If you’re an NHS consultant

[cookingthebooks]

How much do you actually earn?
Both from the NhS and private work?
DH has 2 years left until consultancy and we are trying to forward plan financially for us and the kids but there’s just so little info or guidance (other than base salary rates) available and pretty much nothing RE private work.

Short of him flat out asking his colleagues what they earn (which he’s obviously not going to do) there’s no way for us to get an idea of this.

also, do you register as self employed for private work? I assumed as he got closer this info would be available but it’s just not.

It depends on his speciality. Orthopaedic consultant surgeon or anaesthetist and you never have to worry about money ever again if you get into a good private practice. They view NHS work as their pro bono the pay is relatively so little.

In a few years, if your knees or hips ache so much you can't walk, you are likely to pay as much as you can to fix them. Having a few wrinkles doesn't stop anyone leaving the house.

I'm a newish (18 months) consultant anaesthetist. My basic salary started a couple of points up the scale as I was LTFT for several years of training, so with the recent pay rise is now just over £110k. I do 10.5 PAs (small extra amounts for being an educational supervisor and a subspecialty lead) and get a 3% on call supplement for a 1:12 rota. As our normal days are quite long (8-6), I get my standard clinical sessions done in 3 days, so I have roughly one day for SPA/additional roles and one day off in the week.

I don't do private practice, but for those that do, in my city there is a group partnership for any anaesthetists wishing to work privately. You have to buy in, so earnings are typically lower in the first couple of years, but then I believe it's around an extra £60-70k a year, for doing a day a week at the private hospital(s) plus occasional evenings/weekends. More than that would either mean sacrificing more family time or trying to persuade his NHS trust to let you drop sessions, which is unlikely early in his career.

It is much nicer being a consultant than a resident though - I work more hours as I've gone from 60% to full time, but not doing shifts any more is SO good!

@freetradedeal is the 65k just for private work?

By 'no incentive to do extra', do you actually mean there's no payment to do extra?
In which case of course they're not going to work for free. Do you work for free? Does anyone?

NHS consultants have job plans that specify X time doing outpatients, Y time in theatre etc. They do X and Y time and can't reduce the time they give if they are employed to do that time/those sessions.

They are doing the jobs they are employed to do.
Reports suggesting they are on a position to 'deliberately reduce' the number of NHS operations sound like nonsense as it would be impossible. You do your contracted hours, clinic and ops as specified in your agreed job plan.

It may be that the consultants who do not want to do additional work on weekends on top of their normal job want to spend time with their kids etc at weekends etc.
Surely anyone is entitled to turn down overtime work, particularly when they already likely have a hectic full time job!
To be honest I'm surprised anyone wants to do these weekend lists if they have a family and work all week.

OP, as everyone says, this varies hugely depending on specialty and region. But why doesn't your partner just have a chat with some more senior colleagues?

And he will absolutely need a professional accountant to help him. There are accountancy firms that specialise in working with medical professionals. Do not cut corners on this one - he needs to ensure that everything is done properly, for both tax and investment purposes.
Also, be aware that defence fees will shoot up - but obviously they are an essential expense.

So basically, you have to spend money before you can make it!

no, you’re not understanding. They’re prioritising their private work and their income - which they are entitled to do - but it’s not happening in other specialties as much. It is amazing how quickly they can work when they get paid per patient (private work) compared to nhs contracted hours where they’re paid the same set amount no matter how many patients they see.

Most of our orthopods (possible all) are quite part time for their nhs contract.

I didn't know that re this particular speciality.

The NHS consultant salary is so uncompetitive compared to elsewhere that it's not surprising that these consultants only want to do part hours for NHS.
The NHS needs to pay competitively if they want to whittle down those waiting lists...

