Junior Doctors

1
Junior Doctors Final Contract

• For distribution to boards, directors of medical
  education and medical staffing leads

2
Why do we need change?

• A new contract needs to be introduced that is
  safe, fair and effective for both doctors and
  employers.
• The current contract has significant weaknesses
  
• safety does not support safe working practices
• training does not support the educational and
  training needs of doctors
• pay has perverse incentives that do not
  recognise or effectively reward hours being
  worked or the intensity of work being done.

3
Key features of the new contract

• Safeguards
• Appointment of Guardian of Safe Working to
  oversee robust work schedule review process and
  address concerns relating to hours worked and
  access to training opportunities.
• Safe care for patients through protection and
  prevention measures to stop doctors working
  excessive hours
• New system of financial penalties to be applied
  where doctors are working excessive hours
• Training
• New terms to support training and education
  include ensuring proper notice of deployment to
  rotational placements exception reporting
  applying to missed educational opportunities and
  a review of access to more flexible training

4
Key features of the new contract

• Pay
• Cost neutral not looking to save money from new
  contract reforms
• Pay for doctors and employers more stable and
  predictable better financial management for
  employers
• Pay progression linked to responsibility and
  point of training no longer time served
• Reward targeted at doctors working onerous rotas
  and unsocial hours supports staff deployment to
  meet needs of patients on evenings and weekends
  (including those who work most Saturdays)

5
Safety Restrictions on excessive hours
Current contract November offer Final contract
Twice-yearly hours monitoring exercises Exception reports to replace hours monitoring Exception reports to replace hours monitoring
Departmental rota Individual work scheduling Individual work scheduling
Work schedules for GP trainees in practices to reflect COGPED guidance on work plans
Work schedule reviews on request Work schedule reviews on request and when required by the guardian
Rigid on-call rules with limited flexibility More flexible on-call arrangements linked to intensity or work Limits on on-call working No more than three rostered on-calls in seven days except by agreement Guaranteed rest arrangements where overnight rest is disturbed
Rigid paid rest break requirements Paid 30 minute rest breaks at intervals in line with working time regulations Paid rest breaks 30 minutes if shift exceeds 5 hours, 2 x 30 minutes if shift exceeds 9 hours, taken flexibly across the shift
Best practice guidance on rostering
Financial penalty levied on employer for breaches of WTR 48-hour average working hours or contractual 72 hour weekly limit.
6
Safety Restrictions on excessive hours
Current contract November offer Final contract
Maximum average 56 hour working week Maximum average 48 hour working week Maximum average 48 hour working week
Opt out capped at maximum average of 56 working hours per week Opt out capped at maximum average of 56 working hours per week Opt out capped at maximum average of 56 working hours per week
Maximum 91 hours work in any seven day period Maximum 72 hours work in any seven day period Maximum 72 hours work in any seven day period
Maximum shift length of 14 hours Maximum shift length of 13 hours Maximum shift length of 13 hours
Maximum of 7 consecutive long shifts Maximum of 5 consecutive long shifts Maximum of 5 consecutive long shifts
Maximum of 7 consecutive night shifts Maximum of 4 consecutive night shifts Maximum of 4 consecutive night shifts
Minimum 11 hours rest after final night shift Minimum 11 hours rest after final night shift Minimum 48 hours rest after a run of either 3 or 4 consecutive night shifts
7
Safety Restrictions on excessive hours
Current contract November offer Final contract
Maximum of 12 consecutive long, late evening (twilight into night) shifts Maximum of 5 consecutive long, late evening (twilight into night) shifts Maximum of 4 consecutive long, late evening (twilight into night) shifts
Minimum 11 hours rest after final long, late evening (twilight into night) shift Minimum 11 hours rest after final long, late evening (twilight into night) shift Minimum 48 hours rest after 4 consecutive long, late evening (twilight into night) shifts
Maximum 12 consecutive shifts Maximum 12 consecutive shifts Maximum 8 consecutive shifts
48 hours rest after 12 consecutive shifts 48 hours rest after 12 consecutive shifts 48 hours rest after 8 consecutive shifts
8
Training
November offer Final contract
Work schedule to be linked to the educational curriculum Work schedule to be linked to the educational curriculum
Training needs to be identified and included in the work schedule Training needs to be identified and included in the work schedule
  HEE commitment to performance manage deaneries against code of practice on notice of deployment
  HEE to establish benchmark standards for educational facilities
  Contract will facilitate both standard and lead employer models
  HEE commitment to identify ways of reducing the costs of training through centralised provision and other means
  Improved access to less than full time training
  Enhanced continuity of service provisions to ensure that trainees returning from OOP are not unfairly  deprived of occupational maternity pay
Fixed leave to be replaced by a mutual obligation for employers and doctors to appropriately manage leave arrangements
9
Pay Base pay - old and new




