The Department of Health has confirmed that it is re-writing the employment contracts for all new doctors starting in England from August 2016. The new contract applies to all doctors below consultant level. So although it is referred to as the ‘junior doctor contract’, this is somewhat misleading, as the changes would affect experienced and senior doctors, such as registrars.
The new proposals will have an effect on how much junior doctors get paid, and their decisions surrounding which specialties they choose to train in. It also impacts whether they switch specialty later on in their careers and if they take time out either to pursue an academic qualification such as PhD or to have children.
The government is changing the contracts on the basis of recommendations made by an independent body called the Review Body on Doctors’ and Dentists’ Remuneration (DDRB).
Its role is to make recommendations to the Prime Minister and the Secretary of State for Health. In reaching its recommendations, the Review Body takes into consideration many factors, including:
In formulating their recommendations, the DDRB have also set out six criteria that would guide their recommendations
According to the DDRB the proposed pay system for junior doctors “looks to improve patient outcomes across the week, through providing separate unsocial hours payments. It seeks to reward greater responsibility and professional competence, in their approach to basic pay and progression, and for consultants via what we call payments for excellence.”
The government will increase the basic rate of pay for junior doctors and the changes do not mean that junior doctors will be working any more hours.
According to the Department of Health, “these proposals, endorsed by the independent pay review body set out a fairer deal for all medical and dental trainees so that their pay relates to actual hours worked. We want to encourage trainees to take up specialities like general practice, and these plans provide incentives to do so. We are also increasing GP training places and working on a national recruitment campaign with the Royal College of General Practitioners to help deliver 5,000 more doctors in general practice.”
Junior doctors are currently paid a standard rate for shifts where the hours fall between 7am and 7pm on Mondays to Fridays. They earn an extra supplement for hours worked outside of this called ‘banding’. As it stands, many junior doctors boost their basic pay by 40 or 50% thanks to banding – reflecting the antisocial hours worked.
It has been proposed that the hours which are considered as ‘standard’ will be increased by 30 hours per week to include 7am to 10pm on Mondays to Saturdays. This means that junior doctors will be paid the same rate for working on a Saturday evening as they would on a Tuesday morning.
Doctors would still need to work these hours, therefore if they cease to receive extra pay for these hours and are paid at a standard rate, the new contracts will result in a pay cut for doctors. The government is, however increasing the rate of basic pay, which currently stands at just over £22,000 for a newly qualified doctor.
The BMA, which is the doctors’ trade union, has ‘opposed any extension to standard time hours for junior doctors during contract negotiations.’ Clarifying further: ‘Junior doctors routinely work outside of ‘standard time’ and are committed to continue doing so in order to provide their patients with high quality care around the clock, however evenings and weekends are precious opportunities to spend time with friends and family and it is only fair that your pay reflects this when work requires you lose them.
Dr Andrew Collier, co-chair of the BMA junior doctor committee, which represents junior doctors has said: the BMA wants to deliver a contract that protects patient safety and is fair to both junior doctors and the health service as a whole. However we can only do this if the UK government and others are prepared to work collaboratively in a genuine negotiation. We listened to the vast majority of junior doctors who told us that the DDRB proposals are not acceptable. We remain committed to agreeing contract that protects against junior doctors routinely working long hours, delivers a fair system of pay, values the vital role of training and does not disadvantage those in flexible working. We have not received adequate assurance from the government that they are committed to achieving these goals. We urge the government not to impose a contract that is unsafe and unfair. We will resist a contract that is bad for patients, bad for junior doctors and bad for the NHS.”
The DDRB are also proposing the removal of the GP registrar supplement, which is extra pay for GP trainees used to incentivise doctors to train in general practice and can comprise up to 31% of a GP trainee’s pay. There are concerns that this will encourage more doctors into hospital medicine at a time when there is already a severe shortage of GPs.
There is a concern that the new proposals will discourage doctors from choosing specialties where there is a large proportion of antisocial hours work, such as A&E, again, at a time when Emergency Medicine is already facing a recruitment crisis.
The new contract also affects those who wish to switch specialties later on. Currently if you decide to retrain in a new specialty, your pay is protected. Under the new contract, if you switch specialty you would have to start again from the bottom of the pay scale, meaning a potentially significant pay cut.
Just a few days after announcing more strike action, the BMA called of the planned for the week commencing the 12 September 2016 due to concerns about patient safety.
You can read more on this story on the BBC here.
The BMA announced that from 12 September, 2016 there will be five days of ‘all-out stoppages’. The junior doctors dispute has now become the worst industrial relations dispute in the history of the NHS.
Earlier in the summer, junior doctors voted against the contract that was agreed back in May between BMA representatives and Jeremy Hunt. As a result, the health secretary is to impose the contract, against the junior doctors’ votes.
The planned 5-day strikes are a response to this unwanted imposition. BMA junior doctor leader Dr Ellen McCourt is reported by the BBC to have said that “the government could stop the strikes by calling off the imposition”, which is due to happen in October.
On the 18th May, it was reported that an agreement has been reached over the junior doctors contracts. The new contract will now be put forward to the 40,000 doctors who are members of the BMA to vote on in June 2016. However, although this contract has been agreed between the minister and the BMA, it could still be rejected when the doctors vote.
On the 20th April 2016, it was reported in the Independent that Jeremy Hunt, the UK Health Secretary has rejected the BMA’s offer to cancel strikes if he agrees not to impose the new contract. The BMA wrote to the health secretary outlining that whilst no junior doctor wishes to take industrial action, many feel it is the only option to express their opposition of the new contract being forced upon them.
The BMA wrote seeking further talks with the Department of Health, however, the latter responded saying they will not halt the planned enforcement of the new contract as the BMA are unwilling to negotiate on the issue of Saturday pay.
The Guardian reported on the 23 April 2016 that GPs and senior doctors have written a letter to Mr Cameron in support of the junior doctors strikes. As well as this, the letter also entailed information for patients, ensuring them that they will not be placed at risk.
The strikes on the 26th & 27th of April 2016 were the first instance of an all-out strike in the history of the NHS. As a result of these strikes, routine elective services were cancelled to allow consultants and middle-grade doctors & GPs to cover emergency procedures.
On the 6th April 2016, the BBC published an article explaining the dispute. In this article, it explains that the junior doctors contract affects recent graduates from medical school as well as medics who have more than 10 years of experience. The current starting salary for a junior doctor is £23k per annum.
However, doctors can receive extra payments for working during ‘unsociable hours’, easily increasing their income to £30k. The new contract proposes to increase the basic pay by 13.5%, but will also redefine what ‘unsociable hours’ are, meaning that junior doctors may miss out on extra income.
On 1st April 2016, the Guardian reported that the new junior doctors contract discriminates against females, and could result in female doctors quitting. The proposed contract states “any indirect adverse effect on women is a proportionate means of achieving a legitimate aim”, which has raised concerns that the contract does not reflect equality.
In particular, the contract may negatively impact on those training part time, such as mothers, carers or single parents. Consequently, the BMA has launched legal action against the contract in a review that challenges the legality of the imposition.
You can read more about the new contract and what doctors and medical students at various levels of training think about the new contract on the BMA website.
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