In August 2023, University Hospitals Sussex secured extra-contractual rates at 98% of the old BMA rate card for consultants and autonomous SAS doctors. This success was achieved through a programme of local activism, resulting in £158/£211/£264 for day/weekend/night rates, and £106/hr for non-resident on-call, rates that have now been in place for over a year.

This demonstrates that unity can drive change.

Catalyst for action

In March 2023, our trust attempted to cut our already low EC (extra-contractual) rates by unilaterally introducing a new, lower, local ‘rate card’. Existing rates had not been revised in about 10 years and were already disputed in some departments, so this caused much anger. The LNC (local negotiating committee) responded swiftly with a call to action.

Response strategy

A powerful response was coordinated through Teams meetings and all-consultant email communications. We explained to consultants the history of rate fixing and gave comparisons of other rates locally and nationally. We empowered colleagues to refuse the new low rates, reassuring that there was no penalty as this work was optional.

We stressed to them the value of their time and work. We described how each department could unite in protest by signing a combined rate refusal letter, signalling their intent to discontinue EC work until BMA rate card rates were paid instead.

Clearly, every member of a department might not sign up, but we felt this allowed colleagues to feel a safety in numbers where they wanted to join in to protest. A template letter was shared.

Execution

Many departments sent refusal letters to the trust executive, copying these to the LNC. This helped the LNC identify key link people within departments and gauge employee sentiment. Although, as anticipated, not every consultant joined (as with the recent strikes), a critical mass of rejection letters from key specialties created enough disruption to prompt a rate revision. The response was surprisingly strong.

Our trust now offers the best rates in the region

Preliminary outcome

In June 2023, after four months, the rates were reverted to pre-imposition levels by the trust, but the LNC recommended continuing action to address the long-standing issue of fixed rates amid rising costs of living. It was not enough to default to the old rate when sentiments were high. Departments agreed – they maintained their refusal to accept EC work even at the restored historic rate, leading to eventual new negotiations with the trust and LNC.

Ultimate success

Through consistent pressure, the trust agreed to rates close to the BMA rate card two months later. Consequently, our trust now offers the best rates in the region, encouraging high uptake of EC work, which helps reduce waiting lists.

This success story shows the power of collective action in advocating for fair pay. EC rates are not arbitrated externally by an impartial body – they tend to be dictated by the employer, considering only their own overheads. The only way to ensure the rates do not stagnate is to unite, to value yourself and to say no to low rates.

Lynne Campbell is a consultant anaesthetist and LNC chair at University Hospitals Sussex