Dr Blogs

Junior doctor contract: despite the tinkering, juniors are going to reject the deal

So, in a nutshell, here are the changes to the juniors’ NHS contract. Note that no one has explained how you make a five day service become a seven service without additional resource or exploitation.

I doubt there’s been enough improvement for most juniors, and the ‘safeguards’ against over-work still appear paper thin. Just read today’s King’s Fund update to put it in context.

I’m sure it’ll get kicked into touch in June, with a massive majority, when put to the vote:

Seven-day Service

In future, Saturdays and Sundays will count as “plain time” – part of a junior doctor’s normal working week.

However, trainee medics will receive extra money for working at least seven full weekends a year up to a maximum 10% increase in their pay, depending on how often they do so.

Most will receive at least the 3% uplift for doing seven weekends.

Hunt claims the new system makes it a third cheaper for hospitals to roster junior doctors to work at weekends, he says.

Night shifts

The BMA are claiming that a complicated new payments system for overnight working is a big improvement for doctors. Pay is going down from 50% extra for a shift to 37% for working at least eight hours any time between 8pm and 10am.

But the union says that it will also end some anomalies that meant some doctors working very late at night did not get a premium rate in return.

Basic pay

Basic pay will rise by 10%-11% and not the 13.5% the health secretary previously promised, because other changes to their payments make it harder to keep the package cost-neutral.

Also, most juniors will also get a separate 8% uplift to their pay so long as they do on-call work, which almost all do.

Pay premia for young doctors opting to specialise in A&E, psychiatry and oral and maxilo-facial medicine have been increased to £20,000. And while doctors doing locum shifts will have to first offer their services to the NHS, they will get a 22% bonus every time they do.

Role of new guardians of safe working

The BMA has strengthened its role in creating these new posts, which will ensure that hospitals do not force junior doctors to work excessive hours. Trainee medics see them as vital to ensuring they do not become overworked and so compromise patient safety. Each NHS trust must now set up a junior doctors’ forum to advise the guardian, while the BMA will also now be represented at any hearing of an appeal against a guardian’s decision.

Equalities issues

Efforts have been made to minimise the discrimination against part-time and, especially, female junior doctors, which the government acknowledged in its own equalities impact assessment of the previous contract.

Medics returning after some time out – after having a child, for example – will receive “targeted accelerated learning”, including a mentor, to help them get back up to speed fast with learning they have missed.

But the new deal does not offer anything concrete to help junior doctors overcome the difficulty of arranging childcare for the extra weekend shifts many will be working – another problem identified by the equality assessment back in March.

Imposition

If junior doctors endorse the whole package in their ballot, the contract will be introduced as planned from August.

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