Junior doctor Medical student England Contract

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Junior doctor contract review 2018

In August 2018, the BMA, working in equal partnership with NHS Employers and the Department of Health and Social Care (DHSC) have begun the review of the 2016 junior doctor contract. 

The first meeting of the newly reformed Joint Negotiation Committee (Juniors) met on 31 August 2018 to formally commission and start the review process.

Read the joint statement

Since the imposition of the 2016 contract, the BMA has remained in dispute with the government and therefore hasn’t been able to agree any changes to the contract. However, we have been meeting regularly with NHSE on an informal basis and have focused on resolving issues raised by members, including tackling fatigue, improving rostering, and securing improvements for less than full time trainees. Further details on key achievements between 2017-18 are outlined below. 

There remains a number of areas where substantive change is still required, and we plan to address these in the review now that we have secured a commitment to negotiations as equal partners. We have been clear that the review must result in enhancements that will improve junior doctors’ working lives and address the issues that have previously stopped the contract from being collectively agreed.  

We have secured commitments from the Secretary of State for Health and Social Care as part of the 2018 review process on the following: 

  • The pay linked to evening and weekend working will be re-considered and the potential for additional, new, outside of the envelope funding will be part of that conversation, particularly for those working the most weekends.

  • There will be a strong focus on safety and training, and on ensuring that exception reporting works so that juniors don’t miss out on training, or work excessive hours, because of service pressures. 

  • HEE will look at how the Enhancing junior doctors working lives programme of improvements related to training (for example rota notice periods) can be accelerated.

  • Extension of the less than full time emergency medicine pilot to other specialties. 

  • In future, as part of the Quality Accounts, every trust must publish a consolidated annual report on rota gaps (which reflects rota notice periods) and the plan for improvement to reduce these gaps. This would need to be signed off by the chief executive of every trust and would be publicly available. 

  • All trusts will implement e-rostering for juniors to improve work-life balance and flexibility.
  • £10m will be made available to trusts via the guardians of safe working and local junior doctors forums; and will be specifically allocated to improving working conditions for junior doctors via facilities and resources.

The 2018 review process

The first step in the review process has been to establish five working groups that will gather data and evidence on how the contract is working. Our focus will be on jointly agreed themes, which reflect the outstanding issues and areas of concern as identified by your JDC.

The five key themes are:

  • Less than full-time, flexible working and equalities
  • Pay structure and transitional arrangements
  • Safety and wellbeing
  • Workforce 
  • Training and education

The role of the working groups is to commission research, evaluate data and prepare possible options and recommendations to improve the contract. The issues arising from the thematic research will inform how the review proceeds, with BMA members kept informed and engaged throughout the process. 

The groups will be supported by an overarching data group comprised of BMA, NHSE and DHSC analysts, that will draw together a shared source of data to enable discussions to be underpinned by agreed facts and evidence. 

The research outcomes from the working groups will be used to support the development of evidence-based objectives for improving the contract. These will form the basis for formal negotiations in 2019 to agree amendments to the 2016 contract. 

The final package of amendments will be presented to members and a referendum undertaken on whether to accept the new contract.

  • Key improvements and issues resolved during 2017 and 2018

    Over the last two years, the BMA has worked with NHS Employers, HEE (Health Education England) and other organisations to resolve a number of issues raised by members. We have secured improvements in a number of key areas:

    Rostering

    During the negotiations for the 2016 junior doctor contract, a set of new working hour limits and rest requirements were introduced at the request of the BMA. In partnership with NHS Employers, we have jointly developed guidance on good rostering practices. We have also updated our useful rota checker tool.

    Enhancing junior doctors' working lives

    During the junior doctor contract dispute the BMA identified a substantial number of issues that sat outside the contract itself, such as a lack of flexibility in training, late notification of rotas and problems with study budgets. These issues were taken forward through the Enhancing Junior Doctors' Working Lives group, chaired by HEE with the BMA and NHS Employers, with input from the Royal College and General Medical Council.

    Rota gaps

    The culmination of 18 months research across secondary care, our report into medical rota gaps offers practical solutions. We are now lobbying stakeholders who can implement our recommendations.

    Exception reporting

    Along with NHS Improvement, NHS Employers, GMC, CQC and others, we have joined a working group that is assessing how the exception reporting mechanism can be improved. We are also working with the two main NHS exception reporting software companies to amend their systems and ensure junior doctor input into the future development of ER and related software packages.

    Less than full time trainees

    We have collated guidance on pay, rostering and working patterns in a hub for less than full time trainees. In addition, we secured key improvements to NHS Employers’ guidance on champions of flexible working.

    Gender pay gap

    We have a unique and integral role on the gender pay gap review launched in May 2018, following lobbying by the BMA on this issue.

    Locum work

    Aware that trusts were misinterpreting a clause on locum activity, we challenged and obtained clarification on the intention of the clause, with NHSE updating their FAQs accordingly. 

    We have also lobbied for explicit updates on LTFT trainees undertaking locum work in both the Gold Guide and GMC guidance

    Transitional pay protection 

    Following lobbying from the BMA, at the end of March 2018, a new version of the TCS was published with revisions to Schedule 14. This incorporated amendments to extend transitional pay protection to junior doctors moving to England from a training post in the devolved nations or a Defense Medical training programme.

    Flexibility

    Asked by the Secretary of State to explore increasing flexibility for junior doctors, in March 2017 the GMC published their report, featuring a number of recommendations aimed at identifying and removing barriers to flexibility in postgraduate training. 

    Fatigue and safety

    Our Fatigue and facilities charter outlines simple steps that can be taken to improve facilities and reduce fatigue, so doctors can safely, effectively and efficiently care for your patients. So far, it has been formally adopted by 83% of trusts across England and Wales.

    GP trainees

    Working with NHS England and COGPED, we have agreed scheduling guidance for juniors undertaking training rotations in GP settings, as well as guidance for GP practices employing GP trainees under the 2016 contract.

    Academics

    We have worked closely with UCEA (University Council for Educational Administration) to ensure pay parity between the academic sector and the NHS, to commit to transitional pay protection and to match flexible pay premia.

    These are just some of the gains we have made for junior doctor members while still in dispute and without a formal remit for negotiations, which also include; securing improvements to the cash floor protection for unbanded foundation trainees, agreeing a number of joint FAQs with NHS Employers to clarify areas of ambiguity and ensuring correct maternity pay for trainees who transition onto the new contract during, or after, the qualifying period or while on maternity leave.  

    Read more about the work we have been doing