Junior doctor contract negotiations
Latest announcement from NHS Employers
NHS Employers has today released an updated version of the terms and conditions of service.
The majority of these changes are amendments and clarifications but there are two elements to highlight of significance for those working on less than full time (LTFT).
- An amendment to the weekend allowance for LTFT trainees, so that it is paid pro rata and will be based on contribution to the rota. This is to ensure that LTFT trainees are not disadvantaged by the lower limit on the weekend allowance.
- An addition of a pay premium of £1500 for LTFT trainees at the time of transition, or those who are on maternity leave at the time of transition and subsequently return directly to an LTFT post.
These amendments have been agreed with NHS Employers over the past few weeks. This process is now complete and this is the final version of the terms and conditions on which you should base your decision in the upcoming referendum. Please remember to vote before the closing date of 1 July.
Junior doctor contract roadshows
We have been running a series of over 120 roadshows from Monday 6 June to Friday 17 June across England to talk to junior doctors and final or penultimate year medical students about the new contract ahead of the member referendum in June. We encourage as many of you as possible to attend and participate.
Watch the presentation (BMA member login required)
NHS Employers – T&Cs and FAQs
NHS Employers have published the final Terms and Conditions of Service for junior doctors in England.
They have also published supporting FAQs to help answer your questions.
New contract FAQs
We understand many of you will have questions about the new contract and what it will mean for you.
In order to keep you informed on the details we have produced a set of FAQs about the new contract.
What changes have been made to address concerns raised about equalities?
The agreement introduces several new measures to improve equality of opportunity, including:
- An accelerated training support programme to help those who take time out for reasons such as maternity or caring responsibilities to catch up with colleagues. This support will include mentorships, tailored teaching, and extra funding for study leave.
- Pay protection for those who choose to re-train in a different specialty as a result of a disability or caring responsibilities.
- Safe working guardians to oversee employers’ performance on diversity and inclusion. The BMA, Health Education England (HEE), and NHS Employers will also put in place equalities monitoring mechanisms for all protected groups.
- A review, led by HEE, of processes which allow transfer between regions, joint applications between couples who are married or in a civil partnership, and training placements for those with caring responsibilities within defined travel times.
As part of the agreement, the BMA and NHS Employers will also draft new guidance about doctors with caring responsibilities, flexible working arrangements, and balancing work and personal leave. These measures will help to address a number of challenges that junior doctors – particularly those with caring responsibilities – often face during their training. The Department of Health has confirmed that a new equalities impact assessment of the proposed new contract will be published with the final terms and conditions.
What new safeguards have you negotiated?
Throughout the negotiations process, the BMA has been clear that any new contract must prioritise the safety of doctors and their patients. We believe this contract has made significant improvements on what had previously been offered, including clear contractual limits on working hours, the taking of safe breaks during shifts, and protected rest periods.
In particular, we have strengthened the requirements and powers surrounding the ‘guardian of safe working‘ role. This will help significantly to ensure that junior doctors are working safe, sensibly-designed rotas, which will benefit both patients and doctors. The guardian of safe working must be a senior appointment with no other role in the management structure at the trust, and must be appointed by a panel that includes junior doctor representatives. The guardian will be advised by an elected junior doctors’ forum who will scrutinise the use of guardian fine money in the trust. Any disputes relating to the guardian’s decision can be escalated to a final stage panel which must include junior doctor representatives from the BMA. Where there are concerns regarding the performance of the guardian, the BMA can raise those concerns with the Trust Medical Director.
In addition, the contract now explicitly enshrines the protection of junior doctors who raise concerns in line with whistleblowing legislation. It is vital that doctors feel empowered to speak out against unsafe working practices and this contractual safeguard is critical both to patients and the health service.
What happens to the money raised through fines resulting from unsafe rotas?
The contract is clear that money raised through fines has to be used to benefit the education, training and working environment of trainees. It is a responsibility of the guardian of safe working hours to work with the newly established junior doctors’ forum to work out how funds should be allocated. These funds must not be used to supplement the facilities, study leave, IT provision and other resources that are defined by HEE as fundamental requirements for doctors in training and which should be provided by the employer or host organisation as standard.
The details of the guardian fines will be published in the organisation’s annual financial report (accounts), which are subject to independent audit. The guardian’s annual report must include detail on how the money has been spent.
Are there any changes to the dispute process for the outcome of work schedule reviews?
