Junior doctor contracts in England

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.[1]

On 31 August 2016 the BMA Junior Doctors Committee announced further industrial action and the following day confirmed there would be 5-day strikes, including the withdrawal of emergency cover, in September, October, November and December 2016 (and due to occur between 8am and 5pm on each day of industrial action). On 5 September the BMA suspended the strike planned for 12-16 September after NHS leaders raised concerns about the ability of NHS to make contingency plans in time. On 24 September the BMA suspended strike action on the remaining dates:

• Wednesday 5 to Friday 7 October and Monday 10 and Tuesday 11 of October 2016 (the weekend of 8/9 October was not included in the planned industrial action);
• Monday 14 to Friday18 November 2016; and
• Monday 5 to Friday 9 December 2016.

While the BMA Junior Doctors Committee said it would not go ahead with the industrial action, it confirmed its continuing opposition to the implementation of the contract and said it is “planning other actions over the coming weeks”.

The Secretary of State has made statements to Parliament on the junior doctor contract, on 6 July 2016, following the BMA ballot rejecting the contract, and on 5 September 2016, following the BMA announcement of plans for industrial action. In both statements he confirmed the Government’s intention to implement the contract agreed in May in a phased process between October 2016 and October 2017 [see HC Deb 6 July 2016 and HC Deb 5 September 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 6 July 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, planned industrial action, and implementation of the 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