A recent BBC News investigation has shed light on the high overtime costs associated with NHS consultants, many of whom work part-time and charge significantly increased rates—often over £200 per hour—to cover shifts beyond their contracted hours. According to Health Secretary Wes Streeting, these rates are not sustainable, as every NHS penny must be carefully managed.
The British Medical Association (BMA), however, has argued that these overtime costs are largely driven by NHS staffing shortages. Covering absences due to sickness and strike days has also contributed to the rise in expenditures. The government has responded to these challenges by investing an additional £25 billion over the next two years to increase appointment and operation availability—a pledge Labour made to reduce wait times and address the backlog. However, concerns have emerged regarding the long-term sustainability and value of using overtime as a primary method to meet patient demand.
BBC News obtained data showing that overtime expenditures for consultants have nearly doubled over the past decade, reaching almost £1 billion in 2023-24, compared to £512 million ten years earlier. This rise has been partially attributed to the increased number of consultants now employed by the NHS. Currently, 60% of NHS consultants work beyond their contracted hours, with many earning over £27,000 annually in overtime. In some cases, individual consultants are paid well above £100,000 for extra work, with hospitals citing this as a necessary measure to maintain patient care.
One hospital trust in Bradford paid four consultants from its medicine department over £100,000 each in overtime in 2023-24. One consultant alone received over £208,000 for 128 days of overtime work, earning an average of £188 per hour. Similarly, the shortage of radiologists, specialists in interpreting patient scans, has forced some hospitals to pay higher rates. Three radiologists in Bradford each received more than £150,000 in overtime, with one exceeding £200,000.
To address delays in internal examinations, NHS Frimley Health Foundation Trust paid two consultants in its endoscopy department more than £180,000 each in overtime. Meanwhile, NHS Humber Health Partnership, which oversees five hospitals, paid three consultants between £185,000 and £240,000 for extra hours to manage patient backlogs. Chief Medical Officer Kate Wood explained that these payments were assessed based on the risk of not providing coverage, emphasizing that patient safety is prioritized.
Worcestershire Acute Hospitals NHS Trust reported paying three consultants over £100,000 in overtime, with one consultant receiving just above £198,000. Managing Director Stephen Collman stated that while efforts are being made to reduce such payments, covering staff absences and filling vacant posts is essential for maintaining safe and effective services.
Higher overtime costs have also been driven by the BMA’s recent guidance encouraging consultants to request higher rates for covering strike days. This has created a precedent, raising expectations around payment levels for unscheduled work, according to a hospital official. Despite these costs, BMA consultant leaders Dr. Helen Neary and Dr. Shanu Datta noted that consultants face an overwhelming workload due to a shrinking workforce and increasing patient demand, making overtime essential. They argue that these highly trained professionals deserve compensation that reflects the value of their time, particularly for hours worked outside standard schedules.
Danny Mortimer from NHS Employers stated that health leaders are working to curb extra-contractual pay rates given the NHS’s financial constraints. However, due to consultants’ critical role in reducing patient wait times, solutions remain complex. An NHS England spokesperson added that, despite these challenges, the reliance on even costlier external agencies has decreased. Hospitals, however, are often forced to match the pay rates offered by the private sector to attract the necessary staff.
Reference:
1. Triggle, Nick. “NHS Consultants Earning £200,000 in Overtime to Tackle Backlog.” BBC News, November 5, 2024. https://www.bbc.com/news/articles/cy0lkxl7061o.
(Input from various sources)
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