The process for dealing with individual disputes for the outcome of work schedule reviews largely follows the process set out in the March contract offer, however significant improvements have been made to the final stage grievance process. It is now a requirement that any final stage grievance panel includes a representative from the BMA (or other recognised trade union) nominated from outside the employer, in addition to the hearings being conducted in accordance with the ACAS ‘Code of Practice on Discipline and Grievance in the workplace’.
In addition, if it is identified that issues or concerns of a work schedule review may affect more than one doctor working on a particular rota, a joint review will be carried out. Where appropriate, any changes may be agreed to the working pattern for all affected doctors on that rota.
Why are doctors at nodal point 2 exempt from the restriction on working more than 1 in 2 weekends?
During negotiations the BMA advocated strongly for a fully robust set of restrictions around working hours and rest requirements to ensure the safety of junior doctors. These new restrictions represent a significant change and are more comprehensive than the current working hours limits.
However, many doctors pointed out to us that the restrictions we introduced could cause a real workforce shortage in the specific area of Foundation Year 2 rotas in emergency medicine. So, rather than introduce limits that could damage patient care and training opportunities for doctors, we made a pragmatic compromise and made one very limited exemption to this rule – on the basis that this will be reviewed as part of the scheduled contract review in two years’ time when it is expected that workforce concerns will have been addressed.
Which specialties are designated as ‘hard to fill’ for the purposes of the provisions on pay protection when switching specialty?
Currently the hard to fill specialties are designated as general practice, emergency medicine and psychiatry. The flexible pay premia for general practice is a different amount as it is awarded partly to recognise the unique working pattern of GP trainees who are working in a GP practice setting and the reduced opportunity for out of hours work, but it is also currently designated as a shortage specialty.
The specialties designated as hard to fill are set out in Annex A and may be subject to change in future years subject to changes in workforce levels, however once a shortage specialty FPP is awarded the trainee will continue to receive it at the rate applicable when first awarded until they complete their training programme, regardless of whether or not the specialty is still designated as hard to fill.
Will the BMA now abandon its judicial review scheduled for the beginning of June?
No, the BMA is not abandoning the judicial review launched in February. The proceedings have been suspended with the agreement of the court while the final terms and conditions are considered and the referendum of members is held.
How is pay calculated?
Under the new contract, you will be paid for all work done with an average increase in basic pay of between 10 and 11% (depending on the final modelling), pay for additional hours worked, enhanced rates for unsocial hours including a weekend allowance for those who work more than six weekends per year, on-call availability allowance and pay for hours worked while on-call, and (where appropriate) flexible pay premia and London weighting.
What will my basic salary be?
You will be paid a basic salary at a nodal pay point linked to your grade or level of responsibility (rather than time served). There are four points on the nodal pay scale (FY1, FY2, ST1-2/CT1-2, CT3/ST3-8). The values of these nodal pay points are set out in the pay circular.
Is the 10-11% basic pay increase consistent across all grades?
No, the 10-11% figure is a weighted average according to the number of doctors receiving each nodal point and in each clinical grade. It includes reinvested money from the very highest current nodes and it is front-loaded.
The actual percentage increase in basic pay for each grade is shown below:
|Current 2016/17||% change||Proposed|
Why is there no longer a fifth point on the nodal pay scale?
In order to ensure that pay is distributed more fairly, the uplift from the fifth nodal pay point has been redistributed across all junior doctors. This means that funds can be redistributed into allowances for nights, weekends and on-call, as well as enabling the introduction of a senior decision makers’ allowance – that will be available from October 2019 – to compensate those who take on these responsibilities.
What will I be paid for additional rostered hours?
Basic pay will be for a 40 hour week, including paid breaks. Additional rostered hours, up to maximum of 8 hours, can be contracted additionally and reflected in the work schedule. Such additional hours will be paid at the basic hourly rate (with appropriate enhancements payable for nights and weekends above a certain frequency). Additional rostered hours are not pensionable.
What will I be paid for evenings and nights?
You will be paid an enhancement of 37% of the hourly basic pay rate on any hours worked between 9pm and 7am, on any day of the week. In addition to this, if you work a shift which begins no earlier than 8pm and no later than midnight, and is at least 8 hours in duration, you will be paid an enhancement of 37% of the hourly basic pay rate on all hours worked up to 10am on any day of the week.
