We welcome the opportunity to submit evidence to the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) on behalf of NHS trusts and foundation trusts, to inform the 2025/26 pay round for doctors. For the purposes of this submission, we are providing relevant findings from our annual survey of trust HR directors and our annual ‘State of the Provider Sector’ survey, accompanied by key messages and context.

• Context: The current context for NHS staff is challenging, with sustained high service demand and dilapidated physical working environments, industrial relationships that are still in recovery, and a new government with plans for service reform which staff are key to. The role of the DDRB as an independent pay review process remains important, as pay is a key lever to ensuring that the NHS can attract and retain the doctors it needs.
• Trust finances: In order to manage or improve the current financial position of their trust, 85% of our survey respondents said it is very likely or likely that their trust will have to reconfigure services, and 87% said they are very likely or likely to review responsibilities within clinical roles with a view to optimisation. Other common themes centred on staffing and recruitment, including recruitment freezes across non-clinical roles, eliminating bank and agency spend and scaling back spending on training and personal development.
• Agency spend: Agency spending is significantly reduced this year, following sustained focus on this area from trust leaders, and is now at its lowest since 2017, with trusts on plan to meet the target reduction in agency spending of £500m for 2024/25.
• Timing: We welcome the earlier timing of the remit letter, and consequent commencement of the pay round, this year. While this is progress on previous years, it is disappointing that the 2025/26 pay award will again not be confirmed in time for the start of the financial year. We are keen to see this amended for the 2026/27 pay round.
• Pay award process: In our annual survey of trust HR Directors, we asked our members which model for NHS pay awards they would prefer to see in future years. Over half (56%) would like to see multi-year pay awards recommended. Only 10% of respondents said they would like to see annual pay awards via the pay review bodies (which is the current model).
• Funding (national): We again ask that the DDRB makes an explicit recommendation for government to commit to fully funding any pay uplifts it decides to award NHS staff, to ensure that cost pressures are not passed onto trusts. This is of particular importance this year, with trusts under significant financial strain, concerned about staff numbers and quality of patient care.
• Funding (community and mental health trusts): The calculation of funding allocations for pay costs disadvantages community and mental health trusts, an ongoing concern for these providers.
• Trade union deals: It is our understanding that all of the non-pay elements agreed in national deals for hospital doctors with the BMA are yet to be completed. It is important for deals made with unions to be implemented in full and hope to see progress towards this set out in other parties’ submissions to the DDRB this year.
• GP action: While the impact of ongoing GP action has not yet been felt to a significant degree across the system, we ask the DDRB to impress upon government the importance of not letting action escalate before resolving the GPs’ contractual dispute.
• Pay for 2025/26: 44% of respondents to our annual pay survey said that a pay uplift of at least 5% would be needed for 2025/26 to support recruitment, retention and morale for doctors.
• Flexible Pay Premia (FPP): Many respondents felt that the current FPP for training programmes were correctly targeted.
• Specialist grade posts: 86% of responding trusts reported creating specialist grade posts since the grade’s introduction in 2021. Only 8% said they have not created any specialist grade posts.
• Impact of pension reform: 47% of responding trusts have seen consultants undertaking more additional work over the last year, as a result of increased pension flexibilities by the last government.
• Retirement rates: 34% of responding trusts have seen an increase in the retirement rate of doctors since April 2024. This is a considerable increase on results for the same question in last year’s survey, when just 2% of respondents reported an increase.
• Ethnicity pay gap: 31% of respondents said their trust’s ethnicity pay gap has decreased in the last two years, while 36% said their trust’s ethnicity pay gap has stayed the same. 7% said they have seen their trust’s ethnicity pay gap increase in the last two years, and 26% said they did not know.
• Staffing: Only 26% of respondents are confident about their trust having the right numbers, quality and mix of staff in currently in place to deliver high quality healthcare to patients and service users. Just 3% were very confident. 20% were very worried and 34% were worried.
• Burnout: 75% of respondents were extremely or moderately concerned about the current level of burnout across their workforce.