HOSPITAL doctors have pocketed over £40 million in less than four years in "extortionate" overtime payments for evening and weekend work, the Sunday Herald can reveal.
Individual consultants are taking home up to £150,000 extra in "triple time" payments - more than their salaries. The sums were branded "eye-watering" by one MSP, but a doctors' group said the figures reflected the "huge pressure" to meet targets set by politicians.
Under the 2004 consultants' contract, doctors do not have to perform non-emergency work on weekends, public holidays and after 8pm.
However, they can receive special Waiting List Initiative (WLI) payments, worth nearly £150 an hour, if they agree to work outside their contract. The "premium" rate is specifically to meet waiting times targets and can be paid up to triple time.
It is in addition to a consultant's annual basic salary, which can reach £100,446.
This newspaper has collated all the WLI payments made by Scotland's NHS boards over the last three-and-a-half years.
l NHS Greater Glasgow and Clyde, which caters for over one million people and includes some of the most deprived areas in Scotland, has paid around £11.5m in overtime to consultants since 2010. The sum rose by over 20% to £3.6m in 2013 alone.
The cash was shared among an average of 409 doctors in each of those years, with nine scooping between £50,000 to £100,000 each last year. One doctor received up to £150,000.
l At NHS Lothian, a board that was rapped for manipulation of waiting-times targets, consultants have received nearly £8m in WLI pay. This included £2.4m in 2012-13, with eight doctors topping up their salaries with up to £100,000 each in out-of-hours payments.
l Around £6.4m of NHS Ayrshire and Arran's budget went into the pockets of consultants for overtime.An average of 135 doctors benefited every year, with several making up to £100,000.
l At NHS Lanarkshire, wealthy hospital doctors were paid £5.5m in WLI, benefiting around 170 doctors every year.
All told, 10 of the 14 NHS boards paid nearly £43m in WLI pay. Three boards did not respond to our inquiry. NHS Grampian spent nothing.
WLI money is not the only funding pot that tops up consultant salaries.
The most able doctors can receive distinction awards of up to £75,889, which are paid annually and are pensionable. Others can receive "discretionary points" that are worth a maximum £25,632 a year.
The Scottish Government has blocked the awards scheme for new entrants, but the points scheme remains open.
Consultants employed by the NHS can also undertake work farmed out by the health service to private hospitals. In theory, consultants could take home around £300,000 in salary and add-ons.
The details of WLI payments are now likely to fuel the debate about the quality and cost of the NHS at evenings and weekends. Critics believe hospitals effectively provide a five-day service, with a minority of consultants offering their time at a high price.
Professor Chris Isles was part of a research team which found that patients admitted as emergency cases on public holidays were nearly 50% more likely to die within a week than those admitted on other days.
He said earlier this year: "Consultant physicians in Dumfries spend as much time on the admissions unit during public holiday as they do on normal days and weekends, but it is also true that fewer consultants and fewer junior doctors cover other medical wards during holiday periods.
"Therefore, we might speculate that higher mortality among patients admitted on a public holiday reflects a cumulative lack of services and/or cumulative lack of doctors during these three to four-day periods."
The Scottish Government has also backed a seven-day NHS.
Jackson Carlaw, the Scottish Tory health spokesman, said: "People all over Scotland have to work anti-social hours, and almost no-one gets this level of three-fold uplift. These extortionate payments risk undermining all the other efficiency savings going on within our NHS. As we look to the future it is precisely this sort of extravagant remuneration for doctors that has to be renegotiated.
"As it stands, this is unsustainable and incompatible with [Scotish Health Secretary] Alex Neil's drive for a seven-day, 24-hour NHS."
Neil Findlay, Scottish Labour's health spokesman, said: "These figures are eye-watering. NHS budgets are under intense pressure, the number of nursing staff has been slashed and low-paid workers got a miserly 1% pay increase to their pay, so to see these levels of overtime and bonuses going to the highest-paid consultants will be difficult for people to understand.
"Audit Scotland have recently highlighted a huge increase in the use of the private sector and agency staff to meet waiting-time targets and now this - Alex Neil really has to get a grip of the situation."
Dr Nikki Thompson, chairman of the BMA's Scottish Consultants Committee, said: "Waiting List Initiative work is ad hoc, non-emergency work over and above that which a consultant is contracted to do.
"It is paid at the enhanced rates agreed with the Scottish Government in the 2003 Consultant Contract. There is currently huge pressure for NHS Boards to achieve waiting-times targets and in order to do so, they are having to spend a lot of money to pay for the significant levels of additional work they are now asking of NHS staff."
A Scottish Government spokesperson said: "Patients in Scotland are being treated quicker than ever and average waiting times remain among their lowest ever levels in Scotland.
"Health boards across Scotland are investing over £67m in recruiting around 420 additional staff and expanding the capacity of operating theatres in order to be able to treat more patients than ever.
"There may also be occasions where patients require urgent treatment and overtime may be paid to staff to ensure the patient is treated within the shortest possible timescale."
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