The principle is that doctors working what is, self-evidently, a night shift, (i.e. a full shift which starts late and goes on through the night), will be paid at the enhanced rate (+37%) for the whole shift. So, if your shift is at least 8 hours long and it starts between 8pm and midnight and finishes by 10am, you get the enhanced rate for the whole shift.
If you work a late shift that overlaps by several hours into the night shift period, you will be paid the enhanced rate for those hours that run late rather than the whole shift: any hours worked between 9pm and 7am get the enhanced rate. So, if you work from 12 noon to midnight, you would get basic pay from noon until 9pm but the hours worked between 9pm – midnight would be at the enhanced rate.
But if a fully enhanced night shift has to start at or after 8pm, what if employers just start designing rotas so that night shifts start at 7:30pm to avoid having to pay the 37% enhancement for the full shift?
The BMA raised this during negotiations, and agreed to the final terms around night work on the basis that the contract makes explicit reference to agreed rostering guidance. This will be agreed between the BMA and NHS Employers and will expressly prohibit the designing of shifts to avoid paying the 37% night enhancement. It is a contractual requirement that this rostering guidance must be adhered to.
What will I be paid for weekends?
Where your work schedule involves rostered work at the weekend (defined as one or more shifts or duty periods beginning on a Saturday or a Sunday), at a minimum frequency of 1 in 8 across the length of the rota cycle, you will be paid a weekend allowance. This means that the vast majority of junior doctors will receive a weekend allowance. This will be set as a percentage of your basic salary and will increase as the number of weekends worked increases, starting at 3% and rising to 10% as per the table below:
|1 weekend in 2||10%|
|<1 weekend in 2 – 1 weekend in 4||7.5%|
|<1 weekend in 4 – 1 weekend in 5||6%|
|<1 weekend in 5 – 1 weekend in 7||4%|
|<1 weekend in 7 – 1 weekend in 8||3%|
|<1 weekend in 8||No weekend allowance|
Are there two different definitions for weekend?
The contract treats pay at weekends and working hours at weekends slightly differently.
With regards to pay, schedule 2, para 5 states: “A doctor rostered to work at the weekend (defined as one or more shifts/duty periods beginning on a Saturday or a Sunday) at a minimum frequency of 1 in 8 across the length of the rota cycle shall be paid an allowance.”
And with regards to working hours, Schedule 3, para 17 states: “No doctor shall be rostered for work at the weekend (defined for this purpose as any shifts or on-call duty periods where any work takes place between 00.01 Saturday and 23.59 Sunday) at a frequency of greater than 1 week in 2.”
Flexible pay premia (FPP) (if applicable)
FPP may be added to your basic pay in some circumstances:
- You must have a national training number (NTN) or dean’s reference number (DRN) as appropriate to receive FPP
- You can receive more than one FPP where the eligibility criteria is met
- FPP will be fixed at the rate payable when first awarded and will continue to be applied to pay at that rate throughout the rest of training
- FPP will be paid to less than full time (LTFT) trainees pro-rata to their agreed proportion of full time (FT) work
- FPP are not pensionable
FPP are calculated at £20,000 for the duration of your training programme if you are training in psychiatry,emergency medicine or oral and maxillofacial surgery. This amount is divided by the length of the training programme, meaning that if you are on a 5-year programme, you will receive £4,000 per year. In addition, those who extend training for any reason will also continue to receive the average yearly premia for those additional years.
As per the March contract proposal, the premia for general practice and academia are still set at £8,200 per annum and £4,000 per annum respectively.
The definition for exceptional FPPs includes the phrase ‘of benefit to the wider NHS’. What does this mean?
This refers to exceptional circumstances in which an individual may take time out of training to undertake specific work to support national health initiatives. One example of these exceptional activities would be extended periods of work related to or arising from public health emergencies. The definition is relatively open to ensure that all exceptional circumstances can be considered.
The value of any such premium will be fixed for each doctor at the time that the recognised activity takes place, as set out in the relevant pay circular, at the point in time when the doctor first undertook the activity.
When do I become eligible for FPPs?
FPPs are paid to any individual working in a post as part of the training programme that attracts the premium. This premium would only be payable to the doctor while they continue to work in the relevant role.
You become eligible for an FPP upon application. If you are already in receipt of such a premium prior to transition, you will receive a proportional amount of the new level of premia relative to the amount of time you will remain in the relevant scheme or post.
