Junior doctors’ contract

The new 2016 contract

Junior doctors’ contract -

Summary of the new 2016
contract

February 2016

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Junior doctors’ contract
The new 2016 contract

Introduction
In November 2015, NHS Employers published a firm but not final offer of a new junior
doctor contract, for introduction in England in August 2016. Following discussions under the
auspices of Acas, on 30 November the British Medical Association (BMA) agreed to re-enter
negotiations, taking the cost neutral November offer as the starting point for further
discussions on a number of specified issues.

Discussions during December 2015 and January 2016 with the BMA focused on three key
areas:

 Safe working
 Training and deployment
 Pay
Constructive and hugely helpful discussions to address the concerns raised by the BMA
continued until 9 February. Significant agreement was reached in most areas and, with both
parties having now signaled that reaching agreement on the outstanding issues is not
possible, this document sets out a summary of the final contract made to trainee doctors
working in the English NHS.

Scope of the new contract

From 3 August 2016, new contractual arrangements will be introduced in England for
trainees in hospital posts approved for postgraduate medical/dental education. These will
replace the existing New Deal arrangements, 2000 and the Hospital Medical and Dental Staff
Terms and Conditions of Service, 2002, as they apply to trainees. The new 2016 contractual
arrangements will also apply in England to general practice trainees during the approved
general medical practice placements that form part of postgraduate medical education, and
will replace provisions currently contained in Schedules to the Directions to Health
Education England (GP Registrars).

The introduction of such a major contract reform will significantly change working patterns
for doctors in training. Careful implementation will be crucial to ensure continued delivery of
safe and effective care to patients.

A phased implementation plan has been developed that will enable employers to introduce
the new working patterns enshrined in the new contract more safely.

Doctors / dentists will therefore transfer onto the new contract on different dates over a 12-
month period, commencing in August 2016 under the phased implementation plan. The
proposed national timetable for this is set out in Appendix B, although this may be subject to
some regional modification.

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The new 2016 contract

Doctors / dentists in training will retain their existing New Deal contract pay, terms and
conditions until the date on which they transfer to the new contract and its associated terms
and conditions, according to the national timetable.

For the purposes of the remainder of this document, for ‘doctor’ read ‘doctor / dentist’
throughout.

Features of the new contract

a) Safe working

While the current contract complies with the UK Working Time Regulations, it does not go
far enough to promote and protect the safety of doctors. The new contract provides a
comprehensive package to address concerns raised by junior doctors and proposes
additional safeguards and restrictions, beyond those in the Working Time Regulations, on
the hours that doctors are required to work. These safeguards reflect the legitimate
concerns raised by many doctors and so go even further than those originally proposed in
the November offer.

The arrangements will be overseen in every trust by an independent guardian of safe

working, who will from August 2016:

• act as the champion of safe working hours for doctors

• provide assurance to the board that doctors are both rostered safely and actually work
safely

• require work schedule reviews to be undertaken where there are regular breaches in safe
working hours

• directly escalate to the trust executive or equivalent, issues over safe working hours that
are not being addressed locally

• take appropriate steps to intervene directly where, in the view of the guardian, the safety
of doctors or patients is being compromised

• provide regular and timely reports on the safety of doctors’ working hours to the local
negotiating committee and to the board for incorporation into annual reports to the Care
Quality Commission (CQC), and to be made available to Health Education England (HEE) and
the General Medical Council (GMC) as part of inspection visits and to the Review Body on
Doctors’ and Dentists’ Remuneration (DDRB).

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The new 2016 contract

Current contract November offer Final contract

Guardian of safe working appointed jointly

with junior doctors.

Appraisal of guardian by board level director

based on multisource feedback and agreed key
performance indicators (KPIs).

Safe working hours enshrined as a KPI for

performance management framework for all
managers.

Twice-yearly hours- Exception reports to Exception reports to replace hours monitoring.

monitoring exercises. replace hours monitoring.

Departmental rota. Individual work Individual work scheduling.

scheduling.

Work schedules for GP trainees in practices to

reflect guidance on work plans from
Committee of GP Education Directors.

Work schedule reviews Work schedule reviews on request and when

on request. required by the guardian.

Maximum average 56- Maximum average 48- Maximum average 48-hour working week.
hour working week. hour working week.

Opt out capped at Opt out capped at Opt out capped at maximum average of 56
maximum average of 56 maximum average of 56 working hours per week.
working hours per week. working hours per week.

Maximum 91 hours’ work Maximum 72 hours’ work Maximum 72 hours’ work in any seven-day
in any seven-day period. in any seven-.day period. period.

Maximum shift length of Maximum shift length of Maximum shift length of 13 hours.
14 hours. 13 hours.

