Junior Doctors’ Contract Offer

Pay system changes

For distribution to Boards, HRDs, medical directors, directors of medical education and medical staffing leads

The case for change

• The BMA has been saying since 2008 that the current contract and pay system needs to be modernised. In 2013, Heads of Terms were agreed between BMA and NHS Employers to negotiate a new contract.

• The government has prescribed that the current system where pay increases every year for time-served must end for NHS employees.

• Some doctors continue to receive an incremental increase each year even though they are not progressing to an increased level of responsibility.

• Employers and the BMA agree the current banding system (introduced in 2000) is outdated, unfair and operates with unintentional consequences.

• For example:- Some doctors who work 41

hours could be paid the same as some who work 48 hours

- A doctor working 9am-6pm Mon – Fri can be paid the same as a doctor working shifts 24/7.

• We need to move to a fairer system and reward those who work the most unsocial hours. Junior doctors are the clinical leaders of the future. We value the contribution they make to the NHS and want to reward them through a fair and transparent pay system.

• The new contract and pay system will better protect junior doctors’ work life balance by making sure that there is a mutually agreed work schedule and review process with their employer.

Underpinning principles of new contract

• Introduction of a robust work schedule review process to address concerns relating to hours worked and access to training opportunities.

• Training to be embedded into the work schedule that will be tailored for individual educational needs aligned to the curriculum.

• Improved quality of training for postgraduate doctors in training through scheduled time for training.

• Improved patient safety through limits on working hours.

• Hours are not being increased.

• Cost neutral – not looking to save money from new contract and pay system.

• A fairer pay system based on hours worked – with higher basic pay, payment for additional hours, enhancements for unsocial hours, flexible premia and on-call availability allowances.

• Ending the banding supplements and extension of plain time hours offset by increase to basic pay.

• More predictable pay and higher basic (pensionable) pay.

• GP trainees will not be worse off.

Are the proposed changes fair for junior doctors?

• Overall pay bill will not be cut and average earnings will remain the same. There is no question of a 30-40% cut as the BMA has claimed.

• Safe working hours will be maintained and improved. No doctor will be required to work above new limits.

• A new system of ‘work scheduling’ with regular, routine reviews and reviews triggered by ‘exception reporting’ will be introduced. Work life balance will be better protected, with limits on additional hours.

• Junior doctors will get an improved training offer delivered through work scheduling.

• The unfairness in the pay system will be removed - pay will relate to actual work done. Progression will be linked to taking up a higher post, not time-in-post.

• Pay protection/transition arrangements put in place.

What will the new pay system look like?Not to scale

Basic pay Basic pay

Existing contract New contract

Banding

On-call availability allowanceFlexible pay premia

Unsocial hours enhancementsAdditional rostered hours

Increase to basic pay

Base pay old and new number of pay points & levels

Why six nodal points?

• Informed by clinical and educational input.

• Clear change in responsibility between F1 (provisionally registered) and F2 (fully registered).

• Clear change in responsibility when moving from the Foundation Programme to Specialty Training (core or run-through), following a competitive recruitment process before being appointed.

• The first two years of Specialty (ST)/Core Training (CT) are similar in the degree of responsibility required of the trainee, and are therefore grouped into one node.

• The stage(s) at which responsibility increases between ST3/ST8 are less clear and are subject to differences between training programmes.

• However, for most training programmes, there was felt to be a significant change in responsibility between ST4 and ST5, and so the nodal changes were pegged at entry to ST3 and entry to ST5 (and similarly again to ST7 where this applies).

• Although this was not true for all programmes (there are, for example, some programmes with a third stage (CT3) of core training), neither NHSE nor the BMA wished to introduce different rates of basic pay for different specialties.

• Accordingly, we opted for this option as being the one that best suited the majority of training programmes.

Rationale for basic pay values

• Parties agreed that there is a need to move a greater proportion of earnings into basic pay, with a reduction in the amount of variable pay.

• Graduate entry (F1) needs to be competitive, although almost every medical graduate is guaranteed an F1 place.

• Basic pay needs to remain competitive throughout a doctor-in-training’s career.

• Each step-change in responsibility is reflected in a change in basic pay.