The Acas statement of 18 May does not contain any reference to academics. Are there any changes in the conditions for academics?
The BMA has continued to argue that a new contract must support academic activity. As part of the latest negotiations, we ensured that the supportive provisions reflected in the March contract offer were maintained, including the existing pay premium of £4,000 per annum.
Will London weighting still be paid?
London weighting hasn’t changed in the new contract. It will continue to be offered at the same rate as before, subject to change from time to time as set out in NHS pay circulars.It remains a fixed sum that is not taken into account when calculating any other allowances or enhancements. As currently, it will be paid pro rata to doctors working less than full time. Across the NHS, London weighting is pensionable so will continue to be so for junior doctors.
Will I still be able to undertake locum work?
Yes, you will still be able to undertake paid locum work in addition to the hours set out in your work schedule. However, initially, you will have to offer these additional hours exclusively to the service of the NHS via an NHS staff bank – but only at the grade you are currently working at. Under the proposed March offer, you would have had to give your primary employer first refusal on these hours. You will be paid a 22% premium for any such locum work, above the prevailing hourly rate.
You are entitled to carry out additional activity over and above the standard commitment set out in your work schedule – up to a maximum average of 48 hours per week (or up to 56 hours per week if you have opted out of the 48 hour limit in the Working Time Regulations).
Does the contract restrict locum work being undertaken during annual leave due to the provision of not being paid twice for the same period of time?
No. The restriction against being paid twice for the same period of time does not extend to locum work undertaken during annual leave, it only relates to private or professional clinical work done during your normal working hours.
Will my pay be protected if I switch specialty?
Pay protection has been retained for those switching to re-train in a shortage specialty (currently designated as general practice, emergency medicine and psychiatry) and the qualifying period to receive pay protection has been reduced from 13 months in the proposed March contract to just 6, – so after 6 months at a certain pay point, your pay is guaranteed to be protected if you re-train in a hard to fill specialty within 12 months of exiting your previous programme.
Your basic pay is also protected if you switch to any specialty for reasons related to a disability or caring responsibilities. There is now no qualifying period for changing either directly or indirectly because of a disability, it applies immediately.
What does ‘cost neutral pay envelope’ mean?
The principle of cost neutrality means that the ‘envelope’ of funding from which the junior doctors pay bill must be financed cannot be increased, but it also cannot be decreased – so any savings made as a result of changes to the contract are re-invested into the envelope. The amount is based on the current number of full time equivalent (FTE) junior doctors working an average of 46 hours per week. There are in reality a number of costs that come from outside this fixed envelope, including additional pension contributions as a result of increased basic pay, any increase in the number of FTE doctors (i.e. if the workforce increases, the funding increases) and the cost of paying doctors for extra hours worked that are exception reported.
How do I accrue time off in lieu (TOIL)?
In certain circumstances, a trainee may have to work beyond the hours described in their work schedule in order to secure patient safety. Compensation for this can either be in the form of additional payment or the doctor can choose to have this work recognised with Time off in Lieu (TOIL).
TOIL can be calculated in blocks of a minimum of 15 minutes. This time can be ‘banked’ but should normally be taken within three calendar months of accrual. In exceptional cases where time off in lieu cannot be taken, payment will be made instead. If a trainee breaches safety requirements, TOIL must be taken within 24 hours or the time will be paid.
What will I be paid for on-call?
For work done on-call, there are three separate elements of pay: an on-call availability allowance, pay for work undertaken while on-call and any applicable hours enhancements (as detailed above).
If you are on an on-call rota – that is, required by your employer to be available to return to work or to give advice by telephone – you will be paid an on-call availability allowance of 8% of basic pay, regardless of frequency. For doctors training LTFT, the value of the availability allowance will be paid pro-rata.
If I work LTFT, how will my on-call availability allowance be calculated?
If you are on an on-call rota – that is, required by your employer to be available to return to work or to give advice by telephone – you will be paid an on-call availability allowance of 8% of basic pay, regardless of frequency. For doctors training LTFT, the value of the on call availability allowance will be paid on a pro-rata basis because it is a flat rate. The on call availability allowance is set out in the pay circular.
How will I be paid for work undertaken while on-call?
You will be paid for your average hours of work undertaken while on call. Such work includes any actual clinical or non-clinical work undertaken either on or off site (such as writing public health reports at home), including telephone calls and travel time arising from any such calls.
