A new contract offer for junior doctors working in the NHS in England has been published by the Department of Health and NHS Employers today.

HSJ’s workforce correspondent Shaun Lintern examines the new offer and explores why the eleventh hour proposal is unlikely to stop a strike by junior doctors, who start their ballot for industrial action tomorrow.

There are a number of areas where the new contract offer published today reveals more detail than the earlier proposals made by NHS Employers. This is a welcome development given the vacuum that has existed around exactly what is being proposed over recent months. But junior doctors and the British Medical Association are likely to be unimpressed with the few concessions made by the government.

Sources close to the process to design the new contract say the government and NHS Employers have tried to head off key concerns around pay and safeguards for hours worked, but for many junior doctors the changes will not go far enough.

Health secretary Jeremy Hunt has renewed calls for the British Medical Association to negotiate over the proposals but remains determined to impose a new contract from August.

This threat of imposition and the lack of any substantial concessions will not dampen the anger of junior doctors. The government will be able to present the contract in a better light but the principles on which it is based remain largely untouched. HSJ understands senior figures in the Department of Health are resigned to the BMA membership voting to take industrial action over the coming weeks.

Changes to planned unsocial hours

The extent of working time classed as being unsocial has been marginally reduced by three hours from 10pm to 7pm on Saturdays, while Monday to Friday normal working hours will stretch until 10pm rather than the current 7pm. Doctors will be paid time-and-a-third for working Saturday 7pm-10pm and Sunday 7am-10pm and time-and-a-half for working 10pm-7am.

Under the contract proposal junior doctors will work an average 40-48 hour week with an absolute limit of 72 hours, no more than four consecutive night shifts and no more than five long days.

New pay protection plan for quarter of doctors

One significant proposal in today’s announcement is for a new pay protection regime to maintain pay levels for a quarter of doctors up to 2019 who might otherwise have seen a cut in their earnings. The government claims three-quarters of doctors will see their pay rise under the new proposal following a basic pay increase of 11 per cent – a smaller rise in basic pay than the original 15 per cent offered by NHS Employers in January.

Offering pay protection means the government can legitimately say it is not cutting doctors’ pay but that will not satisfy junior doctors and the BMA – whose concerns extend to the future workforce working as junior doctors beyond 2019. HSJ understands this additional pay protection and higher pension costs due to the rise in basic pay will be funded by central government and not fall as a cost to NHS trusts.

CQC to oversee working hours

A new measure is the involvement of the Care Quality Commission in monitoring junior doctor hours. This is designed to address the fears that the loss of the current pay banding pay system – which forces NHS trusts to pay higher salaries to junior doctors working the most unsocial hours – would lead to doctors being exploited by trusts without adequate safeguards.

Junior doctors, who will be given a personalised work schedule at the start of their employment, will be able to request a review of their working hours, with exception reports filed to the trust medical director and board if their hours exceed the contract. Data from these reviews will be examined by the CQC as part of its inspection regime.

Annual reports on the work reviews will also be sent to Health Education England, who may withdraw training posts.

This will provide the NHS with an overview of performance and the threat of a poor CQC rating or removal of trainees may provide some sanction, but the BMA’s concern that doctors could be put under pressure not to raise concerns over their working hours is likely to remain. The BMA believes financial penalties for NHS trusts is key to limiting excessive hours.

No changes to pay progression plans

The government has refused to give any ground on its plans to end pay progression linked to time served and is pressing ahead with changes that would see junior doctors only progress through the pay scale when they take on new higher responsibility roles. Today’s offer reveals for the first time what the indicative pay points would be for junior doctors with six pay points ranging from £25,500 for a foundation year doctor to £55,000 for a senior registrar.

Doctors who take time out of training to have a baby will continue to be entitled to 12 months’ maternity leave and to existing maternity payments, but will not receive an increment rise in pay. Instead they will return to work on the level of pay they were at when the left. The BMA has said these proposals are discriminatory to women who are increasingly making up the majority of the junior doctor workforce.

Additional pay elements revealed

For the first time NHS Employers has set out the suggested details of extra ingredients to be included in some junior doctors’ pay. This includes those who are on-call and expected to return to work. Depending on the frequency of their shifts they will receive between 2-6 per cent of their basic salary.

NHS Employers has also suggested using flexible pay premiums for specialties including emergency medicine and psychiatry, which will receive £1,500 while GP trainees will receive £8,200 to offset the loss of the GP training supplement. Employers say the use and level of these rates will be set depending on trainee shortages and advice from Health Education England. Flexible pay premiums will also be used to ensure those doctors who undertake academic research or work which has a benefit to the NHS do not lose out.