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Junior doctors

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Performance management of the Guardian via appraisal and 360 degree feedback. Processes improved so that Junior Doctors Forum or any individual doctor in training ... – PowerPoint PPT presentation

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Title: Junior doctors


1
Junior doctors 2016 contract
2
  • May 2016
  • Under the auspices of ACAS, the government, NHS
    Employers and the British Medical Association
    reached agreement on new terms and conditions of
    service for doctors and dentists in training in
    England.

3
  • June 2016
  • The BMA leadership positively endorsed the new
    terms and held roadshows across the country
    explaining the contract to members.
  • BMA members balloted on the new terms.

4
  • 5 July 2016
  • BMA members voted against accepting the new
    terms, 58 to 42, on a turnout of 68.
  • Dr Johann Malawana resigned as chair of JDC.

5
  • 6 July 2016
  • The Secretary of State announced in the House
    that all attempts to reach a negotiated
    settlement had failed, and that further talks
    were no longer a viable option.
  • As a result of this announcement, details of the
    final 2016 terms and conditions of service were
    published on the NHS Employers website.

6
What will be implemented now? It is expected
that the 2016 contract will now come into force
on 3 August 2016, and the first doctors will take
up employment on those terms on 5 October this
year. These terms and conditions of service are
the same as those previously published on the NHS
Employers website on 16 June.
7
What changed between the March TCS and the
current TCS?
March position New position
N/A Accelerated Training support including access to mentorship, study leave funding and specially developed training inputs, additionally funded from outside the contract pay bill.
N/A HEE mandated by SofS to review transfer between regions for married couples and civil partners, caring responsibilities, travel times to be completed by end of March 2017.
N/A A joint review of good rostering practice, including the proper use of technology, which support greater flexibility for junior doctors and employers, completed by January 2017.
Where trainees have to change training path due to disability, then their previous nodal point pay will be protected. Extended to cover those with caring responsibilities also.    
Guardian role did not cover these issues previously. Guardian oversight of diversity and equality issues, including liaison with the Director of Medical Education to ensure that a member of the educational faculty in the Trust is designated as a champion for flexible training.  
Statutory equalities monitoring. Employers, HEE and the BMA will put in place comprehensive equalities monitoring mechanisms for all protected characteristics to be signed off via the JNCJ for implementation from April 2017.  
8
March position New position
Staff handbook references included but no specific guidance. Joint guidance referenced in the contract to ensure the effective delivery of elements of the NHS-wide staff handbook covering Caring for children and Adults, Flexible working and balancing work and personal life.  
Agreed 5 point nodal point structure Agreed improved 4 point nodal point structure to distribute pay more fairly
Guardian report to the board at least once a year. Guardian report to the board at least once a quarter, including data on rota gaps. A consolidated annual report on rota gaps and improvement plan included in Trust's Quality Account.  
N/A Junior doctors forum established to advise Guardian and play role in scrutiny of the distribution of income from fines.  
System of financial penalties. Financial penalties extended to cover where breaks are not achieved on 25 or more of occasions.
Where the Guardian is appealed local grievance processes will apply. Any appeal against the decision of the guardian will involve a representative from the BMA or other relevant trade union nominated from outside the Trust, and provided by the trade union within one calendar month.  
9
March position New position
Performance management of the Guardian via appraisal and 360 degree feedback. Processes improved so that Junior Doctors Forum or any individual doctor in training should raise those concerns with the Trust Medical Director. These concerns can be escalated to the senior independent director on the Board of Directors where they are not properly addressed or resolved.  
FPP for Emergency Medicine at 1,500 Value increased to 20,000 over the length of the training programme.
FPP for Psychiatry at 1,500 Value increased to 20,000 over the length of the training programme.
FPP for OMFS at 1,500 Value increased to 20,000 over the length of the training programme.
FPP payments pensionable FPP payments non-pensionable
FPP for leadership roles Leadership FPP removed to improve pay system as a whole
Streamlining processes optional. Employers mandated to establish regional streamlining processes by April 2017.
Period of Grace facilitated should funding be available. HEE commitment to fund the Period of Grace.
10
March position New position
13 month qualifying service needed for pay protection and requirement to move immediately to new training programme.     Where changing training path due to disability the eligibility time period before qualifying for pay protection is reduced to zero.  In all other circumstances (change due to caring responsibilities, change to a shortage speciality) then the qualifying period is reduced to six months service. Where in this circumstance a trainee has missed the relevant application round, then they must gain a place within twelve months of leaving the original programme.
N/A Secretary of State asked GMC to lead a review by Royal Colleges to support appropriate recognition of competence where junior doctors change training paths, which should enable quicker progress through training programmes and the salary structure in some circumstances. Work completed by 31 March 2017.  
Breaks provisions as per 31 March TCS. Improvement to TCS wording around flexibility and spacing of breaks.  
Pay for additional hours of work as per 31 March TCS. Improvement to TCS wording around authorisation and guardian oversight, and on-call.  
TOIL as per 31 March TCS. Improvements to TCS wording around time limits.
11
March position New position
First refusal clause. First refusal clause removed. Fidelity to the NHS agreed, flexibility to work for any NHS staff bank. Requirement to offer such service is for work commensurate with the grade and competencies of the doctor, though the doctor may choose to accept work at a lower grade, if they wish. LNC to agree local processes.
Locum rate as per the March pay circular Locum rate improved to provide a 22 uplift on the appropriate hourly rate
N/A An additional payment for senior decision makers will be introduced.
Statutory whistleblowing protections. This right is enshrined in the contract for junior doctors, and this includes the ability to raise concerns regarding the work of HEE without detriment, from either the employer or HEE. 
Pay system as per March TCS. Brand new pay system jointly agreed in order to value the work of junior doctors including at night and weekends. This includes extending the hours which night enhancements apply to, introducing a weekend allowance, and a new system to pay for on-call.
48 hour rest period after consecutive night shifts. 46 hour rest period after consecutive night shifts, amended to improve work life balance and continuity of care.
Implementation timeline as per previously Published in March Implementation timeline amended and agreed with the first trainees moving on to the new TCS in October 2016.
12
March position New position
Transition for a period of 3 years Transition extended by one year.
Employer based variation clause in the contract. Commitment to vary the contract via collective agreement through the JNC(J), and an ongoing review of the contract.
N/A The right for doctors with significant caring responsibilities to this as part of the personalised work schedule review
N/A Addition of a pay premium of 1500 for doctors who are in less than full time training (LTFT) at the time of transition, or who are on maternity leave at the time of transition and subsequently return directly to an LTFT post
13
  • What happens next?
  • The 2016 contract can only be introduced once
    existing contracts of employment expire.
  • A new implementation timeline has been published
    which reflects this position.

