GP practices

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Guidance for GP practices on the 2016 junior doctors’ contract

Background

For those GP practices who employ GP trainees, you need to be aware of the impact of the new 2016 terms and conditions of service for junior doctors which were introduced in August 2016.

GP practices who employ trainees directly, are not obligated to offer these terms and conditions. However, there are many non-negotiable contractual requirements that must be in place before offering the new contract to trainees, if you choose to do so.

These non-negotiable contractual requirements will also apply to GP trainees employed by the practice under a lead employer arrangement.

To help you understand the contractual requirements that you must adhere to, we have compiled this guidance to highlight the key information.

 

What you need to know

Read this guidance to understand the key contractual requirements to have in place when employing a GP trainee.

 

  • Work scheduling

    GP trainees employed under the 2016 contract will be issued with a generic work schedule prior to starting their placement. This will set out the working hours and the training opportunities in their placement.

    This generic work schedule is then personalised. The personalised work schedule is developed jointly by the trainee and the clinical supervisor, who is also responsible for reviewing the work schedule and ensuring it remains fit for purpose.

    The trainer (clinical supervisor) should arrange an educational meeting to agree a personalised work schedule with the trainee either before or at the start of their placement. This should be developed according to the trainee’s learning needs and the opportunities available within the post.

    The meeting will take into account the trainee’s personal circumstances, including any specific training needs that they may have.

  • Exception reporting

    Exception reporting is a feature of the 2016 contract which allows junior doctors to immediately report instances where their actual work and training opportunities vary from their work schedule.

    The employer must provide some form of electronic system for trainees to submit exception reports.

    The report is sent to educational supervisors (in GP practice placements these will be approved clinical supervisors) and copied to guardians of safe working (for work issues) or the Director of Medical Education (for training issues).

    Clinical supervisors will review exception reports and discuss them with the GP trainee to agree what action is necessary to address the issue.

    This could involve revising their work schedule, and approving claims for additional pay or time off in lieu. If a solution agreeable to both parties cannot be found, this needs to be raised with the guardian of safe working.

    This extension of the clinical supervisor’s role will also have implications for their workload. This is additional to the trainer’s grant and may need to be varied locally, and the non-educational element of the changes will be a new skill for many.

    Effective exception reporting should result in timely adjustments to trainees’ work schedules and, where appropriate, allow trainees to receive additional pay or time off in lieu.

    Clinical supervisors responsible for trainees on the 2016 contract should read the BMA's exception reporting guide for senior doctors in full and familiarize themselves with the process.

  • Work schedule review

    If sessions overrun frequently, it may be necessary to undertake a work schedule review.

    This is a conversation between the trainer and the trainee about whether the work schedule is fit for purpose, which may prompt one or more of the following outcomes.

    • No change to the work schedule is required, but compensation in the form of pay or time off in lieu is required for one or more individual breaches of the work schedule.
    • Prospective changes are made to the work schedule so that going forward from the review, the trainee’s hours and/or training commitments are changed.
    • Organisational changes are needed, such as a review of the clinics and administrative tasks. If such organisational changes are needed, this may take a while to happen. In the meantime, temporary alternative arrangements should be made where necessary.

    If a trainee is unhappy with the outcome of the work schedule review, they can escalate this by requesting a level 2 work schedule review within 14 days of being notified of the outcome of the first review.

    If the trainee is still unhappy with the outcome of the level 2 review, they can request a final stage work review. This will involve a formal hearing with a panel that must include a representative from the BMA or other trade union representative.

    For more on work schedule reviews and detail surrounding each stage of the escalation process, see the BMA's guidance on exception reporting outcomes.

  • Guardian of safe working

    The guardian of safe working hours is a key feature of the 2016 contract.

    All trainees employed under these terms and conditions of service must have access to the guardian. This is a non-negotiable contractual requirement.

    If there is a lead employer, it is their responsibility to appoint a guardian. If the practice employs trainees directly, then it is the practice’s responsibility to appoint a guardian.

    Practices that directly employ trainees and who have fewer than 10 GP trainees should:

    • jointly appoint a guardian with a similar employer(s) so that the guardian is responsible for at least 10 trainees; or
    • enter a contract with a neighbouring trust to provide the guardian function for the practice.

    The guardian is responsible for overseeing compliance with the safeguards outlined in the 2016 terms and conditions of service. The guardian will identify and either resolve or escalate problems, and act as a champion of safe working hours for junior doctors.

    The guardian provides assurance to the employer or host organisation that issues of compliance with safe working hours will be addressed as they arise.

