“Mend the Gap: The Independent Review into Gender Pay Gaps in Medicine in England”, was published by the Department of Health and Social Care (DHSC) on 15 December 2020. The report, which can be read here, was commissioned by the DHSC in 2017 to examine the structural and cultural barriers affecting the female medical workforce, and was chaired by Professor Dame Jane Dacre and led by Professor Carol Woodhams.


The gender pay gap for medics is significant, being 24.4% for hospital and community healthcare (mostly hospital) doctors, 33.5% for GPs and 21.4% for clinical academics. The report, which considered the records of 86,000 trust doctors over a 10-year period, 16,000 GPs and 4,500 clinical academics, finds that careers in medicine were designed for a predominantly male workforce and retains a male dominated culture. As a result, the reward package for doctors inadvertently creates a glass ceiling for women based on an expectation of full-time work, with no breaks in service for family reasons, for example.

Explanations for the pay gap

The report identifies the following reasons for the medical gender pay gap:

  • Hours: Women are more likely to work less than full-time (LTFT), which helps to explain why their pay is lower. However, men report working more unpaid overtime, which means that their effective pay is overstated. When these factors are taken into account, the gender wage gap is smaller.
  • Grade and experience: Male doctors are more likely to be older, have more experience and hold more senior positions – all of these characteristics lead to higher pay. Periods of LTFT working have long-term implications for women’s career and pay trajectories as they reduce their experience and slow down or stall their progress to senior positions.
  • Additional payments: Among hospital doctors, gaps in total pay, which include Clinical Excellence Awards (CEAs), allowances and money from additional work, are larger than gaps in basic pay alone.
  • Women are more likely to work less than full time (LTFT), and many never catch up with their male peers even after a return to full-time working. The report also suggests that there may be an unconscious bias amongst peers, recruiters, and even the wider health and care community, that those on LTFT contracts lack the same levels of skill and experience as their full-time counterparts, and urges the NHS to “put a value on individual talent and ability, not hours on the clock”.

What this means for you

Key recommendations of the review include:

  • Review pay-setting arrangements, using fewer scale points and greater use of job evaluation for hospital doctors, and more structure and greater transparency for GPs.
  • Give greater attention to the distribution of additional work and extra payments, by increasing transparency around additional allowances and individually negotiated pay (for example, for locums or waiting list initiatives), monitoring the gender split of applications for CEAs and encouraging more applications from women.
  • Promote flexible working for both men and women, by advertising all jobs as available for LTFT, reconsidering the structure of LTFT training, so that it focuses on competency not time served, and reducing long-term career penalties.

The Government has confirmed that it is to establish an Implementation Panel to tackle the barriers outlined in the report.

How Capsticks can help

Our national employment team acts for all kinds of organisations in the NHS, private healthcare and primary care sectors. We work with clients to take a pro-active approach to diversity and inclusion, offering thought leadership and sharing best practice, and assist clients in responding to any challenges that may arise. We create and review HR policies to ensure that they are Equality Act compliant and to encourage the recruitment, promotion and retention of those with a protected characteristic. We also advise regularly upon on equality impact assessments, how to reduce the gender pay gap and options available to use positive action to increase the diversity of workforces. 

For further information on this issue, please contact Sian Bond, Chloe Edwards or Alistair Kernohan.