Junior doctor

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DDRB recommendations - analysis for juniors

Standard time/unsocial hours rates

What the DDRB recommended:

"Recommendation 6: We support the use of scenarios C and C+ as the basis for further discussion/ negotiation between the parties"

"Recommendation 7: A common definition of core time/unsocial hours is required for all NHS groups. If the definition needs to differ between groups, then a commonly understood rationale would be required"

"Recommendation 18: Further sensitivity testing should be undertaken on pay modelling data to determine an appropriate increase to basic pay and wider applicability of the proposals"

What this means:

  • An extension of 'standard time' from 60 hours to 90 hours per week.

Routine ('standard time') working hours are currently 7am-7pm, Monday-Friday. If any of your work falls outside this period - during evenings, nights or weekends - you receive a pay premium as part of your banding payment. This reflects the impact of unsocial hours on your personal and family life. The DDRB recommend extending standard time to 7am-10pm, Monday-Saturday. This would mean that an hour of work at 9pm on a Saturday evening would be paid in exactly the same way as an hour at 9am on a Tuesday morning. The specific scenarios cited in the recommendation - 'C' and 'C+' - propose splitting remaining premium hours into two different rates, with Sunday hours between 7am-10pm paid at a lower rate than work at night (10pm-7am every day of the week).

The BMA opposed any extension to standard time hours for junior doctors during contract negotiations. Junior doctors routinely work outside of 'standard time' and are committed to continue doing so in order to provide their patients with high quality care around the clock, however evenings and weekends are precious opportunities to spend time with friends and family and it is only fair that your pay reflects this when work requires you lose them.


Contractual safeguards and the banding system

What the DDRB recommended:

"Recommendation 3: We support a contract based on work schedules, work reviews and exception reporting, and the end of banding payments"

"Recommendation 8: We support a contract based on basic pay (up to 40 hours per week), rostered hours (up to eight hours per week, on average) paid at the same rate as basic pay and an unsocial hours premium"

What this means:

  • The end of banding payments.

Your current contract is based on the banding system. This provides pay supplements based on an overall assessment of the length and unsocial timing of your duties. It also has built-in safeguards to prevent excessive hours and to ensure you receive sufficient rest and breaks. Your hours and pay are checked by regular monitoring rounds, which your employer is legally obliged to respect.

The BMA was willing to negotiate on a simpler alternative to the banding system - but only provided that it sufficiently recognised unsocial working patterns, and so did not disincentivise training in certain specialties.

The DDRB failed to demonstrate that the alternatives they did recommend would not have this detrimental impact on trainees in particular specialties. They recommend a premium rate of pay only for those particular hours of work that fall outside 'standard time' hours. This would mean that regular duties involving late shifts on Friday and Saturday evenings would receive a small pay premium just for the couple of hours falling beyond standard time - only after 10pm in the DDRB proposals - rather than one that more fully reflects the overall impact of regularly losing weekend evenings on your personal and family life.


What the DDRB recommended:

"Recommendation 4: Work reviews should be evidence-based, accountable and timely".

"Recommendation 5: We should be provided in the future with annual data on the outcome of employee-triggered work reviews on a UK-wide basis"

"Recommendation 17: The wording on contractual safeguards in Schedule 3 of the draft contract should be strengthened to a mandatory requirement to comply with the requirements of Working Time Regulations or any successor legislation"

What this means:

  • The end of banding safeguards, without an alternative to prevent unsafe hours or ensure you are paid when shifts overrun.

The banding system provides an effective penalty for employers against fatiguing and unsafe working patterns by giving them a financial interest in planning rotas and staffing wards properly. The Working Time Regulations provide broadly weaker protections than existing banding thresholds, with shorter and less frequent rest, and without an enforcement mechanism that has an immediate impact for juniors. They exist in addition to, not instead of, your contractual entitlements.

The BMA was willing to negotiate on a system of pay based on hours, rather than according to pay bands - but only so long as it provided sufficient protections and still meant pay for hours actually worked, not just pay for scheduled hours.

The work review process proposed by the DDRB provides no payment for overtime, no financial incentive for employers to prevent your duties from overrunning, and no reassurance that it can work robustly to protect juniors from unsafe working conditions. The DDRB's alternative to banding safeguards is to more clearly oblige employers to follow the law on the Working Time Regulations, which provide weaker protections than banding currently does. This is important, but not a sufficient protection on its own.


GP trainee supplement

What the DDRB recommended:

"Recommendation 13: GMP trainees should be paid on the same basis as hospital trainees"

What this means:

  • Removal of the GP specialty training supplement.