The hours paid will be calculated prospectively across the rota cycle and the estimated average hours at each rate of pay will be set out in your work schedule.
Provisions to pay you for additional hours worked over and above the hours set out in your work schedule are extended to apply to additional hours of work done above the prospective average estimate on call. This means you will be paid for all work done and not just the average hours in the work schedule.
Does the rate for non-resident on-call (NROC) reflect the best deal that could have been achieved?
The 8% allowance agreed is within the margin of what the BMA deemed to be acceptable during negotiations. Under the March contract proposal, junior doctors could have been paid an availability allowance as low as 5%. Under the new arrangements, everyone is guaranteed 8%. You will also be paid for all hours of work done while on-call, including work off site and travel time between home and work.
How will my pay be protected when I transition to the new contract?
The new contractual arrangements include an initial period of pay protection for some existing doctors. This is a complex area, which is set out in Schedule 14 of the final terms and conditions and we would encourage you to read this in detail when they are published.
The principle is that junior doctors employed on the current contract will have their pay protected to ensure they do not see any drop in pay as a result of the introduction of the new contract. Given that transition to the new contract will now take place in October instead of August, this will now include new F1s, who will start on the 2002 TCS in August before moving to the new one once it starts being used in October.
There are two categories for pay protection – one covering doctors in Foundation, core, GP and the initial stages of run-through training programmes, the other covering those already in higher training programmes and the later stages of run-though training (ST3 and above). The first category will have their pay protected against a ‘cash floor’, based on the basic salary the doctor was earning on the day before they transitioned to the new contract and the banding for the rota they were working the day before transition, based on the value of that banding supplement as at 31 October 2015.
The second category, doctors already at ST3 or above on a run-through training programme on 2 August 2016 above, will have their pay protected by continuing to be paid under the old pay system, including increments and banding (but not band 3). For the purposes of their pay only, the old definitions of ‘plain’ and ‘premium’ time will apply. The final terms and conditions include detailed instructions as to how the old pay system will work with the new contractual terms, including how these doctors can make use of the new exception reporting system under the guardian of safe working.
Pay will be protected either until the doctor exits the training programme, or until four years of continuous employment have elapsed (pro rata for those LTFT or taking time out) or until August 2022, whichever is sooner.
There are various provisions to ensure fairness in the calculation of the cash floor and the length of protection. Those taking time out of training for maternity leave, for example, will have this time out disregarded for the purposes of their four years of continuous employment. LTFT trainees will also have their coverage extended pro rata – so someone working on a 80% basis would have their four year period extended by a year. Doctors who are out of training for maternity leave, for example, or on an approved out of programme (OOP), at the time they would transition to the new contract, will have their pay protected at the incremental pay point that they might otherwise have reached had they not been absent. There are also provisions to ensure fairness for trainees in specialties that would have seen them move from an unbanded post to a banded post after the period of transition.
But the ‘cash floor’ doesn’t protect my pay against what I would have earned had I continued on the old contract, why is the amount calculated only once?
The principle is that no current junior doctor will see a drop in pay compared to what they currently earn, not that your potential future earnings are protected. The cash floor is calculated once and your pay cannot drop below this point, but it will not be calculated again. Your pay is protected against the cash floor until such time as your pay on the new contract would be greater, at which point pay protection stops and you are just paid under the new contract as normal.
What is the timeline for transition?
The following timeline was published in the ACAS statement of 18 May following the conclusion of negotiations:
|July 2016||Alll guardians appointed|
|26 July 2016||Guardian conference|
|2 August 2016||New contract “effective date”|
|October 2016||Transition to the new terms and conditions of service for:
|February – April 2017||All grades in:
What if I return to training following a break after October 2016, but before my grade and specialty is due to transition to the new terms?
In this case you would be entering training after the new contract is in use. However you would have to start working under the terms of the 2002 TCS as your colleagues in your grade and specialty would still be working under these terms and the corresponding working patterns. You will not be eligible for pay protection however as you would not meet the eligibility terms set out in schedule 14. So you would be offered the existing 2002 terms and conditions of service until such time as you are due to transition to the new contract.
Where it would make more practical sense for a doctor to be employed on the new contract earlier than their ACAS date (for example, a doctor will be working on a rota with other doctors already on the new contract), then the employer and the doctor may agree that the doctor will start work on the new contract before their ACAS date.
