NHS strikes: What is happening to consultants

As consultant doctors walk out for 48 hours, analysis by the Nuffield Trust has found that their real terms annual earnings have fallen by 15% since 2010.

The NHS Confederation has said the consultants’ strike is a “step into the unknown” – and it feels like that in terms of the statistics used by both sides to make their case. The British Medical Association and the government each have their own favourite figures.

Let’s start with the real terms pay cut. The BMA says that, because inflation has risen faster than pay, consultants have seen their real take-home pay fall by 35% over the past 14 years.

But the BMA is using the Retail Price Index (RPI) to calculate this. The problem is that it’s not how we measure inflation – the Office for National Statistics (ONS) recommends using the consumer price index – CPI – instead. That’s the measure you see when we talk about inflation on Sky News.

And if you use the CPI to chart consultants’ earnings, they haven’t fallen by quite that much – it’s a 15% decrease since 2010.

But that’s still a big decrease, especially when you compare it to the public and private sector averages.

It’s also worth noting that 2010 was a relative high point for consultants’ pay.

Billy Palmer, senior fellow in health policy at the Nuffield Trust, told Sky News: “People typically use 2010 as a baseline, but in fact that was a fairly high point in the somewhat cyclical nature of consultants’ pay. If you look back over a longer period, three decades for example, consultants have actually received a pay rise.”

What about the amount of pay itself?

You might think this should be uncontroversial enough but again, both sides prefer different data.

Tom Dolphin, a consultant and a member of the BMA council, spoke to Sky’s Kay Burley on Thursday morning and referred to the starting basic pay of a consultant – £88,364.

But any pay rise would be applied to all doctors so we should probably use the average basic pay instead, which is £97,406. And if you compared basic pay to 2010, it’s clear that doctors are being paid less.

And basic pay has fallen more in England than in Scotland across all levels of experience.

While a consultant in England working for 10 years would receive a basic pay of around £105,996 in the 2022/23 year, a consultant in Scotland would get £108,345.

In comparison to 2010/11 (adjusted for inflation) this means consultants in England see a bigger decrease in basic pay – 14% compared to 12% in Scotland.

That figure, though, is still some way away from the figure the government likes to quote, that the average annual salary last year was £127,228. That includes non-basic pay: things like working beyond contracted hours (£14,566), medical awards such as the clinical excellence award (£6,028) and money received for being on call (£2,882).

The government likes this higher number – it’s nearly four times the average UK annual salary – but it’s also not an unfair statistic to choose.

The government also likes to mention its offer of a 6% increase in pay for NHS staff consultants, which might sound relatively generous.

But again, if you use CPI forecasts for next year, this would increase doctors’ annual earnings by only 1% in the year ending March 2024 – still far short of that actual 15% decrease since 2010.

Comparisons to other countries and professions

Dr Dolphin also mentioned that consultants were being tempted by job offers from countries where the weather is sunnier and the wages are higher.

Some of the comparisons here are a bit trickier because of different definitions and data.

We’ll start in the UK and compare how “specialist medical practitioners”, which would include consultants as defined by the ONS, compared to other categories in the professional occupations category.

And they compare very, very well – a median gross annual income of £68,614 in April 2022. That’s 3% more than headteachers and nearly three-fifths higher than aerospace engineers.

So specialists are top of the league at home. Abroad, though, they’re mid-table.

Consultants in the UK rank moderately in terms of earnings on a global scale.

The OECD puts a UK medical specialist’s earnings at $155,418 (we’re using dollars now for ease of comparison). This is nearly a third higher than a consultant in France but around a quarter lower than in South Korea.

Private pay and extra work

One last issue to think about. We’ve been talking about consultants’ pay from the NHS. But they’re also free to do work privately. Unfortunately, we don’t know how much they earn on average from this. (We couldn’t find any reliable data – if you have some, let us know!)

The BMA has said that any striking doctors “should not schedule any other work, including in private practice, when they are taking part in industrial action”.

However, there’s nothing stopping them legally.

And consultants may have also benefitted from their junior doctor colleagues striking. “It appears that the medical pay bill has increased over strike periods. So some doctors are demanding and receiving large amounts to cover a shift,” Mr Palmer told Sky News.

“But in that context, there doesn’t seem to be as much of a financial friction as there would be in maybe some other services and professions about going on strike for some staff,” he added.

To sum it up: consultants have high salaries compared to the UK average; they may have earned more money during other BMA strikes and they may – if they choose to – work privately during strikes. That gives them more financial resilience than other occupations: a train driver can’t really drive a private train on a strike day.

Coupled with that very real 15% drop in wages, they could be prepared to wait a long time for a better offer.

The Data and Forensics team is a multi-skilled unit dedicated to providing transparent journalism from Sky News. We gather, analyse and visualise data to tell data-driven stories. We combine traditional reporting skills with advanced analysis of satellite images, social media and other open source information. Through multimedia storytelling we aim to better explain the world while also showing how our journalism is done.

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