HCSA warns review body: 'Be bold' on pay or face Long-Term failure

HCSA has today told the Hospital Doctors' pay review body the DDRB to “be bold” in their approach to medical salaries and the government – or see the Long-Term plan for the NHS fail.

At an oral hearing in London, an HCSA delegation pressed home evidence of the pressures facing all Hospital Doctor grades and reinforced the key demands of its written submission, including:

  • “Nightmare” pensions rules which are driving hospital doctors to cut back on work and retire early
  • Why the NHS Long-Term plan risks failure if medical vacancy and retention crises are not tackled
  • How the squeeze on Supporting Professional Activity time is undermining attempts to increase Consultant productivity and crippling the medical workforce’s capacity to innovate.

President-elect Dr Claudia Paoloni told DDRB members that medics were currently often “just trying to firefight”, with senior doctors routinely "acting down" to cover vacancies among more junior posts.

“The job vacancy situation is totally underestimated,” she warned. “It’s based on the assumption that they can cover the work by expecting senior doctors to do more direct clinical care.”

HCSA’s Acting Chief Executive Joe Chattin described the current approach to job planning as a crude form of “e-timetabling” more appropriate for a factory workforce than professional hospital medical staff.

He said: “Decisions about time allocation are taken at an ever higher level. This does not augur well for the long-term plan.”

Meeting the aspirations for a diagnostic and preventative revolution required a more strategic approach based on “greater retention and giving medical staff the time to work much more productively. We want to see quality.”

However, he rejected the “clown’s balloon” of pay targeting, which would only shift the problem of vacancies from one part of the country to another - although he highlighted the particularly striking long-term decline in junior doctors' pay against median male workers' pay.

HCSA's delegation also urged the DDRB to take on an oversight role of pay and terms the unregulated Trust/Clinical Fellow grade. Its use is mushrooming partly by Trusts seeking to evade exception reporting requirements, Dr Paoloni warned.

Among its key recommendations, HCSA’s 2019-20 DDRB submission calls for:

  • a base rise of 5.1 per cent (RPI plus 1.9% to address the historic erosion of pay)
  • DDRB members must speak out publicly in defence of their findings
  • an urgent joint investigation into the ethnicity pay gap among medical grades, modelled on the ongoing Dacre review into the Gender Pay Gap
  • protection for the 2.5 in SPA time in order for medical staff to be able to contribute to initiatives designed to increase productivity
  • a task force to explore and seek better evidence around early retirement and trainees exiting the profession early
  • engagement with clinicians to tackle system issues including bed availability, patient flow, IT infrastructure, and availability of medical and support staff.
  • greater access for medical staff to training and leadership development.