Junior Doctors

1
Junior Doctors Contract Offer

• Pay system changes
• For distribution to Boards, HRDs, medical
  directors, directors of medical education and
  medical staffing leads

2
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  system (introduced in 2000) is outdated, unfair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.

3
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.

4
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.

5
What will the new pay system look like?Not to
scale
6
Base pay old and new number of
pay points levels




7
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.

8
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-trainings career.
• Each step-change in responsibility is reflected
  in a change in basic pay.

9
Replacing banding supplementsNot to scale
10
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.

11
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

12
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.

13
Flexible pay premia
Training programmes that FPP will apply to in
2016 are

• 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.

• General Practice (in the practice placement of
  vocational training).
• Emergency Medicine (at ST4 and above).
• Psychiatry (at ST1 and above).

14
Safeguards and work reviews
Work schedule reviews
Safeguards

• 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.

15
Transitional arrangements

• 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 doesnt
  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.

16
Useful links further information

• www.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.