What is the situation for current medical students due to start as F1 in August 2016?
While the new contract will be effective from 3 August 2016, transition to the new terms only starts from October, so incoming F1s will start on the existing terms and conditions before moving over on to the new ones in October. This means that they will qualify for pay protection under the terms described above.
If someone is an ST2 in August 2016 but an ST3 on the date when their grade and specialty is due to transition, what type of pay protection do they get?
You would be entitled to section 1 pay protection (i.e. the cash floor method). To be entitled to section 2 pay protection you would have needed to be already at ST3 or above, or in higher training, on 2 August 2016. This is specified in Schedule 14 of the 2016 terms and conditions of service.
If I am already in one of the hard to fill specialties when transitioning onto the new contract will I get the full £20,000 amount or just a proportion of it?
The annual value of the FPP for hard to fill specialties will be calculated as the full value divided by the full number of years of the training programme. E.g. if the doctor has four years remaining of a six year programme, their will receive 4/6 of the £20,000, spread evenly over their remaining four years. Doctors already in the later stages of training who fall under Schedule 14 paragraphs 23-37 (i.e. “Section 2” pay protection) will not qualify for flexible pay premia. This is because they will continue to be paid on their existing pay scale, including annual increments, and be paid a banding supplement to recognise any unsocial hours working and to protect their current pay expectations. As these doctors will not be paid under Schedule 2 of the 2016 TCS, they will not receive any of the payments or allowances outlined in Schedule 2.
What happens to those who have taken time out of training to complete a PhD, for example?
Doctors absent from training at the point of transition for approved out of programme (OOP) purposes who return to training prior to 3 August 2022 shall have their pay protected so that they would receive the incremental pay point that they might otherwise have reached had they not been absent; plus the value of the banding supplement under the 2002 TCS as at 31 October 2015 for the rota on which the doctor would have been working on 31 October 2015, up to a maximum banding supplement of 50 per cent (Band 1A) or, for those doctors who have opted out of the WTR, to a maximum of Band 2A (80 per cent).
Additionally, a flexible pay premium shall be payable to a doctor who has subsequently undertaken research toward a higher degree as part of an approved out of programme research experience (OOPR); and has returned to employment in a post on the same training programme having successfully completed a higher degree during that OOPR.
What happens if you are on maternity (or similar) leave when the contract comes in?
Doctors absent from training at the point of transition on maternity leave, paternity leave, adoption leave, shared parental leave or sick leave, or for approved out of programme (OOP) purposes who return to training prior to 3 August 2022 shall have their pay protected so that they receive the incremental pay point that the doctor might otherwise have reached had they not been absent plus the value of the banding supplement under the 2002 TCS as at 31 October 2015 for the rota on which the doctor would have been working on 31 October 2015, up to a maximum banding supplement of 50 per cent (Band 1A) or, for those doctors who have opted out of the The Working Time Regulations 1998 (WTR) to a maximum of Band 2A (80 per cent).
My contract isn’t due to change or expire until after my grade and specialty is transitioning on to the new contract, can I choose to stay on my existing contract until it expires?
This depends on the outcome of the referendum and whether or not collective agreement is reached on the new contract. The BMA holds the negotiating rights for the national contract of employment for junior doctors in the NHS, and if the BMA formally accepts the contract it is agreed on junior doctors’ behalf and individual agreement is no longer required to move junior doctors on to the new terms. If the contract is not agreed, there is no collective agreement, so individual doctors would have to consent to being moved on to any new terms – so if you had a lead employer contract that was not due to expire for several years you would have the right to stay on your current contract until it expired, at which point you may be offered a new contract and could choose whether or not to accept it.
Has the clause in the model contract allowing unilateral variation of contractual terms been removed as a result of the recent negotiations?
The wording of this clause also depends on whether or not the contract is collectively agreed. There must be a clause in the contract setting out the process for making changes to it – if there is no collective agreement and the contract is imposed, the clause allowing employers to change it will remain. If there is collective agreement, the clause will be amended to specify that it can only be changed as a result of collective agreement, which would be via the trade union.
If the implementation of the new contract has been paused pending the outcome of the referendum, how come the guardian role appointments are going ahead?
Agreement was reached during negotiations on the usefulness of introducing a ‘guardian of safe working hours’ in trusts to oversee the process of ensuring junior doctors work safely. This role itself is not explicitly linked to any particular system of hours monitoring, but simply involves appointing a senior, independent figure to offer impartial scrutiny of any disputes between junior doctors and their managers over the safety of their working hours.
