The junior doctor contract controversy began in 2013 and has divided both the public and the media. The Department of Health have (DoH) introduced the contract with the intended aim of making pay fairer, and the end goal of spreading both emergency and elective services across seven days of the week.
The British Medical Association have engaged the DoH in sporadic negations, which have led to disagreement over certain points of the proposed contract, including rota shift patterns and pay. Many junior doctors feel that this contract is not safe for patients and not fair for doctors. As a result, junior doctors overwhelmingly voted for industrial action, culminating in walk-out strikes.
How much do you know about the NHS? Take the quiz!
In the old junior doctor contract, doctors were paid a standard rate for shifts where the hours fell between 7am and 7pm on Mondays to Fridays. If a FY1 doctor were to work these standard hours, they would have earned a basic salary of £22,862.
This basic salary would go up as the doctor progressed through their training, and their time served increased. However, junior doctors are also required to do on-call shifts outside of sociable hours. This earned an extra supplement known as banding, which could add an additional 40 to 50% to their basic salary.
What’s the New Junior Doctor Contract?
As of April 2017, the system of pay and hours was overhauled, with four points of nodal pay along the training path:
Stage of Training
Foundation Doctor Year 1
Foundation Doctor Year 2
Specialty Registrar (StR): Core training
CT1 - CT2
Specialty Registrar (StR): Run-Through Training / Higher Training / Specialist Registrar (SpR)
ST3 - ST8
Depending on how many weekends a doctor works and their nodal level, they are awarded an extra percentage of their allowance. For example, junior doctors who work one in every two weekends get an additional 10% of their basic pay, whilst those who only work one in eight weekends get 3%.
On-call allowances follow a similar concept, where extra pay is based on the nodal point.The time served concept is abandoned, and the basic pay packet is now linked only to the level of responsibility held. Basic pay itself has increased by 10-11% but is now determined by on-call and weekend allowances, with no banding system in place.
What are the Concerns with the new Junior Doctor Contract?
There are a range of concerns with the new junior doctor contract:
Patient Care: Many junior doctors have concerns that the new contract will increase stress, tiredness and burnout among their peers, and that patient care will suffer as a result.
Pay Issues: The increase in antisocial hours is also not reflected in an increase in pay and in real terms junior doctors are being remunerated a smaller amount.
Switching Specialties: The new contract also affects those who decide to switch specialty at some point during their career. The previous contract stated that if a doctor trains in one specialty, such as emergency medicine, and then subsequently decides to retrain in another, such as general practice, the salary they gained through their emergency medicine experience will be protected. This would reflect their additional experience, incomparable to a doctor at the start of training. The proposed changes would mean these two doctors would be paid the same, discouraging doctors from changing specialties, harming careers such as general practice which many doctors decide to switch into later in their careers.
Maternity and Academic Research: Initial drafts of the contract elicited concerns regarding equality, centring around maternity or academic research leave. Pay progression in the old contract would have continued throughout time off, but in the new contract it is halted. Many junior doctors felt this was discriminatory to these groups and could jeopardise both female doctors and academic medicine as, despite gaining skills critical to the NHS, trainees would be deterred from taking time out to undertake a PhD.
What action has been taken so far?
The new contract is the result of multiple negotiations between the BMA and the Department of Health. In November 2015, junior doctors voted 98% in favour to reject the contract and were in favour of industrial action, with the historic strikes occurring between January and March 2016 when further negotiations between the BMA and the Department of Health broke down.
When negotiations came to a standstill, the Advisory, Conciliation and Arbitration Service (ACAS) mediated the deadlock. Further negotiations occurred in May and June and led to the BMA submitting the details of the new contract to the BMA Junior Doctor body for a vote.
A group of Junior Doctors took their concerns to the Court of Appeal in September 2016, where they contested that the proposed imposition of the contract was not legal. The Judge did not agree with their arguments and ruled in favour of the Department of Health.
The problems stemming from the initial contract were addressed in the 2018 review, with three key aspects of the contract updated.
Firstly, the salary of third year Acute Care Common Stem (ACCS) trainees have been clarified and corrected to the CT3 nodal pay point
Secondly, the terms and conditions of service (TCS) for access to transitional pay protection were updated, with all trainees who commenced FY1 on 3 August 2016 being eligible to the protection
Lastly, the BMA ensured that ambiguity was removed regarding existing pay protection arrangements for doctors from a career grade post who were under the 2002 contract but have returned to training
However, the BMA has pointed out that problems surrounding out-of-hours pay and less than full time training are yet to be reviewed and discussed.
What are the next steps for the Junior Doctor Contract?
The issue is still ongoing. The BMA has advised junior doctors in receipt of this contract not to sign them. Negotiations between the BMA and the Department of Health are continuing. Although the strikes for October, November and December 2016 were called off, there is a worry that the junior doctors and the government will still be at odds over the contract for some considerable time.
The chair and deputy chair of the Junior Doctor Committee continue to meet with NHS Employers on a regular basis to discuss and resolve issues identified by BMA members concerning the new contract.
Many are concerned about the future of the NHS if this contract is maintained, not least because only half of the junior doctors who finished their foundation training in 2016 went straight into NHS training, a 21% decline in five years.
However, from 2018 onwards, the government has pledged to create 1,500 additional medical student places each year in an effort to ensure that the UK would be “self-sufficient in doctors” by 2025.
As a result, in March 2018, Jeremy Hunt announced five new medical schools opening in 2018/19. These new medical schools are based at University of Sunderland, Edge Hill University, The University of Lincoln (in partnership with the University of Nottingham), a joint school at University of Kent and Canterbury Christ Church and Anglia Ruskin University.
These new medical schools are set to deliver the majority of the 1500 pledged additional training posts and are located in parts of the country where it has been difficult to recruit and attract new doctors. However, it still remains unclear whether this will suffice, especially when factoring in the doctors who emigrate for better working conditions and pay.
Stand out with TMP's Medical School Interview Course, created by doctors. We are officially partnered with the Royal Society of Medicine. Our course equips you with top techniques to help you tackle traditional, MMI and Oxbridge interviews. Plus you get a full length mock and comprehensive 22,500-word workbook.
Experience 20 MMI practice stations! The Medic Portal's MMI practice circuit is truly unique in the way it recreates a real MMI interview experience. It's created and run by a team with deep experience of the medical school interview process. Book your space today!