Junior doctors say they are facing increased pressure to take up locum shifts at short notice and a backlash from employers over attempts to negotiate higher locum pay rates.
The complaints came as the BMA released its locum rate card, which sets out the minimum pay doctors should accept for these extra shifts. These range from £60 an hour for a foundation year 1 doctor covering a weekday shift to £150 an hour for specialty trainees (years 6-8) on a weekend overnight shift.1
“Junior doctors’ skills and work have been undervalued for too long,” the BMA said in its guidance. “Considering the huge responsibility and onerousness of undertaking clinical work through the night on-site, we believe this represents a reasonable rate of pay for locum work.” It said these rates were “already being paid by some employers across the UK” and had been “calculated based on data collected from trusts, and to reflect the fairest rate.”
The NHS’s spending on locum staff has repeatedly come under scrutiny over the years. An investigation by the Labour Party last year estimated that the health service spent £8.9bn on temporary and bank staff in 2021-22. The BMA has argued that the NHS’s locum spend is a symptom of the workforce crisis and can be reduced by investing in recruitment and retention of doctors.2
Backlash
In response to the publication of the rate card, junior doctors have taken to social media to share the responses they have received when trying to discuss or negotiate higher rates of locum pay.
A trainee in Lincoln was removed from a hospital rota WhatsApp group by the coordinator after sharing the BMA rate card. In messages seen by The BMJ, the coordinator wrote, “The trust has not adopted BMA rates or this policy, these do not apply and are not accurate for our trust.” The remaining doctors questioned the doctor’s removal, saying that it made them “uncomfortable.”
“It shouldn’t be seen as problematic to ask for reasonable compensation for carrying that risk,” one posted. Another called the reaction “simply unacceptable.”
Speaking to The BMJ, a junior doctor at United Lincolnshire Hospitals NHS Trust who wished to remain anonymous said that the reaction from rota coordinators was disappointing, calling it “misguided at best.”
“It is never acceptable for a doctor to be punished for asking about their trade union’s guidance, particularly given the clear safety concerns raised if essential shifts are then not filled because rates cannot be negotiated further,” they said.
A spokesperson for the Lincolnshire trust said, “The incident in question is still being reviewed but the trust would not support limiting individual doctors’ rights to question or challenge through the appropriate channels.” They added that the trust had had “productive discussions with our medical teams in relation to extra-contractual payments, although we have not reached a final position on the very recently published suggested junior doctor’s rates.”
In another example, juniors received an email from NHS Lanarkshire saying, “The service have informed me that you have attempted to negotiate enhanced rates . . . Can you please explain this to me please as this may have to be raised with your training programme directors at the Deanery.”
The health board has since apologised for the email. Marlene Fraser, NHS Lanarkshire’s head of human resources, said, “We would like to apologise for any upset caused by this communication. We believe this communication is not representative of NHS Lanarkshire and, as such, are undertaking an internal review to understand the full context.”
Last month foundation doctors at Imperial College Healthcare NHS Trust reported that they had their locum pay rates cut after suggesting that a higher rate could improve staffing levels. In response, the juniors cancelled their extra shifts, and the trust said it was reviewing the situation and was committed to involving doctors in discussions over how and when pay can be increased.3
Commenting on the responses, Sumi Manirajan and Jamshid Ali Khan, deputy co-chairs of the BMA’s Junior Doctors Committee, said, “Unfortunately, it comes as no surprise that some doctors—doing locum shifts and simply asking to be rewarded for what they’re worth—are facing opposition from their trusts. However, it is absolutely their right to earn appropriate rates for any additional work they undertake outside their contracted hours, just as would be expected in any other role.”
They added, “We urgently need to fix the workforce crisis crippling NHS services, which requires valuing staff and making sure they are paid fairly. It is only right that junior doctors working both inside and outside their contracted hours are rewarded for the skills, value, and expertise that they provide to patients on a daily basis.”
The BMA is currently balloting junior doctors in England on potential strike action over pay, saying that juniors have faced a real terms pay cut of 26.1% since 2008-09. If doctors vote in favour of the ballot they will walk out for 72 hours in March.4