The BMA believes that with substantial input from junior doctors themselves throughout the process from appointment to appraisal, the guardian will be a useful and positive force within hospitals. The contract requires that the guardian be jointly appointed by the employing trust and junior doctors, with junior doctors making up 50% of the appointment panel which must reach consensus.
We would encourage junior doctors to take up offers to be involved with the appointment of the hours guardian in their trust, to ensure that the person appointed has the confidence of junior doctors and able to carry out this important role in a truly independent way.
Will I get to have my say on this contract?
Once members have had time to consider the final terms and conditions are published and members have had time to consider these, a referendum of members will be held between 17 June and 1 July (for eligibility, see the question below).
The final terms and conditions of service have been published. These are based on the agreement reached in negotiations between the BMA, NHS Employers and the Department of Health as per the joint statement released by Acas on 18 May.
This agreement is supported by the BMA’s junior doctor executive subcommittee. The junior doctor committee has taken the decision to not adopt a position on the new contract, but to present the facts to junior doctors at a series of roadshows across the country to allow members to make their own decision about how to vote in the referendum.
Who will be able to vote in the junior doctors’ referendum?
All junior doctors who work in England or who have a home address in England will be able to vote in the referendum. In addition, if a junior doctor lives in Scotland, Wales or Northern Ireland but works in England they will also be able to vote in the referendum.
In addition, if a junior doctor does not currently work in England, but knows that they will be working in England from August and can email the BMA with details of their place of work to verify this, we will include them in the referendum.
All final year or penultimate year medical students enrolled in a medical school in England will also be able to participate in the referendum. This means that a medical student with a home address in Scotland, for example, but enrolled in a medical school in England will be able to vote. However, a medical student with a home address in England but enrolled in a medical school in Scotland will not be able to vote in the referendum, unless the following situation applies.
As with junior doctors, if a final year medical student enrolled in a medical school in Wales, Scotland and Northern Ireland graduating in July 2016 is able to email us with details of a place of work for a job offer they intend to take up in England, they will also be able to participate in the referendum. If you believe you will be in this position as a student or junior doctor, please email email@example.com
How will the referendum be conducted?
All eligible members will receive an email with instructions on how to vote online. This message will be sent out on 17 June 2016. Members will also receive a referendum voting paper on or soon after 17 June in the post. Members must vote online or return their referendum paper in time for it to be received by 5:00pm on Friday 1 July 2016.
Although the referendum is anonymous, and the BMA has appointed an independent scrutineer to conduct the referendum, each member will have a unique identifier which be used to ensure that members only vote once. Where a member returns both a postal ballot and votes online, only the first vote received will be counted – whether online or by post.
When will we know the outcome of the referendum?
The result of the referendum will be announced on Wednesday 6 July 2016.
New contract agreement
After many months of negotiation and of action by junior doctors across England, the BMA has reached agreement on new contract terms and wider issues which address the concerns which members have raised.
This agreement has been now been announced by Acas, with statements from the BMA and the Secretary of State.
This agreement forms the basis of the new contract, which will be introduced in stages for different grades and specialties as from October 2016.
The key improvements for junior doctors are:
- Recognition of junior doctors’ work and contribution across every day of the week
- Proper consideration of and provision for equality in the contract, with concrete support, including targeted accelerated training and pay protection for parents and carers
- Improved flexible pay premia for specialties- such as A&E and psychiatry- to address the current recruitment and retention crisis in these areas
- More rigorous oversight of the new guardian role to ensure safe working for junior doctors
Members will have their say on the new contract in a referendum planned for the second half of June – see the timeline below.
These are the key dates over the coming weeks:
- 31st May – Publication of new contract and supporting materials
- 3rd June – Junior doctor committee meeting
- 1st – 17th June – Roadshows to explain the new contract
- 17th June – 1st July – Member referendum on the offer
- 6th July – Referendum result
Why junior doctors took industrial action
The current industrial action comes after several years of discussions with the Government about a new contract for junior doctors. There have been consistent concerns about the safety and fairness of the proposals, concerns which we continue to hold.
In 2015, the DDRB, an independent body, undertook a review and provided recommendations for a new contract. When surveyed our members told us they overwhelmingly found these recommendations to be ‘unacceptable’. The BMA could not agree to negotiations with these recommendations as the basis, and the Government said they would impose a new contract from August 2016.