@SockQueen
thank you

this may be a silly question but why did being LTFT impact your consultant starting salary?
DH wasn’t LTFT but did end up being trust grade for a couple of years between his core and resident training due to covid. He was on intensive care the whole time

It's a complicated legal fudge basically, to make sure that having been an LTFT trainee doesn't impact your ability to get to the top of the consultant pay scale. It's buried deep in here: https://www.nhsemployers.org/system/files/2023-01/Consutants-terms-and-conditions-version-13-January-23.pdf page 34, item 6. Sadly for your DH, it is only applicable to time in training that has been extended (either through LTFT, dual training, or academic time) and not to any time out taken during or between training programmes - so for me, my time on mat leave did not count, but the fact that my last 3 years (FTE) of training took 5 years meant that I started on the consultant pay scale as if I had already been a consultant for 2 years. I imagine your DH is of the cohort that got screwed by the various exam cockups as well as the ST3 bottleneck, which is very crappy, but I'm not sure it will count towards allowing him to start higher up the pay scale.

Oh I agree, IIRC 10 years ago it had cost £250k to train them up paid for by the taxpayer. Must be more like half a million now tho of course they've taken student loans. I'd happily give students massive grants if they were obliged to do many more years in the public sector before going private. Same for all HCPs in fact.

Very speciality dependent. I'm in paediatrics. No WLIs. Certainly never done any private work, nor have the vast majority of my colleagues.

Yes, sorry I thought that was the question but I seemed to have caused confusion!

No group where we are, we all work for ourselves and as a pp said, every surgeon needs an anaesthetist.

I work hard for the NHS, private work is done in my free time which is mine to do with what I want.

Basic salary scales available on BMA website (I work in Wales so no foundation trusts here). Standard full time job is for 10 PA job plan which will include the on call work.

Personally I do no private work at all. As an anaesthetist it is often easier to earn extra if you wish by doing additional sessions for the hospital. No need for additional indemnity cover, working with familiar colleagues and familiar kit. Private insurers often pay very low rates for anaesthetists (less than a third of surgical fees generally) so the general feeling is do none or really commit to it and do loads. Don’t forget he would be on call for complications in his patients at the private hospital too. The complications etc of sole trader vs limited company just made it not worth the hassle for me.

if he is a member of doctorsnet he should have a look at the anaesthetists forum on there. The finance of private practice plus need to be the “medical cover” is a recurrent topic. There is lots of information on association of anaesthetists, MPS etc about private practice.

In any case the first couple of years of consultant practice is recognised as a high risk time in terms of complications and getting used to the clinical job. He should consider that in his planning too.

I forgot to add, as @Hamserfan has pointed out, I can easily make an extra £10-15k a year doing extras and/or weekend WLIs in my own trust. Could get more if I really threw myself into it, this is just doing an average of an extra day a month. They are currently desperate to reduce their waiting lists, so I expect that money won't be around forever, but it's easier and less hassle than setting up private practice.

Would be interesting to know how many hours a consultant is contracted for NHS work. I've heard it's only 35 which is good money for £105,000

If they do those hours over four days, they've got one day free for private work.

10 PAs (a normal FT contract, many will end up being more) is 40 hours in "normal" time. Slightly less if lots of those hours are after 7pm or on the weekend

What's a PA?

@freetradedeal it was the question, I was reading in a rush! Thank you

In this context, it stands for "programmed activity," and is how consultant jobs are planned and paid. It's basically a unit of time - 4 hours if in normal time, usually 3 hours if antisocial hours.

Consultants are usually contracted to provide a certain number of PAs as clinical time (for an anaesthetist this is mostly theatre lists, but for other specialties it may include clinics, ward rounds, MDTs etc), there may also be some PAs given for on call depending on frequency and intensity.

Then there is some time for "supporting programmed activities," so admin, meetings, audit, mandatory training, appraisal. Most of the time this is 1-2PAs per week. Some people also get additional time for other roles - e.g. I get 0.25 PA for being an educational supervisor. This isn't exactly an hour a week; some weeks I'll do barely anything, but others I may spend a half day or whole day doing teaching or assessments. It's up to me how I manage my non-clinical time, as long as all the work gets done.

A standard FT consultant job plan is 10 PAs but many, especially surgical jobs, may end up being more.