REMUNERATION SUPPLEMENT 33 TO THE OCCUPATIONAL PHYSICIAN APRIL 2011

Transcription

1 BRITISH MEDICAL ASSOCIATION REMUNERATION SUPPLEMENT 33 TO THE OCCUPATIONAL PHYSICIAN APRIL 2011 INTRODUCTION This supplement sets out British Medical Association guidance for the remuneration of occupational physicians. It has been prepared to assist: doctors who work as occupational physicians employers who require the services of occupational physicians, either as employees or as selfemployed contractors organisations which provide occupational health services Basis of Guidance The Association believes that, as a minimum, doctors working as occupational physicians should earn a comparable amount to doctors who work in the NHS hospital service. In June 2011 the Coalition Government announced a two year pay freeze for all public sector staff earning above 21,000 a year and therefore doctors in the NHS will receive a 0% pay award for the financial year However, this decision should be seen in the context of the spending restrictions imposed on Government by the need to reduce the national deficit. Those doctors working as Independent Health s should take into account additional expenses caused by the consumer price index (CPI) rising by 4% 1. This guidance takes into account the expected seniority and responsibilities of each grade of occupational physician in relation to his/her NHS counterparts. These range from specialist registrars to consultants in receipt of Clinical Excellence Awards. Details of the duties expected of an occupational physician are set out in the attached appendix. A new contract for consultants was introduced in the NHS in 2003 and this guidance reflects this. 1. EMPLOYED DOCTORS a) Basic salaries As mentioned above, the Association believes that, as a minimum, doctors working as employed occupational physicians should earn a comparable amount to doctors who work in the NHS hospital service. Furthermore, we recommend that additional expenses caused by the consumer price index (CPI) rising by 4% should be taken in to account and that any pay award should at least be commensurate with Senior Managers in employing organisations. Table 1 shows the range of salaries payable to full-time hospital doctors in the NHS at various grades. physicians and employers may find it useful to refer to this in negotiations. The table also shows the seniority of occupational physician that the Association believes is equivalent to the corresponding NHS grade. In negotiating a salary, the doctor s experience, qualifications, length of service, level of responsibility and contribution to the specialty should to be taken into account, as well as the terms and conditions of the NHS contract (see Table 2). NHS employers can also offer additional recruitment and retention payments for posts that may be hard to fill. The appendix contains some details of the duties and qualifications of occupational physicians

2 Table 1 - NHS salary ranges from April 2010 ( per annum) NHS Grade equivalent NHS range pay Comment Senior Registrar Trainee 35,596to 46,708 Progress through this range should normally take no more than 5 years. This range applies to a doctor who enters specialist training directly after completing basic medical training. A higher rate for doctors who have other qualifications or relevant experience may be appropriate. Consultant, initial appointment 74,504to 83,829 Progress through the salary range should normally take no more than 5 years depending on experience, qualifications and responsibilities. Note that within the NHS it is possible for a consultant within this band with additional responsibilities and/or who demonstrates a significant contribution to the specialty/profession can earn up to 98,614. Experienced Consultant Senior 83,829to 135,930 Progress through the salary range should normally take no more than 10 years depending on experience, qualifications and responsibilities. An experienced NHS consultant in a senior position with additional responsibilities and/or who demonstrates a significant contribution to the specialty/profession can earn up to 176,242 a year. b) Out of hours responsibilities The above salaries do not include any allowance for any out-of-hours or standby duties that the doctor may be obliged to perform. In the NHS, the allowance for such duties by specialist registrars ranges from 20% to 100% of basic salary, depending on how onerous these duties are. For consultants, additional payments ranging between 1% and 8% of basic full-time salary are payable, depending again on the intensity of these duties. c) Terms and conditions of service Apart from salary, doctors and employers need to take into account other terms and conditions of service. A summary of the main terms and conditions of service for NHS doctors is given in Table 2. As with salaries, the Association believes that non-nhs employers should at least match these. 2

