This briefing article was originally published in Student BMJ, a magazine produced by the British Medical Journal for medical students. It was co-written with the editor of Student BMJ, Matthew Billingsley. An online version can be found here.
The outcome of the junior doctor contract negotiations could have a major impact on current medical students’ pay and working conditions. Below is a timeline of the major flashpoints and an overview of the changes being proposed.
October 2013 – Talks begin between NHS Employers and the BMA
NHS Employers, acting on behalf of the government, and the BMA, the trade union for doctors in the UK, start discussing the terms of the new contract, with a view to implementing it by April 2015.
October 2014 – BMA walks away from the negotiation table
After a year of negotiations the BMA pull out of talks citing concerns about patient safety, doctors’ welfare and a lack of evidence underpinning the changes. Kitty Mohan, co-chair of the junior doctors’ committee at the time said the contract proposals lack a “fundamental grasp” of the way in which NHS staff work and that doctors are “upset and frustrated” doctors were with how their work was not being “valued, noticed and recognised.”
November 2014 – DDRB step in
Following the breakdown of talks, the government commissioned the Review Body on Doctors’ and Dentists’ Remuneration Boards (DDRB) to review the contract proposals.
July 2015 – DDRB report published
The DDRB report says that the current contract is no longer fit for purpose and is hindering the achievement of the NHS’s goals to improve patient care and outcomes, and is unaffordable in the current financial climate. The report includes a number of recommendations which upset junior doctors (box 1). NHS Employers in England agreed that the DDRB report should be the basis for finalising new contractual arrangements. NHS Northern Ireland, Scotland and Wales all rejected the new contract and have decided not to enforce it.
August 2015 – Junior doctors vote against re-entering contract negotiations
The BMA’s junior doctor committee reject further negotiations with NHS Employers citing the proposals in the DDRB report as “unacceptable.”
August 2015 – Jeremy Hunt threatens to impose the contract
Jeremy Hunt, secretary of state for health, threatens to impose the new contract if an agreement cannot be reached between the government and the BMA by early September 2015. The chair of the BMA, Mark Porter, accuses Jeremy Hunt of making a “wholesale attack” on doctors.
This month also saw the hashtag #imatworkjeremy take off in reaction to Hunt’s speech at the King’s Fund where he said the new contract was necessary in order to deliver a seven day NHS. Many healthcare staff took exception and proceeded to post photos on Twitter of themselves on working at weekends.
September and October 2015 – Protests on the streets
Tens of thousands of junior doctors and supporters protest in a number of UK cities against the changes proposed in the new contract.
October 2015 – Pay rise offer rejected
Just before the BMA were due to ballot their members for strike action, Jeremy Hunt offered junior doctors an 11% rise in their basic pay. The BMA dismissed this as effectively as a pay cut because junior doctors’ overtime hours are still being reduced, which can make up as much as 40% of their income. The Department of Health also refused to enter conciliatory talks with the BMA, mediated by ACAS, an organisation that resolves employment disputes.
19 November 2015 – 98% of junior doctors vote to strike
The BMA represents 37155 of junior doctors in England and 98% of them voted in favour of taking strike action in protest against changes to their contract. The BMA announced the dates of one day of industrial action and two days of strikes in advance so that junior doctors and their employers could make arrangements to cover the withdrawal of their services. The knock on effect was that some operations and procedures were cancelled.
30 November 2015 – Strikes suspended
On the eve of the first day of industrial action, the BMA agreed to suspend the strikes until the 13th January and negotiate with the government, after Jeremy Hunt agreed to pause the imposition of the new contract. Despite the strike action being called off, 4,000 operations were cancelled and the BMA and Jeremy Hunt both accused each other of stalling on talks which could have averted this inconvenience for patients.
13 January 2016 – Deadline to agree new contract
The BMA and the government have until mid January to come to an agreement on a new contract. It is unclear at the time of press what concessions each side would be willing to make to resolve the dispute. If an agreement cannot be met, then the BMA may set new dates for industrial action.
What does the new contract propose?
- Your overtime pay: is Saturday the new Tuesday?
As a foundation year one junior doctor you start on a basic salary of around £23000 for the hours worked between 7am to 7pm, Monday to Friday. For any hours worked outside these standard hours you receive overtime pay, which many junior doctors rely on to top up their wages. The new contract proposes extending the standard hours to Monday to Saturday between 7am to 7pm (this was initially proposed until 10pm). The BMA says this will result in a 27% reduction in the number of hours doctors are eligible to claim premium pay, representing an overall pay cut.
- Your rota: a return to working unsafe hours?
Currently, employers are financially penalised if they let their employees work longer than the hours they are contracted to work. The government want to scrap this financial penalty and the BMA are concerned that there will be less pressure to ensure safe work hours –which could be to the detriment of doctors’ health and patient safety.
- Your pay on call: an end to hours-based payments
The DDRB report proposes that junior doctors who work on call should receive a single allowance payment, rather than an hours-based payment. This has been criticised by the BMA for not taking into account how long doctors can be on call for and the costs associated with being on call, such as having to make last minute childcare arrangements.
- Your pay progression: on pause if you take a career break or switch specialties
Doctors’ salaries currently increase each year depending on how long they’ve worked in the NHS. The new contract proposes that doctors should receive a salary determined by the stage of training they are currently working at, rather than their length of service. Under the new contract, doctors who want to take time out to have children or pursue an academic post would have their pay progression suspended at the level they left at while taking a break from clinical work. Trainees who decide to change specialties will also not be entitled to the pay progression and will have to start lower down on the pay ladder.
- Your expenses: compensation for relocation
As a junior doctor you will move around as you train, which can be an inconvenience if it happens on a regular basis. Junior doctors are entitled to relocation expenses that are incurred as part of their duties but employers don’t always pay up. The DDRB reports says that employers should not be allowed to opt out of these expenses – meaning that all junior doctors would be able to claim for “reasonable relocation expenses” related to their job.