Currently GP trainees are paid a supplement, which ensures they are not financially disadvantaged for their choice of specialty compared with hospital trainees. The proposal is to end this, with only the possibility of it being replaced for some trainees by an uncertain 'flexible' pay premium that might only be offered in certain geographic areas and could be removed over time. The GP training supplement ensures pay parity between hospital and GP trainees, as the experience of GP trainees is very different to that of hospital trainees - for example, there is far less potential for out of hours work - and without the supplement GPs would be paid 31% less.

This proposed change could risk general practice becoming an inequitable training option and an unattractive career choice for medical graduates, and the BMA has called for the GP training supplement to be retained.


Non-resident on-call pay

What the DDRB recommended:

"Recommendation 9: The contract should include an availability allowance to recognise an obligation to be on standby to return to work, with the rate of the allowance varied to reflect the frequency of on-call"

What this means:

  • Replacing hours-based pay for non-resident on-call duty with a single 'allowance' to compensate you for being available.

Currently you receive a banding supplement for all hours spent on non-resident on-call duty. Under these proposals, this would be replaced by a single allowance to compensate for the inconvenience of remaining on standby, however long for.

This change may mean the rates of pay for doctors working these sorts of shifts could be extremely low. As juniors well know, the risk of being called into work means that childcare arrangements would need to be in place whether working from the hospital or from home, adding an extra cost to the trainee that an availability allowance is unlikely to cover. The BMA has argued that non-resident on-call duty should continue to be paid based on hours actually available.


Pay progression

What the DDRB recommended:

"Recommendation 1: Pay should be based on stages of training and actual progression to the next level of responsibility, evidenced by taking up a position at that level"

What this means:

  • The end of automatic annual pay progression, with pay linked to stage of training instead.

At the moment your pay increases every year in recognition of your experience. Under these proposals your pay will only rise if you progress to subsequent stages of training.

This proposed change could disadvantage those who take time out of training, for example because of sickness or maternity leave, or to train Less-Than-Full-Time - as these trainees would take longer to progress through different stages of training. It would also negatively impact those taking time out for academic training, such as a PhD, who could receive some form of extra pay premium but only if their research is deemed 'valuable' by employers. The BMA has argued that pay progression should recognise the increase in valuable experience that comes with time spent training, working and researching in different capacities, and must not negatively impact those trainees who need to take time out or train LTFT as compared with their pay under current arrangements.


Pay protection

What the DDRB recommended:

"Recommendation 1: Pay should be based on stages of training and actual progression to the next level of responsibility, evidenced by taking up a position at that level"

"Recommendation 2: Flexible pay premia could be used to recognise, where appropriate, junior doctors who take a break from training for exceptional reasons that benefit the NHS or health provision more broadly"

"Recommendation 12: Flexible pay premia should potentially be used to recognise additional experience, where appropriate, for junior doctors that choose to retrain in a different specialty"

"Recommendation 14: Flexible pay premia should be used to recognise, where appropriate, academic trainees that take a break from training to undertake a relevant MD, PhD or other relevant postgraduate qualification, not only for academic work related to an individual's CCT, but also when the work benefits the wider NHS and the continuing improvement of patient care"

What this means:

  • The use of 'flexible' pay premiums to partly make up for the loss of pay protection and automatic pay progression to some trainees.

At the moment your pay is protected if you choose to retrain in a new specialty and your pay can continue to progress annually (see above). But under these proposals you would return to train in your new specialty at a lower salary by default, with only the possibility of some form of pay premium for certain trainees to recognise the value of their experience. The proposals appear to envisage your employer making the determination of what is 'valuable'.

These proposals would also mean your pay would not be protected if you took time out of training, again with only the possibility of a pay premium for those who take time out for certain reasons deemed 'valuable' by employers. The BMA has argued that it is important to mitigate against the negative impact of removing automatic pay progression on all trainees, not just academics or those who can 'prove' their time out will benefit the NHS. Also, recruitment and retention problems may well be exacerbated by the removal of pay protection, as it would disincentivise any doctor wishing to retrain in another specialty. The BMA has called for juniors' pay to be protected when they retrain.


Recruitment and Retention Premiums

What the DDRB recommended:

"Recommendation 10: The contract should include the potential use of RRPs (or flexible pay premia) to incentivise hard-to-fill specialties and that they are paid where required"

"Recommendation 11: For future rounds, the parties should submit evidence setting out what advice has been put forward on shortage specialties and RRPs (or flexible pay premia) so that we are able to review retrospectively the effective use of RRPs and make recommendations as appropriate"

What this means:

  • The use of 'flexible' pay premiums to incentivise recruitment to shortage specialties.

The proposed move towards using pay premiums to incentivise recruitment would mean that pay would vary according to the popularity of your speciality choice at a given time, not the length or intensity of work done.

