House of Commons Library

Junior doctor contracts in England

Published Wednesday, July 13, 2016

This Commons Library briefing provides background information on the introduction of a new contract for doctors in training (junior doctors) in England, including a summary of the proposed changes, and background on negotiations between NHS Employers and the BMA. The briefing also provides some brief information on the delivery of seven day services.

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Following three years of on-and-off negotiations about the introduction of a new contract for junior doctors an agreement was reached between the BMA, NHS Employers and the Secretary of State for Health on 18 May 2016. The agreement was subject to a BMA referendum of junior doctor members. On 5 July 2016 it was announced that junior doctors had rejected the contract offer, with 58 per cent of junior doctors voting against, while 42 per cent voted to accept. The turnout was 68 per cent. The BMA junior doctors’ committee chair Dr Johann Malawana, who had backed the deal, announced his resignation following the result. Dr Malawana said:

The result of the vote is clear, and the government must respect the informed decision junior doctors have made. Any new contract will affect a generation of doctors working for the NHS in England, so it is vital that it has the confidence of the profession.Given the result, both sides must look again at the proposals and there should be no transition to a new contract until further talks take place.[1]

The Secretary of State Jeremy Hunt said:

It is extrememly disappointing that junior doctors have voted against this contract, which was agreed with and endorsed by the leader of the BMA Junior Doctors’ Committee and supported by senior NHS leaders.The BMA’s figures show that only 40% of those eligible actually voted against this contract, and a third of BMA members didn’t vote at all. We will now consider the outcome.[2]

The Secretary of State made a further statement on the junior doctor contract, to Parliament, on 6 July 2016. He confirmed the Government’s intention to implement the contract agreed in May in a phased process between October 2016 and October 2017 [HC Deb 6 July 2016].

The 18 May 2016 agreement came at the end of 10 days of negotiations at ACAS, brokered by the Academy of Medical Royal Colleges. If followed a protracted dispute over the terms of the contract, which has seen junior doctors taking industrial action on five occasions, earlier in 2016.

Under the agreement the increase in basic pay is reduced and weekend allowances adjusted to increase in-line with the number of weekends worked. Those working one in eight weekends or fewer would get nothing for working Saturday or Sunday. That compares to Saturday evening work and all-day Sunday attracting a premium payment under the terms which were to have been imposed.

There were also additional commitments to protect doctors with caring responsibilities, to ensuring safe working for doctors, to protect whistle blowers, to “appropriately compensate” overtime, and to introduced new “Flexible Pay Premium” to support recruitment.

Further detail can be found in the Junior Doctors Contract Terms and Conditions document, updated on 16 June 2016, but key points include:

  • An increase in basic pay of between 10% and 11% (down from 13.5% announced on 11 February 2016).
  • A weekend allowance of between 3% and 10% paid when any junior doctor is rostered to work more than 6 weekends per annum. The allowance, applied as a percentage of basic pay, will increase as the number of weekends worked increases (from 3% for working 1 weekend in 8 up to 10% for doctors working 1 weekend in 2).
  • A new system for overnight pay, with shifts that start at or after 8pm, last more than 8 hours and finish at or by 10am the following day paid at an enhanced rate of 37% (the Government’s previous position was to pay any hours between 9pm and 7am at an enhanced rate of 50%).
  • An on call allowance is applied as 8% of basic pay over and above any weekend allowance payable.
  • A clarification of the role of Guardian of Safe Working, including a requirement to report on rota gaps at least once a quarter and to levy additional fines on trusts where breaks are missed on more than 25% of occasions across a 4 week period.
  • An increase to the flexible pay premia paid to those training in emergency medicine, psychiatry and oral and maxillofacial surgery, to £20,000 (£5,000 per annum over a standard four year training programme).
  • Employers to appropriately compensate individual doctors working beyond scheduled hours to secure patient safety, where authorised by an appropriate person.

The parties also agreed to number of issues outside of the contract including:

  • To remove, as far as possible, disadvantages faced by those who take time out of training due to, for example, caring responsibilities.
  • Health Education England to review the process for training placement applications, to consider joint applications by couples and defined travel times for those with caring responsibilities.
  • While all NHS staff currently have protected rights to raise concerns about their employers under whistleblowing legislation, junior doctors will be given the right to raise concerns regarding the work of HEE without detriment, from either their employer or HEE.

The negotiations and new contract only relate to junior doctors in England. The Scottish Government has repeated assurances to the BMA made in August 2015 that it will not be seeking to impose any new arrangements on trainees in Scotland. In September 2015, Welsh Government officials issued a statement to BMA Cymru Wales indicating that they will retain the current junior doctor contract in Wales. The Northern Ireland health minister, Simon Hamilton, has said he would like to develop a negotiated solution for Northern Ireland.

This briefing sets out some background to the contract negotiations and some of the key measures in the contract agreement announced in May 2016, and in previous contract proposals in February 2016. Further information on junior doctor contract negotiations can be found on the Department of Health, NHS Employers and BMA websites. The further reading section of this briefing also provides links to coverage of the most recent developments. See the further reading section of this briefing for coverage of the most recent developments.

 

[1]     BMA, Junior doctors reject proposed contract, 5 July 2016

[2]     Gov.uk update on junior doctor contract negotiations, 5 July 2016

Commons Briefing papers CBP-7314

Author: Tom Powell

Topics: Health services, Health staff and professions

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