    For more on appointing a guardian and what the role involves, please read the BMA's guidance for doctors undertaking the guardian of safe working hours role.

  • Scheduling out-of-hours (OOH) shifts

    When designing a rota for the 2016 contract you must ensure that there is a minimum of 11 hours’ rest between shifts. This means that instead of having a trainee carry out a day shift and then arranging a separate evening shift for OOH work, a single shift must be rostered to encompass OOH without any gaps between duties. It is an additional requirement that individual shifts do not exceed 13 hours in length.

    OOH work must be deducted from a clinical shift in the same week, or a later week (if agreed), to ensure that the working hours on average per week do not exceed 40 hours.

    20170920 Guidance for GP practices doc/ web graphic.   Title: The template rota below shows how a rota could be organised to schedule OOH work in compliance with the above requirements

    Work schedules (including rotas) should be planned in advance, and personalised together with the trainee.

    The full range of safeguards that must be adhered to when planning a rota can be found in the BMA’s rota rules at a glance.

    BMA members can check whether their rota is compliant with the contractual requirements using the BMA’s rota checking tool.

    OOH for less-than-full-time (LTFT) trainees

    Out-of-hours will be pro-rata for LTFT trainees. This means that if a trainee is working 50%, their OOH requirement will be 36 hours over the course of the year.

  • Understanding the new pay system

    The new pay system is made up of multiple different elements.

    For GP trainees, the main elements of pay will be:

    • Basic salary: GP trainees on the new contract will be paid a salary linked to their grade, calculated on an average of 40 hours’ work per week.
    • Flexible pay premia (if applicable): GP trainees are entitled to a flexible pay premia when working in a practice. GP trainees on integrated academic pathways or who take approved time out to undertake academic research leading to the award of a higher degree may also be eligible to receive an academic pay premia.
    • Unsocial hours enhancement: GP trainees will receive a 37% enhancement on hours worked between 21:00 and 07:00 on any day of the week. OOH should be scheduled to have no fewer than 12 and no more than 22 hours of work during the hours of 21:00-07:00 each year. Where a placement is shorter than one year, the number OOH scheduled to take place in unsocial hours will be pro-rated accordingly. For example, a 6 month placement should have no fewer than 1 hour and no more than 11 hours of OOH work during the hours of 21:00-07:00.

    Further elements of pay are available but are likely to not be relevant to GP trainees in practice placements, these are:

    • Weekend allowance (if applicable): A weekend allowance is payable to trainees working on rotas with a frequency of 1:8 or more weekends, up to maximum frequency of 1:2. GP trainees should normally not be expected to work more than 6 weekends per annum, and should therefore work at a frequency less than 1:8.
    • On-call availability allowance (if applicable): Trainees who work on-call will receive 8% of their basic salary for their availability.
    • Pay for additional hours (if applicable): Trainees can be rostered and paid for an additional 8 hours of work per week on average above their 40 hours. Additional hours will normally be considered as service provision and therefore not be eligible for reimbursement by HEE.

    Useful resources:


    Pay for less-than-full-time (LTFT) trainees

    The values of basic salary and any flexible pay premium should be calculated pro-rata in proportion to the trainee’s commitment to the full time rota. This means that a trainee working 50% of a full time one-year practice placement would receive 50% of the basic salary and flexible pay premium during each year of their two-year placement.

    The 37% enhancement applies on any eligible hours as standard.

  • Transitional pay protection

    Some trainees may be entitled to transitional pay protection. Under the new contract, there are two types of transitional pay protection. The first type ("Section 1") is known as the 'cash floor' pay protection and applies to trainees who were below ST3 on the 2nd August 2016. The second type ("Section 2") applies to trainees who were already at ST3 or above on the 2nd August 2016.

    If a trainee is already employed on the 2016 contract, their previous employer will have calculated their pay protection and this information should be provided to you when the trainee takes up the post. If the trainee has not previously been employed under the 2016 contract, you may need to calculate their pay protection.

    Transitional pay protection is complex and will vary depending on the trainee's circumstances, so it is strongly recommended that you read the BMA's guidance on pay protection in full and use the calculator if necessary. This is especially the case if you will be moving a trainee onto the 2016 contract who was previously employed under a different contract in their previous post, as you will need to determine whether pay protection applies.

    If you are unsure about whether pay protection applies or the type of pay protection a trainee should receive, please contact the BMA for individualised advice at [email protected] or on 0300 123 1233.

  • Contract comparator guide

    GP trainees employed under the 2016 contract will be subject to a number of changes to their terms and conditions as compared with the 2002 GP trainee framework contract.