Problems of recruitment and retention in some specialties go much deeper than just salary, and require contractual change that improves quality of life - the BMA has supported attempts to address recruitment problems through a combination of approaches. Under the DDRB's proposals pay premia would be funded from within the current total amount available for juniors' pay, meaning that they could only be used by cutting the pay of other trainees - so under these circumstances the BMA has stated that it could not support the introduction of pay premia.


Annual leave

What the DDRB recommended:

"Recommendation 19: Whilst fixed leave may be necessary, its use should be exceptional"

"Recommendation 20: The current arrangements for ad-hoc public holidays (via local implementation) should continue"

"Recommendation 21: Annual leave on first appointment to the NHS should be 25 days, rising to 30 days after 5 years' service"

What this means:

  • No increase in annual leave, and no firm action to stop fixed leave.

At the moment annual leave for juniors is (equivalent to) 25 days in F1, F2 and the first three years of StR service - then it rises to 30 days. The BMA proposed that all junior doctors should receive 30 days annual leave.

Fixed leave is the practice of setting specific dates during which a doctor in training can take annual leave instead of allowing individuals to request leave when they need it. This can have a profoundly negative impact on junior doctors' quality of life by making it difficult to accommodate unexpected life events, to manage family life, and to create a healthy work-life balance. The BMA has argued that fixed leave is almost always used unnecessarily and has called for its use to be restricted.

Currently there is no entitlement to ad hoc public holidays (like the Royal Wedding, for example) so these are given only at the discretion of the individual employer. Under these proposals this arrangement would continue, whereas a contractual entitlement to these holidays would ensure consistency for all trainees in access to leave on these days.



What the DDRB recommended:

"Recommendation 22: Fees earned for private professional work during NHS time should be remitted to the employing organisation"

What this means:

  • Juniors' earnings for doing private professional work would have to be handed over to their employer if the work was done during NHS time.

At the moment you can retain any fees earned for work beyond NHS entitlements, as long as it doesn't interfere with your other contractual duties or other NHS activities, subject to any charge made by your employer for the use of their facilities.

Under these proposals, fees earned would have to be given to your employer so would constitute a significant loss of income for some doctors in training, and restrict their potential income compared to what is available currently. This may disproportionately affect some groups of trainees, for example psychiatry trainees who undertake Mental Health Assessments - like Fitness to Plead reports which are part of their training experience - for a fee.

The BMA has called for the current contractual provisions on private professional fees to be retained so that juniors can keep these earnings.



What the DDRB recommended:

"Recommendation 23: Junior doctors should be fully reimbursed for reasonable actual relocation expenses incurred in the performance of their duties"

What this means:

  • Juniors must be reimbursed for their relocation expenses and employers can't set arbitrary limits on this.

At the moment juniors should be entitled to full reimbursement for reasonable relocation expenses, but in practice employers are able to set arbitrary upper limits on this at their own discretion. The BMA has argued that doctors should not be financially disadvantaged by costs they have legitimately incurred in the interests of the NHS or their training, and that the existing provision for removal expenses should be retained and strengthened.

In their recommendations the DDRB stated that they did not agree that employers should have discretion over whether or not to pay relocation expenses, and that the relevant schedule of the contract should be amended to show clearly that juniors should be fully reimbursed for reasonable actual relocation expenses as part of their 'duties'. However, the DDRB failed to make clear that these expenses would still be available when juniors move between employers as part of their training requirements. If they were available only for relocation while staying with a particular employer then there could be a significant fall in the numbers of juniors eligible to receive reimbursement of the relocation costs their incur.



What the DDRB recommended:

"Recommendation 16: The year immediately preceding contractual change should be used as the baseline for the cost-neutral pre-condition of the negotiations"

What this means:

  • A change to the total pay available for sharing among juniors.

In entering contract negotiations in 2013, the BMA agreed with the employer side that changed pay arrangements would not result in a change to the total amount of pay available for the junior workforce, and agreed that extra employer pension contributions arising from any increase to basic pay would be funded additionally and not taken from this total.

The DDRB propose changing the reference year to the year preceding contractual change.


What the DDRB recommended:

"Recommendation 15: Once the parties agree the pay and new contractual arrangements for junior doctors, then the BDA and Health Education England should discuss an appropriate level of salary for dental foundation trainees, based on an assessment of job weighting equivalency"

What this means:

  • The future salary levels for dental trainees will be discussed with the British Dental Association.

This recommendation relates to future consultation with the British Dental Association, which is the trade union and professional association for dentists in the UK. The DDRB proposal is to discuss and agree the future salary for dental foundation trainees only after it becomes clear what juniors at similar stages of their career would be paid under the DDRB's proposed contractual terms.

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