NHS Employers' evidence to DDRB 2027/28

Access DDRB 2026/27 (opens PDF).

Read the key messages for the DDRB 26/27 (opens PDF).

Access DDRB 25/26

Key messages

• Employers welcome the pay deals ending industrial action but are concerned that ongoing dissatisfaction and differing pay settlements could lead to further industrial action, hindering progress in rebuilding relationships, financial stability, and reducing waiting lists.
• We will support employers by implementing the doctors and dentists in training agreed pay deal with the British Medical Association (BMA), which includes pay increases for 2023/24 and 2024/25, collaborate with Department of Health and Social Care (DHSC) on training reforms, renegotiate exception reporting for fair compensation, and explore issues with Flexible Pay Premia (FPPs) in certain specialties.
• We will support employers in implementing the SAS agreed pay deal with the BMA, addressing SAS contract imbalances, supporting career progression, and promoting the SAS advocate role to improve recruitment, retention, and wellbeing.
• We continue to support employers with the consultant pay deal agreed with the BMA and Hospital Consultants and Specialists Association (HCSA), including consultant pay scale reforms, pay progression, and shared parental leave. We will work to resolve Local Clinical Excellence Awards (LCEA) issues, focus on future contract reform, and re-establish joint negotiating committees.
• Employers face challenges recruiting entry-level primary care dentists, leading to prolonged vacancies. The LTWP is exploring measures to ensure new dentists deliver NHS care, which may require pay and employment terms changes. Addressing abuse towards salaried dentists is crucial for their wellbeing and retention.
• The rise in locally employed doctors (LEDs) due to less than full time (LTFT) posts, training gaps, and workload pressures highlights the need for better education and career development support to improve retention, patient safety, and training programmes.
• Employers welcome the government's commitment to introduce changes to the operation of the DDRB process and their ambition to return to a timelier annual pay process. Making prompt payment of pay award changes at the beginning of the financial year would significantly help employers' budgetary and financial management processes.

Access DDRB 2024/25

Our submission includes:

• the impact ongoing industrial action has had on employers and staff
• an update on the consultant work programme priorities
• information about maintenance and administration of the junior doctor contract
• an update on the implementation and take up of the new specialty doctor and specialist contracts
• information about the recruitment, retention and morale of salaried primary care dentists
• information on pensions and reward. 

Key messages

• Ongoing industrial action has led to poor morale and strained relations with doctors. Planning for and covering industrial action has exhausted employers, limiting their capacity to develop and improve services.
• Specialty and specialist grade (SAS) doctors 2021 contract reform aimed at attracting, motivating, and retaining SAS doctors, but fewer doctors than planned are transitioning to new contracts due to pay differentials. Remedial action is welcomed to reset pay differentials and encourage transition.
• Employers want to see a pay award that is fully funded and sustainable, allowing them to continue to prioritise workforce growth in key areas. 

Access DDRB 2023/24 (PDF)

Our submission includes: 

• information about maintenance of the junior doctor contract following the 2019 framework agreement
• an update on the implementation and take up of the new specialty doctor and specialist contracts
• an update on progressing Local Clinical Excellence Awards (LCEAs) successor scheme arrangements from 2022/23
• information about the recruitment, retention and morale of salaried primary care dentists
• information on pensions and reward. 

Key messages

• Employers are currently experiencing exceptional workforce challenges. While there has been an increase in the numbers of doctors and dentists in the year to July 2022 (2.8%), vacancy rates have also continued to grow and the number of leavers are in excess of 20,000. These high vacancy rates have impacted on service provision as employers cover vacant posts with agency locums and other temporary staff, which comes with significant financial impact. It can also create challenges in ensuring continuity of care.
• For the NHS to fully recover from the pandemic, tackle its waiting lists and support its staff, it will need the government to provide investment for an ambitious long-term plan for the workforce.
• There has been lower investment in the medical paybill relative to other staff over the last 12 years. Long term contractual agreements have meant lower pay awards in some cases, and there are taxation issues related to pensions that undermine the value of the total reward package for some senior clinicians.
• There is a worsening position on health and wellbeing measures across all occupation groups. The overall staff engagement indicator has declined for the first time in three years. This was driven largely by the reduction in the percentage of staff willing to recommend the NHS as a place to work, and reductions in most indicators of staff motivation and staff involvement, which are the other elements of the staff engagement indicator.
• Employers want to see a pay award that is fully funded and sustainable, allowing them to continue to prioritise workforce growth in key areas.
• It is important to bring the timetable of the pay review body back to normal, enabling a return to prompt implementation and payment of pay awards to staff. 

