Public sector pay review bodies 2009: the NHS
This feature looks at the the second year of the three-year deal for workers covered by the NHS Pay Review Body, and the 2009 recommendations of the Review Body on Doctors' and Dentists' Remuneration.
On this page:
NHS Pay Review Body
Second year of three-year NHS pay award
Doctors and dentists
Background to the report
Review Body on Doctors' and Dentists' Renumeration recommendations
Union reactions
Table 1: Summary of pay review body awards for Agenda for Change staff and doctors and dentists, 2009
Table 2: Agenda for Change pay scales, 1 April 2009
Table 3: Example full-time salaries for doctors and dentists on main grades, 1 April 2009
Table 4: Example consultant pay scales, 1 April 2009
Additional resources on XpertHR.
Key points
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NHS workers in the UK are covered by a number of review bodies. A previous part of this feature looked at the recommendations of the Review Body on Senior Salaries, which covers "very senior managers" in the NHS in England. Doctors and dentists are covered by the Review Body on Doctors' and Dentists' Remuneration (DDRB). Staff on Agenda for Change terms and conditions, including nurses, midwives, cleaners and administrative staff, are covered by the NHS Pay Review Body (NHSPRB). The 2009 pay increases for staff covered by the NHSPRB and the DDRB are summarised in table 1.
NHS Pay Review Body
In 2008, the NHSPRB made recommendations for a single-year deal, recommending a pay increase of 2.75% from 1 April 2008 for the 1.3 million workers in its remit group. However, separate talks between the Department of Health, NHS Employers and the two largest healthcare sector unions (Unison and the Royal College of Nursing) eventually resulted in a proposal for a three-year pay deal, adopting the NHSPRB's recommended increase in the first year, with further increases of 2.4% from 1 April 2009 and 2.25% from 2010 in the final year of the deal.
After consultation in June 2008, 12 of the healthcare sector unions representing the majority of staff agreed to accept the three-year settlement. Unite, however, did not accept it.
As part of the three-year agreement (on NHS Employers website), the NHSPRB was given the power to request a review of the deal: "In the event that the NHSPRB receive and identify new evidence of a significant and material change in recruitment and retention and wider economic and labour market conditions, they may request a remit from the secretary of state to review the increases set out in this agreement for 2009/10 and/or 2010/11."
Shortly after the deal was agreed, the healthcare sector unions asked the NHSPRB to review the agreed increase for 2009/10 in view of the high rate of inflation, and evidence was submitted to the review body in October 2008. The NHSPRB declined to do this, but said it would undertake a review in autumn 2009 to consider the proposed increase for 2010/11.
Second year of three-year NHS pay award
In addition to the increase of 2.4% on all pay points, the second year of the agreement provides for some changes to the pay bands:
- the bottom point of band 1 is removed;
- the value of the top pay point of band 5 is increased by an additional 0.33%; and
- some pay points in band 5 (and because they overlap, the first three points in band 6) are increased to redistribute the pay points in band 5.
The resulting pay scales are shown in table 2. All pay points have been renumbered as a result of the lowest point being removed.
In addition to its role in reviewing the increases set out in the three-year pay agreement, the NHSPRB also collected evidence from the parties on a range of issues identified in its 2008 report. These include recruitment and retention and workforce planning; efficiency savings targets and staff contribution; quality of staff and applicants; motivation and morale; and high-cost-area supplements. The review body will report on these issues in 2009.
In recent months, as the economic situation has worsened and many employees in the private sector have seen their pay frozen or even cut, the long-term deals agreed in the public sector in 2008 have come under scrutiny. However, NHS staff have been reassured that their three-year pay award will be honoured in full.
Doctors and dentists
The DDRB covers 186,563 doctors and dentists in the NHS in the UK (as at September 2007). These include consultants, doctors and dentists in training, general medical practitioners (GMP) and general dental practitioners (GDP).
