Summary of the DDRB report on consultant and junior doctor contract reform

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21 / 7 / 2015 2pm

The report on consultant and junior doctors contract reform has now been published by the Doctors' and Dentists' Review Body (DDRB).

The DDRB has made a number of recommendations on new contractual arrangements for doctors and dentists in training and observations on the consultants contract. 

To support your understanding of the report, and facilitate any discussions you might have with your staff, we have highlighted some of the key conclusions.  These conclusion can be downloaded as a pdf from our case studies and resources section of the website or can be viewed on our DDRB report conclusions web page. 

For a further summary of information of the offers under consideration during the consultants’ contract and junior doctors' contract negotiations please see our web page.  

Daniel Mortimer's quote
Consultant contract reform
Doctors in training contract reform
Supporting employer quotes

Commenting on the publication of the DDRB 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 today’s 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 British Medical Association (BMA) have been pressing for reform for several years and a new contract is urgently needed.

"Today’s 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."

Consultant contract reform

DDRB observations include:

  • the removal of the opt-out clause and the inclusion of appropriate contractual safeguards
  • pay progression to be linked to achievement of excellence (assessed at appraisal)
  • basic pay spot rates (2-3 in total) based on recognised stages of a consultant career
  • separate payment for working unsocial hours - designed around the needs of the patient and what needs to be incentivised and balanced against the benefits of having a simple system to administer. There was a general comment also stating that a common definition should be applied across all staff groups
  • an allowance for undertaking specific additional roles - this allowance would allow the types of roles that the DDRB intended to be covered by the principal consultant grade in their previous report on Clinical Excellence Awards (CEAs) to be recognised in pay
  • recruitment and retention premiums (RRPs) to incentivise certain specialties/regions - adopt a more flexible approach to encourage their wider use to address recruitment issues
  • reforming local CEAs as payments for achieving excellence and making such payments contractual - implementation of this requires that employers and staff are properly resourced, trained and supported to deliver the new scheme
  • continuation of national CEAs but no overlapping of payments covered by local payments for excellence
  • provide appropriate flexibility for doctors in managing the new pension allowances
  • clinical academics pay structures for should not inhibit the ability for staff moving in and out of such roles.

Doctors in training contract reform

DDRB recommendations include:

  • the ending of time served incremental progression, with pay instead based on stages of training and actual progression to the next stage of responsibility
  • a supplementary pay structure in line with NHS Employers proposals, including additional hours, unsocial hours premium, availability allowance for on call, flexible pay premia for hard-to-fill specialties and other flexible pay premia for breaks in training for exceptional reasons that benefit the NHS
  • implementation of proposals on work scheduling, work reviews and exception reporting and an end to banding payments
  • a common definition of core time and unsocial hours for all NHS groups
  • GP trainees to be paid on the same basis as hospital trainees
  • a requirement to comply with Working Time Regulations or any successor legislation
  • reimbursement of relocation expenses incurred in the performance of the doctor’s duties
  • further sensitivity testing on the increase to basic pay and wider applicability of the proposals
  • data to be provided to DDRB on the outcomes of all work reviews
  • an agreed deadline for consideration of any outstanding issues and for early implementation of the new contract.

Further work is needed on some aspects including distribution of pay, matching pay progression to stages of training, issues impacting clinical academic and public health trainees, the pay level for dental foundation trainees and the final detail of contractual safeguards.

Supporting employer quotes

David Grantham, Director of workforce and organisational development at the Royal Free and Chair of the NHS Employers Medical Workforce Forum:

“The DDRB’s conclusions reflect the views employers have expressed in this forum and elsewhere that there is a compelling case for changing the NHS contracts for doctors. The contractual relationship needs to evolve as the demand and patterns of patient care change over time. We also need to recognise that the current contracts sought to address issues different to those of today. Junior doctors hours are reduced and protected by the Working Time Regulations.

"For consultants, like other staff, we need the flexibility to allow them work weekends, as very many already do, but without others being able to use the contract to opt out so that meeting the needs of our patients seven days a week is harder to deliver and falls upon fewer of their colleagues. Our culture and service delivery must be focused on high quality patient care across seven days of the week with enough flexibility to support that.”

Philip Marshall, Director of Workforce and Organisational Development at Harrogate District General Hospital:

“For some time now employers have recognised that contracts with our clinical staff need to change to better support both the services to patients and delivery of organisational priorities. Clearer links between pay progression and performance are required if we are to truly incentivise and support a changing culture in the NHS.

"This is a necessary part of any proposed changes to the existing national pay system.”

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