Filling the Gaps: Why Consultants Step Up

Unpacking the Myths About Consultant Overtime Pay

A recent BBC article has stirred the pot among the On-Call community, claiming senior doctors are charging "rip-off" rates for overtime. Enter Wes Streeting, stage left, declaring these rates "unacceptable" and stressing the importance of wise NHS spending. Someone should probably tell him that these payouts wouldn’t be necessary if rota gaps weren’t as common as uncharged bleep batteries.

According to a BBC Freedom of Information request, 6 in 10 consultants are already working beyond their contracted hours. The article featured dramatic examples of hefty overtime earnings but failed to differentiate between long-term locum contracts offered through agencies and genuine extra hours worked. Labelling it all "overtime" is not only inaccurate, it lacks the standard of journalism that we would expect from the BBC.

But let’s talk about the real kicker here: the language. “Rip-off rates.” “Disgraceful.” Really? We’re talking about highly skilled professionals clocking extra hours to help the NHS hit its ever-elusive targets. Consultants are among the best-trained individuals this country has to offer, and their work is fundamental to the nation’s prosperity.

Many of them know this reality and for that reason, they maintain a degree of leverage. They’re not the bad guys—they’re the reason things keep ticking over when the rota looks like Swiss cheese.

Let’s face it: skilled labour at inconvenient hours commands a premium. If you want seasoned consultants to step up for overtime, you’ve got to make it worth their while.

Of course, there’s always the option of hiring enough consultants to meet demand and paying them properly to stay in the NHS. But until that utopian vision comes to life, these overtime bills are simply the cost of patching a system stretched to its limits.

Who’s Holding the Needle, and Are They Qualified?

Injectables are back in the spotlight this week, with more botched jobs reminding us that in the UK, cosmetic injections remain largely unregulated. Shockingly, around two-thirds of injectors aren’t doctors—just 32% are, and 24% are our esteemed dentist colleagues.

A recent study found that 69% of patients reported lingering side effects like pain, anxiety, and headaches. And thanks to filtered social media feeds, the demand among young people continues to rise.

The Health and Social Care Act has made it an offence to carry out these procedures without a license, which is a step in the right direction. But let’s be honest—does it really go far enough? Let’s be daring and ask: How well can a non-medic truly grasp head and neck anatomy? Until stricter regulations are in place, the injectable industry might remain a little more Wild West than we'd like.

Brains, Breakthroughs, and Bank Balances

Why We Must Protect Academic Careers in Medicine

When speaking with the on-call community, one theme often emerges: many of us grew up holding academics in high regard—and rightly so. These are the trailblazers who expand our knowledge, discover life-changing therapies, fine-tune guidelines, cut inefficiencies, and transform medical education. Simply put, without them, medical advances would grind to a halt faster than the IT system during a lunchtime power outage.

The UK has long been a global leader in medical education and research, but there’s a growing concern. The Medical Schools Council recently flagged a worrying trend: fewer doctors are pursuing academic roles. And it’s not just burnout or lack of interest—it’s the pay. Academic clinicians often earn less than their NHS counterparts, who supplement their free time with locum or private work, and this financial disparity is becoming a significant barrier to attracting and retaining talent in higher education.

Our last health secretary, Stephen Barclay sounded the alarm: the number of consultant clinical academics is on track to nosedive in the coming years. Why? Because there just aren’t enough fresh-faced academics waiting in the wings to step up when the current cohort retires.

The Universities and Colleges Employers Association (UCEA) has recently updated pay scales for medical academic trainees in England, but they’ve done little to address the imbalance. For many doctors weighing their options, the prospect of contributing to groundbreaking research is dampened by the knowledge that their bank accounts might be healthier if they stayed in full-time clinical roles. Government research funders also need to tackle the wobbly, precarious foundations of academic careers by offering more long-term postdoctoral positions.

Perhaps we’re trying to fix the problem a bit too late in the game. If ‘academic foundations’ aren’t laid during medical school through the curriculum, can we really fault students for not taking an interest? The logical answer to insert this content could be intercalated BSc/MSc degrees. But let’s be honest—between an already bloated curriculum and the prospect of additional tuition fees, is this a practical solution?

If we value innovation, new therapies, and future-proofing our profession, we need to ensure academic medicine is not just intellectually rewarding but financially sustainable. Otherwise, we risk losing the very people who make those cutting-edge treatments—and our careers—possible.

“Recently chaperoned an F1 during a DRE and had to stop her just in time before she attempted the procedure with both fingers on an 87-year-old patient.”

“I failed a hand-washing audit because I didn't wash halfway up my forearms”

“I was trying to get a second opinion on a minor issue with my baby so took her to the GP having deliberately not told anyone I was a doctor, let alone a paediatrician, so that they wouldn't just take what I said at face value. I walked in to find the GP registrar who was my SHO 6 months before”.

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The debate over the "ideal" commute is as varied as the deaneries themselves. Opinions abound, but one consensus emerges: anything over an hour door-to-door comes with significant challenges. The impact is not just physical—exhaustion after a long shift—but emotional and mental, especially for those balancing families, exams, or personal commitments.

While some doctors tolerate extended travel for short-term rotations, most agree that long commutes are draining, unsustainable, and, for some, outright “soul-destroying.” Yet, rotational training often leaves little room for choice. The variation in commute types—quiet train rides versus traffic jams—further muddies the waters.

The crux of the issue? A system that places career progression and service needs above individual well-being. Without transparent rota examples or proximity-based placements, many trainees feel they’re gambling with their quality of life. The solution may not be straightforward, but a reimagining of rotational training—one that factors in commute time—could make all the difference.