3 Table 2 - Principal features of NHS terms and conditions of service Item NHS terms and conditions Hours of work 40 hours per week Holiday entitlement 6 weeks per annum plus statutory holidays; consultants with 7 or more years of service receive an extra day's leave per annum Study leave and Recommended levels are up to 30 paid days a year for specialist registrars continuing professional development and 30 paid days over 3 years for consultants; the cost of courses should be reimbursed Medical Indemnity NHS doctors are indemnified for their NHS work but must arrange insurance for other work London Weighting 2,162 a year from April 2010 Pension 1995 section Final salary index linked scheme. Pension calculated as (n/80) x final salary where n is years of service, plus a tax-free lump sum of 3 times annual pension. The overall value to consultants is 23% of salary, of which they 1995 section of the NHS Pension Scheme (as at April 2011) Normal pension age section of the NHS Pension Scheme (as at April 2011) Normal pension age 65 Motoring costs/ car allowance pay 8.5%. Final salary index-linked scheme. Pension calculated as (n/80) x final pensionable pay where n is years of service, plus a tax-free lump sum of 3 times annual pension with the option to increase this up to HMRC limits. The employer contribution is 14% of salary, and employees pay tiered contributions dependent upon their earnings. As at April 2011 for earnings over 110,274 the top tier of contributions is 8.5%. Final salary index-linked scheme. Pension calculated as (n/60) x reckonable pay where n is years of service. There is no automatic lump sum entitlement in the 2008 section but there is the option of receiving a taxfree lump sum up to HMRC limits by giving up a part of the pension. The employer contribution is 14% of salary, and employees pay tiered contributions dependent upon their earnings. As at April 2011 for earnings over 110,274 the top tier of contributions is 8.5%. A mileage allowance is paid if the doctor s own car is used on NHS business. The amount depends on the car engine size and annual mileage. NHS employers may, at their discretion, offer a car under the Crown car scheme if they consider it necessary or beneficial. For further information about mileage allowances and the Crown care scheme, please see the BMA guidance which is available at mileagerates.jsp d) Part-time/sessional employment If a doctor is employed on a part-time/sessional basis, then pay and entitlement to benefits should be pro-rata to the whole time salaries and benefits outlined above. 3

4 2. SELF EMPLOYED DOCTORS Some employers may choose to meet their requirements for the services of an occupational physician by contracting these out to self-employed physicians. For some doctors, acting as an occupational physician may represent only a small part of their total work - this applies particularly to general practitioners. An increasing number of specialist OPs work as self-employed practitioners with a portfolio of clients contracting separately with each one. If a doctor is working in a self-employed capacity, it is important for both the doctor and the employer to realise that the fees charged must reflect both the loss of benefits which are available to an employee and the overhead costs of running a business, where appropriate. The Association believes that it is reasonable that doctors working in such a capacity can expect that their income, after allowance for the loss of these benefits and the additional costs, should be broadly comparable to that of a similarly qualified and experienced occupational physician who works as an employee (as shown in Table 1). It is impossible to be prescriptive about how much needs to be included in fees to allow for these costs as this will vary widely according to individual circumstances. However, the Association believes that for a self-employed occupational physician to earn an annual equivalent amount to the NHS salaries shown in Table 1, then their fees should be at least 50% higher than these salaries to take account of benefits normally available only to employees and business costs incurred such as: contributions by an employer to a pension scheme National Insurance continuous professional development professional indemnity insurance provision of support staff provision of supplies & equipment premises, etc. 4

5 3. COMMERCIAL ORGANISATIONS PROVIDING OH SERVICES An increasing number of commercial organisations contract to provide a variety of occupational health advice and support. This may include the services of doctors who may hold a range of qualifications (see attached appendix I). Their charges will depend on negotiation between the parties concerned. These organisations and doctors who work for them may find this guidance useful in determining appropriate pay scales. 5

