NHS England Criticizes High Overtime Payments to Senior Doctors

NHS England has criticized senior medical professionals for imposing “rip off” charges for extra hours, following a BBC investigation that revealed certain consultants are earning over £200,000 annually for supplementary work due to the imperative to reduce waiting lists. This figure is almost twice the typical basic salary for a full-time consultant in England. It is believed that many of the highest-earning consultants are employed part-time, which enables them to undertake substantial overtime at rates surpassing £200 per hour – a sum more than quadruple their standard remuneration. NHS England declared these amounts “totally unacceptable”. The organization overseeing England’s health service stated to the BBC: “It is totally unacceptable for hospitals to be forced to pay rip-off rates – over which they have limited control.” The body further commented that while compensating consultants for extra duties was “essential” for reducing delays and ensuring safe patient care, the NHS was “committed to spending taxpayer money wisely”. Concurrently, Health Secretary Wes Streeting expressed his agreement that the rates were unacceptable, stating: “Every penny that goes into the NHS needs to be well spent.” Conversely, the British Medical Association (BMA), which represents doctors, highlighted that the NHS’s reliance on overtime would be significantly less if not for existing staffing deficiencies. Hospitals indicated that, in addition to addressing the NHS waiting list, overtime was necessary to compensate for staff sickness, vacant positions, and to provide coverage during junior doctor strikes. These revelations emerge as the government allocates increased funding to the NHS, aiming to expand the availability of appointments and operations – a significant electoral pledge from Labour. The chancellor announced within the Budget that the NHS would be allocated an additional £25bn this year and the following, with the reduction of waiting times identified as a primary objective. A central component of Labour’s strategy involves staff working during evenings and weekends to diminish the backlog. However, the BBC News investigation prompts questions regarding the cost-effectiveness of this method. A senior source within the NHS commented: “Consultants hold all the cards – they know we cannot make progress on the backlog without them.” The source elaborated that consultants possess a “pretty unique position compared to other staff” because their contractual terms permit them to decline non-emergency weekend duties and subsequently bill any amount their hospital agrees to for overtime. The source indicated that it was not advantageous for the BMA to renegotiate these “outdated” contracts, which are over 20 years old. The source added: “What worries me is that the overtime costs are going to keep increasing with the need to tackle the backlog and this will breed resentment among other NHS staff who often work overtime for little more.” They further suggested that the NHS should recruit additional consultants, delegate some of their responsibilities to other personnel, and invest in technologies like artificial intelligence to alleviate the workload. BBC News utilized Freedom of Information requests submitted to hospital trusts, alongside data provided by NHS England, to disclose the expenses incurred by the NHS due to consultants working beyond their stipulated hours: During the 2023-24 fiscal year, Bradford Teaching Hospitals NHS Foundation Trust disbursed over £100,000 in overtime payments to four consultants within its medicine specialty. One individual received slightly more than £208,000 for 128 days of overtime work. The average hourly rate for these shifts was £188. The trust stated that, “in common with most NHS trusts”, it was compelled to depend on overtime payments to “manage waiting lists and to cover rota gaps and vacancies”, noting that covering strikes had imposed additional pressure. Medway NHS Foundation Trust verified that it had paid three radiologists, professionals who diagnose and treat patients through scans and tests, over £150,000 in overtime, with one earning in excess of £200,000. The trust explained that scarcity in this particular medical area necessitated the payment of premium rates, occasionally calculated per scan. NHS Frimley Health Foundation Trust compensated two consultants in its endoscopy department, which conducts internal examinations, with over £180,000 each in overtime, aimed at addressing the treatment backlog. The trust commented: “We’re focused on ensuring we always provide value for money – and anything we spend is in proportion with the benefit it brings to our patients.” NHS Humber Health Partnership, which operates five hospitals, paid three consultants between £185,000 and £240,000 for overtime. Chief medical officer Kate Wood stated that the expenditure on overtime had facilitated additional weekend operations, thereby reducing waiting lists. She remarked: “We assess the costs of these shifts against the risks of not having cover,” adding, “We have put patient safety first as that is our key focus.” She concluded, “This is not something that is unique to us.” Worcestershire Acute Hospitals NHS Trust paid over £100,000 in overtime to three consultants, one of whom earned slightly more than £198,000. Managing director Stephen Collman indicated that the trust was endeavoring to minimize “premium payments” wherever feasible, but the necessity to cover staff absences and unfilled positions left no alternative to maintain services “running safely and effectively”. Several hospitals reported that overtime rates had escalated over the previous year, influenced by the exceptionally high rates the BMA had advised its consultants to request for strike coverage. An official commented: “It created a new expectation of what they should get.” However, BMA consultant co-leaders Dr Helen Neary and Dr Shanu Datta stated: “Unfortunately, a declining workforce in crisis and spiralling patient demand – which has led to sky high waiting lists – means that extra hours of work are essential to get the job done.” They highlighted that a significant portion of the overtime was performed during unsocial hours, asserting that these were “highly-trained and experienced professionals” and thus it was justifiable for them to value their time “at appropriate rates”. Danny Mortimer, from NHS Employers, an organization representing hospitals on employment matters, commented: “In light of the difficult financial position of the NHS, health leaders are trying to bear down on extra-contractual premium pay rates.” He acknowledged, however, that there were no simple remedies given the “critical role” consultants play in addressing waiting lists. Copyright 2024 BBC. 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