Proposed junior doctors' contract detailed which would support better patient care and fairer rewards

Danny Mortimer

13 / 1 / 2015 1.47pm

NHS Employers today published its submission to the Doctors and Dentists Review Body (DDRB), proposing details for a new junior doctors’ national contract which would more fairly reward doctors in training and support better care.

The submission also suggests revisions urgently needed to the contract of consultant doctors to remove major barriers to better, safer patient care and make services more sustainable in future. In particular, these aim to end consultant doctors’ veto on working in evenings, nights and weekends - which is hindering the development of better seven-day services - and to better link earnings to local priorities.

NHS Employers preference remains negotiated settlements and it hopes this submission can widen the debate over necessary changes to doctors’ contracts. The British Medical Association abandoned 12 months of formal negotiation during October 2014. The report details the issues discussed during the negotiations and makes proposals for contract changes that can now be seen by a wider audience of doctors and employers.

Examples of issues with the current contracts include: rotas cannot always be planned efficiently; costs to employers can spike greatly if junior doctors work only a small amount outside their rotas; and their contract can incentivise unhealthy working hours; consultants can often demand three times or more their normal wage in return for working in evenings and at weekends.

The proposed changes aim to redistribute the money available for pay, in order to reward doctors equitably for the contribution they make and be cost-neutral to the NHS. They would support safe working hours and service delivery. They address current concerns that junior doctors need to be supported more effectively in their training and development during evenings and weekends. Flexibility of working hours would increase. Doctors would be protected during any transition.

Danny Mortimer, chief executive of the NHS Employers organisation, said:

“For years these hospital doctors’ contracts have been problematic and every year it worsens. The current junior doctors’ contract was formed in 2000 and, while it’s frustrating that no change has yet been agreed, we can base this next step on years of constructive debate. I would urge all parties to consider the detail of our proposals and recognise how the improvements would benefit patient care.

“The consultant doctors’ contract has served the NHS and its patients for years, but key elements are increasingly unhelpful - especially the veto that lets consultants name their price for working out-of-hours.”

Summary of suggested consultant changes:

  • The removal of contractual barriers to the introduction of seven-day services, including the removal of the right to opt-out of non-emergency evening and weekend work.
  • An extension to what hours are considered ‘plain time’.
  • A schedule of safeguards to ensure staff are safe to work where the service moves to the provision of seven day services.
  • A revised pay structure that appropriately rewards those staff that contribute the most and work the most onerous working patterns. This involves:
    o bringing to an end incremental pay progression based on time served.
    o the introduction of spot pay rates .
  • Bringing to an end the current nationally prescribed local clinical excellence award arrangements (which are tied only to time served once given, not performance) and replacing them with new locally determined, non-consolidated payments for performance.
  • Transitional protection arrangements to support the introduction the revised contractual arrangements.
  • Financial modelling suggests consultants would get £70,000/annum on entry, rising to between £94,000 and potentially £127,000 after five years.

Summary of suggested junior doctor changes:

  • Replacing the New Deal contract, which is no longer fit for purpose. The DDRB and British Medical Association agree that less variable pay is needed, to improve fairness and consistency.
  • Removing the exceptionally complex “banding” system that can result in significant pay inconsistencies and also big costs to employers due to very small rota overruns. For example, one trust reported an additional £250,000 cost for an eight person rota over a six-month period when one person in that team exceeded the banding on one occasion.
  • End time-based incremental pay progression and relate it to level of responsibility, supporting better patient care.
  • Setting ‘recruitment and retention premia’ nationally to support the appropriate distribution of these incentives to encourage people into careers in demanding specialist medical roles.
  • Working patterns and training would be managed via a new work scheduling process (made possible by contractual changes) that reflect the short-term nature of junior doctors’ placements and reduce the problem of junior/consultant mix being very variable at different working hours.
  • Better work scheduling systems would also support staff to be healthy and safe, and not encourage over-long hours.
  • Simplification of many other elements of the contract and also bringing the expenses provision in line with the Agenda for Change framework that covers over a million non-doctor NHS staff.

The full report can be viewed here:


Notes for editors:

  • The NHS Employers organisation is the recognised body for employers in the NHS, supporting them to put patients first. See for more information.
  • Follow Danny Mortimer on Twitter at @NHSE_Danny and NHS Employers on Twitter at @nhsemployers. Or for medical pay and workforce matters follow assistant director of medical pay and workforce, Bill McMillan, at @NHSE_Bill.

Contact details:

If you have a media enquiry, please contact the press office:
Mike Foster
Senior Media Officer
NHS Employers
Tel: 020 7799 8671
For out of hours media enquiries, please contact the duty press officer on 07880 500 726.

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