According to recent studies, top doctors in the NHS are billing outrageous sums for overtime effort. Some consultants make almost double the basic pay for a full-time consultant in England as demand increases to lower waiting lists using extra shifts.
How Are Part-Time Consultants Raking in Premium Pay?
The research reveals that many of the highest-earning consultants work part-time, enabling them to commit significant amounts of overtime. Some reportedly earn more than £200 an hour, more than four times the average wage rate. NHS England agreed that, given the present strains on the system, hospitals must provide competitive rates to draw workers.
However, the physicians’ organisation, the British Medical Association (BMA), noted that the NHS would not have to rely so much on overtime if staffing shortages were not so severe. Hospitals have also mentioned employee illness and covering for strike days as critical causes of the rising dependency on overtime.
What are the government investments and Labour's election promises?
These results reflect the government’s growing financial support to the NHS, which is meant to improve the number of appointments and operations—a significant promise the Labor party made before the next elections. During the budget speech, the Chancellor said that the NHS would acquire an extra £25 billion over the next two years, mainly with an eye toward lower waiting times. Encouragement of staff members to work evenings and weekends helps Labour’s approach aid to alleviate patient backlog.
What Concerns Are There About Value for Money?
Notwithstanding these initiatives, the research raises serious questions regarding whether this strategy will provide value for money. “Consultants hold all the cards – they know we cannot progress on the backlog without them,” said a senior NHS source. With contracts permitting consultants to opt out of weekend work and charging hospitals whatever rates they are ready to pay for overtime, one source observed that they occupy a “pretty unique position compared to other staff.” The insider also voiced worry that renegotiating these “outdated” contracts—which have existed for over two decades—is not in the BMA’s best interest.
“What concerns me is that the overtime costs are going to keep increasing with the need to tackle the backlog; this will breed resentment among other NHS staff who often work overtime for little more,” the source said. To reduce the load on current workers, they underlined the need for the NHS to hire more consultants, assign tasks to other staff, and invest in technology such as artificial intelligence.
How High Are Overtime Bills and Consultant Earnings?
Using Freedom of Information inquiries aimed at hospital trusts and statistics from NHS England, it was computed that the NHS’s total overtime expenditure in 2023–24 was close to £1 billion, a dramatic rise from £512 million ten years before. Six in ten consultants are working above their contracted hours, with average extra remuneration above £27,000 yearly, despite some of these increases being ascribed to the rise in the number of consultants. Moreover, at least half of the 41 hospital trusts who answered the inquiry now pay some of their consultants more than £100,000 in overtime.
For example, Bradford Teaching Hospitals NHS Foundation Trust said that four doctors from its medicine specialty received over £100,000 in overtime pay; one physician made just over £208,000 for 128 days of work, an average of £ 188 per hour. Emphasising that covering strikes has further taxed their operations, the trust said, “in common with most NHS trusts, we have to rely on overtime payments to manage waiting lists and to cover rota gaps and vacancies.”
A similar disclosure by NHS Frimley Health Foundation Trust revealed that two endoscopy department consultants were paid over £180,000 in overtime to handle treatment backlogs. Declaring, “We’re focused on ensuring we always provide value for money, and anything we spend is in proportion with the benefit it brings to our patients,” the trust underlined its dedication to offering value for money.
What Are the Consequences of Staffing Shortages?
Operating five hospitals, NHS Humber Health Partnership recorded three consultants earning between £185,000 and £240,000 in overtime. Declaring, “We assess the costs of these shifts against the risks of not having cover,” Chief Medical Officer Kate Wood said that the overtime expenses enabled extra operations during weekends to reduce waiting lines. As our main concern is patient safety, it comes first. This is not something particular to us.
According to Worcestershire Acute Hospitals NHS Trust, three consultants, including one who made just above £198,000, also paid more than £100,000 in overtime. Managing Director Stephen Collman pointed out that although the trust works to lower “premium payments” whenever feasible, the need to cover illness and empty jobs meant they had no alternative but to pay these fees to maintain safe and efficient services.
What Solutions Are Being Considered?
Some hospitals reported that increased expectations established by the BMA about strike cover rates had risen over the past year. “It changed their expectations of what they should get,” one hospital official said. Still, BMA consultant co-leaders Dr. Helen Neary and Dr. Shanu Datta backed the consultants, noting, “Unfortunately, a declining workforce in crisis and spiralling patient demand – which has led to sky-high waiting lists – means that extra hours of work are essential to get the job done.” They also pointed out that most of the overtime happens outside of social events and that it makes sense for highly skilled and experienced workers to value their time “at appropriate rates.”
Representing hospitals on employment issues, Danny Mortimer of NHS Employers admitted to the problematic financial situation the NHS is experiencing. “Health leaders are trying to bear down on extra-contractual premium pay rates,” he stated. He stressed, nevertheless, that there are no simple answers since experts are necessary to handle waiting lists. An official from NHS England points out that dependence on agencies, which might be even more expensive, is diminishing.
