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Everything but the pay - Why surgeons discontent runs deeper than their payslip

20 July 2025

‘Resident doctors seek 29% pay rise’,^[1] shout the headlines, causing a wave of fury amongst the British public, many of whom understandably can’t comprehend how and why, when the NHS is in such deep crisis, doctors, surgeons, and consultants should be paid more money. After all, when did spending more money ever fix anything? But, in solely debating pay, we are completely missing the point.

“I carry my office on my back,” says consultant plastic and hand surgeon - and CBS Neurodiversity Lead - James Henderson, referencing the lockers that are so far away from his working environment that he (and other staff members) resort to carrying everything they could possibly need in a day in a huge rucksack. This ‘office in a bag’ includes medical devices, laptop, charger, snacks, PPE, theatre shoes, and water, because there is no suitable place for him to leave all these items. “On top of that, there is no parking available, so I park on the street half a mile away and walk in. Many of these seemingly innocuous and incidental inconveniences add up to an incredibly frustrating working life.”

Consultants no longer have their own secretary, or even a member of their team, who can undertake admin tasks that are required for every patient. This means that the most valuable (in terms of how much they are paid) workers in the NHS are using the time they could allocate to patients flitting between 14 different IT software programs, as well as paper notes, to write up patient records. Courses, conferences, exams, publishing, and professional memberships are all expensive, compulsory, yet self-funded. On top of an already overloaded work schedule, these are all carried out in the consultant’s own time. Resident doctors have different but equally intense pressures, often not knowing where they will work, or having to travel long distances to their workplace. This can lead to separation, with some forced to live apart from their families, funding two homes and associated costs.

“It’s hard to offer a perspective that doesn’t feel like ‘poor me’ to the public,” admits James. “But the way we are all working is not conducive to a healthy workforce, and this has a huge impact on patients. I am no longer in charge of my own clinics or operating lists, so a simple admin error can leave my schedule empty. With people waiting for over a year for an appointment, that is simply not fair to patients. We need an overhaul of the system, or a return to some of the tried and tested systems of the past. Consultants should be in charge of their services, as this is the only way to do the very best for our patients. In no other profession would someone in their fifties, or older, be expected to work 120 hour weeks, or to work through the night, making life and death decisions and carrying our complex microsurgical procedures.”

This isn’t a one-off experience. Across the surgical workforce, consultants report working in hospital systems where there’s no space to do admin, no place to eat lunch, and nowhere to park. Facilities are stretched. Resources are limited. And the wider culture, many feel, treats clinicians as transient, replaceable, unsupported, and expected to get on with it. But surgeons need the infrastructure to do their job well. They need a space to meet with other surgeons to talk, in confidentiality, about their patients. Somewhere that isn’t a crowded canteen, but a dedicated space, like the doctors’ mess used to be. They need their own desk, and a secretary that isn’t shared by 30 other consultants. They need to feel as though the money they are being paid is used wisely, that their value is recognised and utilised. They need to be sure of a system that values their expertise, and the expertise of others. A secretary could write a patient’s notes up in half the time it takes a surgeon to do so, freeing the surgeon up to exactly what they are trained to do: see patients.

According to James Henderson;

“If I could click my fingers and change things tomorrow, the first thing I would do is to give surgeons back their resources — secretaries, offices, parking spaces, lockers... the time saved could be used to do what consultants do best: treating patients. I would love to reintroduce proper ‘firms’ — teams with continuity, support, and clear lines of responsibility, because the current system leaves everyone isolated and unsupported.”

According to consultant plastic surgeon and CBS President Mark Henley;

“We are naturally challenged by the idea of industrial action, but the frustration of colleagues at all levels is palpable - and history suggests that attempts at being reasonable and anticipation of any return of professional goodwill often fall victim to political / managerial expediency. Our younger colleagues are very enthusiastic to learn and to contribute to the NHS but are being treated by the institution with what appears to be a total lack of respect for the individual or any concern for the future provision of healthcare.

“Crucially, there appears to be an alarming lack of concern abut the doctor/patient relationship when it comes to throughput. The current practice of pooling whereby the patient sees the operating surgeon for the first; and quite possibly the only; time five minutes before the surgery might be good for managerial efficiency - but is totally undermining the doctor patient relationship and flies in the face of what the GMC states is good medical practice. Surgeons are committed to the welfare of their patients but their ability to deliver is being compromised by those who appear to have no understanding of its importance in the delivery of best practice.”

CBS wants non-pay issues to be at the forefront of the conversation around strikes. We support the surgical team as well as the wider workforce and, just as importantly, we support the NHS as the thriving institution it was, and should be again.

 

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