The BMA - along with the British Dental Association (BDA) - has called for a 'fundamental reform of the pay review process for doctors and dentists', warning that urgent action to improve pay is vital 'to avert a full-blown workforce crisis'.
In a damning seven-page report, BMA leaders warn that 'in recent years the DDRB has showed a complete lack of independence by accepting government policies on pay caps in the public sector' and adhering to government restrictions on its remit.
Doctors have lost 'almost all faith' in the pay review process conducted through the Doctors and Dentists Review Body (DDRB), BMA leaders say, in a report that also condemns the government for 'causing significant delays' to pay uplifts by submitting evidence outside agreed deadlines. Doctors had faced an 'unprecedented cut in their average real-terms income' - with GPs losing out by up to 29%.
Pay advice ignored
The BMA report detailing its deep concerns with the review process comes as negotiations over the 2019/20 GP contract - which could deliver substantial changes for the profession - are ongoing.
For 2019/20 the BMA has demanded a pay uplift for 'all doctors across the UK at least in line with the retail prices index (RPI) measure of inflation for 2019 - plus a mechanism to address the up to 30% real terms pay cut that doctors have experienced since 2008'.
The report comes six months after the government in England announced it would award a 2% increase for GP partners for 2018/19 - half the 4% rise recommended by the DDRB, which itself was well below the amount demanded by the BMA.
The BMA and BDA have drawn up four key demands over the future of the DDRB:
- Restitution of the DDRB's independence and return to its original purpose.
- Revision of its terms of reference to narrow the DDRB's focus purely on pay uplifts rather than making recommendations on wider contractual matters.
- Clear timetables for submission of evidence and publications of the report, and an undertaking that government(s) must not fetter the parameters of the DDRB's recommendations.
- Re-establishment of the undertaking that government(s) will respect and implement the DDRB's recommendations.
BMA chair Dr Chaand Nagpaul said: 'The repeated failure of the Body to adhere to its founding principle of independence from government, and ensuring fair pay, is deeply worrying. We have advised the DDRB that it has failed in its duty and, crucially, it must rectify its failings by securing a better deal for doctors in future. However, if the DDRB continues to act in such a partisan manner, we may have no choice but to reconsider our future relationship.
'Whilst recommended pay rises for GPs and some specialist hospital doctors, were closer to inflation, recommended rises for other doctors were significantly below inflation and all fell far short of correcting the long-term pay erosion. For example, the derisory new pay settlement for hospital consultants in England gives them an average weekly increase of just £6.10 after tax - at a time when they have lost nearly a quarter of their take home pay in the last decade. The effect this has had on motivation and morale is untenable.
'The DDRB and government must act now to avert a full-blown workforce crisis, by recognising the value of doctors with a pay rise at least in line with RPI for 2019 and with a concrete commitment to start addressing the real-terms pay cut doctors have experienced since 2008.'
The BMA report says the union was 'shocked and angered' that the DDRB 'yet again conformed with the unacceptable and unnecessary remit imposed by HM Treasury and the DHSC', and 'incensed' that the review body had 'clearly overstepped its remit and interfered in contractual issues'.
Warning that some doctors felt singled out with lower pay increases, the BMA said that for the 2019/20 contract round, the it would seek 'a common recommendation for all doctors regardless of their branch of practice or place of work'.
The BMA report warns: 'Doctors have been unfairly punished by governments with continual real losses in earnings and increasing cost pressures for over a decade. Some groups of doctors have seen their pay fall by up to 30 per cent against RPI. We believe it is time for the DDRB and governments to recognise the value of doctors and the disastrous effect that repeated sub-inflationary pay uplifts have had on morale.'
A DHSC spokesperson said: 'We expect all stakeholders to engage with the pay round process in the usual way, and to be as cooperative as possible. The DDRB is independent and plays a crucial role in making evidence-based recommendations and we will continue to consider these carefully.'