• Access DDRB 22/23 (PDF)
• Our submission includes:
• information about maintenance of the junior doctor contract following agreement of all outstanding provisions from the 2019 framework agreement
• an update on the transition of doctors to the new specialty doctor and specialist contracts
• an update on progress with negotiations for a Local Clinical Awards successor scheme from 2022/23
• information about the recruitment, retention and morale of salaried primary care dentists
• information on pensions and reward.

• Key messages

• The COVID-19 pandemic has presented one of the biggest challenges that the NHS has ever faced, with work demands peaking and services being adapted, impacting negatively on staff health and wellbeing. The workforce is exhausted and in many situations it is struggling to cope.
• There are not enough staff to meet demand; the NHS entered the COVID-19 crisis with a shortage of at least 100,000 clinical staff. The significant gaps in the workforce must be addressed at a national level.
• With rises to national insurance (NI) contributions, freezing of personal allowance tax thresholds until 2026, and increased NHS Pension Scheme contributions for some, there is potential for members to experience a compounded negative impact on their take-home pay.
• Medical staff levels of engagement remained stable, with staff still highly motivated and positive about their jobs.
• Any pay award must be fully funded.
• All outstanding provisions from the 2019 framework agreement for doctors in training have been agreed.
• Securing the benefits associated with the introduction of the new SAS contract remains a priority for employers.

Access DDRB 21/22 (PDF)

Key messages

• The outbreak of the COVID-19 pandemic is one of the biggest challenges the NHS has faced.
• There has been an outstanding response from the workforce to the challenges presented by the pandemic.
• Staff have been under enormous pressure and supporting their health and wellbeing is a priority.
• Workforce shortages remain the highest concern for employers and the supply issues need to be addressed. Employers remain committed to retaining staff but the health and wellbeing of staff and the risks of staff burnout, especially considering the pandemic, coupled with gaps in the workforce make this a greater challenge.
• We welcome the confirmation in the 2020 Spending Review that NHS staff will receive a pay award. Employers want to see an award which is fully funded and sustainable and which is fair to all staff.
• In December 2020, parties concluded negotiations on two contracts, a new Specialty Doctor and a Specialist grade contract that will replace the closed associate specialist grade. The framework agreement proposal is now being put to a referendum of BMA members in the SAS grades, for implementation from April 2021.

Access DDRB 20/21 (PDF)

Our submission includes:

• an update following the agreement reached with the British Medical Association (BMA) on the junior doctor contract
• progress on work taken forward to develop the specialty and associate specialist (SAS) grade and proposals for contract reform
• an update on the revised Local Clinical Excellence Awards scheme for consultants and plans for a successor scheme from 2021
• information on pensions and reward.

Key messages

• The NHS, and its staff, continue to feel the combined effects of financial pressure, workforce shortages and rising demand.
• There is a risk that without the right workforce then the aims of the NHS People Plan will not be met.
• Any pay award over and above that already planned must be fully funded.
• The pensions tax issue is having a significant impact on senior staff across the NHS and on service delivery. We believe that the solution lies in a combination of scheme flexibilities, the removal of the cap and better information for staff, and that this should apply to all staff in time for the 2020/21 financial year.
• Employers, in general, do not support targeting pay. We should await the outcome of work currently underway as part of the people plan on the distribution of specialty trainees.
• The agreement reached with the BMA on the junior doctor contract and the three year pay deal was an important step and has allowed for partnership working to be re-established.
• The start of negotiations on contract reform for the SAS grade is a significant opportunity to re-establish the SAS doctor role as a positive and valued career choice.