Maximum of seven Maximum of five Maximum of five consecutive long shifts.

consecutive long shifts. consecutive long shifts.

Maximum of seven Maximum of four Maximum of four consecutive night shifts.

consecutive night shifts. consecutive night shifts.

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The new 2016 contract

Current contract November offer Final contract

Minimum 11 hours’ rest Minimum 11 hours’ rest Minimum 48 hours’ rest after a run of either
after final night shift. after final night shift. three or four consecutive night shifts.

Minimum 11 hours’ rest Minimum 11 hours’ rest Minimum 48 hours’ rest after five consecutive
after final long shift. after final long shift. long shifts.

Maximum of 12 Maximum of five Maximum of four consecutive long, late

consecutive long, late consecutive long, late evening (twilight into night) shifts.
evening (twilight into evening (twilight into
night) shifts. night) shifts.

Minimum 11 hours’ rest Minimum 11 hours’ rest Minimum 48 hours’ rest after four consecutive
after final long, late after final long, late long, late evening (twilight into night) shifts.
evening (twilight into evening (twilight into
night) shift. night) shift.

Maximum 12 consecutive Maximum 12 consecutive Maximum eight consecutive shifts.

shifts. shifts.

48 hours’ rest after 12 48 hours’ rest after 12 48 hours’ rest after eight consecutive shifts.
consecutive shifts. consecutive shifts.

Rigid on-call rules with More flexible on-call Limits on on-call working:
limited flexibility. arrangements linked to
 No more than three rostered on-calls in
intensity or work.
seven days except by agreement.
 Guaranteed rest arrangements where
overnight rest is disturbed.

Rigid paid rest-break Paid 30-minute rest Paid rest breaks: 30 minutes if shift exceeds 5
requirements. breaks at intervals in line hours; 2 x 30 minutes if shift exceeds 9 hours,
with working time taken flexibly across the shift.
regulations.

Best practice guidance on rostering.

Financial penalty levied on employer for

breaches of WTR 48-hour average working
hours or contractual 72 hour weekly limit.
Doctor to be paid 1.5 times the prevailing
hourly rate. Financial penalty of 2.5 times the
rate to be e vested with the Guardian to be
invested in educational resources and facilities
for trainees (over and above monies already
allocated to those areas).

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The new 2016 contract

b) Training and deployment

The current contract is largely silent on the educational needs of doctors in training. This
contract includes both contractual terms and additional pledges from Health Education
England that support the training needs of doctors. (Separately, the Secretary of State is
commissioning a review of the more longstanding issues relating to junior doctors’ morale,
well-being and quality of life).

Current contract November offer Final contract

Work schedule to be linked to Work schedule to be linked to

the educational curriculum. the educational curriculum.

Training needs to be identified Training needs to be identified

and included in the work and included in the work
schedule. schedule.

HEE commitment to
performance manage Local
Education and Training Boards
(deaneries) against code of
practice on notice of
deployment.

HEE to establish benchmark

standards for educational
facilities.

Contract will facilitate both

standard and lead employer
models.

HEE commitment to identify

ways of reducing the costs of
training through centralised
provision and other means.

Improved access to less-than-

full-time training.

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Enhanced continuity of service

provisions to ensure that
trainees returning from out of
programme (OOP) are not
unfairly deprived of
occupational maternity pay.

Fixed leave to be replaced by a

mutual obligation for
employers and doctors to
appropriately manage leave
arrangements.

c) Pay

The current contract has insufficient links between pay and level of responsibility. It also
makes minimal distinction between different working patterns through a broad-based
system of banding supplements, which sees doctors potentially having to manage huge
variations in pay as they move from one job to another.

The new contract addresses these issues and delivers a model of pay that is fairer, more
stable and more transparent, while ensuring that average pay across the junior medical
workforce, for the current average hours rostered, remains unchanged. It also guarantees
no change in average earnings for existing trainees, and that the level of average earnings
will be maintained for those entering training in the future.

Average pay for junior doctors will remain the same under the new contract. That applies
equally to those entering training in the future.

Doctors working the most onerous working patterns will be more fairly rewarded.

Doctors' pay will link directly to the work that they do and the level of responsibility that
they discharge.

The approach in the final contract reflects agreements on a revised model of pay
progression reached with the BMA during December 2015 and January 2016. The flatter
nodal structure proposed by and agreed with the BMA protects the interests of doctors
wishing to have families, to train part-time, to undertake research or otherwise to take
breaks from training. Additionally, the pay structure has been ‘frontloaded’ at the request of
the BMA, so that doctors benefit earlier on in their careers. The most noticeable change as
a result of the BMA’s preferred approach is an increase in the relative value of the F1 nodal
pay point and a reduction in the new ST8 nodal pay point.

