Consultant contract FAQs

A1. Because they are for two different purposes. Schedule 14.1 defines to whom that schedule applies, that is those who took up their first consultant appointment on or after 31 October 2003. 

For this purpose “date of appointment” is defined as the date on which the post was offered. This is to establish if they are covered by the provisions of Schedule 13 instead.

Schedule 14 does not distinguish between a conditional offer and an unconditional offer. 

Schedule 14.2 addresses pay progression. It tells us that if someone is covered by Schedule 14, then they become eligible to progress on the anniversary of their appointment. For this purpose the date of appointment is defined as the date they first started work under the new terms and conditions.

A2. Yes. NHS Employers, working in partnership with the British Medical Association (BMA), produced a guide to consultant job planning, which provides practical advice and examples of good practice to support effective job-planning discussions and outcomes. The guide also gives more detailed information on a range of issues such as calculating frequency when a doctor is on more than one rota, and the application of prospective cover.

A3. This is a matter for local determination but generally it should be recorded in the same way as annual leave.  

A4. This is a matter for employers to decide at local level. Our expectation is that it would only count if it was equivalent to a substantive post, that is the locum had carried out the full range of duties and responsibilities of a consultant. 

We regard it as very unlikely that a short-term locum appointment (that is less than three months and probably less than six months) would count. 

Also, it can only count once, so if it has been taken into account when deciding where the consultant starts on the pay spine it cannot count again for seniority. 

A7. Eligibility for London weighting depends on the consultant’s employing organisation and work location. The rates are set out in the annual medical and dental pay circulars.

A8. No, our view is that a simple change in hours, from full time to part time or vice-versa is an insufficient reason to require a move to the 2003 contract. 

The consultant may remain on the old contract if they wish, however, the 2003 contract should be offered and a job plan review will be required.  

A9. We would advise against this. The full-time consultant contract is based on ten PAs per week.

Consultants can be asked to perform more but have the right not to exceed ten PAs if that is their wish. Advertisements for full-time posts should be for ten PAs, but the advertisement could indicate (assuming funding is available) that more could be available if the appointee wished. This would need to be discussed after the post had been filled. 

A10. The advice from your finance department is correct. For new consultants without approved consultant level experience, the start point is pay threshold Level 1.  

However, the terms and conditions do allow for recruitment and retention premia to be paid for hard to fill posts. The provisions for these premia are set out in Schedules 16.13 to 16.15. 

(SHAs no longer exist and regional policy no longer applies.  The TCS refer to this but that will need editing when we next republish)

A11. Predictable on-call duties should form part of the working week’s PAs. 

Unpredictable on call work counts towards the number of direct clinical care PAs. This was up to a maximum average of one PA per week until 31 March 2005, and a maximum average of two PAs per week from 1 April 2005. Schedule 5 of the terms and conditions refers to this. 

In exceptional circumstances the employing organisation may agree additional arrangements with the consultant to recognise work in excess of this limit either by additional remuneration or time off. See Schedule 5.2 and the calculating on-call work guide (opens a PDF).

A14. PAs may be planned in whole or half units. Consultants may elect to use smaller units where appropriate with agreement with their employer, to provide for greater flexibility. The Guide to consultant job planning (opens a PDF) notes that many trusts have agreed to pay down to levels of 0.25 PAs.

A15. This is as set out in the terms and conditions schedule 18.1 – 18.3. Those who have completed less than seven-years service as a consultant are entitled to six weeks annual leave. Those with seven or more complete years’ service as a consultant are entitled to six weeks plus two days annual leave.

However, the leave year is calculated from the anniversary of appointment. Thus, consultants who attain seven years service or more in a leave year receive the six weeks plus two days entitlement from the start of that leave year.  

For part time consultants, the entitlement to annual leave is pro rata.

A19. This is a matter to be decided by the employers themselves. Either, or neither, or both the NHS or University employers can offer one or two additional PAs (over and above the ten that make up a full-time contract in any numerical combination). The arrangements are intended to be flexible and payment should be made by the employer choosing prospectively to buy the additional activity. 

When preparing integrated job plans, employers and consultants have a high degree of flexibility in the choice of arrangements. The emphasis is on joint planning of service and educational interests, in keeping with the principles outlined in the Follett Report. 

A20. This is not expressed in almost identical terms to paragraph 106 of the ‘old’ contract terms and conditions. There is, therefore, a continuing general obligation to provide cover where practicable. Some trusts have put in place a policy to cover this matter, an approach we would endorse.

In the absence of such a policy we would offer the following guidance. Employers and consultants are encouraged to come to agreement locally on what is deemed to be practicable, what the proposed cover entails and establish that the work is of a suitable nature to be covered by the consultant. In establishing suitability, due regard must be given to a doctor’s duty to recognise and work within the limits of their  professional competence. It may be necessary to agree re-arranged duties for one or more consultants in the short term in order to provide adequate cover.  

In terms of remuneration, obviously it is not possible to schedule PAs for unexpected absences into a prospective job plan. There are a number of ways of addressing the issue of compensation for additional work. The 2003 contract is sufficiently flexible that the length of the working day (or week) is not expected to be the same week in, week out. It may be possible to re-arrange, by agreement, duties flexibly so that a consultant providing additional cover for an absent colleague can take time off in lieu later.   

