 to the top and bottom of the pay scales, for GPs employed by primary care organisations, and to each pay point for hospital consultants, staff and associate specialists, non-consultant career grades and salaried dentists. Independent GPs received no increase. The gross earnings base under the new contract for general dental practitioners in England and Wales was uplifted by 3%, and the same increase applied to fees in Scotland. The remit of the RBDDR did not include Northern Ireland in 2007. |
Table 2: Proposed Agenda for Change pay scales, 1.4.08 |
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Pay band and job examples |
Min, £pa |
Max, £pa |
1 (spine points 1-4) Finance assistant, healthcare science support worker (entry level) |
12,517 |
13,617 |
2 (spine points 2-9) HR assistant, clinical support worker, phlebotomist |
12,922 |
15,950 |
3 (spine points 7-13) Finance officer, clinical support worker (higher level) |
14,834 |
17,732 |
4 (spine points 12-18) HR administrator, dental nurse |
17,316 |
20,818 |
5 (spine points 17-25) HR adviser, physiotherapist, nurse |
20,225 |
26,123 |
6 (spine points 23-31) Midwife, nurse team leader, finance section manager |
24,103 |
32,653 |
7 (spine points 28-36) HR team manager, clinical psychologist, nurse team manager |
29,091 |
38,352 |
8a (spine points 35-40) Principal finance manager, modern matron |
37,106 |
44,527 |
8b (spine points 39-44) Social care programme manager, chief finance manager |
43,221 |
53,432 |
8c (spine points 43-48) Communications service manager, clinical psychologist consultant |
52,007 |
64,118 |
8d (spine points 47-52) Head of estates, head of arts therapies |
62,337 |
77,179 |
9 (spine points 51-56) Director of estates and facilities, nurse/midwife consultant higher level |
73,617 |
93,098 |
Source: NHS Employers job profile index and 2008/09 pay round (external websites). |
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Table 3: Example whole-time salaries for doctors and dentists on main grades, 1.4.08 |
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Job |
Point on scale |
Salary, £pa1 |
Hospital doctors and dentists - selected grades |
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House officer |
Minimum |
21,862 |
|
Maximum |
24,591 |
Senior house officer |
Minimum |
27,116 |
|
Maximum |
37,7552 |
Specialist registrar |
Minimum |
30,231 |
|
Maximum |
45,5622 |
Staff grade practitioner (1997 contract) |
Minimum |
33,264 |
|
Maximum (normal) |
46,935 |
|
Maximum (discretionary) |
62,310 |
Associate specialist |
Minimum |
36,769 |
|
Maximum (normal) |
65,840 |
|
Maximum (discretionary) |
79,756 |
COMMUNITY HEALTH STAFF - SELECTED GRADES |
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Clinical medical officer |
Minimum |
31,865 |
|
Maximum |
43,942 |
Senior clinical medical officer |
Minimum |
45,029 |
|
Maximum |
64,212 |
1. Salary scales exclude earnings such as out-of-hours payments for training grades. |
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Table 4: Example consultant pay scales, 1.4.08 |
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Consultant contract |
Point on scale |
Salary, £pa |
Consultant (2003 contract, England and Scotland) |
Minimum |
73,403 |
|
Maximum (normal) |
98,962 |
|
Maximum (CEA)1 |
34,956 |
|
CEA bronze2 |
34,956 |
|
CEA silver |
45,955 |
|
CEA gold |
57,443 |
|
CEA platinum |
74,676 |
Consultant (2003 contract, Wales) |
Minimum |
71,138 |
|
Maximum (normal) |
92,357 |
|
Maximum (commitment award)3 |
25,248 |
Consultant (pre-2003 contract) |
Minimum |
60,944 |
|
Maximum (normal) |
79,001 |
|
Maximum (discretionary)3 |
25,248 |
|
Distinction award B4 |
31,486 |
|
Distinction award A |
55,098 |
|
Distinction award A+ |
74,768 |
|
1. Local level clinical excellence awards (CEAs) in England. |
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