Are junior doctors getting a pay cut?

As the situation currently stands, pay is not going to be ‘cut’ in the sense that most junior doctors will either be paid more than they were this autumn, or the same amount, for at least three years. That’s due to “pay protection” measures that were introduced to the contract in November. But some might feel worse off, for instance if their autumn pay happened to be lower than usual.

And some doctors would be paid less under the new contract than they would otherwise have been, given increases in responsibility or weekend shifts they might take on.

Key details of the contract, including how it pays for out of hours work, have changed since the dispute started to make headlines last summer. The proposed “scenarios” that were put forward for negotiation back then—before pay protection was introduced—would have meant pay cuts for some junior doctors, although their architects have said that the scenarios were intended to be a starting point for negotiations rather than the finished product.

The government wants junior doctors’ Saturday daytime hours to be paid at the basic rate

The government wants to change the way doctors are paid for weekend shifts, among other things. Health Secretary Jeremy Hunt has argued that this will help the NHS move towards being a ‘seven day service’, saying that hospitals currently don’t have the incentive to roster as many doctors as they need at the weekend due to “excessive overtime rates”.

The exact details of the proposals have shifted over the course of negotiations. But generally we’re talking about a rise in hourly pay for standard hours and a rise in the boosted pay rates doctors get for night or certain weekend shifts. At the same time, fewer hours would be paid at those boosted rates.

Particularly contentious are changes to pay for Saturday daytime hours. They would be paid at the same rate as weekday hours, though later proposals mean some extra payment for those who regularly work Saturdays.

Proposals put up for discussion in July would have meant a pay cut for some doctors

Back in July 2015 the body tasked with reviewing proposed contracts said it supported two pay “scenarios” to be used “as the basis for further discussion/negotiation between the parties”.

The pay structures were those submitted to it by NHS Employers, another body which supports the new contract. NHS Employers said the structures would result in pay cuts for doctors who tended to work nights or weekends:

“Unsurprisingly, as a consequence of increasing basic pay, those specialties who work very few additional rostered hours benefit on the whole from an increase in basic pay. Some specialties where out-of-hours working is high, but overall weekly hours are less than elsewhere, see total earnings that are lower than under the current system.”

So all sides agreed the proposals up for discussion at the time would have resulted in a pay cut for some junior doctors.

In September a senior figure from NHS Employers reportedly told journalists at HSJ (£) that the proposals were “not ideal” and that they were always intended to be a “starting position” for the negotiations.

Later versions of the contract introduced “pay protection” for three years

November’s proposals contained a new “payment protection” mechanism to help address concerns about falling pay.

Some junior doctors would have a minimum ‘floor' of pay based on their pay as of this October, and this will be in place until July 2019. If the new contract reduces their earnings to below the floor then there'll be a top-up to bring it back up to that level.

The floor wouldn’t rise along with inflation, so doctors could see a real terms pay cut under the system. Some will also be worse off if their salary in the autumn of last year was lower than what’s ‘usual’ for them—for instance if they happened to be working a lower-than-usual number of night shifts at the time.

And some might also be paid less under the new contract than they would otherwise have been, and in that sense would be worse off.

Imagine a hypothetical junior doctor who mostly works on weekdays at the moment, but who ends up doing much more Saturday work by 2018. Under the current contract she would get a pay rise for taking on those Saturday hours. Under the new government’s proposals her pay might not rise by as much as it would have.

Her pay might rise as she gets more experience and moves up to higher pay points. At the very least it would remain at October’s level. But it wouldn’t rise as quickly as under the current contract.

NHS Employers says it can’t guarantee that no one will have a pay cut at the end of the three years, but points out there’s no such guarantee at the moment either.

It says as long as junior doctors progress through training at a typical rate and don’t significantly reduce their hours, they should not see a reduction in overall pay.  It says the exception is a small number of doctors who are currently working unsafe hours and will have these reduced by the new contract, and so would see reduced pay.

There’s also the matter of pension contributions—it’s been reported (£) that the government predicts the rise in basic pay will mean the doctors affected will have to pay £250-300 more per year.

Other doctors—those already in ‘higher' training or in posts that lead automatically to such training—will continue to be paid according to the current system rather than the new contract up until 2019.

Last updated 9 February 2016

We took out a reference to the career plans of our hypothetical junior doctor for clarity.

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