Junior doctor

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Agreed new contract deal for junior doctors - FAQs

Read our frequently asked questions on the agreed new contract deal for junior doctors.

 

FAQs:

 

 

When will the changes be introduced?:

When will the new contractual terms come into effect, will this be in August 2019?

There will be a staggered implementation for the new contractual terms, with some changes being introduced in August 2019, but many will be after this date.

Given the operational implications of some of the forthcoming contractual terms, a phased implementation has been necessary.

Read the full implementation timeline

 

When will my terms change?

For those already working under the 2016 TCS (terms and conditions of service) your terms will have changed in August 2019 following publication of the new TCS (version 5). An updated version of the TCS was published again in October (version 6), and in November (version 7). A final version is planned to be published in December (version 8), which will include all outstanding provisions as per the implementation timeline.

Many employers will have already sent contracts out, and those trainees who have already received their contract are unlikely to have new ones re-issued. Instead, you will receive a notification from your employer notifying you of these changes with a link to the TCS to make you aware of the amendments, and confirmation that your terms will be updated from August as the current model contract allows.

The implementation of the new contractual terms will be staggered. To find out when each amendment will be introduced see the implementation timeline.

 

Why is there a staggered implementation timeline?

There are a significant number of changes that were agreed as part of the revised contract, as outlined in the framework agreement. Many of these require changes to software systems, rotas or operational processes. 

As such, the staggered approach provides minimal disruption to trainees. It also allows the BMA to work collaboratively with employing organisations to ensure that these changes and enhancements are adopted as intended over a set timeframe, reducing the likelihood of serious implementation issues arising, as was a major concern raised by many trainees previously.

 

I am employed on the 2002 terms and conditions by a lead employer in England, when will I transition onto the new updated 2016 terms? What will happen to my pay?

NHS Employers have now confirmed with host organisations the agreed transitional arrangements for trainees due to move from 2002 terms and conditions of service (TCS) to the updated 2016 TCS. This is to happen as soon as possible within each organisation, but must be complete by the deadline of the 5 February 2020. 

The parties are in agreement that pay protection for these trainees will use and update the 2016 transitional schedule to ensure that these trainees can move to the 2016 terms in a fair and equitable manner, which ensures they will not earn less than they did prior to transition.

Trainees' pay protection category will be determined by the doctor's training level at the point immediately prior to the introduction of the TCS in August 2016 (matching those who transitioned at the time, and detailed within schedule 14 of the 2016 TCS). 

Anyone below ST3 immediately prior to the imposition of the 2016 terms (see Schedule 14 Paragraph 3) will be section 1 (cash floor) pay protected; anyone ST3 or above immediately prior to the imposition will be section 2 pay protected (see Schedule 14 Paragraph 25). 

The Section 1 cash floor value determination date will be amended to reflect the pay and banding immediately prior to transition onto the 2016 TCS (and so will have kept pace with progression and pay since the original imposition to the transition point). This value will then be a fixed minimum pay value, and compared to the work schedule pay for any rotations moving forward, with whichever is higher being paid for that post. Cash floor value will not include, nor be added to, by any 2016 pay elements. 

Section 2 trainees will transition to the 2016 TCS, but retain the 2002 payscale and banding system, continuing to progress up the 10 point ST scale as they would have on the previous TCS. As they are not subject to the 2016 pay scale none of the 2016 pay elements including flexible pay premia or LTFT allowance will apply to this group. Their pay will be purely as if they had remained on 2002, but they will have the benefit of all of the additional protections and clauses of the 2016 TCS.

 

When will the annual 2 per cent pay uplift be introduced? Will it be backdated and, if so, what will happen to trainees who have rotated to new employers in August?

The annual pay uplift was introduced in September 2019 and backdated to 1 April 2019 for the 2019/20 period. 

If a trainee has since rotated into a different employing organisation than the one they were based at in April 2019, they will still receive this backdated pay. When the previous employer runs the process for issuing payment, the ESR system will automatically generate arrears for doctors who have rotated, as well as those still based in that organisation, so they should still receive the uplift from their previous employer as part of their payroll.

 

Why was my December work schedule delayed?

Due to version 7 of the TCS containing changes to various pay elements, but not being published until November, BMA and NHS Employers agreed that the issuing of work schedules for December rotations could be delayed until version 7 was published. Now that this has been done, work schedules and rotas should be issued to trainees as normal.

 

When will the champion of flexible training role be made mandatory?

