The Junior Doctor Contract
The controversy surrounding the junior doctor contract began in 2013 and has continued to divide the public and the media. The Department of Health (DoH) introduced the contract with the aim of making pay fairer. The end goal was to spread both emergency and elective services across the seven days of the week.
There have been several sporadic negotiation attempts with the DoH by The British Medical Association over points in the proposed contract, including: rota shift patterns and pay. The biggest argument is that many junior doctors do not feel the contract is safe for patients or fair for doctors. This has led to industrial action and walk-out strikes.
The old Junior Doctor contract
Previously junior doctors were paid at the standard rate for shifts which fell between 7am to 7pm from Monday until Friday. FY1 doctors would earn a basic salary of £22,865 working these hours.
This was a basic salary that would increase as doctors progress through their training. However, junior doctors are also required to work on-call shifts outside of their standard hours. This would earn them an extra monetary supplement, known as banding, which could add an additional 40 to 50% to their basic salary.
The new Junior Doctor contract
The new system of pay and working hours for junior doctors was overhauled as of April 2017. This meant that there were four points of nodal pay along the training path introduced.
Depending on how many weekends a doctor works and their nodal level, they are awarded an extra percentage of their allowance. For example, a junior doctor who works one in every two weekends gets an additional 10% of their basic pay, whilst those who only work one in eight weekends gets 3%.
On-call allowances were affected too. The time served concept was abandoned and the basic salary was linked only to the level of responsibility held. Basic pay increased by 10-11% but is now determined by on-call and weekend allowances, with no banding system in place.
What are the main concerns of the new contract?
- Patient care – Many junior doctors fear the new contract could increase stress, tiredness and burnout, leading to high-standards of patient care to suffer as a result.
- Pay issues – The increase in antisocial hours is not reflected by an increase in pay, meaning that junior doctors are remunerated less in the new contract.
- Difficulty switching specialities – Junior doctors could be affected if they choose to change specialties during their degree. In the previous contract, if a doctor trains in one speciality and then decides to retrain in another, the salary they gained through the first area would be protected as it would reflect their additional experience, which is incomparable to a doctor at the start of their training. The new contract means that the two doctors would be the same, thus discouraging doctors from changing specialities and harming career progress and satisfaction.
- Maternity and academic research – The new contract elicits concerns regarding equality centered around maternity or academic research leave. In the old contract, pay progress would continue whilst on leave but it is halted in the new contract. Many felt that this was discriminatory and could jeopardise female doctors and academics. This could lead to a delay in doctors starting families and/or taking time out to undertake a PhD.
What action was taken?
A group of Junior Doctors took their concerns surrounding the contract 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.
Issues arising from the initial contract were addressed in a 2018 review, with three key aspects of the contract updated:
- The salary of third year Acute Care Common Stem (ACCS) trainees has been clarified and corrected to the CT3 nodal pay point.
- The terms and conditions of service (TCS) for access to traditional pay protection were updated, with all trainees who commenced FY1 on 3rd August 2016 being eligible to the protection.
- The BMA ensured that ambiguity was removed regarding existing pay protection arrangements for doctors from a career grade post who were under the old 2002 contract but have returned to training.
What was the result?
In June 2019, it was announced that negotiations had come to an end after Junior Doctors accepted a new contract. The BMA JDC endorsed the improved contract and BMA members (who are Junior Doctors or final/penultimate year medical students in England) then had the opportunity to vote in an independent referendum on whether to accept the changes.
This brought an end to the four year-long dispute over the proposed contract. The new deal will benefit approximately 39,000 junior doctors in England – all of whom are medics below the level of consultant.
Dr Jeeves Wijesuriya, the chair of the BMA’s Junior Doctors Committee (JDC), said members had approved the new deal as it was recognised that it involved enhanced shared parental leave and better rest facilities. “We have made major strides towards a better future for all junior doctors.” He said.
The main benefits of the new deal:
- A payrise averaging 2% for each of the next four years, beginning in 2020.
- Limits on how much work is carried out over the weekend.
- Increases to weekend and night shift pay.
- Limits on the number of long shifts, of up to 13 hours, they can work in a row.
- Improvements in rest and safety entitlements, with no more pay-to-stay when too tired to drive
- £1,000 a year extra for all less than full-time trainees
Current Health and Social Care Secretary, Matt Hancock said: “I’m delighted that we have successfully brought to an end the Junior Doctor dispute with this landmark agreement. Improved working conditions and an 8.2% four-year pay rise will give Junior Doctors and current medical students the support they fully deserve.”
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