10
Pay Why five nodal points?

• Proposed by BMA in negotiations.
• Informed by clinical and educational input.
• Clear change in responsibility between F1
  (provisionally registered) and F2 (fully
  registered).
• Clear change in responsibility when moving from
  the Foundation Programme to Specialty Training
  (core or run-through), following a competitive
  recruitment process before being appointed.
• The first two years of Specialty (ST)/Core
  Training (CT) are similar in the degree of
  responsibility required of the trainee, and are
  therefore grouped into one node.
• There are two further nodal points at ST3-7 and
  ST8, reflecting the sub-specialised nature of
  work at ST8.
• This allows for a flatter pay structure
  minimising the impact on those on academic
  pathways or taking a break from training.
• Accordingly, we agreed with the BMA for this
  option as being the one that best suited the
  majority of training programmes.

11
Pay Unsocial hours enhancements

• 9pm to 7am every day of the week 50 per cent
  pay enhancement
• Saturday 5pm to 9pm and Sunday 7am to 9pm 30
  per cent pay enhancement
• Trainees who work shifts beginning on Saturdays
  14 weeks or more frequently will additionally
  receive a 30 per cent pay enhancements for any
  work done on Saturday 7am-5pm

12
Pay On-call availability allowance

• On-call availability allowance is a percentage of
  basic pay for being on call when not at work.
  Hours actually worked will be included in the
  work schedule and paid at the normal basic rate
  plus any enhancements applicable.

Frequency required to be on-call Rate paid
1 in 4 or more frequently 10 per cent
Less frequently than 14 5 per cent
13
Pay FPP Indicative Values
November offer November offer Final contract Final contract
Academia1 3,125 Academia 4,000
Emergency medicine training programmes at ST4 and above 1,500 Emergency medicine training programmes at ST4 and above 1,500
General practice2 8,200 General practice 8,200
    Oral and Maxillofacial Surgery 1,500
Psychiatry training programmes at ST1 and above 1,500 Psychiatry training programmes at ST1 and above 1,500
14
Pay Locums

• Junior Doctors who opt out of the working time
  regulations will be required to offer first
  refusal to employer for any additional shifts
  they may wish to work.
• This work would be done via the host
  organisations / employers locum bank, rather
  than via an agency.
• This work is to be paid as per national terms and
  conditions, set out in the pay circular each year.

15
Implementation timetable
Date Grade(s) Rotation(s) / Training programmes
Aug-16     F1 All
Aug-16     ST1/2/3 GP trainees undertaking practice placements
Aug-16     All Psychiatry Public Health
Sept ST1 Paediatrics (Core, higher and all sub-specialties) dentists
Oct CT 1-3 /ST3 All surgical specialties (including orthodontics)
Nov    
Dec    
Jan-17    
Feb   ST3 Anaesthetics / ITU / Emergency Medicine / Obstetrics and Gynaecology
Feb   ST1-2 Core Medical Training /remaining Core Surgical Training / ACCS / Anaesthetics
Mar ST3 Any remaining Paediatrics trainees
Apr ST3 Any remaining surgical and all higher medical specialties
May    
Jun    
Aug-17   Any trainees not already included above
Note Any trainee (e.g. F2 GP trainee in a
hospital setting) sharing a rota with the above
will move to the new contractual (and where
applicable, pay protection) arrangements at the
same time as those trainees.
16
Summary Safer care for patients and a fair
deal for doctors and employers

• The new contract will
• support the delivery of safer care to patients
  achieved through the provision of a new and
  comprehensive package to address concerns raised
  by doctors, with additional safeguards and
  restrictions on the hours that doctors are
  required to work
• include new contractual terms and additional
  pledges from Health Education England that
  support the training needs and experience of
  doctors
• deliver a new model for pay that is fairer, more
  transparent and is financially sustainable, while
  ensuring that the average pay across the junior
  doctor workforce remains unchanged. It reflects
  agreements reached with the BMA in the
  discussions held in December 2015 and January
  2016.

17
Finance

• The contract is cost neutral with small
  additional transitional cost, met from the global
  NHS pay budget.
• The cost neutrality has been modelled at a
  national level and there will be different
  implications depending on the deployment of
  junior doctors.  The phased implementation will
  allow for tracking of the additional cost or
  saving to your organisation.
• The government agreed an increase in predictable
  basic pay when negotiations were approved in
  2012 this does increase pension contributions
  for both the employer and the doctor (an
  advantage to the latter in a career average
  scheme).
• NHS England and NHS Improvement are sighted of
  these implications over the three year
  transitional period, and these costs must also be
  tracked.