As junior doctors threaten industrial action over plans to impose new pay, terms and conditions next year, HSJ answers the big questions on what is being proposed

How did we get here?

The government and NHS Employers said in 2012 that the junior doctors contract was no longer fit for purpose and the British Medical Association agreed the need for reform. Negotiations started in 2013 but collapsed in October last year when the BMA pulled out of talks without warning.

As a result, the government asked the independent Review Body on Doctors’ and Dentists’ Remuneration to make recommendations on a new contract. The DDRB report was published in July after considering evidence from both sides. The BMA junior doctors committee refused to re-enter talks in August resulting in the government saying a new contract would be imposed from August next year.

Will doctors get a 20 per cent pay cut?

It’s impossible to say with any certainty who will be winners and losers under a new contract as there are no final proposals which include all aspects of pay. Claims that junior doctors will see their pay cut by up to 20 per cent are premature and based on calculations that do not include all pay elements set out in the DDRB report. These include basic pay, additional rostered hours pay, out of hours pay, an availability allowance, and extra payments to support recruitment and retention. NHS Employers insists the final contract will be cost neutral overall, and average earnings will remain the same. Doctors have criticised NHS Employers for still not having more detailed proposals.

How will unsocial hours pay be affected?

Junior doctors are paid between 7am and 7pm, Monday to Friday, with remaining hours as well as Saturdays and Sundays considered to be unsocial hours. The amount paid for unsocial hours varies under a banding system that forces NHS trusts to pay more for the most unsocial rotas.

NHS Employers wants to extend normal working hours to 10pm and include Saturday, but also increase basic pay by around 15 per cent. For some doctors the rise in basic pay will not be enough to replace what they lose in unsocial hours pay, but NHS Employers says this system will mean extra money can be paid to those doctors who take on more responsibility, work more unsocial hours or work in specialities affected by shortages.

The DDRB made clear this proposal should be “the basis for further discussion/negotiation between the parties”. The BMA has so far refused to negotiate but says evening work and weekends should be properly recognised as unsocial hours, and that adequate safeguards are needed to protect doctors from being exploited.

Will doctors be forced to work longer?

Under the current contract, junior doctors can work a maximum of 91 hours a week. NHS Employers says the new contract will have better absolute limits written into the agreement with:

  • average hours of 40-48 a week;
  • a new maximum of 72 hours a week;
  • no more than four consecutive night shifts; and
  • no more than five long day shifts.

Doctors will be able to request a review of their working hours.

NHS Employers says including limits in the contract means employers will be at risk of legal action for a breach of contract issues, and that working time regulations would still apply. The DDRB suggested there should be a mandatory requirement to comply with working time regulations. The BMA has argued that without the financial penalties in the current system NHS trusts would be free to exploit doctors.

Will female doctors lose out?

The government believes pay progression should not be based on time served but on responsibility. Under the proposals, pay would increase as doctors progress to new levels of responsibility. However, the BMA claims this will impact women who take maternity leave or work less than full time. It could also affect doctors who switch to a new specialty at a lower level of responsibility or take a career break to carry out academic research. The review body report recommended that doctors who take time out to do work of a wider benefit to the NHS such as research could still receive additional pay in recognition. The final proposals have not been set out but the BMA believes there should be no disadvantage for doctors working less than full time.

Will GP trainees see a 40 per cent pay cut?

Employers suggest the current supplement for GP trainees, which maintains pay levels with hospital doctors, should be replaced with a flexible pay premium. NHS Employers says the result would mean the system was almost identical as it is now and has no plans to reduce GP trainees’ pay overall.

How will flexible pay premiums work?

Throughout the DDRB report there are recommendations of using flexible pay premiums to recognise GP trainees, academic research, doctors changing specialty and those taking on additional work and unsocial hours. The difficulty for NHS Employers and the BMA is that it is unclear how these will work in practice, what rates they will be set at, and for how long. Doctors argue they need certainty about their earnings and that flexible pay could ultimately be removed or reduced at a later date. NHS Employers says it will produce a final contract and a full accurate pay calculator in due course.

Will doctors leave the NHS?

A number of medical royal colleges have expressed concerns about the impact of imposing a new contract on morale, recruitment and retention. The General Medical Council has reported a surge in doctors applying for certificates of good standing to allow them to work overseas. Gaps in medical rotas have been highlighted by royal colleges and there are already shortages in GP training programmes and specialties such as paediatrics and obstetrics.