Employer evidence to the DDRB

Employers highlighted concern that differential pay awards between doctors, dentists and Agenda for Change staff risked undermining perceptions of fairness, morale and cohesion across the NHS’s integrated, multi‑professional workforce. 

Employers said greater coordination between pay review bodies was needed to improve transparency and understanding where different pay awards are made, given the interdependency between medical, dental and wider NHS roles.

Employers supported prioritising headline pay award uplifts across all DDRB remit groups, emphasising that awards should be fully funded, sustainable and applied consistently, rather than using targeted pay approaches. 

Employers stressed that for resident doctors, consultants, SAS doctors and dentists, working conditions, facilities, training quality, rota stability and day‑to‑day experience were critically important alongside pay for motivation, wellbeing and retention.

Employers reported that while organisations had become more resilient to industrial action by resident doctors, it continued to generate substantial financial costs, service disruption, management burden and negative impacts on workforce morale and longer‑term planning.

Employers warned that legislative and industrial relations changes could lower the threshold for lawful industrial action and increase its frequency across medical and dental workforces, adding further risk to service continuity. 

Employers highlighted persistent recruitment and retention challenges across all medical and dental remit groups, particularly in hard‑to‑fill specialties, rural and less favourable locations, and amid reduced international recruitment linked to immigration policy changes.

Employers raised ongoing contractual challenges across consultants, SAS doctors and locally employed doctors, including inflexibility, job planning ambiguity, issues supporting seven‑day services and the need for contractual modernisation to reflect contemporary working patterns. 

Employers said there was strong support for a review of flexible pay premia, affecting doctors and dentists in hard‑to‑fill specialties, noting that existing arrangements had not been updated since 2016 and may no longer reflect current workforce pressures. 

Employers reported significant financial constraints, including productivity and cost‑reduction requirements, limits on capital investment, and unfunded pay and industrial action costs, constraining service delivery and workforce investment across medical and dental services. 

Employers emphasised the importance of the NHS Pension Scheme across resident doctors, consultants, SAS doctors and dentists, noting increased membership overall but continued opt‑outs among international recruits and challenges applying partial retirement flexibilities. 

Employers highlighted significant dental workforce pressures across salaried, community and special care dentistry, including difficulties recruiting entry‑level dentists, uncompetitive starting salaries, workload stress, abuse and violence, and risks to service sustainability.