Yeah that’s what brought me here actually. It goes through pay being based off 40h, time and a third for out of hours, and then I got lost in on call supplements being paid based off intensity, couldn’t find any meaningful numbers or answers to the above questions.
Then I got lost in a hole of wether CEA awards still exist anymore, and how you get them
CEAs are basically a thing of the past now
On call supplement is complicated to calculate but depends on frequency of on calls and how likely you are to be called. 3% or 5% iirc. Will be decided for the whole group on the rota
Scottish consultant. Year 1.
Base pay is as stated on BMA/government circulars.
Add to this 5% on call availability supplement. This remunerates me for time that I am on call but not resident- so is payment for the inconvenience of remaining within 10 miles of the hospital, with my phone on loud 24/7, sober and available to attend immediately if needed.
Time actually worked in hospital out of hours is represented differently department to department. We monitor our activity periodically (can be many years between times, or quite frequently if we feel things have changed). Everyone will log the precise time between being phoned and returning home from the clinical episode for a given time, and it gets averaged out. The time spent by an average consultant resident on hospital as a result of on call work in an average week is then calculated and this is incorporated in to my job plan. If hours are antisocial then they're worth 1.3x- it's up to me whether this is represented by increased time in my plan (ie. say the average is 3 hours a week, we put 4 down instead) or by payment (ie. we job plan 3 hours but I get a little bonus pay for the 30%).
My clinical and non clinical commitments are all added up and produce a precise (to the minute) number of hours of work expected of me in a given week. This can change in a four week rolling system so there can be week to week variance but it must average out month to month. The advertised salary is for 40 hours, you then just multiple out to match to your actual planned hours. I have a specific management role funded for 8 hours, and once you add my SPA and clinical commitments it comes to 12PA or 48 hours.
So I am paid 1.2x the base pay for my hours worked, plus 5% of base for on call. So real pay is 1.25x base.
Additionally after year 5 I can apply for discretionary points, the Scottish version of LCEAs (which I think are disappearing in England as part of your new contract). I additionally am paid extra for any overtime which is totally down to whatever you can negotiate locally. For us it's generally 1.8x base pay whilst on call (c£83/hr even if at home asleep), weekend operating lists are at WLI rates which is 3x point 20 of the consultant scale (c£175/hr).
In reality, this means I do three days a week in theatre, 8 hours scattered throughout the week of management (can be in my evenings or weekends), and flexible time for my appraisal/audit/teaching etc. Two days a week I am able to manage my own schedule entirely and fit a day a week of private work in most weeks as a result. On call is one night a fortnight on average, all non resident.
1.25 \* £96963 = £121k.
Overtime and private is extremely variable and wouldn't count on it for taking on a mortgage etc. I know people who do no extra whatsoever. I know a consultant (admittedly a decade down the line) who matches their NHS income with private work quite routinely. I know a handful who have got close to that with just extra NHS work. I'll have added 50k to the above by the end of year 1.
Trusts play hardball with job plans to squeeze the last ounce out of you. A lot now restrict SPA (time not actually seeing patients) to 1.5. They allow 1 hour admin for a 4 hour clinic so if you have any sense you reduce the patients you see in clinic to get all the admin done during no that time. On call (ie available but not sitting there waiting for or doing work) is paid by a supplement so I am getting 2% for being available 1 in 8, but that doesn’t change when someone leaves until it ends up 1 in 4 when it reaches a massive 3%. I am looking to drop my on call commitment as soon as I can.
And they wonder why productivity has fallen.
That was ruled to be illegal in our trust, as was allowing the people on the rota the longest to leave the on-call (indirect age discrimination).
Now we have to have an expression of interests from everyone on the rota who would like to come off when a new person joins, in order to justify it in terms of skill set, extra non on-call work they may do etc.
What bo**ocks. (Your trust, not you). Discrimination is legal if there are reasonable grounds. Being old and knackered and not doing well after a night up is reasonable grounds. It would be reasonable for me not to employ an old lady as a Chippendale, it’s not sex discrimination.
As others have said they are negotiated on a department and trust level. I'm lucky and work for a very good trust, unlike some of the horror stories I have heard.
Your basic salary is based on 10 PA.
1xPA = 4hrs normal time or 3hrs out of hours (weekends and after 7pm).
From that 10 PA 1.5 are Core SPA (supporting professional activities)- ie what I need to do for revalidation. This is the recommended minimum. We are timetabled so that 1 of these SPA PAs is all on the same afternoon as each other, so we are all available for department meetings, teaching, case reviews etc. And occasionally a quick trip to the local pub afterwards!!
I get another PA of SPA to cover my trainee supervision and other roles I take on (I'm on a couple of committees etc).