Duties may be rearranged temporarily so that, for example, extra direct clinical care PAs are worked to cover the absence, with supporting professional activities PAs time shifted to be taken at a later, more convenient date perhaps in lieu of direct clinical care PAs at that time.

Alternatively, or in addition, thought may be given to a temporary reallocation of specified responsibilities (with enhanced supervision as necessary) to an appropriate specialist grade, specialty doctor or specialty registrar. 

In the longer term, the question of additional remuneration may arise, including in respect of the on call availability supplement (if the rota frequency has increased) and PAs for on call work undertaken. These may need to be re-calculated.

The formula for calculation and payment is that contained within the terms and conditions. Schedule 16.5 of the terms and conditions anticipates changes in rota frequency, which may require a change in on call availability supplement. Schedule 5 deals with recognition for work arising from on call duties, while schedule 13 deals with payment for additional PAs.   

In summary, cover for an unexpected absence is a contractual obligation for consultants, whether on the ‘old’ contract or the 2003 contract.  

The practicability of providing such cover should be determined locally by agreement. Compensation for the additional work should be in accordance with the applicable contract.

A21. Trusts are able to make additional payments in respect of these roles – see schedule 16.16 of the terms and conditions. 

A22. The full details are set out in schedules 13 and 14 of the terms and conditions of service.

In summary, it’s the number of completed whole years worked for the NHS as a consultant (or other employment as specified) plus, for doctors appointed prior to 31 October 2003, the position on the “old” salary scale when first appointed.

The salary scale in the old contract has 5 points (0 to 04) so the position would be the actual salary point plus 1.  In addition, approved non-NHS consultant level experience may be taken into account assuming it has not already been counted in establishing the starting salary point. 

A23. No, the fact that this was employment as a MPT consultant does not affect the method of calculation. 

Seniority is calculated as set out in the answer to the question above.  

A24. This is a matter for employers to decide at local level. Our expectation is that it would only count if it was equivalent to a substantive post, that is, the locum had carried out the full range of duties and responsibilities. We regard it as very unlikely that a short term locum (that is, less than three months and probably less than six months) would count. 

Also it can only count once, so if it has been taken into account when deciding where the consultant starts on the pay spine it cannot count again for seniority.  

A25. Yes 

A26. Yes 

A27. No, a formula does not exist. However, schedule 13.7 and schedule 14.6 of the terms and conditions are clear that employers should credit appropriate additional seniority so as to negate the effects of prolonged training by virtue of a flexible training scheme (the previous name for approved less-than-full-time training).

For example, if LTFT training extended a training programme by three years, then an additional three years seniority would be given to the consultant upon first appointment to the 2003 consultant contract. 

A30. No, from what you have said he is wrong. Pay thresholds are not the same as an annual incremental scale. Schedule 14.7 specifies the gap in years between the different pay threshold points. This consultant would start on threshold point 5, and be eligible to move to threshold 6 after a further four full years in post. 

A31. No, our view is that it does not. Schedule 13.5 of the terms and conditions, which defines seniority, makes provision for the recognition of previous employment as a consultant and/or NHS consultant level experience.

Previous service as a GP principal is not, in our view, the same as employment in the NHS as a consultant. The training route, resulting qualification, and professional experience differ markedly between GPs and consultants.

For GPs, a shorter period of training prepares them for work in a primary care setting. 

For consultants, following core training or its equivalent in run-through programme, an extended period of four to five years’ specialist training is required in order to receive the necessary accreditation for entry to the GMC’s specialist register, which is a pre-requisite for working as a consultant in the UK.  

We acknowledge that, within the UK, only consultants and general practitioners are able to practice without supervision. However, our understanding is that a general practitioner may not practice without supervision in a hospital setting (unless in a GP or community hospital) but would normally be under the supervision of a named consultant, similar to the position of SAS doctors. 

GP principals providing secondary care sessions in a hospital are employed as specialty doctors (prior to 2008 they would have been employed as clinical assistants or hospital practitioners). A characteristic of those grades is that they do not have independent clinical responsibility. This distinguishes them from consultants working in the same setting, in terms of professional seniority. 

For the above reasons, we do not believe GP principals are caught by the first provision for granting additional seniority.  Nor do we believe service as a GP principal could count under the second provision related to non-NHS consultant level experience.

When considering what should be counted as non-NHS consultant level experience it is necessary to have a benchmark. We believe that an appropriate benchmark is the accreditation that a practitioner would be expected to hold in order to be considered as equivalent to a NHS consultant in the UK. For doctors within the EEA this is clear-cut, as the equivalent qualifications are contained within the relevant legislation. 

For other overseas doctors, the test of equivalence is whether they have been trained to a standard equivalent to CCST. 

A GP principal in the UK would not be able to meet the test of equivalence applied to EEA or other overseas doctors and we therefore believe that to allow experience as a GP principal in the UK to be counted towards seniority would be discriminatory.  

We do not believe it appropriate to consider previous work as a GP Principal nor, for the avoidance of doubt, as a specialist, specialty doctor, clinical assistant or hospital practitioner, to be equivalent to that of a consultant for seniority purposes.