Pay rise half-truths

The government this week announced a pay rise for a swathe of public sector employees, among them doctors. If you thought this would bring about high fives, congratulatory back slaps and the medical community celebrating a Covid-induced financial reward you’d be very much mistaken. The announcement contains an (un)healthy dose of spin, papers over cracks and belies the reality for the majority of doctors.

The beneficiaries of the rise

The headlines would have you believe that all doctors are in line for an ‘above inflation’ 2.8% pay rise. This is not the case as the 2.8% figure only applies to Consultants*. This group represents a minority, albeit the most senior portion, of UK doctors. 

The remaining majority of the clinician cohort are ‘junior’ doctors. This unhelpful term describes a broad spectrum of medics, from those in their mid-20’s fresh out of medical school to those with up to a decade’s worth of on-the-job experience. The latter doesn’t seem very ‘junior’ to me. Junior doctors won’t be beneficiaries of the 2.8% wage increase. Indeed it is akin to stating the pay rise applies to teachers (but actually only headteachers), police officers (but only superintendents) or the armed forces (but only generals).

Non-Consultants remain on pay trajectories negotiated in 2018. Both junior doctors (increase of 8.2% over four years) and other NHS staff including nurses and physiotherapists (6.5% over three years) are receiving less than the vaunted 2.8% rise. I’ve posted before about how bona fide inflation might be significantly higher than published figures. If so, all of these pay rises simply don’t cut the mustard when it comes to matching the rise in cost of living.

Behind the curve

If we’re talking about this Consultant pay rise as ‘inflation-beating’ then we must describe their current salary as ‘inflation-decimated’. Wage growth has lagged behind CPI since 2008 and has also been below DDRB recommended increases. The basic starting salary for a Consultant in 2020 is nearly 20% below what an expected, inflation-adjusted wage would be. 

Consultant basic starting salary since 2005. Actual wage (blue line) has not risen as it should have according to inflation (black line). Source for salary figures is the NHS Employers pay circulars 2005-2020.

For junior doctors, sweeping salary changes were made after the 2016 contract negotiations. These have permitted basic pay to (barely) hang on to the coat-tails of inflation. However, the changes to how ‘unsociable’ hours of work are paid may have led to overall pay cuts for some**. Significant pay progression is also lacking as one ascends the medical hierarchy despite the added responsibility and experience – pay is stagnant for up to five years at a time during registrar and Consultant years.

First year doctor [FY1] basic pay (blue line) vs. expected inflation-adjusted pay (green line). Only the new junior doctor contract in 2016 (black arrow) has kept pay near, although still below, inflation corrected levels.
Registrar [ST4] basic pay (blue line) vs. expected inflation-adjusted pay (red line). The new contract (black arrow) has brought basic pay to ‘only’ 3.5% below expected, inflation-adjusted, wage. These ‘junior doctors’ have at least six years’ experience on top of their five year degree.

A word on context. On the spectrum of salary-related changes, a pay rise is better than static pay, which is in turn better than a pay cut or being let go. The reality in the current clime is that many lie towards the latter end of the spectrum. There are also more pertinent contemporary economic issues than doctor’s pay, for example widening wealth inequality. I appreciate this. On the other side of the contextual ridge, there’s a cohort of healthcare workers who have endured supra-normal occupational risk and worked incredibly hard during the zenith of the Covid-19 pandemic. They’re seeing all the lip service to ‘NHS heroes’ and ‘saving the NHS’ backed up with…more hot air. The government’s announcement has been met with derision on social media by some, dubbed as lacking in substance by others.

Inflation-matching increases in salary should surely be the minimum for any job, otherwise you’re being devalued year-on-year. To dole out an ‘inflation busting‘ Consultant pay rise and claim the moral or fiscal high ground in the context of long-term pay stagnation is insulting. Some feel this is little more than government PR point-scoring, conceding an inch now to reclaim a metaphorical mile down the line. A significant proportion of UK doctors already feel undervalued beyond just the financial aspects – the numbers that flock to the Antipodes each year is evidence enough of this. This most recent turn of events will do little to assuage these widespread feelings of under-appreciation.


Mr. MedFI

* And specialty doctors; a senior, non-Consultant, specialist role. In Wales the pay rise is across the board for doctors.

** A quirk of doctors’ pay is that a significant proportion of their salary comes from time working ‘unsociable’ hours. These include night shifts, weekend shifts and work outside the classic ‘8am-6pm’ bracket. The 2016 contract increased basic pay, but both re-defined unsociable hours and reduced renumeration for them. The net effect may have been a pay decrease for those who work a significant number of unsociable hours.

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