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Monday, 17 December, 2001, 15:19 GMT
How hospital doctors are paid
Hospital doctors
Hospital doctors can receive weighty "merit" bonuses
Hospital doctors do have a pay scale, unlike their GP colleagues.

But it is extremely complicated, and varies depending on how much experience they have and how many hours they work.

Although they are salaried employees, there are openings for private work for senior doctors, plus a bonus scheme for high achievers in the form of merit awards.

Doctors in training

Pay scales April 2002
House Officer - 18,585 to 31,595*
Senior House Officer - 23,190 to 55,284*
Specialist Registrar - 25,920 to 64,218*
Consultant - 52,640 to 68,505
Consultant with B distinction award - 95,910
Consultant with A plus distinction award - 133,585
(* includes overtime pay)
Junior doctors, or doctors in training, are split into house officers and registrars.

House officers are fresh out of medical school and will work in several different areas before becoming specialist registrars, who have chosen a field in which they aim to become a consultant.

Junior doctors, those who are qualified and are working their way through the training grades to consultant level, get a basic salary that covers a 40-hour week.

Average pay for a junior doctor before the latest award was around 26,244. Many earn less - the starting salary before the latest increase was 17,935.

After years of campaigning, the BMA won an overhaul of the overtime system.

Juniors had been paid overtime through additional duty hours (ADHs) which paid overtime by the hour, and were a fraction of their basic rate.

They will be replaced by a new banding system which will pay a set amount calculated as a proportion of their salary.

What doctors get will depend on how intensive their work is and how anti-social the hours are.

Junior doctors are only supposed to work a maximum of 56 hours on the ward.

An on-call rota shift pattern equals 72-hours a week, partial shifts make up a 64-hour week, and full shifts add up to 56 hours over seven days.

An agreement called the New Deal was made in 1991 to ensure that by 1996 no doctor worked more hours than that. But many doctors do still work longer hours.

The European Working Time Directive, which limits the working week to 48 hours, will not apply to juniors for at least 13 years, after the government won an exemption from having to implement the rule for doctors in training.

Career grades

There are different grades of hospital doctor depending on how much training they have received. Consultants, associate specialists and staff grade doctors are out of training and in the "career grades".

They are salaried, but they can opt to be employed part-time by the NHS and use the rest of their week practising privately.

The basic starting salary for a consultant, prior to the 2002 award, is 50,810.

A "typical" consultant would earn 66,120 because most are at the top of their scale.

Under the 10% rule, a full-time consultant is restricted to earning 10% of gross NHS remuneration by way of private practice.

But the government is considering plans to restrict newly qualified consultants to working for the NHS for the first seven years after they have qualified.

Gross NHS remuneration includes merit awards and discretionary points, so the highest paid NHS doctors will also be allowed to earn the most privately.

Doctors who charge higher rates for their private work must give up some NHS earnings.

The most common arrangement is for consultants to surrender one-eleventh of NHS pay without giving up any commitment to the NHS.

The consultant concerned is known as a maximum part-time consultant and is expected to deliver the same amount of NHS work as his whole-time colleague.

New payments were introduced last year to reflect increased work for consultants.

They can now receive an intensity payment for daytime work - an extra 1,000, or extra pay for working out of their normal hours - of up to 2,250 - which the BMA estimates around 80% of consultants will receive.

The Review Body prices only the NHS work of consultants - they set their own prices for private work.

Consultants can double their salaries and boost their pensions if they are given distinction, or merit, awards. The BMA says 15% of consultants receive these awards.

Merit awards are given for "outstanding contribution" to NHS services. They are awarded by a body of doctors called the Advisory Committee on Distinction Awards.

The system is currently under review with a view to including lay people in the selection process, following attacks on the closed shop approach during the Bristol Heart Babies scandal.

Consultants who do not hold distinction awards may be given discretionary points. Worth 2,545 each, they can hold a maximum of eight.

About a third of consultants earn extra discretionary points on their salary which could take a minority of them up to a maximum of 87,280.

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