The contract for junior doctors working in the NHS is “not fit for purpose” and should be fully renegotiated according to a report by NHS Employers.
The report on the contract, commissioned by the Department of Health, was published today.
Both NHS Employers and the British Medical Association have accepted the existing contract, which was introduced in 2000 to reduce working hours for junior doctors, has led to multiple problems.
NHS Employers will now seek a mandate from the government to start talks with the BMA’s junior doctors’ committee which could take more than a year to reach a conclusion.
The report concludes the existing contract focuses too much on the number of hours worked and that higher pay bands for those working more than 48-hours incentivises doctors to work longer and “does not encourage professional ways of working.”
It says: “Failure to change the current system will result in continuing financial risk, is likely to encourage increasingly adversarial relationships between doctors and their employers, and would potentially work against attempts to improve the way doctors are trained and developed.”
Under the proposals, a fully re-negotiated contract could link pay progression to the demonstration of competencies and training. It would include relevant thresholds doctors would need to meet and involve some local flexibility.
The report says the change would link trainees more closely with the contracts of other doctors and have a greater focus on teamwork.
NHS Employers could also seek to replace the existing pay banding for junior doctors with a system weighted more towards basic pay – but this would increase pension costs.
The JDC has highlighted the reduced earnings of trainees compared to previous generations and the increases in student debt, pension contributions and the loss of mandatory accommodation.
But employers are reluctant to support more pay for those working over 48 hours as this “effectively discourages doctors” from complying with the law.
The JDC has said it will not support any changes to the contract that disadvantage junior doctors while employers have said they will not allow changes which make the contract more expensive, less flexible and more onerous to administrate.
Ben Molyneux, chair of the junior doctors committee, said: “We need terms and conditions that better recognise the professionalism and vital contribution of junior doctors to the NHS.
“The scoping document is now three years old, and we need to move on quickly to consider the impact of the huge changes being made to the way medical training is funded, delivered and regulated.”
NHS Employers director Dean Royles said: “The contract no longer works as effectively as it could for junior doctors or their employers. All parties agree there are opportunities to improve and modernise the contract, so it works better for patients, staff and the NHS.
“Junior doctors work most effectively when they are able to focus on the quality of care and the well-being of patients, and on their personal development rather than the rigid shift patterns that have become the norm.”