Referendum opens on Welsh junior doctor contract deal

by Milan Makwana

Cast your vote on a new offer for doctors that includes more pay and better hours of work 

Location: Wales
Published: Wednesday 5 October 2022
Milan Makwana

Last week, we announced the new contract package – the culmination of several years of hard negotiation with NHS Wales Employers and Welsh Government – and invited you all to attend our contract explainer events to learn more about the proposed new contract. 

This new contract promises to end dangerous and antisocial working patterns, increase basic pay, and contractualise key rights around workplace facilities. Underpinned by investment from Welsh Government, this is a deal which the committee felt was a significant step forward for junior doctors in Wales and was therefore happy to endorse. 

Some of you will have already been able to attend events in your workplace to hear about the deal or will have attended our online webinar; others will be waiting for events to take place in their area over the coming weeks. Hopefully many of you will have been able to read the framework agreement and supporting documentation to familiarise yourself with the proposals. 

WJDC has been clear that we believe that this deal represents a step forward for junior doctors in Wales. It is the best deal that we were able to negotiate based upon our red lines, and Welsh Government’s and NHS Wales Employers’ red lines. It makes a number of improvements over the 2002 contract, some of which are: 

  • Safer working hours, including a maximum of seven consecutive shifts and 46 hours’ rest after nights  
  • Ending fixed leave and ensuring you only need to take 1 day of leave to have a full day off, regardless of shift length 
  • Ensuring you get paid for your overtime through exception reporting, ending the dysfunctional rota monitoring system.  

It also makes significant, hard-won improvements over the English contract upon which it is based, including:  

  • A 4.8% higher basic pay scale 
  • Including Friday shifts in weekend working payments for full shifts 
  • A new flexible training pay premium to recognise experience gained outside of training.  

Make sure to read the full detail of the advantages and disadvantages, as well as the changes we’ve made, on our webpage. 


Pay protection for non-training junior doctors announced

Since we launched the contract package, we have heard a wide range of feedback from members across Wales. One concern we kept hearing was that, under current proposals, the cash-floor pay protection that was negotiated would only apply to junior doctors who were in a training post at the time of transition. We recognised this was unfair to junior doctors currently taking time out of training who intend to return and would disadvantage them compared to their peers. 

We are therefore delighted to announce that, following us raising the issue, NHS Wales Employers has agreed that junior doctors currently out of training will also receive pay protection. If you have been training in Wales previously but are currently taking time out of training, you will receive pay protection on the same basis as your colleagues currently in training, so long as you return to training before or at the summer 2024 rotation. 

This means that trainees taking time out at the point of implementation can take a wider view on the contract, reassured that their own pay would be guaranteed upon return to training based upon their last substantive Welsh salary. In this, they join junior doctors in training in Wales and junior doctors taking parental leave or sickness absence at the time of implementation. 


The new pay system

Clearly this contract represents a marked change against the existing one. For one, the pay system is very different, although the overall aim is that overall pay will remain roughly the same for many rotas.

Firstly, basic pay is higher and pay for additional work comparatively lower – this smooths out big fluctuations between intense and less-intense placements, which currently can be as much as one-third of your pay cheque, whilst keeping pay overall roughly the same. 

Currently all additional work beyond a basic 40-hour week, as well as recognition of unsocial hours, is contained in the banding supplement. Under the proposed new contract all these elements are paid individually. This ensures that pay is overall fairer and more accurate to the precise work you’re doing.

It also ensures that what you’re paid really does reflect your work – whereas in the current contract significant variations in working intensity can all be covered under one banding. And we don’t even need to mention how unaccountable rota bandings have become, with rota monitoring exercises rarely valid, let alone producing the changes they should. 

These additional payments are as follows – and you need to make sure you account for all of them in any comparisons you do based on your own rotas whilst making your decision: 

  • Additional hours: these are paid at an hourly rate to a maximum safe working limit of 48 hours average per week 
  • Enhanced hours: all hours (both basic and additional) worked between 9pm and 7am attract a 37% enhancement 
  • Weekend frequency allowance: a sliding scale of payment based upon the frequency of weekends you work 
  • NROC availability allowance: a flat rate of 8%, paid to all trainees making themselves available for NROC work, on top of the payment for the actual hours of work performed during NROC duties. 


Trainee pay journeys

In order to make some of the effects of these big changes in the way pay works clearer, we have produced sample trainee pay journeys, which were launched last week. These compare career-long earnings under both the old and new contracts. 

These examples take fictional trainees and look at typical training pathways using real-life rotas that are very similar to the ones trainees would work under if this contract is approved. The rotas include the new safe working limits that would be introduced by the new contract. 

Included in the examples are general medicine training, general surgery training, GP training, some less-than-full-time training examples, as well as examples that involve trainees taking time out of training. Some of the pay journeys show trainees seeing their earnings increase substantially under the new contract; others show pay staying more or less level. 

In some scenarios not shown in these illustrations, because our data suggests they are less common, we know there will be trainees who would see their career-long earnings drop in the new contract compared with the old. This is an unavoidable consequence of the end of automatic pay progression, which has historically allowed trainees to progress to high levels on the registrar pay scale without having achieved similar levels of training progression.  

This won’t affect current trainees, however, as they will benefit from cash-floor pay protection to guarantee their income on switching to the new contract. Furthermore, all trainees will benefit from significant improvements to their working lives through all the other changes the contract would bring. 

In effect, the new contract redistributes these significantly higher earnings from a smaller number of people and shares it amongst the greater majority. To ensure pay remains fair for trainees who are taking time out after foundation to refine their skills or explore the specialties they may wish to train in later, as well as for trainees who are retraining in a second specialty, we have negotiated the flexible training pay premium. 

This will ensure the additional skills and experience these trainees have gained beyond their training grade are appropriately recognised. For trainees taking parental leave, we have also ensured that they will continue to see pay progression – if they otherwise reasonably would have expected to do so – during their parental leave. 

These are important changes, and some of them were very hard won. They ensure that the nodal pay system doesn’t inappropriately disincentivise well-established and justified flexible training pathways. For the significant majority of trainees, they will also ensure their career-long earnings remain comparable between the two contracts, even if they choose to train flexibly. 


The referendum

Yesterday, the referendum opened on the deal. It closes on 21 October – just under 3 weeks’ time. This is the moment for BMA members to have their say on the deal: it’s your contract, so it should be your voice that decides the future. 

I’ve been very clear what WJDC thinks: that this is a good deal and the best that can reasonably be achieved. If it is approved, trainees will benefit from a host of changes and we will work hard to make a success of it through implementation and into the future.

If it is not approved, we would seek to understand why and to re-enter negotiation. However, we must be realistic about the possibility of finding a substantially different deal that would still be acceptable to Welsh Government and NHS Wales Employers. 

Agreeing this contract deal, which we think will bring significant improvements to our working lives, will not prevent us from also continuing to campaign for the higher rates of pay that the BMA recognises are needed to restore pay levels in real terms to those we saw in 2008.

WJDC wants to see that as well, but the committee believes the improvements in terms and conditions of service that this new contract would bring are important too. They deal with many of the concerns trainees across Wales have raised with us in recent years, and that’s why we are of the firm view you should support this contract. You can be rest assured, however, that WJDC and the BMA more widely will continue to fight for all doctors to receive a fair deal on pay. 

Please keep an eye on your email inboxes for an email from Civica – our partner who is administering this referendum on our behalf. Once you have read through the materials we’ve provided and attended one of our contract explainer events if you can (or catch up with our webinar), then remember to cast your vote and have your say. 

Milan Makwana is BMA Welsh junior doctors committee deputy chair