The DDRB's 2009 report (on the Office of Manpower Economics website) was published on 31 March 2009. It recommended increases of 1.5% for all the salaried members of its remit group, as it saw no reason to differentiate between them. For independent contractor GMPs and GDPs, the DDRB took account of changes in business expenses and made a recommendation for awards aiming to increase the net income of these groups by the same amount as the salaried groups.
Secretary of State for Health Alan Johnson announced that the Government accepted the DDRB's recommendations in full, effective from 1 April 2009.
Background to the report
As with the review bodies making recommendations for 2009, the DDRB noted that this had been a particularly difficult pay round in view of the economic situation.
It acknowledged that affordability could not be considered separately from other priorities, especially recruitment and retention, and said it had not been easy to make its decisions during a period of such economic uncertainty.
The Department of Health (DH) had stressed that the Government's pay policy was unchanged, and said that pay awards "above the appropriate level" would be at the cost of service improvements. It also said that higher levels of pay would "reduce the demand for workforce". The DH emphasised the total reward package available to the remit groups covered by the DDRB, and in particular the final-salary NHS pension scheme.
The health departments supported a headline pay award of 2% for directly employed groups, an increase of 1% in gross contract values for GDPs and a gross increase of up to 1.6% for GMPs.
NHS employers wanted an award that was fair to staff but also recognised the need for organisations to balance their finances. It concluded that an increase of 2% would be affordable.
The British Medical Association (BMA) was looking for basic earnings increases of at least 4%. It made the case for junior doctors to have a higher award because of the reduction in their pay as a result of the implementation of the Working Time Directive, which from August 2009 will restrict working hours to 48 per week. It again argued that there should be compensation for the loss of free accommodation for those in the first year of training.
When the general dental services contract was introduced in 2006 in England and Wales, it was agreed that the DDRB would make recommendations on uplifting the value of the contract for three years. That agreement ended in March 2009, but the parties asked the review body to make a recommendation from April 2009. However, the parties expressed various opinions about the formula used by the review body to calculate the uplift. The DDRB itself was not sure that the approach it used was appropriate, and said it was important that the parties agree on its future role with regard to this group.
The British Dental Association had suggested an increase of 5.3% in the net income of GDPs, and said that this figure should apply to all staff groups in order to maintain the income relativities within the profession. The Dental Practitioners Association wanted a 5% increase in fees to account for inflation.
The DDRB said that the evidence it considered indicated that overall, recruitment and retention of doctors and dentists was satisfactory. It noted that surveys suggest that medical and dental staff have some of the highest levels of job satisfaction in the NHS.
The review body also remarked that, since that evidence had been prepared, public sector employment had become more attractive, offering considerable job security and a defined-salary pension. It emphasised that, becase of the uncertain and rapidly changing economic climate, it had tried to interpret the evidence presented in September and October 2008 in light of the economic situation at the time of compiling the report five months later. It therefore decided that, in the "highly unusual economic circumstances", only modest increases were justified, and made its recommendations accordingly.
The DDRB recognised that the parties may have been expecting its recommendations to be higher, but it described the uplift as "fair and reasonable", adding that it would be sufficient to recruit, retain and motivate the groups in its remit.
Review Body on Doctors' and Dentists' Renumeration recommendations
The recommendations for each group are as follows (see table 3):
- Independent contractor GMPs. Since the previous year's DDRB report, the parties had agreed a methodology for distributing an overall uplift across components of the general medical services contract for 2009/10. They asked the DDRB to recommend this overall uplift. As the DDRB could see no reason for the net uplift for this group to differ from that awarded to salaried doctors and dentists, it calculated an increase of 2.29%, designed to give a 1.5% average increase in net income.
- Salaried GMPs. The DDRB considered the salary range for this group to be appropriate, with scope for employers and employees to negotiate a pay point within the range. It therefore recommended that the minimum and maximum of the range be increased by 1.5%.
- GMP registrars. The DDRB found no cause for concern in recruitment in this group, and in principle supported the alignment of contractual arrangements between GMP registrars and trainees in hospitals. GMP registrars are paid a supplement, and although the DDRB said that this should continue to be paid at the existing levels for registrars already in receipt of these payments, it agreed with the proposal put forward by the DH and NHS employers, and recommended that the supplement should be reduced from 50% of basic salary to 45% for those starting training from 1 April 2009.
