Update on Welsh junior doctor contract reform

by Evan Sun and Milan Makwana

With negotiations in their final stages, the Welsh junior doctors committee outlines the key issues and next steps

Location: Wales
Published: Thursday 25 August 2022
Contract and pen article illustration

For the past two and a half years, the Welsh junior doctors committee has been focused on partnership talks with Welsh Government and NHS Wales Employers to examine the case for contract reform in Wales and, if there is one, what that new contract should look like.

All the while, the committee has continued to advocate for members across other areas: our annual submission of evidence to the pay review body (the DDRB) on pay; the huge challenges of COVID-19, where we agreed principles that protected junior doctors working emergency rotas in the hardest weeks of the pandemic and ensured we could all continue to take our annual and study leave, or see it rolled over to future rotations and years if not; pushing for study leave reform; improved funding for travel and relocation; the introduction of the single lead employer for hospital-based trainees.

However, the work related to ensuring the best outcome for contract reform has been our greatest priority.

Early in 2020 we staged a series of workshops across Wales to hear the views of junior doctors on their contract and working lives. We issued an all-Wales survey to canvass views on what our priorities should be. We assembled a dedicated team of trained negotiators from amongst our membership, working alongside expert staff to represent the views of members and the committee in talks with government and employers. These talks have taken place – with hiatuses during the most difficult moments of the pandemic – throughout 2020, 2021 and 2022.

During this time we have done our best to keep members as up to date as possible regarding how we were progressing. We have issued newsletters describing the work of negotiations and their progress as well as providing regular web updates.

The new contract must address overwork and unsafe rostering patterns

However, as is always the case with negotiations, there is a strict limit to the amount that can be announced publicly. Anything that reveals our negotiating positions will weaken our hand and may make it harder for us to deliver the contract that addresses the issues that junior doctors face.

That said, we have been consistent in our views that the new contract must address overwork and unsafe rostering patterns; make the pay scale flatter and with more pay concentrated on basic pay to maximise pension contributions; and reform the system for reporting work beyond rostered hours, where rota monitoring has lost the confidence of trainees and managers. Our negotiating team has therefore focused on securing improvements to the contract that can deliver against these priorities.


During the last few years, the stark unfairness of the erosion of junior doctors’ pay has become clearer and more pressing. With inflation at the highest levels for a generation, this is even more urgent in 2022 than it ever has been.

Through our social partnership approach in Wales, we have a commitment to ongoing dialogue around pay levels and the awards recommended by the DDRB. Whilst it’s fair to say we often enjoy a constructive working relationship with Welsh Government and NHS Wales, clearly that relationship still needs to deliver the outcomes that junior doctors, and the health service, need. That includes proper pay and safe working conditions; on this we have been resolute, and continue to be so.

Our fellow UK junior doctors committee has committed to move towards industrial action in England if pay demands are not met soon. While we are not yet at this point in Wales, we are keeping all options open for ensuring that Welsh junior doctors also get paid properly, and will continue to do so alongside the vital work of delivering on the current contract reform process.

Contract reform – which addresses the structures and criteria through which pay is awarded – can deliver vital improvements for the working lives of junior doctors, whilst the discussion of overall pay levels remains largely within the remit of the separate DDRB process and our collective lobbying, through the BMA Welsh council, to demand that the Welsh Government provides adequate pay uplifts across all branches of practice.

Next steps

Finally, after many months of work, we are in the final stages of discussion of a contract deal for junior doctors in Wales. There are still many important issues left to solve – and no agreement is secure until all the details are worked out. However, if, as we hope, we are able to reach agreement with Welsh Government and NHS Wales Employers on a package of contract reform that we think will benefit junior doctors in Wales, then we will put this deal to a ballot.

Only BMA members will be allowed to vote, so it is vital that all junior doctors in Wales join the BMA to ensure that they are able to have their voice heard on this pivotal issue.

Evan Sun is co-chair of the Welsh junior doctors committee and Milan Makwana is deputy chair for terms and conditions