13 / 1 / 2015 12.27pm
Consultants' and junior doctors' contract reform – submission of evidence to the Doctors and Dentists Review Body (DDRB)
Following the breakdown in negotiations with the BMA, the Government wrote to the DDRB asking it to make:
- observations on the reform of the consultant contract to better facilitate the delivery of health care services seven days a week in a financially sustainable way
- recommendations on new contractual arrangements for junior doctors, including a new system of pay progression which better links performance with pay.
The DDRB subsequently wrote to key stakeholders calling for submissions of evidence. NHS Employers' evidence, informed by employer views gathered in the build up to and during the negotiation phase, has now been submitted. The DDRB is expected to report back to the Government in July 2015 following any supplementary evidence requests (expected February) and an oral evidence session (March).
Executive summary of NHS Employers' evidence to the DDRB
- Patients are at the heart of everything done by and within the NHS, which must seek to safeguard patient safety, seeking to remove unacceptable variations in care and patient outcomes.
- This submission argues there is a compelling case for changes to the national terms and conditions contracts for consultant graded doctors employed in the NHS in England and Northern Ireland, and for doctors in nationally approved postgraduate training programmes employed in the NHS.
- Employers face a challenging environment as they seek to deliver efficiency challenges and generate more value from taxpayers’ investment in the NHS. This makes it important that they get the best value they can from the reward system.
- Employers want contracts and terms and conditions for their staff that are effective in helping them plan and deliver consistent high-quality services every day of the week.
- The DDRB is urged to support the introduction of these proposed new national contracts without delay, enabling employers to adopt and adapt them to better meet local needs.
Consultant contract reform
Consultants are our senior clinical leaders. It is through their hard work that the quality of service can be maintained and increased. It is vital that their contract of employment fully engages them. It needs to be a contract for a mature professional occupation that incentivises the best clinical outcomes.
Reform is also necessary to make the contract more supportive of the delivery of seven-day patient care and to make them financially sustainable for the future. Junior doctors must be supported more effectively in their training and development during evenings and weekends.
Our evidence sets out our proposals to amend the current 2003 contract, not the introduction of a new contract, which entail:
- The removal of the contractual barriers to help facilitate the introduction of seven-day services, including the removal of the right to opt-out of non-emergency evening and weekend work in premium time and an extension to plain time coverage.
- The introduction of a schedule of safeguards to ensure staff are appropriately protected 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
- bringing to an end incremental pay progression based on time served
- the introduction of new pay rates, and
- linking progression to higher levels of responsibility and competence, with progression being contingent on performance.
- Bringing to an end the current nationally prescribed local clinical excellence award arrangements and replacing them with new locally determined, non-consolidated payments for excellence.
- Transitional protection arrangements to support the revised contractual arrangements.
- Based on the modelling of the employer team proposals, consultants (per full time equivalent) will progress from an entry stage consultant to established consultant with salary values of £70k rising to £93k after five years. For experienced consultants this could rise to £107k, to reflect additional activity and work undertaken out of hours. Up to £6.9k will be available for additional responsibilities and around £7.5k for performance-related payments for experienced consultants.
- There is possibly another £5-6k additional payment available for out-of-hours work, generated from savings elsewhere in the contract. Funds for out-of-hours work will increase over time to reflect the shift to seven-day services.
Junior doctor contract reform
The aim of reforming the contract for doctors and dentists in training is to produce a new pay system and a new set of terms and conditions to replace the New Deal contract, which is no longer fit for purpose. This is consistent with both the DDRB and the BMA view that a greater proportion of pay should be fixed, with less variable pay.
- The 'banding' system with its penalty payments on which the New Deal is based is inherently adversarial for junior doctors and their employers. Banding was not the key driver to reducing junior doctor hours and is now an anomaly.
- Our proposed pay system ends time based incremental progression. Increases to basic pay would be determined by changes in level of responsibility as the doctor progresses through training. Some levels of specialty training would be at a similar level of responsibility and so would attract the same pay.
- Pay is based on hours and is similar to the specialty doctor arrangement. Raising the level of basic pay is important to stabilise the pay bill but this tends to create a greater benefit for doctors who do not work out of hours. Therefore, the proposals include different rates of pay for Sundays and night shifts, and also suggest nationally set recruitment and retention premia (RRPs) for particular specialties to ensure that incentives are appropriately distributed.
- Working patterns and training opportunities would be managed via a work scheduling process. This is similar to job planning, but the schedule would be designed around the post and then tailored to the individual post holder, due to the short-term nature of junior doctors’ placements.
- Safe working hours are a priority and the new terms and conditions propose a set of simple rules to ensure that hours of work and duty are limited. However, it is not acceptable for health and safety breaches to be linked with additional reward, and we propose that any concerns about safe working hours should be addressed through the work schedule review process.
Other aspects of the terms and conditions, such as leave, private professional practice, and termination of employment, are simplified. The expenses provisions are brought in line with Agenda for Change, with an additional section incorporating existing provisions on relocation and excess travel, some of which are discretionary.
As the DDRB is reporting in July 2015, our aim would be for the new arrangements to be in place for August 2016.
The revised contracts must be cost neutral, with the exception of the higher employer pension contributions related to increasing basic pay for junior doctors, which was approved by the Department of Health as an allowable cost during the negotiation phase. Further modelling will be needed once final details have been confirmed on each contract and transitional arrangements established.
Read our full submission
Our full NHS Employer's evidence to the Doctors' and Dentists' Review Body 2015 is now available to download.
You may also be interested to read our evidence to the NHS Pay Review Body.
Other stakeholders evidence
Other stakeholders submitting evidence include the Department of Health, the British Medical Association, Health Education England, NHS Providers (formerly the Foundation Trust Network) and NHS England. All evidence will be made available on their respective websites.
The BMA evidence is available on the BMA website.
We believe that the BMA's evidence does not accurately reflect the comprehensive proposals offered by the employers’ negotiation team on the reform of the contracts. We do not accept the BMA's statement that our proposals 'could jeopardise the safety of patients and doctors' and lack 'credible evidence to support changes being proposed'.
As our evidence shows, patient safety is central to our proposals and doctors will continue to be afforded appropriate workplace protections and reward structure. We support NHS England’s drive towards the implementation of seven-day services policy and where there is uncertainty on the implications for doctors pay, as changes are made to the delivery of patient services, we have offered a range of mitigating actions.
Employer case studies
We are continuing to collate case studies which illustrate the problems faced by employers posed by the current consultants’ contractual provisions. If any employer would like to share their stories with us to supplement our engagement with the DDRB please contact us at firstname.lastname@example.org