14
New implementation timeline
Date  
July 2016 Appoint guardians
26 July 2016 Guardian conference
3  August 2016 2016 contract is live
October 2016 Transition to the 2016 TCS for Obstetrics trainees taking up new appointments at ST3 and above
November / December 2016 Transition to the 2016 TCS for F1 doctors taking up next appointments F2 doctors taking up next appointments  and sharing rotas with F1 doctors
February / April 2017 Transition to the 2016 TCS for Psychiatry trainees taking up next appointments (all grades) Pathology trainees (lab based) (all grades) Paediatrics trainees taking up next appointments (all grades) Surgical trainees (all disciplines) taking up next appointments (all grades) F2 doctors and GP trainees (ST1/2) taking up next appointments and sharing rotas with any of the above
August / October 2017 Transition to the 2016 TCS for All remaining trainees taking up next appointments (all grades) All new starters (all grades)
Notes 1. The above does not include trainees
employed on long-term contracts in lead employer
arrangements (other than those who joined such
arrangements on a single placement contract in
August 2016, or those whose contracts have a
clause allowing for them to be varied in this
way) these trainees will remain on the 2003 TCS
until they finish training current contracts
expire. 2. There will be some parts of the
country where rotation dates do not coincide
precisely with the above timetable. In such
cases, trainees will move to the 2016 contract at
the next rotation date following their scheduled
transition date, and by October 2017 at the
latest.
15
Next steps for employers
  • Appoint a guardian of safe working hours
  • Ensure sufficient time allocation (PAs) in the
    job plan
  • Ensure appropriate admin support to manage flows
    of exception reports and other information
  • Agree reporting cycle, liaison with local
    negotiating committees (LNC) etc.
  • Establish junior doctor forum to advise the
    guardian.

16
Next steps for employers
  • Take appropriate steps to meet local public
    sector equality duty (guidance is on the NHS
    Employers website).
  • Agree local processes for managing exception
    reports and work schedule reviews.
  • Ensure medical staffing / HR / payroll teams are
    trained and able to deliver rapid implementation
    of the 2016 contract.
  • Agree amendments to working patterns to ensure
    safe rostering.
  • Draw up work schedules for posts.
  • Offer employment on 2016 TCS in accordance with
    transitional timeline.

17
Legal position
  • The two judicial reviews were conjoined at an
    early stage.
  • Both were stayed pending the ballot.
  • A case conference is scheduled for the 21 July

18
Local engagement
  • Employers will need to work with individual
    trainees locally to ensure that the 2016 contract
    can be introduced without negatively impacting
    patient care.
  • The best way to do this is to engage with doctors
    locally, rota by rota, to work through the
    benefits of the 2016 contract from a safety
    perspective when agreeing new rotas.

19
Trust doctors
  • The 2016 TCS are not suitable for trust doctors
    employers must decide on which (local) TCS to use
    for this group (or to use the SAS contract, where
    appropriate).
  • Employers seeking to ensure pay parity for this
    group must use the parallel pay codes that will
    be set up in ESR.
  • It is vital that we are able to see, at a
    national level, who is on the 2016 TCS and who is
    not.

20
System support for employers
  • Skills for Health / Allocate rota and pay
    calculations (July)
  • ESR new pay elements (September)
  • Skills for Health / Allocate exception reporting
    systems (September)

21
  • Available now
  • 2016 Terms and Conditions of Service
  • Pay and Conditions Circular
  • Model contracts
  • Model offer letter
  • Guardian of safe working hours JD / PS
  • Work schedule template
  • Public Sector Equality Duty guidance
  • Implementation timeline
  • Implementation guidance
  • FAQs

22
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_at_NHSemployers Facebook.com/NHSEmployers
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