The inclusion of the champion of flexible training provisions in the 2016 TCS – originally intended for version 7 – has been delayed. During drafting, it became clear that further clarification is needed on the appointment and implementation of this role, particularly within non-hospital settings, and in scenarios where the role could span multiple sites. NHS Employers and the BMA felt it would be prudent to publish the provision within the TCS simultaneously to the publication of supplementary guidance regarding the role, in order to provide the necessary clarity, and ensure successful implementation of these roles.

As such, the champion of flexible training role will be made contractual in version 8 of the TCS, with supplementary guidance published alongside this. In the meantime, we encourage employers to consider the process outlined in the framework agreement, and prepare the necessary appointment panel ahead of time to allow for smooth implementation upon the publication of version 8.

 

 

Pay:

What happens if inflation rises above 2 per cent?

If inflation rises to a level at which we no longer believe the 2 per cent annual uplift is acceptable, the BMA will be able to submit evidence to the DDRB as usual, requesting a higher uplift as a result.

Will the 2 per cent uplift apply to the pay of those on section 2 pay protection, i.e. paid under the old contract pay system?

Yes.

How will the new enhanced "disco shift" rates rules be applied? 

The change to enhanced rates means that for any shift ending between midnight and 4am (inclusive) the entirety of the shift will attract an enhancement of 37 per cent of hourly basic rate. All other payments for the enhanced rate remain the same. 

Is it likely that pay protection will be extended beyond 2025?

This will depend on whether there are there are still trainees in receipt of Section 2 pay protection at that stage. The BMA will review this in 2025 with the aim of extending it for any remaining trainees reliant on pay protection arrangements.

What will happen to trainees still fully employed under the 2002 terms and conditions in England? (note – this does not apply to trainees who transitioned on to the 2016 contract but are still paid under the terms of the 2002 contract due to transitional pay protection)

Some trainees did not transition on to the 2016 contract when it was imposed because they are employed under a long-term lead employer contract that wasn’t due to expire. If the amended 2016 contract is accepted the BMA will collectively agree it on behalf of all junior doctors in England who will all transition on to the new terms. NHS Employers and the Department of Health and Social Care have given a clear commitment that pay protection for trainees who currently remain on the 2002 contract will use and update the 2016 transitional schedule, to ensure that these trainees can move to the 2016 terms in a fair and equitable manner which ensures they will not earn less than they did prior to transition. These updates will be for those transitioning on to the new amended contract and will not affect those who transitioned in 2016/17 under the existing protection arrangements.

We are agreed that further detailed work is needed to ensure that the different mix of individual circumstances in affected groups is properly considered in post contractual discussions, and that circumstances can be further considered on a case by case basis. DHSC and NHS Employers have given the JDC a firm commitment to work together to agree a transition process and timeline which provides fair pay protection arrangements, that will be applied to all trainees transitioning onto the new TCS, in line with the pay protection that is always applied in national collective bargaining of NHS staff contracts.

Will LTFT trainees continue to receive the £1,000 allowance if they decide to go back to full time?

No, the allowance has been introduced to recognise the additional costs LTFT trainees incur throughout their training and will only apply to trainees when they are LTFT. As such, a trainee can go back to full time, and if they return to LTFT training at a later point they will then begin receiving the allowance again.

When do the pay elements scheduled for December 2019 come into effect?

The uplift to the weekend frequency allowance, new enhancement for "disco shifts", and widened eligibility criteria for the academic flexible pay premium all come into effect from 4 December 2019. The £1,000 LTFT allowance is payable from January 2020, but will be backdated to 4 December 2019.

Why has the introduction of the fifth nodal point been staggered between October 2020 and April 2022?

The significant additional investment for the various changes and improvements to pay can only be achieved through the funding being released in fixed amounts each year across the next 4 years.

Extensive modelling was undertaken to ascertain the earliest point that changes could be brought in. The staggered approach adopted for the fifth nodal point represents the highest amounts that can be introduced at each stage to cover to all those ST6 and above, without delaying or reducing the amount of the other pay elements that will come into effect in December 2019, such as the LTFT allowance, weekend frequency allowance uplifts, and the extension of enhanced pay to the entire duration of shifts that finish between midnight and 4am (inclusive). The only other option available is to reduce the fixed 2% annual pay uplifts to release funding earlier, which is equally unfeasible due to the scale of detriment that would be caused to the wider population of trainees. Introducing the fifth nodal point sooner or at an earlier stage of training than ST6 would have significantly reduced the amount available to each trainee.

How is it fair that some trainees who were in higher training in August 2016 will not receive the full benefit of the fifth nodal point nor the earlier front loading of nodal point 4?

