CONSULTANTS could demand extra payments to put their lives on the line in intensive care units if Scotland experiences a second and potentially deadlier wave of Covid-19, doctors’ leaders have warned.

Dr Lewis Morrison, chairman of the British Medical Association (BMA) Scotland, said a failure by the Scottish Government to reward consultants for going “above and beyond” contracted hours during the pandemic had created ill-feeling amongst staff, many of whom have put themselves and their families at risk to care for the most seriously ill patients.

With cases of the virus reaching a four-month high, Mr Morrison said there has been little chance of the “rest and recuperation” that was talked about by Government leaders in early July when cases of the virus were low.

Health Secretary Jeane Freeman announced in July that NHS medical and dental workers would be awarded a 2.8% increase in their annual pay rise, in common with those across the rest of the UK.

However, the chairman said there is a “real frustration” that after four months of lobbying, the Government did not agree a separate, national deal to recognise extra hours and changes in working practices and blamed the “tired narrative” that senior doctors are already overpaid for the decision.

Mr Morrison stopped short of saying consultants could refuse to work but said the prospect of staff “with little left in the tank” working through a second spike of the virus alongside re-establishing core services is cause for concern.

In his speech to the BMA’s first virtual Annual Representatives Meeting, the chairman also said the pandemic could finally force a debate on what the NHS can realistically expect to deliver going forward and how treatments are prioritised.

He said: “Many of the people who have been frontline for months now are nervous about numbers rising and whether or not we might see a big rise in hospitalisations and very unwell people.

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“The rest and recuperation that was talked about a lot when cases of the virus were low, a lot of people just haven’t had that. 

“I think many people are pretty tired and strung out, both physically and mentally and I think that raises worries for me about the NHS’s capacity to respond if we have to do it all over again.

"It remains areal frustration that Scottish Government wouldn’t, even after nearly four months of lobbying, agree a national deal to appropriately reward consultant and specialist doctors for “going above and beyond” what was asked of them.

“The issue of a lack of a pay deal to recognise Covid-specific, very unusual ways of working, it should have been a tiny footnote in the pandemic.

The Herald:

“I don’t think it would have cost a great deal in pounds, shilling and pence but I think it might have cost quite a bit in terms of goodwill.

“I think the Scottish Government took their eye off the ball and, I don’t know this, but I suspect that rather tired narrative that senior doctors are already over-paid... to be seen to be paying doctors more when there has been a tendency to paint doctors as over-paid in the first place, would have been uncomfortable.

“The bottom line is doctors who have been working in acute intensive care units in April, they will be asking themselves how much value has been put on that, in retrospect. They have put themselves at quite considerable risk.”

According to the BMA,  consultants employed in Scotland after 2004 are
paid between £82,669 and £109,849. Those employed before 2004 are paid from £68,638 to £88,023.

Mr Morrison said the BMA will now be focused on trying to secure local deals with health boards in the absence of a national agreement.

In his address, Mr Morrison also called for an end to a target drive healthcare system, which “lumps everything together” irrespective of how sick patients are or how pressing the clinical problem.

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He said: “There’s a window of opportunity and, generally, we have seen a more collegial response to healthcare (in the pandemic).

"Given where we are as a country, there are two priorities. One of them is that we prioritise healthcare and allocate more resources to it.

"Or in the cold hard reality of resources not being infinite we have to have a conversation about what it is the NHS can deliver.

“Everyone is asking the question ‘Are there things that shouldn’t be as much of a priority and are there things that need to be more of a priority?’.

“That questioning approach must lead us away from a tired focus and narrative on numbers seen and how long it takes to
be seen.”

Mr Morrison said that after the pandemic the NHS should not return to a “target culture”.

“Now is the time to finally be honest that the NHS cannot deliver all we ask of it with current funding and staff,” he said.

“Healthcare is not a political football and it is not good enough to keep squabbling over NHS figures like they were the latest opinion poll results.”

Mr Morrison asked politicians to “put party politics and point scoring to one side and unite to make our NHS a less politically driven institution” and to “depoliticise the debate on our NHS”.

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He called for a new partnership between “Scotland’s people, politicians and the healthcare professions” and said a national conversation is needed
about expectations around healthcare services.

He said: “We can’t just go back to the way we were doing things before, which wasn’t working.”

A Government spokeswoman said:“The pandemic is having an unprecedented impact on those working in our NHS, and we are hugely grateful for the extraordinary hard work, dedication, skill and commitment of all those working in NHS Scotland during this emergency.

“We have accepted the independent recommendations of the Doctors and Dentists Pay Review Body for a pay uplift for medical and dental staff of 2.8% backdated to April 1.

“This will be paid in September salaries, with arrears of pay to follow as soon as practical thereafter.

“The Health Secretary meets regularly with BMA Scotland, most recently on September 11, where all issues related to medical staff, including pay, can be discussed. We continue to engage fully with NHS unions on all issues related to pay and reward.

“All staff are able to claim payment or time back for extra hours worked.

“Extra and overtime hours are paid at applicable the national contractual rates.”