• NHS chiefs and directors warn against cost of implementing new junior doctor contract
  • Concerns relate to pay protection and expansion of seven day services
  • Loss of goodwill and impact on morale also highlighted as risks

Senior NHS leaders have privately expressed concerns over the cost of implementing a new junior doctor contract, with some estimates suggesting it could cost individual trusts more than £1m.

A number of chief executives and workforce directors, speaking to HSJ on condition of anonymity, warned any concessions offered to the British Medical Association need to be fully costed and allowances made for how they will be funded.



Implementing pay protection was a major concern for trust directors

Many of the board level directors who commented on the progress of negotiations also raised fears over the longer term impact of the dispute on goodwill and morale among doctors.

Principal among the worries were the costs of implementing pay protection for 25 per cent of junior doctors, which the government revealed before Christmas. This would come at the same time as 75 per cent of trainees would see their basic pensionable pay increase.

Even with reductions from the loss of unsocial hours banding, senior leaders said the additional costs of seven day working meant the new contract would be significantly more expensive during any transition years.

HSJ understands a number of medical and workforce directors raised concerns with NHS Employers last year about the cost of the junior doctor contract. They sought “assurance and clarity” that elements of the offer were being costed with the Treasury in light of November’s spending review settlement.

What chief executives say

  • ‘It is a disastrous combination to lose all this goodwill and cost us more money’
  • ‘The whole thing has not been handled very well. I am pretty unimpressed with both sides’
  • ‘The ill feeling that is caused by such disputes leaves a long lasting legacy’

One chief executive of a large acute trust said their organisation had taken a representative sample of junior doctors and calculated what moving to a new contract, based on NHS Employers’ offer to the BMA in November, might cost.

They said: “It came to… between £1m and £1.5m. If three quarters are going to get a pay rise and the remaining are going to get pay protection then logically it’s going to cost us. All the additional cost will come in the coming year but the savings won’t come for several years.”

They added: “The biggest cost frankly will be the loss of goodwill, it is a disastrous combination to lose all this goodwill and cost us more money. It worries me there has been a breakdown in trust.”

They said junior doctors did not feel valued and “they just want to be loved a bit more”.

A workforce director at a major teaching hospital trust said: “My view is that it is certainly going to be more expensive than the current contract and a few trusts have sought clarity and reassurance from national colleagues that they have been estimating the additional costs with the Treasury but we haven’t had an unequivocal assurance that that has been happening.

“Overall [it was not] clear enough, and we aren’t [clear] now, about the cost of the additional reassurances they have offered the BMA.”


Another chief executive said: “I agree the current contract is not fit for purpose and we do need to find a way to treat [junior doctors] more like professionals. But the whole thing has not been handled very well. I am pretty unimpressed with both sides.”

A West Midlands trust chief executive said they “would question” the benefit of pursuing the dispute further. “Our workforce, at this particular time when there is so much pressure on the NHS, is our most important asset and we should be sitting down with them to agree a negotiated settlement because the ill feeling that is caused by such disputes leaves a long lasting legacy,” they said.


Another workforce director said the key cost would be pay protection that lasted for years. “If no one loses that could be seven years if all your postgraduate training is protected for anyone currently in post.

“It is mightily complex to have two pay systems for those who are protected and those who are not running together. The danger is the gainers gain and any losers don’t lose for far too long and we pay more from money we haven’t got,” they added.

A leading trust chief executive told HSJ the costs were difficult to estimate, but added: “The proposed pay protection could be very expensive. It’s not clear how this is reflected in next year’s tariff.”

NHS Employers referred HSJ’s enquiries to the Department of Health, which said: “We recognise the importance of NHS leaders in our aim to deliver a fairer, safer contract. That is why Sir David Dalton has been brought in to lead a reference group of hospital leaders, engage with all parties in negotiations and listen to junior doctors’ concerns.”