We are aware that some trainees who were ST3 in August 2016 may not have transitioned onto the contract until August 2017 and may finish training before the fifth nodal point is introduced in August 2020, or finish training before the maximum amount of the nodal point reaches £7,200 in April 2022. We absolutely recognise the frustrations felt by the trainees in this situation.

The rejection and subsequent imposition of the contract meant that advocating for individuals to transition onto the 2016 contract earlier was not a possibility. Furthermore, as outlined above, it hasn’t been possible to introduce the fifth nodal point any earlier without compromising on other elements of pay. The nature of the additional investment and the fact that this funding is available in stages means that difficult decisions have had to be taken to ensure that as much money, as early as possible, for as many as possible could be achieved, while also ensuring no-one was any worse off than the status quo. 

What can I claim under the new GP trainee mileage provision in schedule 11 paragraph 16?

The BMA and NHS Employers have committed to clarify what additional mileage expenses can be accessed by GP trainees who may be required to undertake home visits in their own vehicle to enable employers to process claims. Clarification is needed around the rates, tax status, and scope of this provision. The parties will work to resolve this as soon as possible, within version 8 of the updated terms and conditions (due for publication December 2019). Any claims unresolved at the point of resolution will be processed immediately and payment will be backdated. As such, trainees should continue to submit claims, as their payment will be backdated.

 

 

Pension contributions:

The pay uplift means that I will see a reduction in take home pay, due to my pension contributions increasing. Is the BMA aware of this, and what is being done about it?

As the pay uplifts for junior doctors across the UK came into effect in September 2019, backdated to April 2019, some trainees noticed a large pension contribution made that month. As you may know we’ve been campaigning for changes to the inflexible NHS pension scheme for some time, for exactly this reason.

Currently in the NHS scheme, there is a significant increase from tier 4 (9.3%) to tier 5 (12.5%) pension contributions. The BMA have been lobbying for various changes to the pension system for many months, including for a flatter contribution structure and for the removal of the higher two contribution tiers. However, this work is currently unable to progress as we await the Government’s plan to address the age discrimination effect of younger staff moving to the 2015 Career Average Revalued Earnings scheme.

While this issue persists, some trainees will experience the unintended effect of pay uplifts causing them to move to tier 5 pension contributions, and see an initial reduction in overall take home pay. This is the case for certain trainees receiving either the pay uplift under the new deal for the 2016 TCS, or the DDRB recommended uplift under the 2002 TCS.

The pension threshold is currently unavoidable in the long term, and this issue of higher contributions has already been faced by London trainees for some time, where the London weighting is also pensionable. Once crossed, this threshold won’t need to be crossed again – meaning pay uplifts beyond this won’t cause the same effect – but it is a key reason behind why we continue to lobby for changes to the pensions system.

Due to the 2019 pay uplifts being backdated to April 2019, some trainees faced back payment of higher pension contributions in September. The BMA has argued repeatedly that employers should offer a staggered re-payment method, rather than reclaim all of the arrears in September and has spoken to NHS Employers to ensure trusts know they are able to offer this. We recognise that this may not be possible where local payroll cut-off dates have passed, but please contact the BMA if you are being affected by this so we can try to help.

This issue is an effect of a pension system that the BMA has continued to raise concerns about. Higher pension thresholds cannot be avoided in perpetuity without refusing further pay uplifts. Due to an agreed 4 year pay deal, the current issue of backdating will not be repeated for any doctors facing this now under the 2016 TCS. This highlights the importance of consistently securing effective pay uplifts for doctors, which mitigate the effects of a pension system that requires urgent reform.

Despite justified bad press about pensions taxation (annual allowance and LTA), coupled with some doctors crossing tiers into higher thresholds, which temporarily reduces take home pay, no junior doctor should consider leaving the NHS pension scheme without seeking robust tailored advice from a registered financial professional, as the NHS pension remains excellent value for money for juniors. This will continue to be the case at least until pensions tax becomes an issue for more senior consultants and GPs.

For example, a 28 year old junior now earning £49,036 (and therefore just in the 12.5% tier) will pay £6,129.50 in gross pension contributions. For that, you will earn £908.07 in pension; however, that increases by 1.5% above inflation each year, so will be worth £1,645.25 per year by state pension age (likely to be at age 68). Your pension will then increase by inflation, so assuming you draw the pension for another 24 years your £6,129.50 contribution will have bought you £39,534 in pension payments (in today's terms). This represents far better value for money that anything you would be able to purchase in the open market with your pension contributions if paid as normal salary.