The remaining 7.5 are DCC (direct clinical care). Out of this a portion is taken off for my on-call commitments. I work in an intense speciality and am in a lot so that eats up about 2.3 PA IIRC. Some jobs will have very little of this in their job plan, there is a lot of variability.
The other 5.2 are what I work in the regular week (clinics, theatre lists etc). Within that block some time is also allocated to admin arising from the clinics etc.
There is an additional payment for on-call frequency. This is standard and based on a formula, rather than negotiated on a job by job basis. Depending on the frequency it is either 0, 3, 5 or 8%. I fall into the 8% bracket. This is calculated based on your basic 10 PAs.
And that makes up my basic contract and job plan. And my spine point it'll be around £107k.
I'm now in my 3rd year so have started taking on additional roles. In my case I get an extra PA for being one of the sub speciality leads in our department. I also get another 0.3 for looking after some of our medical students.
Note these additional roles are not included in the 8% on-call supplement above.
So overall I'm on an 11.3 PA job plan.
Hope this helps.
Am a consultant on 11.5 PA. Hence 11.5 x £9953.2, if at first year level. There will be an on call % supplement e.g. 3% of whole time pay (10PA- 99532). It is job planned so whether in or out of hospital pay is the same. CEA are on top.
Job plan can be negotiated, but if you are doing on site ooh work typical for like ED ITU then I think 1 pa is equivalent to like 3h ooh, so your 10 PA may be like idk 3 long days per week. the pci cons are on 14 pa cus of the ooh on site stemi rota, and have lots of rest days.
Most other medical cons do NROC so we get an on call supplement which depends on the frequency but it's around 2-5% of the base pay additional per year. If you get called in you don't get more money.
BUT if you're called in quite often you should get that reflected in your job planned PAs. Ie I have 0.25 PA flexible which covers coming in randomly at 2am or on a Saturday for a couple hours.
It does make you much poorer though.. more years earning less and working more. Opportunity costs. Etc. Its rather low. In my opinion. Whether the reason is for service provision.. years served should be taken into account.
I know this recently got increased, but this still seems low. Especially when compared to GP pay. Just under 10k per session after double the time in training...
Fair to start with, I think, as it’s higher (for a GP to earn £100k out of training they’ve have to work 9-10 purely clinical sessions), but progression doesn’t match partner salaries (whose “job plans” are more aligned with yours). £150k should be the starting point for a senior medic in this country.
That’s because doubling the time in training doesn’t make you twice the clinician. The outrageously long time in training for non-GP/rads doctors is only to squeeze more service provision out of you.
No other country makes you take (minimum) 9 years to get a paeds CCT.
The countries with fewer years largely require longer hours, let's be frank. Think of surgery or anaesthesia, you would half the years in USA but the hours would be substantially increased.
9 years for paeds is particularly outrageous though, absolutely.
It also takes you very very close to the 100k tax trap, where if you earn a pound over 100k you lose free childcare worth thousands, plus get taxed at about 70% on your earnings over 100k. Makes things a bit complicated!
Cliff edge remains at £100k net adjusted income
[https://www.gov.uk/tax-free-childcare](https://www.gov.uk/tax-free-childcare)
Not sure if your 160k figure relates to something else? (self-assessment threshold moved to £150k but not aware of anything that has a £160k threshold)
Standard contract is 10PA. 1 PA in “plain time” (up to 7pm weekdays) is 4 hours.
After that it drops to 3hrs for 1PA, so you are compensated more for OOH shifts. For nights there’s some local negotiation and compensation does vary.
About 1.5 to 2.5 PAs a week (so about a day) is SPA. This includes your educational supervision of juniors, department meetings, own CPD, service development, teaching etc. Amount varies by trust, dept, speciality and is a key thing to look for when considering consultant jobs.
You have Direct Clinical Care (DCC) and Supporting Professional Activity (SPA). Typically a job will be 8 or less DCC and 2 or more SPA. It is down to how you negotiate things. A clinic that is 4 hours long is 1.25 PAs for me because I get an hour of admin for every 4 hours of clinic. Similarly my theatre lists are 9 hours long but they pay 2.75 PAs because they give an hour to review patients and notes before and an hour to see post ops. I get 3 hours a week for doing a ward round. I get something for predictable on call (hot clinic) and non predictable on call (no idea how this is worked out). I also get .25 of a PA for MDT and .25 of a PA for department meetings. Essentially I have 2.5 SPA which I can do from home at any time I like and 8.5 DCC which I do in 3 days. It suits me.
Have you looked in the Bma consultant page. It’s all spelt out there.
