“Only a matter of time” until local pay is applied to doctors

Authors: Helen Jaques 

Publication date:  29 六月 2012

Locally determined pay for doctors in England is “only a matter of time” but would inhibit the free movement of doctors around the UK, have a negative effect on the training of junior doctors, and create recruitment problems in deprived areas, doctors have said.

Delegates at the BMA’s annual representative meeting agreed that the association should campaign to maintain national contracts for doctors but stopped short of mandating its governing council to ballot on strike action if local negotiations on pay are imposed.

The government is conducting a review of locally determined “market facing” pay for NHS staff on the Agenda for Change contract, which covers staff such as nurses and physiotherapists but not doctors, with the aim of making it easier for private organisations to compete with the public sector for staff.

Medical staff have so far been excluded from the NHS pay review body’s assessment but could “clearly” be included in the future if other NHS staff are subject to local pay variation, said the BMA council member Anna Athrow.

She said: “This would mean the end of equal pay for equal work, [would mean] lower pay in areas such as the north, the Midlands . . . and the south west and south coast, and would have a negative effect on recruitment and retention of staff outside London and the south east.”

Local pay would particularly affect junior doctors, who tend to move area roughly every three to six months, said Eleanor Draeger, deputy chairwoman of the BMA’s Junior Doctors Committee. “It would be a disaster if there were local pay negotiations for junior doctors because . . . how could you possibly negotiate contracts if you’re only in a place for three months or six months? You just wouldn’t have the wherewithal or the support and resources to do that,” she said.

However, the surgeon Gordon Matthews argued that staff on the Agenda for Change contract do not tend to move around as much as doctors, so locally determined pay might be appropriate for these workers.

Both the Department of Health and NHS Employers have argued that national Agenda for Change contracts for non-medical NHS employees should be maintained, albeit with more flexibility in local pay supplements such as London weighting.[1] [2]

In the south west of England a consortium of at least 16 NHS trusts is already pushing to reduce pay, terms, and conditions for employees on Agenda for Change contracts so as to save around 8% of current workforce costs.[3] In his opening speech to the conference the BMA’s chairman of council, Hamish Meldrum, referred to the “cartel” as one of several “cynical moves to drag down pay” in the NHS.

Athrow also argued that local pay would “hasten private involvement in the NHS” and threaten the existence of unions such as the BMA. “With the passage of the Health and Social Care Act the government is using its powers to drive down public sector pay and pensions, weaken the unions, and assist private corporations in taking over the NHS,” she said.


  1. Jaques H. Government cites high public sector pay to bolster case for local pay variation. BMJ Careers  22 Mar. [Link] .
  2. Jaques H. NHS should keep national pay framework for Agenda for Change staff, says health department. BMJ Careers  18 Apr. [Link] .
  3. Calkin S, Lintern S. South West trusts set up “pay cartel.” Health Service Journal  25 May. [Link] .

Helen Jaques news reporter BMJ Careers


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