Junior doctor Consultant England

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Key point summary of DDRB report

In its response to the DDRB report the Government has committed to creating a seven-day hospital care service by 2020.

In October 2014, the DDRB was asked to make observations on proposals for reforming the consultants contract to better facilitate the delivery of healthcare services seven days a week in England, Northern Ireland and Wales.

For doctors in training in England, Northern Ireland and Wales, the DDRB was asked to make recommendations on changes to contractual arrangements. For juniors in Scotland, they were asked to just make observations.

The BMA has been clear in their support for more seven-day hospital services, with a focus on urgent and emergency care. Despite the publication of the DDRB, and the government's response, we are still no closer to finding out how they will pay for more weekend care or how they will ensure there isn't a reduction in mid-week services.

This is a point reiterated by the DDRB who explicitly recognise that it is not clear that "change could be implemented without further resource."

 

Consultant contract

The absence of contractual safeguards was one of the reasons negotiations over the consultant contract stalled last year. Now, both the government and the DDRB have accepted the need for these to guarantee both patient safety and doctor's wellbeing.

However, both the DDRB and the government are adamant that section 3, paragraph 6 of the English contract is a contractual barrier to the delivery of seven-day services (despite evidence that doctors are currently working across seven days of the week) and seek its removal. The Welsh government has not yet formally responded to the DDRB report, and we await their response.

For consultants, as well as junior doctors, the DDRB recommends an extension of plain time working further into the evenings from 7/8pm to 10pm, "in line with other sectors".

However, the DDRB noted that premium pay rates are not out of line with other sectors, and may in fact be lower for consultants in the UK than in other countries, although comparisons are difficult. The health secretary has highlighted the high out-of-contract premium rates sometimes negotiated and insisted this stops.

The DDRB also talks about a new model of pay progression, where consultants will progress more quickly to a plateau. The DDRB recommended that any decisions "should be rooted in a robust evaluation of recruitment, retention and motivation," and we will of course be urgently requesting the necessary data to test the impact of these proposals.

The DDRB also echoed the BMA's arguments that greater clarity on the seven-day service model is needed and that "shared assumptions on the extent of unsocial hours working" are needed to ensure proposed pay arrangements can be modelled. Regarding clinical excellence awards, government will consult on the reform of local and national CEAs.

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Junior doctors

For junior doctors in training, the DDRB has accepted many the Government's arguments, even where these are based on hypothetical, rather than actual, evidence.

The DDRB recommends a replacement of the banding system with a contract based on work schedules, work reviews and exception reporting. On pay progression they also accepted the employers' position that pay should be based on the responsibility of the job. This has the potential to cause disputes over job evaluation, and to create huge swing in income as juniors move from one placement to another, deter changing specialty, and crucially not reward the full range of a trainee's skills and experience.

In addition the DDRB, like employers, supported the idea that where juniors take a career break, such as for maternity leave or to pursue an academic degree, they should not receive a pay increment on their return. This could jeopardise academic medicine for instance, as - despite gaining skills critical to the NHS - trainees will be deterred from taking time to undertake a PhD. The DDRB seems to recognise this risk by proposing flexible pay premia, but this seems on paper to replace a system that works with a more complex and less guaranteed approach.

Despite little evidence that these work, the DDRB seems to place great weight on the power of Recruitment and Retention Premia (RRPs) to solve problems of specialty shortages. Proposing the removal of the GP registrar supplement, in the hope that it will be replaced by an RRP, seems an odd solution to the crisis in general practice recruitment.

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