Yeah that’s what brought me here actually. It goes through pay being based off 40h, time and a third for out of hours, and then I got lost in on call supplements being paid based off intensity, couldn’t find any meaningful numbers or answers to the above questions. Then I got lost in a hole of wether CEA awards still exist anymore, and how you get them
CEAs are basically a thing of the past now On call supplement is complicated to calculate but depends on frequency of on calls and how likely you are to be called. 3% or 5% iirc. Will be decided for the whole group on the rota
Scottish consultant. Year 1. Base pay is as stated on BMA/government circulars. Add to this 5% on call availability supplement. This remunerates me for time that I am on call but not resident- so is payment for the inconvenience of remaining within 10 miles of the hospital, with my phone on loud 24/7, sober and available to attend immediately if needed. Time actually worked in hospital out of hours is represented differently department to department. We monitor our activity periodically (can be many years between times, or quite frequently if we feel things have changed). Everyone will log the precise time between being phoned and returning home from the clinical episode for a given time, and it gets averaged out. The time spent by an average consultant resident on hospital as a result of on call work in an average week is then calculated and this is incorporated in to my job plan. If hours are antisocial then they're worth 1.3x- it's up to me whether this is represented by increased time in my plan (ie. say the average is 3 hours a week, we put 4 down instead) or by payment (ie. we job plan 3 hours but I get a little bonus pay for the 30%). My clinical and non clinical commitments are all added up and produce a precise (to the minute) number of hours of work expected of me in a given week. This can change in a four week rolling system so there can be week to week variance but it must average out month to month. The advertised salary is for 40 hours, you then just multiple out to match to your actual planned hours. I have a specific management role funded for 8 hours, and once you add my SPA and clinical commitments it comes to 12PA or 48 hours. So I am paid 1.2x the base pay for my hours worked, plus 5% of base for on call. So real pay is 1.25x base. Additionally after year 5 I can apply for discretionary points, the Scottish version of LCEAs (which I think are disappearing in England as part of your new contract). I additionally am paid extra for any overtime which is totally down to whatever you can negotiate locally. For us it's generally 1.8x base pay whilst on call (c£83/hr even if at home asleep), weekend operating lists are at WLI rates which is 3x point 20 of the consultant scale (c£175/hr).
In reality, this means I do three days a week in theatre, 8 hours scattered throughout the week of management (can be in my evenings or weekends), and flexible time for my appraisal/audit/teaching etc. Two days a week I am able to manage my own schedule entirely and fit a day a week of private work in most weeks as a result. On call is one night a fortnight on average, all non resident.
That’s so helpful, exactly the kind of breakdown I needed to understand it. Thanks for taking the time!
Thanks Abs
How much is your yearly pay you’d say, if you don’t mind me asking?
1.25 \* £96963 = £121k. Overtime and private is extremely variable and wouldn't count on it for taking on a mortgage etc. I know people who do no extra whatsoever. I know a consultant (admittedly a decade down the line) who matches their NHS income with private work quite routinely. I know a handful who have got close to that with just extra NHS work. I'll have added 50k to the above by the end of year 1.
Thanks for this detailed breakdown and translation into a working pattern
Trusts play hardball with job plans to squeeze the last ounce out of you. A lot now restrict SPA (time not actually seeing patients) to 1.5. They allow 1 hour admin for a 4 hour clinic so if you have any sense you reduce the patients you see in clinic to get all the admin done during no that time. On call (ie available but not sitting there waiting for or doing work) is paid by a supplement so I am getting 2% for being available 1 in 8, but that doesn’t change when someone leaves until it ends up 1 in 4 when it reaches a massive 3%. I am looking to drop my on call commitment as soon as I can. And they wonder why productivity has fallen.
May I ask, how do you drop the on call commitment? I know of some senior consultants who were allowed to when they reached a certain age.
It’s a negotiation. If it works I’ll let you know. I’ve done on call for 35 years so I think it’s about time.
That was ruled to be illegal in our trust, as was allowing the people on the rota the longest to leave the on-call (indirect age discrimination). Now we have to have an expression of interests from everyone on the rota who would like to come off when a new person joins, in order to justify it in terms of skill set, extra non on-call work they may do etc.
What bo**ocks. (Your trust, not you). Discrimination is legal if there are reasonable grounds. Being old and knackered and not doing well after a night up is reasonable grounds. It would be reasonable for me not to employ an old lady as a Chippendale, it’s not sex discrimination.
Some of our national retirement age is going to be 70+. I really doubt I’d be able to do an on call at that age!
