Contract reform

agendaNi takes a look at the dispute over the proposed changes to the contracts of junior doctors.

The British Medical Association (BMA) is in the middle of a contract dispute with the Department of Health (DH) and health secretary, Jeremy Hunt MP, over the proposed changes to the contracts of junior doctors. Under the proposals by the DH, junior doctors’ hours would be increased from 60 to 90 hours per week. This increase has been described by the BMA as “bad for the patient, bad for junior doctors and bad for the NHS.”

Scoping study

In December 2012 a scoping study on the contracts for doctors in training was published. The study set out a vision and principles for a new contract that emphasised a need for, amongst other things, better patient and care outcomes and affordability. The health secretary accepted the report provided the basis for discussing the prospects of negotiating a change to junior doctors’ contracts.

By October 2013 NHS employers, mandated by all four UK health departments, began negotiations with the BMA to discuss the prospect of negotiating changes to the junior doctors’ contract. In February 2014 an interim report on these negotiations confirmed both sides agreed that the new contract must be cost neutral, that high level definitions of pay had been agreed and that discussions to develop a set of pay principles were continuing.

However, in October 2014 the BMA withdrew from negotiations claiming they had stalled due to a lack of credible evidence to support the proposed changes and a concern it was being asked to make decisions that had the potential to make a considerable impact on patient safety, doctors’ welfare and the sustainability of the NHS. Despite a review by the Doctors and Dentists Review Body (DDRB) which claimed there was a “sound basis for negotiation of the junior doctors’ contract” the BMA have outlined 10 reasons why it will not re-enter negotiations.


Among the reasons the BMA lists for not re-entering negotiations is its belief that what is on offer now is, in fact, worse than when it left the negotiating table. The BMA wants the government to reverse its position on extending working hours by 50 per cent and the removal of vital safeguards that discourage employers from making junior doctors work dangerously long hours. It also wants to see the health secretary scrap the proposed changes to junior doctors’ pay that will mean salaries no longer reflect the experience gained through training.

Currently, trainee doctors start on Foundation Year One with a salary of just over £22,000, which rises to £30,000 within four years. Doctors undergoing training towards a speciality can earn between £30,002 and £47,175, which eventually rises to £69,325.

With supplements for weekend, overnights and other work, the Department of Health estimates that a junior doctor under training can earn an average of £40,000 in the initial stages of training and £56,000 in the later stages. However, these proposals could result in a junior doctor currently earning around £31,000, 40 per cent of which comes from working one evening until 9pm and one weekend in four, receiving just £23,000 for a similar amount of time worked.

The BMA also believes that these proposed changes will put the patient at risk and are critical of the health secretary’s desire to extend plain-time hours to 7am-10pm. The BMA also claims that the changes will penalise woman doctors who wish to start a family. One of the proposals recommended by the DDRB is that trainees’ pay should no longer be protected if that choose to have a baby, if they need to train less than full time, or re-train in a new specialty. The BMA feels these changes will disincentivise woman in particular from becoming doctors. 

The BMA also claims that certain specialities will be affected more than others. Trainees working in psychiatry would, the BMA claims, be hit by the hours-based system, the pay progression system and the removal of the entitlement to undertake fee-paid work. These changes would impact not only their training but their potential income in comparison with other specialities. 

Hunt’s position

For their part, the British Government is intent on improving the range of NHS services that are available seven days a week and believes this contract is the best way of delivering upon that promise. A letter sent by the health secretary to all 50,000 junior doctors in England, a day before their ballot on industrial action stated as much. The letter claimed the changes will help the delivery of a seven-day NHS and suggests that just 1 per cent of NHS junior doctors will lose out under the proposals. An 11 per cent pay rise for junior doctors, taking their starting basic salary from £22,636 to £25,500 was outlined in the letter as well as a concession regarding what is classed as unsocial hours. The original plan included classing Saturday working from 7am to 10pm as normal hours, but that has been reduced to 7am to 7pm. Hunt also scaled back his 90 hour working week to 72 hours in a bid to appease junior voters.

However the health secretary’s letter confirms that pay rises linked to the time in the job are being scrapped and pay will be directly linked to progress through dedicated training stages. The health secretary claims these changes will result in three-quarters of junior doctors earning more than they would at present while the rest would see their salaries protected. The health secretary believes that the only doctors who will lose out are the ones who undertake a lot of extra hours and therefore are, under current arrangements, entitled to extra pay. 

Northern Ireland

While he Scottish and Welsh authorities have confirmed that they will not be following the health secretary’s lead, there is a fear amongst junior doctors in Northern Ireland that Stormont appears intent on following suit. Many junior doctors here fear that these changes will have a disastrous impact on our local health service as doctors take the option to move to Scotland or Wales where working conditions will be more lucrative. 

Whether or not the BMA returns to the negotiating table or junior doctor protests continue, the health secretary is clear that the government fully intends to introduce these changes in full.

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