Last year, we became aware of a system-wide collaborative planning to drive down rates for bank and locum work across our South East region.
BMA South East wrote to every ICB and Trust across the region. to share our principles and to remind them of their duty to consult with their BMA Local Negotiating Committee on any proposed rate changes.
We have met with the collaborative leads, held a survey of members across the South East, and written to all our members to outline the issues and summarise the survey results.
About our campaign
There is a significant disparity in the rates paid for extra-contractual work, indicating that many colleagues might be receiving far less than you deserve.
We want to secure fair pay for all grades of doctors undertaking extra-contractual work across the region. Together, we can make a difference.
Our goal
To force employers to significantly increase the bank and extra-contractual rates for all grades of doctors across the South East and to resist local plans to reduce rates.
Our leverage
By uniting as one, we hold the power to collectively withdraw from paid extra work beyond our contracts. Together, we can apply the pressure needed to negotiate meaningful pay increases across all Trusts, specialties and grades. Whether you join with colleagues in your department, your grade, your Trust or wider, only together will we resist planned reductions and leverage rates up to a fairer level.
Our principles
Your BMA SE LNC Chairs have agreed seven core principles for our campaign:
- any agreed rates should be mindful of the cost of living, contractual pay rates, inflation and adequately reflect the skills and experience of the member of medical staff undertaking the work
- any agreed rates should rise annually in line with any pay (DDRB) uplifts and should be regularly reviewed
- time off in lieu instead of hourly pay and or in conjunction with hourly pay should always be an option
- weekends and evenings (after 7pm) should attract a higher rate
- Waiting List Initiative (WLI) rates should be the same as bank rates
- autonomous SAS doctors should be paid at the same rates as Consultants
- breaks should be paid. Where a Trust insists on unpaid breaks staff must be able to take a genuine rest – arrangements must be in place to facilitate that.
How you can get involved
Join the fight for fair pay by committing to our collective power. We are calling on members to work together.
We understand that it can be difficult to negotiate locum rates as an individual, and doctors tend to have more success calling for rate increases when they negotiate as a collective. This collective can be small (such as all the locums in your department), or large (across your specialty, workplace or your region).
Our survey
We were thrilled with the level of engagement in our survey which found that 85% of respondents are willing to withhold all extra-contractual work in support of our campaign. This campaign is clearly important to many with 30% willing to undertake full strike action, and 50% action short of a strike if required in support of the campaign.
You can still share your views: complete the BMA SE rates survey.
Get involved locally
If this issue is important to you, you may be interested in building a local locum rates campaign. We recommend you:
- contact your BMA LNC chair or local BMA LNC representative to let them know
- ask them to help you campaign collectively with other doctors on this and to raise with your management.
We’ve done this before, both nationally and at local hospitals, with great outcomes. Let’s do it again across the region.
If you accept extra-contractual work
For 2025 we are urging individuals to negotiate a fair rate for your extra-contractual work. Please bear these points in mind when accepting any extra contractual work this year:
- The cost of living is high, and in most cases, rates have been frozen for years.
- This work is 100% voluntary and over and above the full-time 40-hour working-week.
- There is no GMC consequence to saying no to additional work at low rates and no reason for guilt – you work hard and are entitled to fair pay for skilled work.
- Accepting low rates for this work reduces our negotiating hand and devalues this work.
Now is the time to Act
- Use our model letter to set a deadline when you will stop all extra contractual work in your department without a meaningful rate uplift.
- Download our poster and put it up in your Trust.
- Start preparing – save money now in case we need to withhold extra work for a period of time.
- Read about how organising and local activism has already achieved success in one South East trust.
- See our latest update letter for Consultant and SAS members or our rates campaign update letter to residents.
- Complete the BMA SE rates survey, if you haven’t already done so, to allow our local reps to have your views.
- Encourage colleagues to register as a South East rates activist on this campaign and be linked in with your LNC. Or contact your BMA LNC chair if you want to pursue a more proactive coordinated campaign of action with a group of colleagues in your department.
- Use our reporting portal to log when you are paid any rates above ‘published’ Trust rates as a result of any departmental activism.
- Value your time – do not carry out extra-contractual work if you are not being properly remunerated. Low fill rates for this type of work helps us make the case that current rates are inadequate.
- Tell your departmental/divisional leads that these rates need to increase.
- Support each other – there is no obligation to carry out extra work over and above your contract if the pay rate is inadequate. It is easier to refuse or register dissatisfaction as a group.
- Join your local BMA WhatsApp groups to discuss this proposal and plan a collective response.
Example responses to employer questions
Below are some responses you may hear from your employers when negotiating rates for non-contractual work and answers you may want to consider.
You cannot hold the department to ransom
This work is extra-contractual, and I have the choice to value my time appropriately. I am following BMA advice to value my time. The average consultant take-home pay in England is down, the rates offered for this work have stagnated for a long time and it is my right to earn appropriate rates for additional work I do outside of my contract. I would like to help my employer by doing extra work, but if they are not paying a fair rate, I am not required to undertake the work.
You have a responsibility to the patients
And I take that responsibility very seriously and will continue to fulfil all aspects of my contract and continue to deliver excellent care. However, I cannot be forced or made to feel guilty about not undertaking extra work in my own time for inadequate rates of pay.
This is a GMC matter
It is not a matter for the GMC and indeed, threatening referral and using this as a threat for me to work extra in my own time is harassment. I continue to deliver everything expected of me as required under my contract and Good Medical Practice. Whether or not I undertake additional extra-contractual work is my choice. I have also given my employer the required notice.
You are taking money from other staff
The funding of the health service is a matter of political choice for the government. I am only asking to be paid fairly for work I undertake that is outside of my contract.
You are taking money from patients
The government have a responsibility to provide a health service, it is not the responsibility of individuals. Part of that responsibility is to pay staff enough to motivate them. It’s a political choice.
Your colleagues are agreeing to less
Being extra contractual it’s a matter for personal choice.
You’re already well paid
Our pay has fallen compared with comparators and the private sector (our true comparators); consultant pay has done markedly worse even compared to other staff in the NHS who have performed worse than others in the public sector.
There is a financial crisis
It’s not fair that the public sector is expected to pay for every financial crisis when others in the economy do not. We cannot expect NHS staff to subsidise the service with their own pay.
It is not in our budget
It is not my responsibility to ensure that sufficient budget is allocated to adequately pay doctors to provide the service.
It’s not professional
What I do outside my contract is a personal choice and plenty of other professionals decline extra work if the remuneration is not appropriate.
Get in touch
To contact us for more information, or to share your thoughts, email Hugh Townsend, Head of BMA South East.