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Current contract November offer Final contract

Basic pay linked to length of Basic pay on a 6-nodal point Basic pay on a 5-nodal point
service rather than level of structure (F1, F2, ST1-2, ST3-4, structure (F1, F2, ST1-2, ST3-7,
responsibility. ST5-6, ST7-8). ST8), as proposed by the BMA,
with indicative values
highlighted in Appendix A.

Pay progression not linked to Pay progression linked to Pay progression directly linked
progress through training / responsibility. to key changes in level of
employment. responsibility.

Pay structure that stakeholders Even flatter pay structure

worried might provide agreed with BMA to minimise
disincentive for academia or impact on those taking
breaks from training. academic route and / or breaks
from training.

Banding system that results in Increased basic pay with a Increased basic pay - increase at
huge variations in pay when lesser proportion of pay being transition on average of 13.5%
doctors rotate from one post to variable, providing for a more with a lesser proportion of pay
another. stable salary for doctors and being variable, providing for a
increased pension benefits. more stable salary for doctors
and increased pension benefits.

Inflexible banding system that  50% premium for night  Every day 2100 – 0700: 50%
does not properly distinguish work (2200 - 0700) premium.
between unsocial and social  33% premium for Saturday  Sunday 0700 - 2100 and
hours worked. evening (1900 - 2200) and Saturday 1700 – 2100: 30%.
Sunday (0700 - 2200) work.  Saturday 0700 – 1700 will
also be 30%, if any shift
starting on a Saturday is
worked 1:4 or more
frequently

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The new 2016 contract

Current contract November offer Final contract

Availability supplement payable Doctors from ST1-ST8 will be

for on-call duty at the rates of paid an on-call availability
2, 4 and 6% of basic salary, allowance based on the
depending on frequency. frequency of the rota
commitment. The value of the
allowance will be a cash sum,
which will rise in cash terms in
line with any increases in base
pay and will be set at 10% of
the ST3-7 nodal point if
rostered 1:4 or more
frequently, and at 5% of that
nodal point if rostered less
frequently. Doctors in
foundation years working on-
call will be paid an availability
allowance calculated at the
same percentages but based on
their own nodal point values.

Pay premium paid to trainees Pay premium* paid to trainees

on emergency medicine or on emergency medicine or
psychiatry training programmes psychiatry training programmes
to incentivise recruitment. to ensure appropriate pay
incentives to support
recruitment.

Pay premium paid to clinical Pay premium* paid to clinical

academics or other trainees academics or other trainees
holding a training number who holding a training number who
complete higher degrees, to complete higher degrees,
offset impact on pay approved courses (e.g.
progression. leadership) and / or approved
work in the wider interests of
the NHS, to ensure appropriate
pay incentives to support
academic research.

Supplement paid to GP trainees Pay premium paid to GP Pay premium* paid to GP

in practices to ensure parity of trainees in practices to ensure trainees in practices to ensure
pay with hospital-based current level of pay is matched current level of pay is matched
trainees. in the new system. in the new system.

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Current contract November offer Final contract

Time off in lieu for additional Additional work paid at

work. prevailing rate unless a breach
of WTR 48-hour average
working hours or contractual
72-hour weekly limit, in which
case, time and a half would be
paid.

*Doctors receiving pay premia will receive them throughout all periods of paid employment under
these terms and conditions from the point that they become eligible for payment until the point that
they exit the training programme, at the rate applicable at the time that they first became eligible. GP
trainees will only receive the pay premium whilst working in practice placements.

Locum work

This contract also sets a clear limit on weekly average hours of work in any setting at 56
hours (where a doctor has opted out of the Working Time Regulations). Doctors have a
responsibility to ensure that when working any additional hours outside their work schedule
those hours are safe and in line with contractual limits that are binding on both the
employer and the doctor.

Before undertaking additional locum work, doctors will need to offer their employer (the
employing trust, or the host trust where there is a lead employer) first refusal on any such
locum work, and this will be paid in line with NHS terms and conditions as set out in the
annual pay circular. The employer must act reasonably, in accordance with guidance and
respond to requests within rapid, defined timescales. Where employers do not wish to take
up that first refusal, they will need to be informed of additional work that doctors are doing
to ensure that they are working safely; employers can withhold permission if that is not the
case.

