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:
Some of the proposed changes sparked a bitter 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 around the Junior Doctor contract began in 2013 when the Department of Health shared its proposals. It said 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.
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 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.
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.
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.
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:
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.
The new Junior Doctor Contract will bring £90 million investment over the next four years. The BMA has a document comparing the 2016 Contract with the latest version.
Some of your interview questions may ask you how much you know about the Junior Doctor contract, as a way of probing your depth of interest or knowledge of the topic. You may also be asked specific questions about life as a Junior Doctor, for the same reasons.
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 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:
Negative Answer Traits / Common Mistakes
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