How 15 minutes of one doctor's overtime costs the NHS (pounds)

New money poured into the NHS is being swallowed up by higher salaries for existing medics, according to research by Scottish economists.

A report by the Scottish Economic Policy Network has questioned whether patients are getting any benefits from the extra cash being spent on the health service. It asks: "What is the NHS getting, in terms of benefits to patients, from extra expenditure on pay? In a system where the supply of new doctors and nurses will be slow to increase and recruitment targets difficult to meet in the short term, there is a danger that the extra NHS expenditure will be spent on the pay of existing staff and that higher pay will not lead to improvements in productivity or capacity."

In the wake of the Wanless Report on NHS spending, published in April, the percentage of UK gross domestic product (GDP) spent on the NHS is to increase from around 6.5% to almost 9% by 2007.

But the Economic Policy Network, a group of economists from Scotland's main universities, claims that much of this money will be used to fund nationally negotiated pay deals for NHS staff. It points out that junior doctors' salaries have increased by 30% since 2000, with some trainee doctors now earning the same amount as consultants.

The "new deal" for junior doctors, agreed between the government and the British Medical Association (BMA), the doctors' union, requires that junior doctors should not work more than 56 hours a week, and should not work more than 72 hours in total, including on- call time. If junior doctors work extra hours outside the new deal, then health trusts have to pay them twice their basic salary - which is costing the NHS millions. Many junior doctors are now earning between (pounds) 60,000 and (pounds) 70,000 a year because of the overtime rules.

An implementation support group, with members from the Scottish Executive and the BMA, monitors whether hospitals are complying with the new deal. But one senior consultant has already compared the group to the Spanish Inquisition.

Professor Richard Olver, head of the Tayside Institute of Child Health at Ninewells Hospital in Dundee, said: "There is a general problem that the implementation group is too hard and rigid in its interpretation of the rules. If there is a small breach of the guidelines, this puts doctors onto the next band of pay. It is a nonsense.

"We seem to have gone for this with the zeal of the Inquisition. It doesn't take any account of the reason for a doctor working over the limit - it could be that the doctor has forgotten to take a break. This is a major issue for providing a service. I do think juniors need protected and their hours controlled, but I think the situation has got out of hand."

As a result of the new deal, hospital doctors are costing the NHS around (pounds) 20,000 every time they work just 15 minutes over their permitted hours. Whole teams of junior doctors are paid an additional (pounds) 570 a month each just because one of their colleagues has worked an extra quarter of an hour.

At one Scottish teaching hospital, a junior doctor cost the trust around (pounds) 20,500 because he stayed behind for 15 minutes to complete an emergency caesarean section. Because the doctor exceeded his weekly limit, he and the 11 other doctors on his rota were paid an extra (pounds) 570 a month each. Doctors remain on the higher salary until their hours are re-evaluated, normally not for at least three months.

Tim Davison, chief executive of North Glasgow University Hospitals NHS Trust, believes that public cash is being wasted on double pay for junior doctors. "This has gone way beyond the legitimate drive to reduce the number of hours that junior doctors are working," he said.

"Everyone supports and applauds the fact that junior doctors are now working hugely reduced hours compared with even five years ago, but we have come to a situation where the rigidity of the bureaucracy of the system is hugely penalising and restricting our ability to spend money on improving patient services."

However, Dr Jason Long, deputy chairman of the Scottish junior doctors' committee of the BMA, defended his colleagues' pay. "Rules are rules, and the question is where you set the limit," he said. "If someone breaks the speed limit by going just slightly over the limit, they are fined. If trusts manage to change the working practice, then doctors' pay will be reviewed again. They will not be on this higher pay rate forever," he said.

A spokeswoman for the Scottish Executive said: "Ensuring that employees do not work excessive hours is a key part of ensuring that patients receive safe and effective care."

Copyright 2003 SMG Sunday Newspapers Ltd.
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