Transitional arrangements

The new contractual arrangements will be phased in over the year beginning August 2016.
Individual doctors affected will have salary protection throughout the period of transition to
the new system, until 31 July 2019, as outlined below:

1. For those trainees remaining at F1 or F2; those entering F2 from F1; those entering core
or run-through specialty training (including general practice) at ST1 or CT1 directly from F2;
those remaining in core training at CT1, CT2 or CT3; those remaining in run-through specialty
training at ST1 or ST2; those remaining in general practice training at ST1, ST2, ST3 or ST4 or
those entering higher training at ST3 or ST4:

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‘Cash floor’ protection as described in the November offer, based on the

incremental point reached on 31 October 2015, plus any cost of living award made
in April 2016, plus the value of any banding supplement / GP supplement payable in
October 2015 (excluding Band 3 payments). This would set a cash level below which
pay will not fall during transition, for so long as the doctor remains in training
provided that the doctor continues to work the same proportion of full-time hours.

2. For trainees already in run-through specialty training or higher specialty training at ST3
level or above before 3 August 2016, and moving to ST4 or above in August 2016.

Pay will continue to be calculated as per the current New Deal contract, as described
in the November offer, including annual increments on the current pay scale, subject
to a maximum banding payment of 50 per cent (or 80 per cent for those opting out
of the Working Time Regulations), and subject to minor modifications of the New
Deal rules to allow them to comply with the new safeguards on working time in the
new contract.

Trainees falling into category 1 who were on maternity leave or on a recognised out-of-
programme activity (OOP) will have their salary calculated for pay protection purposes as
being the basic salary that they would have earned on 31 October 2015 had they not been
out of programme, plus any cost of living award made in April 2016, plus the value of the
banding supplement earned during the final NHS placement prior to the break from training.

Trainees falling into category 2 who were on maternity leave or on a recognised OOP will be
paid upon return to training as described in category 2.

As the proposal is for a phased implementation over 12 months from August 2016, further
detail will be provided about how the transitional provisions will apply to different groups of
doctors moving onto the new contract at different times.

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Appendix A
Nodal pay values

November offer Final contract

Level of Indicative basic pay value Level of Basic pay value

responsibility responsibility

F1 £25,500 F1 £27,000

F2 £31,600 F2 £30,000

CT1 / ST1 CT1 / ST1

£37,400 £37,000
CT2 / ST2 CT2 / ST2

CT3 / ST3 CT3 / ST3

£42,500
ST4 ST4

ST5 ST5 £48,000

£48,400
ST6 ST6

ST7 ST7
£55,000
ST8 ST8 £52,000

Flexible pay premia values

November offer Final contract

Academia1 £3,125 Academia1 £4,000

Emergency medicine training Emergency medicine

programmes at ST4 and above £1,500 training programmes at ST4 £1,500
and above

General practice2 £8,200 General practice2 £8,200

Oral and Maxillofacial £1, 500

Surgery

Psychiatry training Psychiatry training

programmes at ST1 and above £1,500 programmes at ST1 and £1,500
above

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Notes on pay values

The values of the nodal points have been set to reflect both the BMA’s preference for a front
loaded structure but also to reflect the costs of improvements compared to the November
offer in relation to unsocial hours and availability payment.

1. Academic premia will be paid to those on recognised academic programmes upon

successful completion of a higher degree; or to those completing higher degrees whilst
holding a training number and on an OOP approved by the postgraduate dean, upon
successful completion of the higher degree and return to training. A similar premium will be
paid to trainees taking time out of programme to undertake work deemed to be of wider
benefit to the NHS, as defined in the contract schedules.

2. The general practice premium will only be paid to doctors undertaking general practice
placements as part of a general practice training programme (replacing the GP supplement).
It will not be paid to those trainees whilst they are in hospital or other community
placements, or to trainees on other programmes (e.g. F2) undertaking placements in general
practice.

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Appendix B
Implementation of new 2016 contract, as trainees enter F1 or as contracts of employment expire as trainees move through training.

Date Grade(s) Rotation(s) / Training programmes

Aug-16 F1 All
ST1/2/3 GP trainees undertaking practice placements
All Psychiatry; Public Health
Sept ST1+ Paediatrics (Core, higher and all sub-specialties) ; dentists
Oct CT 1-3 /ST3+ All surgical specialties (including orthodontics)
Nov
Dec
Jan-17
Feb ST3+ Anaesthetics / ITU / Emergency Medicine / Obstetrics and Gynaecology
ST1-2 Core Medical Training /remaining Core Surgical Training / ACCS / Anaesthetics
Mar ST3+ Any remaining Paediatrics trainees
Apr ST3+ Any remaining surgical and all higher medical specialties
May
Jun
Aug-17 Any trainees not already included above

Note: Any trainee (e.g. F2; GP trainee in a hospital setting) sharing a rota with the above will move to the new contractual (and where applicable, pay protection)
arrangements at the same time as those trainees.

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