The BMA’s wider, ongoing, work on pension reform for NHS doctors is aimed at addressing issues such as these, and lobbying for changes which fairly reflect LTFT trainees’ earnings. We will keep our members up to date with progress as it is made. 

The BMA will continue to advocate for pension changes, but equally we cannot advocate that government continue to freeze or reduce junior doctors’ pay in the long term to avoid this short-term impact. 

In the meantime, please do use the BMA’s welfare services and hardship provisions if you are in need of any assistance or find yourself in difficulty.

 

Safety limits:

What is the process for locally agreeing the use of the maximum of 8 consecutive shifts or 5 long day shifts once they are reduced as standard?

It should follow existing local processes for agreeing changes to the work schedule and should involve consultation with the trainees on the rota. A work schedule review should be initiated as necessary. Disagreements on changes to the working patterns should be escalated to the guardian of safe working and junior doctor forum in the first instance, then escalated further through the work schedule review appeals process. The second stage of the work schedule review appeals process involves a trade union representative, such as your industrial relations officer.

Are there any safeguards to protect trainees from being pressured to agree to work the maximum 8 consecutive days or 5 consecutive long days? Will there be guidance on this?

As above, escalation layers such as the involvement of the junior doctor forum and guardian of safe working to ensure that trainees are supported by a wider group when disagreements arise in relation to the use of the higher limits. This can also be further escalated through the work schedule review appeals process as necessary, with the final stage appeal process involving trade union representation from your local industrial relations officer.

We will be producing guidance to support employers and trainees with implementing the changes to the TCS.

Why has a third paid break been introduced for 12-hour night shifts but not for day shifts?

While every effort was undertaken to secure an introduction of an additional break for day shifts, operational data at provider level indicated that in many Trusts this would significantly affect daytime capacity. We reached a compromise to introduce the additional breaks for nights, and also secured a commitment to review breaks and associated operational data through a dedicated health and wellbeing group to see where further improvements can be made in the future.

What is the definition of a 'night shift' for the purpose of a third 30-minute paid break?

For the purposes receiving a third 30-minute paid break (as per version 7 of the TCS, schedule 3 paragraph 21), the definition of a night shift is as per schedule 2 para 17: a shift which begins no earlier than 20.00 and no later than 23.59, lasting up to 10:00 on any day of the week. In order to receive a third 30-minute paid break, such a shift must be rostered to last 12 hours or more.

What is the definition of a 'night shift' for the purpose of rest after a night shift?

For the purposes of receiving 46 hours rest after any night shift (as per version 7 of the TCS, schedule 3 paragraph 13), the definition of a night shift is as per schedule 3 para 12: a shift where at least three hours of work falls into the period between 23.00 and 06.00.

Have there been any changes to rest prior to night shifts?

The changes to rest that have been negotiated apply to those after night shifts rather than prior. However, guardian fines will now apply to a breach of the minimum 11 hours rest between resident shifts, which will improve mechanisms for raising and addressing issues that arise for those cycling from day into night working patterns. 

We will be continuing to review the safety and rest provisions on an ongoing basis through the JNC(J) and an outcome of the negotiations is that a dedicated working group on the health and wellbeing of junior doctors will be convened.

How will guardian fines impact rotas with non-resident on-call?

The intention is that fines should provide impetus for the reviewal of NROC working patterns where safety limits are breached. It should facilitate mechanisms to encourage more pragmatic discussions to find agreeable solutions. This does not mean an automatic change to a full-shift pattern and often other solutions may be found, but it could be an outcome that trainees and employers may agree is necessary in certain circumstances.

Does this deal adequately address the concerns related to non-resident on-call working?

The contractual changes secured to make the NROC elements of the good rostering guidance contractual, extending fines to safety breaches and ensuring the free provision of accommodation for those too tired to drive home or who have to secure accommodation due to emergency response timeframes, are a start in the journey to make further improvements.

We are aware that there are wider and more systemic issues with NROC working patterns which we will be looking to review as part of a dedicated NROC working group that will be commissioned. 

Are trainees who don’t drive covered by the too tired to drive home provision?

The BMA’s position is that if a trainee is too tired travel home, and provision of an appropriate rest facility is not possible (as per schedule 12 paragraphs 9 and 10), provision of a taxi should be the first alternative arrangement which is considered for the doctor’s safe travel home. If providing a taxi is not possible, an employer could then consider if public transport is more appropriate. Public transport should not be the first arrangement offered to the doctor, because the provision is intended to ensure safety and reduce fatigue. Having to make multiple changes or ensure vigilance whilst travelling on public transport is not consistent with meeting this aim, so should be the last resort.