Replacing banding supplementsNot to scale

Existing contract New contract

On-call allowanceFlexible pay premia

Unsocial hours enhancementsAdditional rostered hours

Increase to basic pay

Band 3 - 100%Band 2A - 80%

Band 1A & 2B - 50%Band 1B - 40%Band 1C - 20%

Benefits for junior doctors

• Virtually guaranteed employment after graduation.

• Competitive graduate entry basic pay of £25,500, increased from £22,636.

• As responsibility increases then basic pay will rise.

• On full registration with the GMC, basic pay of £31,600, increased from £28,076.

• Specialty training basic pay will begin at £37,400, increased from £30,002.

• No one will earn less than they currently do.

• Trainees at ST4 and above will keep their current pay progression until their training is complete or until 2019, while moving to the new arrangements for terms and conditions.

Enhancements for unsocial hours

Hours which attract enhancements:

• Saturday 7pm to 10pm and Sunday 7am to 10pm – 33% pay enhancement

• 10pm to 7am every day of the week – 50% pay enhancement

Monday Tuesday Wednesday Thursday Friday Saturday Sunday7am-8am8am-9am9am-10am

10am-11am11am-12pm12pm-1pm1pm-2pm2pm-3pm3pm-4pm4pm-5pm5pm-6pm6pm-7pm7pm-8pm8pm-9pm9pm-10pm

10pm-11pm11pm-12am12am-1am1am-2am2am-3am3am-4am4am-5am5am-6am6am-7am

Normal basic rate

50% enhancement

33% enhancement

On-call availability allowance & additional rostered hours

• On-call availability allowance is a percentage of basic pay for being on call when not at work. Hours actually worked will be included in the work schedule and paid at the normal basic rate plus any enhancements applicable.

• Up to eight hours per week above the 40 hours full time.

• Paid at the same basic rate as normal 40 hours. Enhancements for any hours worked in unsocial hours.

Flexible pay premia

Flexible pay premia will apply:

• for those on hard-to-fill training programmes, for the duration of the their training programme.

• to protect the pay of those choosing to retrain/switch specialty to an agreed hard-to-fill training programme.

• for those taking time out of the ‘standard’ training pathway, for example clinical academics and public health, or those doing work which benefits the NHS or patient care more broadly.

Training programmes that FPP will apply to in 2016 are:

• General Practice (in the practice placement of vocational training).

• Emergency Medicine (at ST4 and above).

• Psychiatry (at ST1 and above).

Safeguards and work reviews

• Exception reporting – significant variation in hours or working pattern.

• Three-stage contractual work review process if work schedule no longer fit for purpose or frequent exception reporting. Informal stage, formal stage, and an appeal process to include the director of medical education.

• Annual report on outcomes of all reviews to HEE/Deanery, DDRB and CQC.

• Potential for employers to lose training recognition for repeat offenders.

• Maximum shifts length 13 hours.

• No more than 72 hours over seven days.

• Max four consecutive nights.

• Max five long days.

• Work schedules.

• Exception reports.

• Work schedules review process.

• Regular discussion of work schedule and review with educational supervisor.

Safeguards Work schedule reviews

• All trainees will transfer onto the new terms and conditions on 3 August 2016. The old terms and condition will be closed.

• Those already in run-through or higher training at 2 August 2016 would be moved onto the terms of the new contract on 3 August 2016 but remain on the existing pay system.

• Existing trainees for whom the above doesn’t apply will be offered cash pay protection to ensure they do not lose out. Their current pay point and banding supplement (plus any uplift in April 2016) will form a cash floor which they cannot fall below.

• Pay under the new system will be compared with the cash floor, and the trainee will be paid the higher of the two until transitional arrangements end in 2019.

• Therefore trainees could earn more under the new system, but cannot earn less than their cash floor under transitional arrangements.

Transitional arrangements

Useful links – further informationwww.nhsemployers.org/juniordoctors

• Scoping report on the contract for doctors in training

• Heads of Terms for negotiations to achieve a new contract – June 2013

• NHS Employers evidence to the DDRB

• DDRB report – Contract reform for consultants and doctors in training

• Summary of the DDRB report

• DDRB conclusions (pdf resource)

• DDRB report questions and answers

• Health Secretary assurances to BMA Juniors Chair

• Access all the latest information and resources on the junior doctors’ contract at

www.nhsemployers.org/juniordoctors including:

– Pay calculator – Video– FAQs.