Thread by @Vish_Sharm

1/ Interesting Comments from NHS CEOs:

One CEO described current rates being paid as "mixed". Massive understatement - we found huge variation of rates being paid including different rates for the same type of work in the same trust and even the same operating theatre #notfair

https://twitter.com/Jamesillman/status/1572138679786774530

2/ Another CEO said "the optics are poor - people asking for many multiples of their hourly rate when others are doing for time and a half or double time".

Doctors already work incredibly long hours including regular overtime (at standard contract rates) and unpaid overtime....

3/ Consultants will continue to do this but it is perfectly reasonable to be paid higher rates when being asked to give up what little is left of your free time to do EXTRA WORK. And whilst the rates received by the doctor are higher the total employer cost is not that different

4/ Standard rates of pay include pension contributions, personal development and study time, annual leave, allowances for excellence awards and sickness cover. For too long, trusts have tried to guilt consultants into doing extra work as it was cheaper than employing more doctors

5/ Another CEO described this as the biggest threat to elective recovery. WRONG. The biggest threat to elective recovery is that we simply don't have enough doctors, enough nurses/AHPs, enough operating theatres, enough diagnostics or enough beds.

6/ Flogging the existing staff and/or undervaluing them when asking them to do more is not going to help the situation and will simply result in yet more senior staff leaving the NHS. Morale is already at rock bottom.

7/ Another CEO said the "BMA were operating like football agents and pushing up the rates based on their own egos rather than members wishes"

You have consistently told us in that after more than a decade of real terms pay cuts that has seen your pay fall by more than a 1/3rd..

8/ ..that you are fed up, demoralised and that you want to take action to restore your pay. @theBMA rate card is simply about #ValuingYourself

And as for being a "football agent", if that means us standing up for colleagues and securing better terms -I'll get my Sheepskin coat!!

9/ But the @BMA_Consultants is not just about getting more money. In many cases, consultants don't want to take on these extra shifts. We are already exhausted and burnt out but are left feeling guilty if shifts are not covered.

10/ So the rate card outlines options to get time off instead of money if they have to cover EXTRA shifts. Interestingly trusts didn't mention this important safeguard to protect consultants from burn out.

11/ And whilst trusts may be "frustrated" with @theBMA for releasing the rate card, for years trusts have been working together across regions to form mini "cartels" to suppress rates of pay for EXTRA work. This is continuing with many ICSs trying to keep rates artificially low.

12/ @BMA_Consultants you are not worth a 1/3rd less than your colleagues were in 2008 nor are you worth 25-50% of your counterparts in the USA, Canada or Australia. We ask again #ValueYourself

13/ But some positive news in this @HSJnews article. @NHSEmployers have supported our calls to abandon the application of the AA to to public sector pensions and in the short term to fix the issue with #CPIdisconnect.

14/ @BMA_Pensions beleive the best way to do this is by introducing the option of a separate #TaxUnregistered scheme for higher earners in the NHS. This is not a tax break - it ensures that the correct rate of (income) tax is paid at source and is therefore fair to the tax payer.

15/ Crucially however it breaks the link between how much work you do and the risk of incurring additional punitive pension taxes (which contrary to what is often stated are often based on pension benefits that you will never receive). This means doctors can maximise patient care

16/ @KwasiKwarteng urgently needs to amend Section 234 & 235 of the Finance Act to fix #CPIdisconnect and address the issue of "Negative PIAs"- not being able to be offset negative growth against positive growth in other NHS schemes or carried forward/backward to other tax years

17/ Failure to address this will result in an unprecedented rate of retirements amongst senior NHS staff THIS year. Retirements in this financial year to date are already the highest on record. #TheClockIsTicking

18/ @DHSCgovuk should also immediately amend the 1995 scheme to include the option of partial retirement and pensionable re-employment to bring it in line with other schemes. They also need to introduce late retirement factors so as not to penalise those in 2 schemes

19/ However, tinkering with partial retirement/retire and return arrangements is not a solution on its own and must be accompanied by changes to the Finance Act and a tax unregistered scheme.

20/ Another mitigation is the central mandation of recycling of employers pension contributions. @DHSCgovuk support this and yet there is still a postcode lottery in terms of access. @CommonsHealth instructed national leaders to implement this has still not happened

21/ What will not work is pension flexibilities. One consultation on this was pulled and a second rejected. It simply adds more complexity to an already complex situation and crucially you don't have the necessary information in real time to make financially sound decisions.

22/ @theresecoffey and @KwasiKwarteng - @BMA_Pensions have repeatedly outlined to Government what will work and more importantly won't work in solving the pensions taxation crisis that @commonsHealth correctly describe as a "national scandal'.

23/@KwasiKwarteng and @theresecoffey - you may be making your first major announcements this week but they are of critical importance. Without urgent action the NHS faces an unprecedented exodus of senior staff, a loss from which it may never recover. Speak to us @BMA_Pensions