6 APPENDIX I THE OCCUPATIONAL PHYSICIAN health focuses on enhancing and maintaining: the health of people at work, ensuring they operate safely; and the organisational effectiveness of enterprises by providing expert advice to management. Like most areas of healthcare, occupational health is a discipline which employs doctors, nurses and sometimes allied professionals. Doctors who practise occupational medicine include both the generalist and the specialist. Only some of the work in occupational medicine requires the expertise and competencies of a specialist. Whichever doctor it is that provides a service, the level of expertise needs to be appropriate to the work to be performed. THE DUTIES OF AN OCCUPATIONAL PHYSICIAN The precise duties of an occupational physician will be determined by the requirements of the employer or customer. These duties may include to: 1,7 visit the workplace regularly and advise on the provision of safe and healthy conditions by informed scientific assessment of the physical and psychological aspects of the working environment promote compliance with relevant health and safety legislation help develop policies, practices and cultures that promote and maintain the physical, mental and social wellbeing of all workers assess the fitness of workers for specific tasks, ensuring a satisfactory fit between person and job, recommending suitable adjustments to enable a person to undertake the work they have been selected to perform safely and effectively, considering any health issues or disabilities they may have monitor the health of workers who are potentially exposed to hazards at work through health surveillance programmes analyse data from surveillance programmes using sound epidemiological methods to identify trends in worker health and recommend any remedial measures necessary to improve worker health advise employees and employers regarding work-related health issues assess potential cases of occupational injuries and illness; investigating, managing and reporting individual cases appropriately and establishing if this is a single case or if there is wider incidence manage immunisation programmes for workplace biological hazards and for business travellers work with employers to promote best practice in physical and mental health in the workplace to help prevent sick leave. case manage workers who are on sick leave, working with other health professionals to ensure the earliest return of functional capacity and return to work recommend suitable alternate work in circumstances where a worker cannot perform their normal job, either temporarily or on a permanent basis because of a health problem determine whether employees satisfy the medical criteria for ill health retirement under the terms of the relevant pension fund rules ensure people have the necessary health information to undertake their work safely and to improve their own health. 6

7 QUALIFICATIONS After completing the normal period of undergraduate medical education, a pre-registration year and at least two years of general professional training, medical practitioners who wish to practise occupational medicine full-time or part-time will need to undertake extra academic study. This includes gaining knowledge of a range of subjects not normally included in general medical training, such as health and safety law, industrial toxicology and occupational epidemiology. This leads to a formal qualification from the Faculty of Medicine (FOM). Doctors who wish to become accredited Specialists in Medicine have to undertake a substantial additional period of supervised higher specialist training in posts approved by the Faculty. Diploma in Medicine (DOccMed) The FOM established the Diploma in Medicine specifically for doctors working part-time in occupational medicine or who have an interest in occupational health as it affects other branches of medicine. Although the Diploma demonstrates a level of competence appropriate to a generalist (often a GP) working in occupational health, it does not form part of the formal training route to specialist accreditation. Associateship of the Faculty of Medicine (AFOM) Associateship of the FOM recognised the competence of doctors committed to practising full-time or substantial part-time occupational medicine. The AFOM was withdrawn as a stand-alone examination for non-specialists in January Candidates who have passed the AFOM in its entirety will be exempt from part one and two of MFOM. Membership of the Faculty of Medicine (MFOM) Membership of the FOM is awarded to doctors after completing four years of supervised training, or its part-time equivalent, in posts approved by the Faculty and after passing the three central elements of examination (Part 1 and Part 2 MFOM, dissertation). Training must be supervised by a registered specialist who has MFOM or FFOM. Advice on the suitability of posts in the UK can be obtained from Regional Specialty Advisers, available through the FOM. Fellowship of the Faculty of Medicine (FFOM) The Fellowship Committee of the FOM awards Fellowships to those Members who have made a distinguished contribution to the specialty and who demonstrate a greater depth of experience and expertise in occupational medicine. For further information please refer to the BMA publication The, available on the BMA web site or from the BMA Health Committee Secretariat: Matthew Lasham, BMA House, Tavistock Square, London WC1H 9JP. mlasham@bma.org.uk 7