The new junior doctors’ contract and their reaction

The new contract being introduced for junior doctors will affect them in a wide variety of ways as there is no ‘typical’ junior doctor. We’ve looked at some of the changes in the contract, including pay and working hours, the junior doctors’ latest reaction, and outstanding issues in the dispute.

The new contract

Following high profile debate and industrial action a new contract for junior doctors is in place and junior doctors are set to begin switching to it from October 2016. NHS Employers has said that the old contract was not “fit for purpose”.

The changes are complicated, and how they translate into junior doctors' actual pay and working conditions is even more so. Different hospitals, different specialties, different managers—there's no simple way to quantify what their impact would be on a 'typical' junior doctor.

The British Medical Association (BMA) has drawn up a comparison of key aspects of the existing junior doctors’ contract and the new one introduced by the government. NHS Employers has also drawn up an FAQ.

Pay will change in a number of ways

The new contract includes an increase in basic pay of between 10% and 11%. But this is an average across doctors of all pay grades. According to the BMA, once this is broken down, it varies from 4% to 32% depending on the training stage and grade of the doctors.

Doctors who work one weekend in eight or more will also receive an allowance worth between 3% and 10% of their basic salary, depending on the number of weekends they work. Previously all weekend work was paid at a premium rate, which varied depending on the doctor’s pay band.

Any doctors working between 9pm and 7am will receive 37% on top of their basic hourly salary. They’ll also get this if they have shifts starting between 8pm and midnight which last more than eight hours. In this situation they will continue to be paid the extra 37% rate for all hours they work until 10am the following day.

In the pre-2016 junior doctors’ contract all work between 7pm and 7am is paid at a higher rate, depending on the pay band of the doctor.

Doctors will also receive an allowance of 8% of their basic salary when they are on call under the new contract. In the previous contract, the amount was paid as part of the doctor’s pay band.

Working hours for junior doctors might also change

The new contract says that doctors can work no more than 72 hours over seven consecutive days, down from 91 hours in the current contract.

It also continues to set doctors’ average working hours at 48 per week, unless they opt out of the Working Time Regulations in which case the maximum is 56 hours.

The new contracts introduce a new ‘guardian of safe working hours’. The guardian role was introduced during negotiations with the responsibility of overseeing their hours and ensuring doctors are properly paid for all their work.

The new contract also reduces the number of long days a doctor can be asked to work in a row from seven to five and the number of nights in a row they can work from seven to four.

The old contract required junior doctors to be given a break roughly every four hours for at least 30 minutes. The new contract requires doctors to be given at least one 30-minute break for a five hour shift and then another for a nine hour shift.

The junior doctors’ latest reaction

Junior doctors voted in July to reject the contract.

Following a survey of junior doctors on why they rejected the contract, Dr Ellen McCourt, Chair of the BMA Junior Doctors’ Committee set out four main areas of concern the BMA wants the government to address:

• Protection for junior doctors who raise concerns at work
• The guardian-of-safe-working role
• Terms and conditions for junior doctors working less than full time
• How weekend working is treated

The BMA has since said that movement has been made on the first two.

In August agreement was reached on protection for whistle-blowers. Health Education England (HEE) has now agreed to give junior doctors the right to take HEE to an employment tribunal if they raise an issue with them and feel that their career has suffered or they experience bullying or harassment as a result of making a complaint. This will be written into the contracts HEE have for providing training with the junior doctors’ employers. Junior doctors did not legally have this right before because HEE is not their legal employer.

We spoke to the BMA who said that NHS Employers had provided more direction to trusts on exactly what the role of guardians should be and how it would work in practice. It described this guidance as “far more robust” than it had been.

The BMA says some issues still need to be resolved

Dr McCourt has said that in order to end the dispute, junior doctors want to resolve the remaining two priorities, and to see a fully costed plan from the government on how they will deliver a seven day NHS. The government has said the money will come from £10 billion already going to the NHS during this Parliament. Experts have said the NHS will struggle to fund the seven-day NHS through this money alone, and have highlighted that the increase is less when you include health spending outside of NHS England. 

The BMA has raised a particular concern on the impact of the contract on those who work part-time, such as parents. We’ll be looking into this separately.

We spoke to the BMA who said that it is also concerned that as the definition of ‘unsocial hours’ is changing doctors who work in the most struggling and understaffed specialties, and who work more weekends as a result, will lose out financially compared to their colleagues.

We’ve asked the Department of Health and NHS Employers for their latest position on this.

Other concerns have also been raised by junior doctors including restrictions on temporary ‘locum’ work and how locums’ pay will be affected. Any hours that junior doctors want to work as a locum now need to be offered to the NHS first rather than to private agencies.

The BMA has also said that it is concerned about the pressure on health services as a result of the government’s seven-day NHS policy. A group of medical professionals recently called into question the research behind this policy and asked the government to pause contract changes until this could be reviewed.

The government has made claims in the past that thousands of excess ‘weekend deaths’ can be attributed to under-staffing in hospitals, which the evidence did not support. Full Fact has twice requested that Mr Hunt correct the record on a specific version of this claim. To date he has not done so.

The government maintains its commitment to the seven-day NHS.  

Correction (2 September 2016)

We corrected a previous version of this article to reflect that junior doctors' average working hours are already capped at 48 per week unless they opt out of the Working Time Regulations. It was originally included in our introduction to the dispute over junior doctors’ contracts.

Image courtesy of Alex Proimos