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a. How junior doctors are paid: the current model of ‘banding’ and ‘annual increments’b. How junior doctors would be paid under the new contract: the new modelc. Worked examplesd. Your right to do locums and the new ‘fidelity clause’e. Recruitment and retention: pay premia
Dear junior doctors and medical students,
The aim of this document is to give you the facts you need to make your own judgments about the new contract. It is detailed and requires careful reading, but I hope that it provides you with the comprehensive information you need ahead of the vote. The BMA will do its best to answer all of your questions and will regularly update its FAQs on its website.
One way in which we have sought to address questions and concerns about this new contract is to contrast it against the protections your current contract affords you. To give you just one example, under the current contract junior doctors working on a 1A banded rota have no contractual protection from a hospital trust rostering them to work every weekend of the year (1 in 1) and from making every =shift a night shift. Theoretically, a doctor’s work-life balance could be non-existent under the current contract. More worryingly, some of the minimum rest breaks to which junior doctors are entitled (such as the 11 hours minimum rest between resident shifts at work) do not exist in the existing contract – instead, they come from external European Working Time Directive (EWTD) legislation from which all doctors could at any time be exempted.
What actually stops hospitals currently rostering doctors in combinations of eternal nights and weekends is of course the practical pressures of ensuring patients receive continuity of care, the need for junior doctors to receive some training, and that daytimes and weekdays are not riddled with rota gaps because everyone is working at night or on a weekend. None of these practical issues disappear with the arrival of a new contract. In fact, the new contract makes them all the more pressing thanks to the new safeguards included to contractually enshrine your rights to meaningful training and adequate rest.
I know that the notion this new contract will somehow ensure ‘cost-neutral’ delivery of new seven-day services is hugely concerning to all of you who believe that the only real way to improve safety at weekends is to train and provide new staff to populate weekend rotas. To allay those fears, I recommend looking closely at the figures provided in this document. I hope they will speak for themselves. Crucially, we have secured a commitment that cost neutrality as set out by the government is limited to ensuring the contract cannot in anyway be used to save money from the full time equivalent budget of doctors working the current average working week. Therefore any additional staff and services needed must be funded from outside the budget.
I want to thank every one of you who has worked towards the goal of ensuring we have a new contract for junior doctors that is as safe and fair as we can possibly manage. Everything now is in your hands – the vote is down to you.
With best wishes,
The current pay bands are summarised below:
(ii) Annual increments
Under the current system, junior doctors receive a small annual increase (an ‘annual increment’) in their basic pay for every year worked as a doctor from FY1 to ST8, as summarised in the table below:
(i) Replacing banding
Under the new contract, banding is replaced with a new way of calculating junior doctors’ overall salaries.
The new contract provides:
Under the new contract, any junior doctor who works more than the standard 40 hour working week will continue to receive a pro rata supplement on their basic pay for additional hours worked. This aspect of the current contract is unchanged. So, for example, if you work a 48 hour week, you will automatically receive a 20% uplift to your basic pay (which will increase by 10% under the new contract).
The remaining additional pay comes from night shifts and/or at weekends, or (more likely) a combination of the two.
(ii) Replacing annual increments
Doctors in shortage specialties, such as emergency medicine and psychiatry, will see their flexible pay premia increased to £20,000 over the length of their training.
This will be divided by the expected number of years taken to complete the programme, but where a trainee takes longer than expected to complete the programme, s/he will continue to receive the average annual sum for each year. Payment will be at a pro-rata rate for those in less than full time training.
Staff recruitment and induction will be streamlined and made more efficient under a joint NHS Improvement and Health Education England mandate, which will require employers to have relevant processes in place by April 2017.
Doctors completing specialty training will also benefit from a six-month grace period after CCT. Health Education England will commit to providing a proportion of funds for salary to prevent a break in employment in between consultant recruitment rounds. The General Medical Council (GMC) has pledged to conduct a review into ensuring appropriate recognition of previous experience for doctors who opt to change training paths.
This aims to ensure that junior doctors whose change in training path relates to reasons other than disability or carrying out a caring role (who are covered by other provisions), will benefit from accelerated progression in training and salary structures.
The GMC is expected to complete its review by March 2017.
There are also other steps which, if properly implemented, could make a significant difference to improving the retention of doctors, including:
- NHS Employers and the BMA will pinpoint the best ways of drawing up work rotas to ensure greater flexibility for doctors and their employers, using academic research to draw on best practice.
The agreement should also make it easier for doctors to move around the country, a complex process at present, particularly for couples or junior doctors with caring responsibilities. The Government will ask Health Education England to lead a review of this process by March 2017.
(i) WORK SCHEDULES
(ii) EXCEPTION REPORTING
What is the guardian?
**Lead employer – guardian established in host employers
***GP Trainees – if employed by practice, responsibility for appointing independent guardian rests with employing practice. If employed by lead employer, lead employer responsible for appointing guardian, who must be familiar with or supported with advice on GP issues. (iv) IMMEDIATE SAFETY CONCERNS (page 36)
Work schedule review The educational sup meet/correspond with you as soon as practicable, ideally <7 working days after receipt of request for a work review.
(v) FINANCIAL PENALTIES
There is a clear understanding on pay in relation to hours worked. Doctors have always recognised that in the interests of patient safety there are times when they work beyond their rostered hours. In the agreement, employers in turn recognise that doctors should be compensated for such hours, if they are authorised by an appropriate person before, during or after the work.
Compensation will be in the form of additional payment, TOIL (time off in lieu), or a combination of the two. TOIL accrued in these circumstances can be accrued for up to three months.
There will also be TOIL for breaches of rest requirements, and this should be taken within 24 hours unless the doctor declares as fit for work and the manager agrees. If TOIL is not taken within the designated limits, the doctor will be paid.