What happens if my employer claims they cannot reduce the weekend frequency to a maximum 1 in 3 by February 2020, in line with the implementation timeline?

The implementation timeline recommends that this change is reflected in rotas by no later than February 2020. However, we recognise that this provision is more problematic to introduce on some rotas than others. In some cases, the introduction of this provision would require recruitment of additional doctors or other healthcare professionals to fill the gaps left on the rotas, which may not be possible by February 2020. If an employer identifies that it is not feasible for a rota to function at a frequency of 1:3 weekends, or less, then prior to February 2020 the appropriate clinical director for the rota should set out the clinical justification for retaining the rota at a higher frequency, which the guardian of safe working hours must adjudge to be appropriate, This justification should be clearly set out and shared with the affected doctors. 

Junior Doctor Forums (JDFs) have the ability to challenge the clinical justification provided by an employer, if they do not believe it to be valid, and/or suggest alternative solutions for consideration, the JDF can request that further evidence is provided for this exemption. However, JDFs do not have unilateral authority to veto an evidenced clinical justification provided by an employer and the guardian. JDFs cannot reject an appropriately justified exemption on the basis of the collective preference of doctors working on a rota not to work a clinically necessary higher weekend frequency.

Following this justification, rotas which exceed the 1:3 weekend frequency should be co-produced with the affected doctors and agreed via the junior doctor form. All rotas which exceed the 1:3 weekend frequency should be reviewed annually as a minimum, but earlier review dates may be deemed appropriate when agreeing the exemption, to assess progress in addressing the need for a weekend frequency of greater than 1 in 3 weekends and whether it is still necessary for the exemption to be retained.

As long as there are no safety implications for both patients and doctors, then it is possible that a rota could remain in place with a weekend frequency above 1:3 where necessary and clinically justified. 

 

 

Exception reporting:

How will the new provisions about adhering to exception reporting time frames be enforced?

Where an educational supervisor (or other nominated supervisor) does not respond within the 7-day time frame, the guardian will now have the authority to intervene in the process and agree an outcome with the trainee.

Where an exception report is left unactioned for an unreasonable amount of time, you should contact the guardian and request that they action your report. If a report is left unactioned after this intervention then you should seek to raise this with your JDF or contact the BMA directly.

Does exception reporting software allow for reports to be sent to a nominated reviewer as well as the educational supervisor?

This will need to be taken forward with the software providers to update their systems to accommodate it. Some current systems allow for reports to be sent to two individuals, this would facilitate the nominated reviewer and educational supervisor to both be selected.

How will the new guardian fine rates work?

The fines are currently outlined on pg.10 of the pay and conditions circular. These are presented in tables; one for plain time hours and one for hours which attract the 37% enhancement. They set out the total hourly rate of the fine, and the apportionment of that to the doctor’s pay and the remaining sum that goes to the guardian pot for the JDF to disburse for the benefit of trainees. 

The rates in these table will be updated to increase the total fine amount in reflection of it being 4x the NHSI locum rate, rather than the standard hourly contractual rate of pay. The fines will then be apportioned as usual, with the doctor receiving 1.5x the NHSI locum rate and the remainder going into the guardian pot. The fines will be frozen at these rates and will not be linked to the NHSI national locum rates contained in a separate table at the bottom of pg.10, which will be removed.

The reviewal and any increases to the fine rates will then be through the JNC(J) mechanism.

What is the penalty for an exception report where a trainee has not met with their educational supervisor within 4 weeks?

Raising an exception report when there has been no meeting with the educational supervisor – as with any educational exception report – is important to file for the trainee’s ARCP. Creating an audit trail of educational failures or missed opportunities is vital on an individual basis to show where curricula requirements or other important educational milestones have not been achieved due to an issue with the employer.

DMEs also must be aware of all educational exception reports and report annually to the trust board – in the case of non-hospital trainees, these must be completed by the relevant Head of School. Filing exception reports when there has been an inability to provide required educational needs for doctors on a postgraduate training programme is important to make sure that the DME/Head of School will resolve those issues going forward.

There is presently no direct financial penalty on a trust for a trainee failing to ensure that the trainee has not met with their education supervisor in four weeks.

 

 

Code of practice:

When will information be available about elements of the Code of Practice being made contractual?

The BMA and NHS Employers legal teams are working together closely alongside BMA representatives, BMA staff and NHS Employer representatives to put into place the legal mechanisms to make the Code of Practice contractually enforceable and ensure provision of generic work schedules and rota/roster information at the relevant 8 and 6-week deadlines.

Further information will be brought to JDC and the wider membership as it becomes available and the legal elements established.