This week the Scottish Government announced its decision on doctors’ pay for this coming year following the publication of the Review Body on Doctors' and Dentists' Remuneration ( DDRB) recommendations 3 weeks ago (as ever the coming year started in April this year however, and the rise will be backdated to then, to be clear).

You may have seen some news coverage of this and our response (which you can find in full here). It’s taken 3 extra weeks for Scottish government to respond following the more immediate UK (for England) and Welsh governments’ announcements.

Our press statement is of course our immediate reaction, but I wanted to spend a bit more time exploring the implications of the pay announcement, and our full position looking to the future. Because that headline 3% doesn’t cover the whole story of course.

Superficially 3% is an improvement on recent years and certainly better than previous years of pay freezes and real terms cuts. Considered in isolation it’s also a further improvement on last year’s 2.6% uplift.

But context is everything here and inflation is a key factor – which on the Retail Price Index was 2.9% in April when this pay rise is backdated to – and indeed has risen to 3.9% since. Inflation (unless it starts falling soon and stays there) can of course wipe out most or more of any pay rise.

It also comes against a backdrop of a 4% award for most other NHS staff backdated to last December which announced with some pre-election fanfare by Scottish government.

We asked for a substantially above inflation pay award. We made that case strongly and directly to both the DDRB the Scottish government, emphasising it was a real and necessary opportunity for them to do better, especially considering all the challenges of vacancies, understaffing, excessive workload and deteriorating morale the profession faces, compounded by years of pay erosion.

We also made it crystal clear that any thought of capping senior doctor pay, as per Scottish government’s Public Sector Pay Policy, which would mean a less than 1% rise for many, wasn’t credible if they had any hope of asking those same doctors to engage with any sort of recovery from the pandemic. The fact that we consistently have to make this point demonstrates the Scottish Government have some way to go to demonstrating they really understand the damaging  effect years of inadequate pay uplifts.

The Scottish government, having taken an extra 3 weeks to make an announcement, also had an opportunity to go one better than other parts of the UK and create a genuine incentive for medical recruitment and retention in Scotland.

The pandemic is not a reason for a one-off extra pay uplift in my view, but it has so very visibly shone a light on the huge responsibilities and workload we bear. Never was the value of what doctors do clearer.

So, this year, of all years, was the obvious and critical time to tangibly demonstrate doctors are truly valued instead of encouraging more clapping and repeated warm words. It is more than disappointing our government hasn’t done that. Especially when we have yet to see any genuine medical workforce plan to redress rising vacancies and expand the workforce to deal with not just our current pressures but the recovery from the pandemic.

All that said the pay award is for all doctors (unlike in England) and Scottish government have accepted the recommendations of the pay review body - the DDRB in full. The DDRB report itself says many things that we have been saying for years about recruitment, retention and morale – in fact if you read it you’d have expected they would have recommended quite a bit more than 3% - it’s almost like the DDRB “bottled it” at the last minute. So, any mixed feelings we might have about this year’s pay award aren’t just about what government have said and decided.

The wider context of our current post-austerity peri-pandemic economic and employment climate also must be considered, and doctors don’t do their job solely for financial reward. But our job at BMA Scotland on doctors’ behalf is to ensure our pay and conditions support a workable, sustainable medical career in Scotland. Whatever is going on in the rest of world, allowing further erosion of pay and conditions harms us, harms our chances of recruiting and retaining colleagues and ultimately that harms patients and the health of the people of Scotland. That’s why I make no apology for making the case for better pay as part of delivering better careers and therefore better healthcare.

We must remember that pre pandemic we were understaffed and under resourced and facing spiralling demand. Covid has exacerbated all those issues and we are facing a huge wave of extra work as a direct result, but also from a public who now expect other delayed or pent-up health issues to be dealt with urgently. It is no surprise many in the profession are exhausted – time and again your honest responses to our surveys provide the very real evidence of that. 

Our careers demand a huge amount and considerable sacrifice from us. Personal and family milestones and celebrations sometimes take a backseat with the ever-present risk of taking the stress and pressures of the job home with us.

Taking that all into account, it is only in terms of fairness that we absolutely expect better in terms of reward. There is obviously much more to a valued career than money, but it is a key component.

Last year our response to the pay award was “OK, but next year you must do better”. There’s a risk of simply saying that again, so this year I say they have missed a critical opportunity. But they still have a chance to make up for that in other ways, by being part of a solution to pensions and taxation issues which affect so many, by having an actual concrete plan to improve recruitment and retention, and a critical role in halting the tidal wave of demand on us as a profession clinically and bureaucratically. It’s not just our job to be the messenger on these things either.

I will finish by saying where we might go from here. As a first step we need to hear from you on what you think of the pay award and indeed the whole process of improving pay. That is why we will very soon be launching a comprehensive survey of doctors in Scotland to gauge your views and what next steps you might want us to take – on pay and other important factors.

To sum up, for doctors’ pay in Scotland it’s another year of “must do better” even if the direction of travel is marginally more positive. But I’d go much further than that. If Scottish government aren’t willing to do better on pay then they are going to have to do far better on so many other things: pension taxation, controlling demand, recruitment and retention and putting in place work conditions that promote a sustainable and career that doesn’t have a negative impact on our own health and wellbeing. They need an actual plan to improve these things, not the usual “Plan for a plan” – if they do these things then everyone’s experience of healthcare will improve – doctors and patients alike. They say they have listened. It’s time to start doing.

Read more: Nurses escalate battle over pay and recruitment; NHS Scotland medics face £10k gender pay gap; NHS pay rise described as ‘disappointing’

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