1% of consultants have opted out of elective weekend working

Authors: Abi Rimmer 

Publication date:  04 Sep 2015


One in every 100 consultants has actively opted out of non-emergency weekend working or used a clause in their contract to avoid non-emergency out of hours work, figures obtained by BMJ Careers show.

The topic of consultants working out of hours and at weekends has been a central part of contract negotiations between the BMA and NHS Employers. The Review Body on Doctors’ and Dentists’ Remuneration’s report on the contract, published in July, said that the clause in the 2003 consultant contract that allowed doctors to opt out of non-emergency out of hours work should be removed.[1]

To find out how many doctors were using this clause, BMJ Careers sent freedom of information requests to all 155 acute hospital trusts in England. Responses were received from 86 trusts employing 20 644 consultants.

Six trusts in total said that they employed consultants who had actively opted out of non-emergency weekend working. The total number of doctors at these trusts who had opted out of weekend working was 11, equating to 1% of the 1130 consultants employed by these six trusts.

A further 54 trusts said that none of their consultants had opted out of weekend working. Two trusts were unable to provide clear data and one trust said that it did not operate an opt-out scheme. The remaining 23 trusts said they did not hold the relevant data to enable them to say how many consultants had opted out.

Commenting on the findings, Paul Flynn, chair of the BMA Consultants Committee, said, “We already know that nine in 10 consultants work at weekends to provide urgent and emergency care for patients. These figures show that many consultants are also working with their trust to deliver elective weekend care, and do so under the existing contract. Crucially, where this happens it must be properly planned, staffed and resourced, and delivered without weekday services being affected.

He said that it was clear that the consultant contract and consultants’ working patterns were not a barrier to seven day services. “If the government are serious about delivering more weekend care then they must stop demonising doctors who are already working across seven days, and urgently define what it is they want to deliver and how they will fund, staff, and resource it,” he said.

Danny Mortimer, chief executive of NHS Employers, said, “We know that many consultants—and other NHS staff of course—already work at weekends. However, employers find this ‘opt-out’ clause has an impact on doctors’ willingness to work at weekends and has created a culture of consultants choosing when they do and do not work, which is not appropriate in any future pattern of care that can be envisaged.”

He added, “We know this is not just about doctors refusing to work out of hours—it’s that the clause gives them the unique ability to negotiate higher rates of pay, which make seven day services a lot less practical and affordable. The current ‘opt-out’ clause in the consultant contract is not appropriate for an NHS which needs to improve patient care with seven day services.”

In response to the freedom of information requests sent by BMJ Careers, just one trust, Bedford Hospital Trust, said that two of its consultants had used the clause in the consultant contract to opt out of non-emergency work outside core hours. Of these consultants, one worked in paediatrics and the other in diabetes care, the trust said. One further trust, Harrogate District Hospital, said that although none of its consultants had used the clause, it was aware that “a couple of consultants have quoted their contractual entitlement to us recently.” The trust added, “The existence of the contractual clause influences discussions in job planning meetings.”

In response to a similar request made under freedom of information legislation by junior doctor Janis Burns, the Department of Health said that data on the number of doctors who had opted out of out of hours work would not reveal how many individuals had relied on the clause in their contract to refuse to participate in weekend work.[2]

“This is because many of those who rely on the clause still, nevertheless, do work during the weekends. The practical effect of the clause is that they can negotiate higher rates of pay for that work, rather than doing it for the rates payable under the national contract terms on which they are employed,” the health department said.

References

  1. Review Body on Doctors’ and Dentists Remuneration. Contract reform for consultants and doctors and dentists in training—supporting healthcare services seven days a week. Jul 2015. [Link] .
  2. Rimmer A. Consultants will have seven day rotas by 2020, government says in response to open letter. BMJ Careers  17 Aug 2015. [Link] .

Abi Rimmer BMJ Careers

 arimmer@bmj.com

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