- Independent GDPs. The review body calculated that an uplift of 0.21% on the gross earnings base under the new contract for GDPs in England and Wales would yield an increase in net income of 1.5%. It applied the same increase to gross fees, commitment payments and sessional fees for taking part in emergency dental services in Scotland and Northern Ireland.
- Salaried dentists. An increase of 1.5% was applied to all grades in salaried primary dental care services.
- Doctors and dentists in hospital training. An increase of 1.5% was made to the salary scales of all grades of doctors in training.
- Consultants. New contracts for consultants, which differ in the devolved countries, were agreed in 2003; fewer than 10% of consultants remain on the old contract. The DDRB makes recommendations on the pay uplift for both old and new contracts (see table 4). For 2009, it recommended an increase of 1.5% on the national salary scales and pay thresholds for both pre-2003 and post-2003 contracts. Traditionally, the review body has recommended the same uplift for the clinical excellence awards (CEAs), discretionary points and distinction awards that reward consultants for exceptional achievements and contributions to patient care. It therefore recommended that these should also be uplifted by 1.5%.
- Specialty doctors and associate specialists. This is the new title for the doctors formerly called staff and associate specialists/non-consultant career grades. The new contract for this group was introduced from April 2008. The review body felt that it was too early to assess whether or not the new contract had improved the motivation and morale of this group, and that it was important that its recommendations did not conflict with the new contract before it had "settled down". It recommended an increase of 1.5% on national salary scales for both pre-2008 and post-2008 contracts.
The DDRB determined that there should be no increase to the level of London weighting, which remains at £2,162 for non-resident staff and £602 for resident staff. Unless mentioned otherwise, it said fees and allowances should increase by 1.5%.
Union reactions
In response to the announcement of the review body's recommendations, Dr Hamish Meldrum, the BMA's chairman of council, said: "Doctors will be disappointed at this award. They will feel that the DDRB appears to have capitulated to Government pressure. Whilst we appreciate that tough decisions have to be taken during this period of economic difficulty, holding back on doctors' pay is not the answer."
The BDA described the gross pay uplift awarded to GDPs as "failing family dentists". John Milne, chair of the BDA's general dental practice committee, said: "We appreciate that a measure of financial restraint is necessary in the current economic climate. Clearly, economic prudence is essential for everyone. But it's also important to remember that high-street dentists are running businesses that provide vital healthcare to millions of people. Those businesses must be properly funded so that they can invest in their premises and equipment to deliver the highest quality care to their patients." The BDA also said that salaried dentists felt "let down" by their 1.5% pay award.
This article was written by Rachel Sharp, researcher/writer, Pay and Benefits Bulletin.