The government has removed automatic pay progression from across the public sector and preserving the incremental scale was not negotiable. The only way of absolutely preventing a pay gap opening up when individuals take time out and/or work less than full time is by having automatic pay progression. The structure of this contract, with a front-loaded pay structure and relatively flat basic pay nodes is the next best defence — however, it is not possible to absolutely prevent doctors from the financial impact and we considered every design choice in the pay structure to minimise this loss.
Doctors who take time out of training to care for children or other family members face particular challenges during their training. The contract addresses this difficulty by introducing several new measures to improve equality of opportunity.
It would introduce ‘accelerated training support’ to help returners catch up with colleagues. Such support would include: mentoring, tailored teaching and extra funding for study leave. This will be funded from outside the overall pay bill.
The contract also strengthens protection for those who switch career path because of caring responsibilities or as a result of disability. Such trainees will return to work on the same pay point at which they left, regardless of the specialty they re-train in, and there is no minimum qualifying period of service to receive this protection.
During transition, the contract will offer less than full time trainees in the earlier stages of training (F1 to ST3), and those on maternity leave who are likely to return LTFT, a pay premium to compensate for the fixed costs of training that are generally equal to those who work full time.
The contract also improves how on-call pay is worked out. This should help doctors cover the cost of childcare when on-call from home. On top of the availability allowance of 8% of basic pay for all on-call periods, non-clinical activity such as telephone calls, writing reports and travel time will count as ‘working time’, as well as medical work, under the contract and will all be paid in addition to the allowance.
The BMA and NHS Employers will draft new guidance about: caring for children and adults, flexible working arrangements and balancing work and personal life, to ensure that existing NHS shared contractual schedules work for junior doctors. This guidance will be explicitly mentioned in the contract.
In the workplace, the guardian of safe working will also be expected to keep tabs on employers’ performance on diversity and inclusion. The BMA, Health Education England, and NHS Employers will work on a new equalities monitoring mechanism for protected groups to be implemented next April.
The new contractual arrangements include an initial period of pay protection for some existing doctors. This is a complex area, which has a dedicated schedule in the final terms and conditions and we would encourage you to read this in detail.
The principle is that junior doctors employed on the current contract will have their pay protected to ensure they do not see any drop in pay as a result of the introduction of the new contract. Given that transition to the new contract will now take place in October instead of August, this will now include new F1s, who will start on the 2002 TCS in August before moving to the new one once it starts being used in October.
There are two categories for pay protection - one covering doctors in Foundation, core, GP and the initial stages of run-through training programmes, the other covering those already in higher training programmes and the later stages of run-though training (ST3 and above). The first category will have their pay protected against a 'cash floor', based on the basic salary the doctor was earning on the day before they transitioned to the new contract and the banding at 31 October 2015 for the rota they are working on the day before transition.
The second category, doctors already at ST3 or above on a run-through training programme on 2 August 2016 above, will have their pay protected by continuing to be paid under the old pay system, including increments and banding (but not band 3). For the purposes of their pay only, the old definitions of 'plain' and 'premium' time will apply. There are instructions in the final terms and conditions as to how the old pay system will work with the new contractual terms, including how these doctors can make use of the new exception reporting system under the guardian of safe working. Flexible pay premia don’t apply to these doctors, even if they would otherwise be eligible, as they are paid completely under the old pay system.
Pay will be protected either until the doctor exits the training programme, or until four years of continuous employment have elapsed (pro rata for those LTFT or taking time out) or until August 2022, whichever is sooner.
There are various provisions to ensure fairness in the calculation of the cash floor and the length of protection. Those taking time out of training for maternity leave, for example, will have this time out disregarded for the purposes of their four years of continuous employment. LTFT trainees will also have their coverage extended pro rata - so someone working on a 80% basis would have their four year period extended by a year. Doctors who are out of training for maternity leave, for example, or on an approved out of programme (OOP), at the time they would transition to the new contract, will have their pay protected at the incremental pay point that they might otherwise have reached had they not been absent.
The principle is that no current junior doctor will see a drop in pay compared to what they currently earn, not that your potential future earnings are protected. The cash floor is calculated once and your pay cannot drop below this point, but it will not be calculated again. Your pay is protected against the cash floor until such time as your pay on the new contract would be greater, at which point pay protection stops and you are just paid under the new contract as normal.
Please look out for a flow chart and further guidance on the BMA website.
These are the key dates over the coming weeks:
- 5-7 June Roadshows to explain the new contract
- 17 June - 1 July Member referendum
- 6 July Referendum result
Implementation would be staggered:
October 2016: All F1s, F2s who share a rota with F1s, ST3/4s in general practice and ST3 and above in obstetrics and gynaecology
February – April 2017: All grades in psychiatry, public health, all pathology and lab-based specialties, paediatrics, dental training programmes excluding orthodontics, and any F2 or GP trainees who share a rota with trainees in these categories.
April 2017: All grades in all surgical specialties, including orthodontics, and any F2 or GP trainees who share a rota with trainees in these categories.
August 2017: All remaining existing trainees and all new entrants.
The cash floor/pay protection for junior doctors who were unbanded at the time the new contract came in is far from fair and totally unjust and it totally unacceptable to expect those doctors to work and earn less than some of their colleagues.
In this rota their annual leave is not prospectively covered so what is the extra leave adjustment Also I was trying to figure out if the salary is paid exactly for 47.75 hours worked or 48 hours .
The reason being I have one particular doctor trying to claim back an hour that he spends extra because he has to go to teaching.
and totally unjust and it totally unacceptable to expect those doctors to work and earn less than some of their colleagues. comoganharnalotofacil.blog.br