Renumeration Supplement 28 to 'The Occupational Physician'
April 2006
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 self-employed contractors
- organisations which provide occupational health services
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. Doctors’ pay in the NHS is determined annually by the government, following the annual recommendations of the independent Doctors' and Dentists' Review Body (DDRB). The DDRB exercises its judgement on the appropriate level of remuneration for doctors based on many factors, including comparability with other professions and the state of the economy. The 35th report was published in March 2006 containing recommendations for doctors’ pay for 1 April 2006 to 31 March 2007.
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.
Table 1 shows the range of salaries payable to full-time hospital doctors in the NHS at various grades. Occupational physicians and employers may find it useful to refer to this in negotiations.
The Table 1 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.
Table 1 - NHS salary ranges from April 2005 (£ per annum)
| NHS Grade |
Occupational Physician equivalent |
NHS pay range |
Comment |
| Specialist Registrar | Trainee Occupational Physician | £33,325 to £43,931 | 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 |
Occupational Physician | £70,822 to £79,812 | Progress through the salary range should normally take no more than 5 years depending on experience, qualifications and responsibilities. Note that within the NHS scale 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 £94,062. |
| Experienced Consultant | Senior Occupational Physician | £.79, 812 to £130,031 | 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 £168,899 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.
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 continuing professional development | Recommended levels are up to 30 paid days a year for specialist registrars 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 2005 |
| Pension | 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 pay 6%. |
| Motoring costs/ car allowance | 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. For a car with a 2 litre engine used for 5,000 miles in a year the allowance averages 52p/mile. NHS employers may, at their discretion, offer a car under the ‘Crown car’ scheme if they consider it necessary or beneficial. |
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.
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 oneother.
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.
The Directive incorporates a number of suggested changes including maximum weekly working time and regulations regarding rest breaks. Workers within the Directive are entitled to four weeks statutory holiday in respect of each leave year. The Directive also cover statutory holiday pay and notice requirements in respect of taking annual leave and pay in lieu on termination.
3. Commercial organisations providing occupational health services
An increasing number of commercial organisations contract to provide a variety of oOccupational hHealth advice and support. This may include the services of doctors who may hold a range of qualifications (see attached appendix I). Their charrges 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.
Appendix I
The Occupational Physician
An occupational physician is a specialist who, in relation to any particular workplace, takes full clinical responsibility for advising employees and management, including contractors and visitors, on all health matters connected directly or indirectly with their work. These may have a bearing on health as it affects work and the effect of work on health, including that of the public at large, either in general or as individuals, at the place of work or in the surrounding environment.
Just as clinical physicians would not take responsibility for the health of patients without examining them, so occupational physicians cannot properly undertake their responsibilities without appropriate assessment of the workplace.
The Duties of a Doctor in Occupational Medicine
The doctor’s duties vary greatly according to the occupational groups involved, but the following is a summary of the duties usually expected of an occupational physician:
- assessing prospective employees and giving advice as to their initial placement. Special consideration of the disabled prospective employee is required, as is liaison with help agencies, to ensure that the working environment is suitable
- advising managers and the workforce on health related issues such as sickness absence, rehabilitation, and redeployment or retirement on health grounds of those people affected by serious illness or accident
- participating in health risk assessment and organising health surveillance appropriate to those risks
- ensuring familiarity with workplaces and work demands
- advising management and committees within the organisation on all health aspects of the working environment, the medical implications of health and safety, disability discrimination legislation, and the significance of hazards to health at work
- having responsibility for the organisation, in conjunction with management, of first aid. In some organisations the occupational physician will also be responsible for the organisation of emergency services within the workplace
- supervision of the hygiene and safety of services, facilities and amenities
- giving advice to management on health promotion, health education and occupational health surveillance, and making arrangements for these to be carried out where appropriate
- counselling and giving advice to all employees and management on health as related to their capacity for specific and general work.
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 Occupational Medicine (FOM). Doctors who wish to become accredited Specialists in Occupational Medicine have to undertake a substantial additional period of supervised higher specialist training in posts approved by the Faculty.
Diploma in Occupational Medicine (DOccMed)
The FOM established the Diploma in Occupational 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 Occupational Medicine (AFOM)
Associateship of the FOM formally recognises the competence of doctors committed to practising full-time or substantial part-time occupational medicine. It represents the first stage of specialist training for a higher qualification in occupational medicine. To be eligible to sit the AFOM examination, candidates should have held one or more full or part-time posts in occupational medicine for not less than six months.
Membership of the Faculty of Occupational Medicine (MFOM)
Membership of the FOM is awarded to Associates after completing four years of supervised training, or its part-time equivalent, in posts approved by the Faculty and after acceptance by the FOM of a dissertation, thesis or substantial published work. Membership is now a pre-requisite for specialist accreditation. 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 Occupational 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 Occupational Physician, available on the BMA web site or from the BMA Occupational Health Committee Secretariat: David Algie, BMA House, Tavistock Square, London WC1H 9JP. Email: dalgie@bma.org.uk