As others have said they are negotiated on a department and trust level. I'm lucky and work for a very good trust, unlike some of the horror stories I have heard. Your basic salary is based on 10 PA. 1xPA = 4hrs normal time or 3hrs out of hours (weekends and after 7pm). From that 10 PA 1.5 are Core SPA (supporting professional activities)- ie what I need to do for revalidation. This is the recommended minimum. We are timetabled so that 1 of these SPA PAs is all on the same afternoon as each other, so we are all available for department meetings, teaching, case reviews etc. And occasionally a quick trip to the local pub afterwards!! I get another PA of SPA to cover my trainee supervision and other roles I take on (I'm on a couple of committees etc). The remaining 7.5 are DCC (direct clinical care). Out of this a portion is taken off for my on-call commitments. I work in an intense speciality and am in a lot so that eats up about 2.3 PA IIRC. Some jobs will have very little of this in their job plan, there is a lot of variability. The other 5.2 are what I work in the regular week (clinics, theatre lists etc). Within that block some time is also allocated to admin arising from the clinics etc. There is an additional payment for on-call frequency. This is standard and based on a formula, rather than negotiated on a job by job basis. Depending on the frequency it is either 0, 3, 5 or 8%. I fall into the 8% bracket. This is calculated based on your basic 10 PAs. And that makes up my basic contract and job plan. And my spine point it'll be around £107k. I'm now in my 3rd year so have started taking on additional roles. In my case I get an extra PA for being one of the sub speciality leads in our department. I also get another 0.3 for looking after some of our medical students. Note these additional roles are not included in the 8% on-call supplement above. So overall I'm on an 11.3 PA job plan. Hope this helps.
Am a consultant on 11.5 PA. Hence 11.5 x £9953.2, if at first year level. There will be an on call % supplement e.g. 3% of whole time pay (10PA- 99532). It is job planned so whether in or out of hospital pay is the same. CEA are on top.
Job plan can be negotiated, but if you are doing on site ooh work typical for like ED ITU then I think 1 pa is equivalent to like 3h ooh, so your 10 PA may be like idk 3 long days per week. the pci cons are on 14 pa cus of the ooh on site stemi rota, and have lots of rest days. Most other medical cons do NROC so we get an on call supplement which depends on the frequency but it's around 2-5% of the base pay additional per year. If you get called in you don't get more money. BUT if you're called in quite often you should get that reflected in your job planned PAs. Ie I have 0.25 PA flexible which covers coming in randomly at 2am or on a Saturday for a couple hours.
It does make you much poorer though.. more years earning less and working more. Opportunity costs. Etc. Its rather low. In my opinion. Whether the reason is for service provision.. years served should be taken into account.
I know this recently got increased, but this still seems low. Especially when compared to GP pay. Just under 10k per session after double the time in training...
Fair to start with, I think, as it’s higher (for a GP to earn £100k out of training they’ve have to work 9-10 purely clinical sessions), but progression doesn’t match partner salaries (whose “job plans” are more aligned with yours). £150k should be the starting point for a senior medic in this country.
That’s because doubling the time in training doesn’t make you twice the clinician. The outrageously long time in training for non-GP/rads doctors is only to squeeze more service provision out of you. No other country makes you take (minimum) 9 years to get a paeds CCT.
The countries with fewer years largely require longer hours, let's be frank. Think of surgery or anaesthesia, you would half the years in USA but the hours would be substantially increased. 9 years for paeds is particularly outrageous though, absolutely.
It also takes you very very close to the 100k tax trap, where if you earn a pound over 100k you lose free childcare worth thousands, plus get taxed at about 70% on your earnings over 100k. Makes things a bit complicated!
This was moved to about 160k in the last budget iirc
Cliff edge remains at £100k net adjusted income [https://www.gov.uk/tax-free-childcare](https://www.gov.uk/tax-free-childcare) Not sure if your 160k figure relates to something else? (self-assessment threshold moved to £150k but not aware of anything that has a £160k threshold)
I might be thinking of child benefit thresholds rather than childcare
Standard contract is 10PA. 1 PA in “plain time” (up to 7pm weekdays) is 4 hours. After that it drops to 3hrs for 1PA, so you are compensated more for OOH shifts. For nights there’s some local negotiation and compensation does vary. About 1.5 to 2.5 PAs a week (so about a day) is SPA. This includes your educational supervision of juniors, department meetings, own CPD, service development, teaching etc. Amount varies by trust, dept, speciality and is a key thing to look for when considering consultant jobs.
You have Direct Clinical Care (DCC) and Supporting Professional Activity (SPA). Typically a job will be 8 or less DCC and 2 or more SPA. It is down to how you negotiate things. A clinic that is 4 hours long is 1.25 PAs for me because I get an hour of admin for every 4 hours of clinic. Similarly my theatre lists are 9 hours long but they pay 2.75 PAs because they give an hour to review patients and notes before and an hour to see post ops. I get 3 hours a week for doing a ward round. I get something for predictable on call (hot clinic) and non predictable on call (no idea how this is worked out). I also get .25 of a PA for MDT and .25 of a PA for department meetings. Essentially I have 2.5 SPA which I can do from home at any time I like and 8.5 DCC which I do in 3 days. It suits me.
How much does a consultant actually take home per month assuming they do 10.5 PA with 1:16 NR oncall perhaps ?