In September, the BMA’s junior doctors committee decided to ballot junior doctor members on support for industrial action. The result of the ballot of more than 37,000 junior doctors in England was announced on 19 November, with more than 99 per cent having voted in favour of industrial action short of a strike, and 98 per cent for full strike action, demonstrating the strength of feeling amongst the profession.
Initially strike action was suspended as negotiations started following talks facilitated by Acas. Some progress was made, but no agreement was reached on several areas of critical importance to junior doctors, and the offer that Government made on 4 January was still not acceptable to the BMA. As a result, industrial action went ahead in January with juniors withdrawing their labour and providing only emergency care.
Negotiations continued, but despite the best efforts of the BMA negotiating team, major sticking points remained. In February the secretary of state for health confirmed his intention to impose a contract, publishing the final terms and conditions at the end of March. Following the BMA’s efforts in negotiations and the attention to equalities issues brought by our judicial review, the final TCS has some improvements on previous offers – but the fact remains that the final contract would be unsafe and unfair for junior doctors.
This is why the junior doctors committee took the difficult decision to escalate action planned for April to a full withdrawal of labour. No junior doctor wants to strike, but the government is pressing ahead with the imposition of a contract that was not agreed with junior doctors.
Information for the public
The junior doctors dispute – in their own words
Few people choose medicine for the glory and the riches. Far more likely is the opportunity to make a difference, to help people – but just because, for most, this is a vocation, that isn’t an invitation to undervalue what they do.
While politicians and commentators may try and portray the junior doctors dispute as being all about money, doctors themselves are clear that it’s more fundamental than that: it’s about valuing what they do – and what they have to sacrifice to do it.
Key dates as the junior contract negotiations have unfolded:
- July 2013 – UK Junior Doctors Committee agreed to enter formal negotiations.
- October 2013 – Department of Health grants NHS Employers a mandate to negotiate with the BMA, formal negotiations commence.
- October 2014 – Talks stalled in light of the Government’s failure to agree measures to ensure patient safety and doctors’ welfare.
- December 2014 – The BMA submitted evidence to DDRB.
- March 2015 – DDRB invited stakeholders to give evidence.
- July 2015 – DDRB submitted its final report to the Government.
- August 2015 – Junior Doctors Committee decided not to re-enter contract negotiations based on the Government’s preconditions and threat of contract imposition.
- September 2015 – The BMA voted to ballot junior members in England for industrial action.
- November 2015 – In a turnout of 76.2 per cent, junior doctors voted overwhelmingly for industrial action.
- November 2015 – Temporary suspension of industrial action by the BMA following talks with NHS Employers and the Department of Health, brokered by Acas
- December 2015 – Industrial action in England was suspended following conciliatory talks with NHS Employers and the Department of Health.
- December 2015 – BMA Junior Doctors Committee negotiating team entered negotiations with NHS Employers and Department of Health
- January 2016 – Talks concluded with no resolution. Industrial action took place on 12 January, but action planned for 26-28 January is suspended while talks resume.
- February 2016 –No agreement between the BMA, NHS Employers and the Department of Health. Industrial action (emergency care only) goes ahead on 10 February.
- March 2016 – Industrial action (emergency care only) on 9 and 10 March
- April 2016 – Industrial action (emergency care only) on 6 and 7 April
- April 2016 – BMA sets out clear offer to the Secretary of State: lift imposition and industrial action (full withdrawal of labour) will be called off. Secretary of State dismisses BMA offer and industrial action due to take place on 26th and 27th April
- May 2016 – BMA re-enter talks with the Government
- May 2016 – A joint agreement on a new contract is announced
Junior doctors in Northern Ireland, Scotland and Wales
The Northern Ireland health minister, Simon Hamilton, has said he has “no desire” to impose the junior doctor contract and an imposed contract would be the “worst possible outcome”. He has said he would like to develop a “tailored solution” for junior doctors in Northern Ireland. BMA will be meeting with the Minister to discuss how we can work together to develop a contract for junior doctors in Northern Ireland.
On 18 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 Scottish Government has made clear that there will be no junior doctor contract imposition in Scotland.
Join 170,000 members standing up to unreasonable Government demands
In the uncertain and volatile environment that the Government seems intent on creating for doctors, representation is more important than ever.