The junior doctor contract in Wales: the future is in your hands

by Milan Makwana

The amount of work juniors are subject to is unsustainable and their welfare must become paramount

Location: Wales
Published: Thursday 10 June 2021
milan makwana

Qualifying for my dream job nine years ago was a moment to stop and reflect on how complex and challenging my road to becoming a junior doctor had been.

While looking forward to my new career, I knew that the years ahead would be filled with even greater complexity. But what I could not have foreseen were some of the unwanted changes to the job that have made it more complex and more challenging than many of us feel we can manage for much longer.

I love treating patients, solving problems and working in a team. It is a privilege to be part of saving and improving people’s lives. But I am worried about my future and the future of my colleagues. We are all exhausted. Working very long hours without breaks for consecutive days and weeks on end is not only unsustainable, but also unsafe; it prevents us from providing the high level of care that our patients deserve.

These problems have been with us for some time now, but they have been compounded by the fear and confusion of the coronavirus pandemic and the massive backlog of care that we now face. We are preparing to treat more than half a million patients – a record number in Wales – who are in pain or suffering a poorer quality of life while they wait for procedures delayed by the pandemic. Now, more than ever we need to improve the welfare of doctors with sufficient rest, satisfactory pay and suitable facilities, so that we can deliver the best care possible.

The Terms and Conditions of Service for Junior Doctors in Wales – the contract which determines our working hours, pay and conditions – have remained largely unchanged for almost twenty years. They simply do not reflect or recognise the way we work anymore, nor do they provide us with the protections against fatiguing and unsafe shifts that we deserve. This is why the BMA Welsh junior doctors committee decided in October 2019 to enter talks with the Welsh Government and NHS Wales Employers to discuss contract reform; and it is part of why I wanted to be a member of the WJDC and its vice chair for terms and conditions of service.

Ultimately, WJDC members want to shape a brighter future for trainees and to make this wonderful country an attractive place to train. When I was elected in August 2020, the committee was already in the midst of contract reform discussions, with a dedicated, trained negotiating team in place. We have used roadshows and surveys to canvass the views of junior doctors throughout Wales, working with them to identify these priorities for change: pay, rota monitoring, hours and working conditions. We will also work with Welsh Government and NHS Wales Employers to improve recruitment and retention of doctors, patient care and the overall health service.

We are working hard to represent your views and to get the best deal for you in the regular meetings between our committee’s negotiating team, the Welsh Government and NHS Wales Employers that have been underway since last summer. Good progress is being made in our discussions about whether we can take the best of the contract currently in place in England while making improvements to those parts that do not work as well as they should. 

It is hard to predict the future in more stable times, let alone in times like these as we begin to emerge from the pandemic. Having said that, we are hoping to reach agreement between all parties and conclude talks in the autumn, and will then ballot all members in Wales so that you get the final say on whether any changes are right for you and the rest of our profession.

In the meantime, we will keep members up to date on the process with newsletters and emails, as well as through our social media channels. For more information about the process please visit our website

Milan Makwana is a specialty trainee in neurosurgery working at Cardiff and Vale University Health Board. He is vice chair of the BMA Welsh junior doctors committee, focusing on the terms and conditions of the next junior doctor contract in Wales