A recent BBC News investigation has revealed that some senior NHS doctors are earning significantly more than their base salaries by charging premium rates for overtime, with some making over £200,000 a year through additional work. These payments come as hospitals struggle to clear patient backlogs, exacerbated by staffing shortages and high demand for medical services.
The report highlights that many of these high earners are part-time consultants, allowing them to take on substantial overtime for which they can command rates as high as £200 per hour—more than four times their standard pay. The rising overtime bill, which hit nearly £1 billion in 2023-24, has sparked concern about the sustainability and fairness of relying on consultants’ overtime to manage the NHS backlog.
Health Secretary Wes Streeting responded to the investigation by expressing dissatisfaction with the rates being paid to consultants, stating, “I don’t think the rates are acceptable. Every penny that goes into the NHS needs to be well spent.” However, the British Medical Association (BMA) defended the practice, attributing it to the NHS’s ongoing staffing shortages, and pointed out that the NHS would not have to rely so heavily on overtime if it were better resourced.
Overtime Costs and Staffing Shortages
According to data gathered by BBC News using Freedom of Information requests and information provided by NHS England, six in ten consultants are working beyond their contracted hours, with many earning significant sums from overtime. Some hospital trusts have reported paying individual consultants more than £100,000 in overtime, with consultants at some hospitals earning upwards of £200,000 for additional shifts.
For example:
- Bradford Teaching Hospitals NHS Foundation Trust paid four consultants over £100,000 each in overtime. One consultant earned over £208,000 for 128 days of work, averaging £188 an hour.
- Medway NHS Foundation Trust paid three radiologists more than £150,000 in overtime, with one surpassing £200,000.
- Frimley Health Foundation Trust paid two consultants in its endoscopy department more than £180,000 each in overtime to help reduce the backlog.
- Humber Health Partnership, which manages five hospitals, paid consultants between £185,000 and £240,000 in overtime.
These payments are being made to cover staffing gaps, including those caused by strike actions and sickness, as well as to tackle the ongoing waiting list of patients requiring treatment.
Balancing Overtime Costs with Patient Care
While NHS hospitals acknowledge the necessity of overtime to maintain safe and effective operations, the rising costs have led to concerns about value for money, particularly with taxpayer funding. Some trusts, like Worcestershire Acute Hospitals NHS Trust, have been paying consultants over £100,000 for overtime, while others are actively trying to reduce “premium payments” where possible.
The increased overtime spending has been particularly pronounced during periods of industrial action, with some hospitals reporting that overtime rates were inflated by the BMA’s strike guidelines. However, BMA consultant co-leaders Dr. Helen Neary and Dr. Shanu Datta defended the overtime, noting that it was essential to manage the ever-increasing patient demand and maintain a safe level of service. They pointed out that much of the overtime is done during unsocial hours, and as highly-trained professionals, consultants are entitled to charge appropriate rates for their time.
Government Response and the Push for NHS Reform
The UK government has committed additional funding to the NHS, with £25 billion earmarked for the service in the next two years. The goal is to reduce waiting lists, with a particular focus on expanding operations and appointments during evenings and weekends. This approach, advocated by the Labour Party, aims to increase NHS capacity and address the backlog that has built up during the pandemic and subsequent staffing shortages.
However, senior NHS figures expressed frustration at the position of consultants, who, under their existing contracts, have the right to opt out of weekend work and negotiate premium rates for overtime. An anonymous NHS source stated, “Consultants hold all the cards—they know we cannot make progress on the backlog without them.” This has led to calls for renegotiation of contracts that are seen as outdated and not fit for modern NHS needs.
Danny Mortimer, from NHS Employers, which represents NHS hospitals, acknowledged the difficult financial position the NHS is in but emphasized that consultants play a “critical role” in tackling waiting lists. He also pointed out that NHS leaders are trying to reduce the reliance on extra-contractual pay but face significant challenges due to a lack of available staff.
The Role of Technology and Workforce Expansion
To mitigate the growing costs of overtime, there are calls for the NHS to invest in technologies like artificial intelligence (AI) and hire more consultants to distribute the workload more evenly. AI, for example, could potentially take on some routine tasks, reducing the need for consultants to work excessive hours. However, NHS leaders stress that while technological innovation is important, it cannot replace the need for human expertise in complex medical situations.
As NHS trusts continue to navigate these challenges, the question remains: how will the government and healthcare leaders balance the need for more staff, fair pay for consultants, and the growing demand for NHS services, all while ensuring the efficient use of public funds? The investigation into overtime costs serves as a reminder that the NHS, already under pressure, must find ways to streamline its operations while maintaining high standards of care for patients.