Table 1: Summary of pay review body awards for Agenda for Change staff and doctors and dentists, 2009 |
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Group (nos. covered) |
2009 pay award |
Previous increase |
NHS Pay Review Body - all staff paid under Agenda for Change in the NHS in the UK (1,300,000) |
Second year of three-year agreement increases all pay points by 2.4%, plus some restructuring of the pay bands from 1 April 2009. |
First year of a three-year pay deal increased all pay points by 2.75% from 1 April 2008. |
Review Body on Doctors' and Dentists' Remuneration - NHS doctors and dentists in the UK (186,563) |
From 1 April 2009, the pay of salaried groups increased by 1.5%. Payments to independent contractor general dental practitioners (GDP) and general medical practitioners (GMP) are increased by amounts designed to give an increase in net income of 1.5% for each group. |
From 1 April 2008, salaried groups received a 2.2% increase, and payments to GDPs were increased by an amount intended to result in a 2.2% increase in income. For GMPs, the global sum element of the contract was increased by 2.7%, designed to give an increase in income of 2.2%, but because this increase was offset by reducing the correction factor payments, most practices did not see any increase. |
Table 2: Agenda for Change pay scales, 1 April 2009 |
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Pay band |
Job examples |
Minimum, £pa |
Maximum, £pa |
1 (spine points 1-3) |
Finance assistant, healthcare science support worker (entry level) |
13,233 |
13,944 |
2 (spine points 1-8) |
HR assistant, clinical support worker, phlebotomist |
13,233 |
16,333 |
3 (spine points 6-12) |
Finance officer, clinical support worker (higher level) |
15,190 |
18,157 |
4 (spine points 11-17) |
HR administrator, dental nurse |
17,732 |
21,318 |
5 (spine points 16-24) |
HR adviser, physiotherapist, nurse |
20,710 |
26,839 |
6 (spine points 22-30) |
Midwife, nurse team leader, finance section manager |
24,831 |
33,436 |
7 (spine points 27-35) |
HR team manager, clinical psychologist, nurse team manager |
29,789 |
39,273 |
8a (spine points 34-39) |
Principal finance manager, modern matron |
37,996 |
45,596 |
8b (spine points 38-43) |
Social care programme manager, chief finance manager |
44,258 |
54,714 |
8c (spine points 42-47) |
Communications service manager, clinical psychologist consultant |
53,256 |
65,657 |
8d (spine points 46-51) |
Head of estates, head of arts therapies |
63,833 |
79,031 |
9 (spine points 50-55) |
Director of estates and facilities, nurse/midwife consultant higher level |
75,383 |
95,333 |
Source: NHS Employers job profile index and Pay Circular 1/2009 (PDF format, 82K) (external websites). |
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Table 3: Example full-time salaries for doctors and dentists on main grades, 1 April 2009 |
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Job |
Point on scale |
Salary, £pa1 |
HOSPITAL DOCTORS AND DENTISTS - SELECTED GRADES |
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Foundation house officer 1
|
Minimum |
22,190 |
Maximum |
24,960 |
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Senior house officer
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Minimum |
27,523 |
Maximum |
38,322 |
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Specialist registrar
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Minimum |
30,685 |
Maximum |
46,246 |
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Staff grade practitioner (1997 contract)
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Minimum |
33,762 |
Maximum (normal) |
47,639 |
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Maximum (discretionary) |
63,244 |
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Associate specialist (2008)
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Minimum |
51,095 |
Maximum |
84,106 |
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COMMUNITY HEALTH STAFF |
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Clinical medical officer
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Minimum |
32,343 |
Maximum |
44,602 |
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Senior clinical medical officer
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Minimum |
45,704 |
Maximum |
65,175 |
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1. Salary scales exclude earnings such as out-of-hours payments for training grades. |
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Table 4: Example consultant pay scales, 1 April 2009 |
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Consultant contract |
Point on scale |
Salary, £pa |
Consultant (2003 contract, England, Scotland and Northern Ireland for main pay thresholds)
|
Minimum |
74,504 |
Maximum (normal) |
100,446 |
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Maximum (local CEA)1 |
35,484 |
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CEA bronze2 |
35,484 |
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CEA silver |
46,644 |
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CEA gold |
58,305 |
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CEA platinum |
75,796 |
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Consultant (2003 contract, Wales)
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Minimum |
72,205 |
Maximum (normal) |
93,742 |
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Maximum (commitment award)3 |
25,632 |
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Consultant (pre-2003 contract)
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Minimum |
61,859 |
Maximum (normal) |
80,186 |
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Maximum (discretionary)3 |
25,632 |
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Distinction award B2 |
31,959 |
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Distinction award A |
55,924 |
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Distinction award A+ |
75,889 |
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1. Local level clinical excellence awards (CEAs) in England. |
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Additional resources on XpertHR
- Public sector pay review bodies 2009: Government imposes pay restraint on senior staff The first part of our coverage of the public sector pay review bodies looks at the pay awards received by police officers, the armed forces, the judiciary, senior civil servants and "very senior managers" in the NHS, along with parliamentary pay rises.
- Public sector pay 2008 A round-up of public sector pay agreements in 2008.
