The Junior Doctor Contract

What Is The Junior Doctor Contract?

The Junior Doctor Contract is the contract of employment for all NHS Junior Doctors, outlining pay scales and other details. The government tried to update the contract for 2016, with changes including:

• Overhauling the system of pay and hours for Junior Doctors.
• Protecting Junior Doctors from any unfair consequences that could come from whistleblowing.
• Designating a member of staff for each hospital to ensure that Junior Doctors are working rotas that are manageable and safe for patients.

Some of the proposed changes sparked a dispute between the government and the BMA, resulting in Junior Doctor strikes. In January 2020, an amended Junior Doctor contract was accepted by the BMA and you can read more about this on the BMA website.

After graduation, Doctors complete a two-year foundation programme and then progress to further specialist training. This post-graduate training period, which can take anywhere from five to ten or more years to complete, is the period in which a Doctor can be described as a Junior Doctor. After completion of their training, they can apply for the role of GP or consultant. The Junior Doctor contract therefore affects a wide variety of Doctors and specialists in the early stages of their career.

The Controversy

The controversy around the Junior Doctor contract began in 2013 when the Department of Health shared its proposals. It said that the updates would make pay fairer and wanted to spread emergency and elective services across seven days a week – but Junior Doctors felt the contract was risking patient safety and was unfair to them. The Guardian has a detailed overview of the issues.

The Old Junior Doctor Contract

In the old contract, Junior Doctors were paid a standard rate for shifts where the hours fell between 7am and 7pm on Mondays to Fridays. If a FY1 Doctor worked 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 40-50% to their basic salary.

The Proposed Pay Changes

The proposed changes to the Junior Doctor contract increased basic salary but drastically reduced the supplements for on-call shifts outside of sociable hours – effectively meaning they were being paid less. The Guardian explained what the proposals meant for pay.

Safety Concerns

Junior Doctors were concerned that the contract would increase stress, tiredness and burnout among their peers, and that patient care would suffer as a result. The new rotas were designed for a seven-day NHS, but did not account for additional staff. The increase in antisocial hours was also not reflected in an increase in pay.

Other Concerns

The old contract stated that if a Doctor trained in one specialty, such as emergency medicine, and later decided to retrain in another, such as general practice, the salary gained through their emergency medicine experience would be protected. This would reflect their additional experience, incomparable to a Doctor at the start of training. With the proposed contract changes, these two Doctors would be paid the same, which could discourage Doctors from changing specialties.

Initial drafts of the contract also elicited concerns regarding equality around maternity and academic research leave. Pay progression in the old contract would have continued throughout time off, but in the new contract it would be halted.

The Junior Doctor Strike

In November 2015, 98% of Junior Doctors voted to reject the contract, and in favour of industrial action. This led to four Junior Doctor strikes between January and March the following year. Each of the four strikes lasted 24-48 hours on 12 January; 10 February; 9-10 March; and 26-27 April.

Key things to know:

• 8 in 10 Junior Doctors didn’t show up to work on the first strike.
• Talks between the government and BMA resumed in May 2016.
• September strikes were called off over fears about patient safety.
• The impact of strikes was significant, the BMJ found.

Updates To The Junior Doctor Contract

In 2018, the Junior Doctor contract was reviewed and updated in a few key areas – however, the BMA still had issues surrounding out-of-hours pay and less than full-time training.

The chair and deputy chair of the Junior Doctor Committee (JDC) had regular meetings with NHS Employers to discuss and resolve issues identified by BMA members concerning the new contract. At the end of May 2019, negotiations over improvements to the 2016 Junior Doctor contract concluded.

How Is The New Contract Different?

The BMA has a document comparing the 2016 Contract with the latest version.

Junior Doctor Interview Questions

In your interview, you could be asked questions about life as a Junior Doctor to test your interest in Medicine.

Example question: How do you think Junior Doctors cope with stress in the workplace?

When you answer this Junior Doctor question, you should keep in mind that the mental health and wellbeing of staff is becoming increasingly important in the NHS. This is a good chance to demonstrate your understanding of the common pressures that a Doctor may face during their work. You may know this through work experience or your wider reading, and you should be able to demonstrate an awareness of strategies for coping with pressure and stress.

Tips for answering:

• Explain why Junior Doctors might experience stress during their work.
• Discuss the many different types of stress encountered – for example, working antisocial hours, dealing with psychologically and mentally challenging situations, balancing career with personal life, studying for postgraduate exams, etc.
• Demonstrate how you’ve arrived at your examples. Was this first-hand through work experience or talking to Junior Doctors? Or was it through additional reading, watching documentaries, etc?
• Talk about how you’ve seen or read about Doctors dealing with these stressful work situations, such as creating job lists, delegating tasks to different team members, and asking for help when they recognise a problem out of their expertise.
• Consider how Doctors relax outside of the work environment, e.g. through sports, hobbies and socialising.
• Acknowledge how important it is to talk about stressful situations, such as an emotionally difficult case at work, and to not bottle up emotions.
• If appropriate, link what you’ve seen with your own personal examples of managing stress.

Negative Answer Traits / Common Mistakes

• If you haven’t done much to explore a medical career and/or have little work experience, you may struggle with answering this question. You should attempt to draw from your own personal experiences of dealing with stress and relate strategies that you have found successful.
• Although you should focus on the strategies for managing stress, you should not miss out the first crucial step – a Junior Doctor needs to be able to recognise and acknowledge when they are stressed to begin with.
• Don’t overplay or underplay the stress involved with being a Doctor. You want to ensure a balanced and realistic insight into the stresses involved.