DDRB report on consultant and junior doctor contract reform published


21 / 7 / 2015 2pm

The Doctors' and Dentists' Review Body (DDRB) has published its report following submission of evidence on consultants' and junior doctors' contract reform.

The DDRB's conclusions have reinforced the long-standing view of employers that there is a compelling case for changing the current national contracts for doctors.  

We have a shared principle with the British Medical Association (BMA) that patients deserve the same high quality of care across the entire week. We will now look to meet with the BMA at the earliest opportunity to explore what scope there is to work together to finalise and implement the necessary contractual changes in light of the DDRB's report.

During his speech to the King's Fund, the health secretary announced that the government:

  • will be asking the BMA to engage with them over the summer. The BMA will need to advise by mid-September if they will work with the government to introduce modernised professional contracts. If they do not agree to consult contract changes will be enforced
  • will be seeking immediate removal of the consultant opt-out and early implementation of new terms for consultants from April 2016
  • wants the introduction of a new juniors’ contract from the August 2016 intake
  • will consult on the removal of the current local Clinical Excellence Award (CEA) in the autumn, alongside proposals for a reformed national CEA.

Commenting on the publication of the report, Daniel Mortimer, chief executive of NHS Employers, said:

“Patients and employers want the delivery of the same high quality of care across the entire week, and we welcome the report from DDRB as a key step towards achieving our ambition for seven-day services across the NHS. 

"To afford and sustain seven-day services, employers need to overcome the current obstacles that exist and, as our evidence demonstrated, we firmly believe that the removal of the contractual opt-out for non-emergency work undertaken at weekends and evenings is crucial to improving the quality of patient care.

"We are also keen to progress with reform of the junior doctor contract, to ensure that it is safe, fair, affordable and flexible enough to meet the needs of patients.  Both we and the BMA have been pressing for reform for several years and a new contract is urgently needed.

The report sets a clear direction for reform which is good news for patients and we now need to work together with our medical colleagues and their trade union, the BMA, to implement the changes the Secretary of State has endorsed."

The DDRB's conclusions:

  • The key principles proposed by the government and NHS Employers are reasonable – to improve patient outcomes across the week and to reward greater responsibility and professional competence.
  • The case for expanded seven-day services in the NHS, in order to address the ‘weekend effect’ on patient outcomes, to be compelling. 
  • The proposals should be viewed as a total package of reform across the two contracts.
  • Changes are required to the antiquated approach for time served, mainly annual incremental progression in both contracts.
  • The ‘night window’ for out-of-hours work should start at 10pm and that a common definition should be applied across all staff groups.
  • The DDRB supported the proposed approach to the pay package for juniors, whilst it noted that the rates for unsocial hours and other elements were for the parties to agree. It also noted that total pay for juniors compares favourably with comparator groups and that, given the cost-neutral pre-condition for negotiations, that position will continue.
  • Contractual safeguards are needed to ensure that consultants and junior doctors are not expected to work excessive hours, and can maintain a reasonable work-life balance.
  • DDRB considers that removal of the opt-out is important and significant: “In our view, the current opt-out clause in the consultant contract is not an appropriate provision in an NHS which aspires to continue to improve patient care with genuinely seven-day services, and on that basis, we endorse the case for its removal from the contract.”
  • There is scope for progressing some elements of consultant reform at different speeds, including early removal of the consultant opt-out.
  • The DDRB supports the continuation of national CEAs. They believe that given the separation of local CEAs (to be reformed as performance pay, or payments for excellence), the value of national CEAs will need further consideration.

Further information

Read details of the evidence that was compiled and submitted to the DDRB on our pay review pages. 

Read the NHS Pay Review Body's observations on Agenda for Change and seven-day services.

Next steps

  • We will seek to discuss the conclusions of the DDRB report and the government’s response with the BMA at the earliest opportunity. We would hope to get agreement on the implementation of our proposals, in line with the DDRB conclusions.
  • The government has set out a timetable to seek agreement with the BMA on the implementation of the proposed changes. This engagement will need to be concluded by September 2015 to allow for implementation in 2016.

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