    An overview of the key differences contained in the 2016 contract is set out the contract comparator guide, but should be read in conjunction with the full terms and conditions set out in the 2016 TCS.

    Contract comparator guide

  • FAQs

    Can I offer the new contract without appointing a guardian of safe working?

    No, the guardian of safe working is an integral part of the new contract and it is imperative that trainees are able to access a guardian in order to ensure that they are working safely. If you are employing trainees on the 2016 contract directly, you will need to ensure that they have access to a guardian. This is a non-negotiable contractual requirement and employers who do not have a guardian in place will be in breach of the 2016 terms and conditions. For more on the process of appointing a guardian, please refer to the guidance on guardians of safe working.

     

    What type of system should be used for exception reporting?

    The contract stipulates that the system must be electronic, so trainees cannot be expected to fill in forms by hand. There are multiple software systems for exception reporting, and the two most commonly used by employers are Allocate and DRS.

    For further guidance on exception reporting, please consult the BMA’s exception reporting key guidance resources.

     

    What happens if an educational session is cancelled?

    If an educational session is cancelled, the session itself should still be used for educational purposes. If a structured educational session is cancelled, then an independent educational session should be taken at that time. Trainees should exception report any changes to planned training sessions and a work schedule review may be required for the trainee and educational supervisor to agree the soonest possible date that the missed structured session can be arranged in place of a future independent session.

     

    Can I offer the new contract without setting up a junior doctor forum?

    The 2016 contract includes a requirement for junior doctor forums to be set up. The forums are not an optional add-on but a non-negotiable contractual requirement, and all trainees in England must be able to access and participate in a forum.

    Further information and resources, such as a draft constitution for setting up a forum, can be found on the BMA’s junior doctor forum webpage.

     

    What should a work schedule look like for trainees in GP practice placements?

    Guidance on managing work scheduling in general practice settings for trainers and trainees is available from NHS Employers.

    For trainees who are employed under the 2016 terms and conditions of service, the template generic work schedule can be used as the basis for developing the personalised work schedule.

    It may be necessary to change the work schedule during a placement if there are significant changes in the facilities, resources, or services, or if the practice or the trainee decide that the schedule is not fit for purpose.

     

    What are the new hourly limits under the 2016 contract?

    For a full list of the hourly limits under the new contract, see 'rota rules at a glance' on the BMA's check your rota guidance page.

     

    What if a trainee breaches the new hourly limits under the 2016 contract?

    If a trainee works hours that result in a breach of the following limits, a penalty fine will be levied.

    • The trainee works over 48 hours average per week.
    • The trainee works over 72 hours in any seven consecutive days.
    • The minimum rest period of 11 hours between shifts is reduced to less than 8 hours.
    • The trainee misses more than 25% of breaks across a four week reference period.

    The guardian will review all exception reports copied to them and levy a fine if any of the above circumstances have been breached, equal to four times the hourly rate. The fines will then be distributed as follows.

     

    Total financial penalty Hourly penalty rate paid to the doctor Hourly penalty rate paid to the guardian
    Additional hours worked attract a basic rate The total value of the fine is four times the basic hourly rate x1.5 of the basic hourly locum rate The remaining money (equalling the total value of the fine minus the rate paid to the doctor)
    Additional hours worked attract an enhanced (night) rate The total value of the fine is four times the enhanced hourly rate   x1.5 of the enhanced hourly locum rate The remaining money (equalling the total value of the fine minus the rate paid to the doctor) 

     

    If a trainee works over their rostered hours - for example if they work nine hours on a day when they are scheduled to work eight, or if their average weekly hours exceed the contracted 40 hours (inclusive of out-of-hours) - but this additional time does not result in one of the aforementioned breaches, they will be compensated for the additional time worked either through payment for the additional time at the applicable hourly rate, or through time off in lieu (TOIL).

    It is for the supervisor and trainee to jointly agree the method of compensation.

     

    Will all GP trainees be employed under the 2016 contract as of August 2017?

    No, it is possible that you may have GP trainees working in your practice employed under two different contracts, or only trainees employed under the 2014 COGPED framework contract.

    As the 2016 terms and conditions of service have not been collectively agreed by the BMA, trainees under lead employer arrangements must consent to being moved onto the new contract and they retain the right to remain under their existing contract until it expires.

    Practices that employ trainees directly may choose to offer trainees a choice of the 2016 contract or the 2014 COGPED framework contract.

    For employment advice, please email [email protected]bma.org.uk or call 0300 123 1233 .