Senior doctors are charging the NHS premium rates for overtime, as pressure to cut waiting lists is allowing some to make more than £200,000 a year from additional work, a BBC News investigation has found.
That is nearly double the average basic pay for a full-time consultant in England.
Many of the consultants earning the most are thought to be part-time, allowing them to work significant amounts of overtime for rates exceeding £200 an hour – more than four times normal pay.
NHS England said hospitals had to offer rates that were competitive with the private sector.
But the British Medical Association (BMA), the doctors’ union, pointed out the NHS would not have to rely so much on overtime were it not for staffing shortages.
And hospitals said covering for strike days and sickness had also been factors.
The findings come as the government invests more money in the NHS, to increase the number of appointments and operations it can offer – a key election promise made by Labour.
As part of the Budget, the chancellor said the NHS would receive an extra £25bn this year and next – with reducing waits a priority.
A key part of Labour’s plan is for staff to work evenings and weekends, to cut the backlog.
But the BBC News investigation raises concerns about whether this approach can deliver value for money.
One senior NHS source said: “Consultants hold all the cards – they know we cannot make progress on the backlog without them.”
The source said consultants were in a “pretty unique position compared to other staff” because their contracts meant they could opt out of weekend work and then charge whatever their hospital was willing to pay for overtime.
They said it was not in the BMA’s interests to renegotiate these “outdated” contracts, more than 20 years old.
‘Artificial intelligence’
“What worries me is that the overtime costs are going to keep increasing with the need to tackle the backlog and this will breed resentment among other NHS staff who often work overtime for little more,” the source said.
They added that the NHS needed to hire more consultants, ask other staff to take on some of their work and invest in technologies such as artificial intelligence to lighten the load.
BBC News used Freedom of Information requests to hospital trusts and data supplied by NHS England to reveal what consultants working beyond their contracted hours was costing the NHS:
- The overall overtime bill hit almost £1bn in 2023-24, up from £512m 10 years ago, albeit some of that rise is related to more consultants being employed
- Six in 10 consultants work beyond their contracted hours, with average extra pay topping £27,000 a year
- At least half of the 41 hospital trusts that responded to BBC News are now paying some of their consultants more than £100,000 in overtime
In 2023-24, Bradford Teaching Hospitals NHS Foundation Trust paid four consultants from its medicine speciality more than £100,000 in overtime payments.
One earned just above £208,000 in overtime for 128 days work.
And during those shifts, their pay averaged £188 an hour.
The trust said “in common with most NHS trusts”, it had to rely on overtime payments to “manage waiting lists and to cover rota gaps and vacancies” and covering strikes had placed it under added strain.
Medway NHS Foundation Trust confirmed it had paid three radiologists, who diagnose and treat patients using scans and tests, more than £150,000 in overtime – one of whom had earned above £200,000.
It said shortages in this field meant it had to pay premium rates, sometimes on a scan-by-scan basis.
‘Extra operations’
NHS Frimley Health Foundation Trust paid two consultants in its endoscopy department, which provides internal examinations, more than £180,000 each in overtime, to tackle the backlog in treatment.
The trust said: “We’re focused on ensuring we always provide value for money – and anything we spend is in proportion with the benefit it brings to our patients.”
NHS Humber Health Partnership, which runs five hospitals, paid three consultants between £185,000 and £240,000 in overtime.
Chief medical officer Kate Wood said the overtime spending had helped fund extra operations at weekends, to reduce waiting lists.
“We assess the costs of these shifts against the risks of not having cover,” she said.
“We have put patient safety first as that is our key focus.
“This is not something that is unique to us.”
‘Critical role’
Worcestershire Acute Hospitals NHS Trust paid three consultants more than £100,000 in overtime, including one who earned just above £198,000.
Managing director Stephen Collman said the trust was trying to reduce “premium payments” where possible but the need to cover sickness absence and vacant posts meant to keep services “running safely and effectively” it had no option.
Some hospitals said overtime rates had been driven up over the past year by the particularly high rates the BMA had told its consultants to ask for to provide strike cover.
“It created a new expectation of what they should get,” one official said.
But BMA consultant co-leaders Dr Helen Neary and Dr Shanu Datta said: “Unfortunately, a declining workforce in crisis and spiralling patient demand – which has led to sky high waiting lists – means that extra hours of work are essential to get the job done.”
They pointed out much of the overtime was done during unsocial hours, adding these were “highly-trained and experienced professionals” so it was reasonable for them to value their time “at appropriate rates”.
Danny Mortimer, of NHS Employers, which represents hospitals on employment issues, said: “In light of the difficult financial position of the NHS, health leaders are trying to bear down on extra-contractual premium pay rates.”
But there were no easy solutions as consultants played a “critical role” in tackling waiting lists.
And an NHS England official pointed out the use of agencies, which could be even more expensive, was falling.