The 2016 contract came into effect on 3 August 2016. The 2016 contract will start to be introduced in England for GP trainees and trainees in hospital posts approved for postgraduate medical/dental education in line with a phased implementation timetable from October 2016.
Q1. What does the 2016 contract mean for the pay for doctors in training?
Overall average earnings are expected to remain the same and individual pay will be more predictable and less variable between placements. Doctors will be paid more accurately for actual work done, with an increase in basic pensionable pay, additional pay for additional rostered hours, enhanced rates for unsocial hours, allowances for weekend working, on-call availability supplements for those required to be on-call, pay for anticipated work done whilst on-call and (where appropriate) flexible pay premia.
Some doctors may require transitional pay protection to maintain their level of pay under the 2002 new deal arrangements (protected at the level of banding for their current post as it was on 31 October 2015 excluding band 3). These are likely to include those on working patterns which were unfairly advantaged under the new deal banding system (e.g. those receiving a band 1B supplement for a 42.5 hour week in which all hours of work fall between 9am-5.30pm Monday to Friday), as well as those doctors whose current basic salary is significantly out of line with their current level of training, perhaps as a result of switching training programmes or training less than full time. These examples represent an inherent unfairness in the new deal contract that the 2016 contract seeks to rectify going forward.
Q2. How will monthly pay be calculated where hours vary from week to week in a rota?
The annual salary should be calculated according to the working pattern set out in the individual work schedule for each post, taking all the pay elements into account. Monthly pay will be a consistent amount each month and a month’s pay will reflect 1/12 of that annual amount.
Payments for exceptional additional and unscheduled hours of work, that have been approved to secure patient safety at the time the hours were worked, should be paid in the next available payroll.
Q3. How will pay be calculated for trainees who are less than full time (LTFT)?
Pay for trainees working less than full time will be apportioned as follows:
- basic pay (and the value of any applicable flexible pay premia) will be calculated pro rata to their agreed proportion of full time work
- the on-call availability allowance will be calculated pro rata, based on the proportion of the full time commitment to the rota that has been agreed in the doctor’s work schedule
- unsocial hours enhancements will be paid according to the working pattern detailed in the work schedule
- weekend allowance will be paid pro-rata based on the proportion of full time commitment to the weekend rota. For example, if the LTFT doctor contributes 60 per cent of the FTE weekend rota, they will receive 60 per cent of the cash sum outlined in Annex A for the FTE rota frequency according to their nodal point.
Q4. What are flexible pay premia and what is their value?
The 2016 contract offers new flexible pay premia for those training in GP practice placements and recognised hard-to-fill training programmes where there is the greatest need – currently this includes emergency medicine (ST4+) and psychiatry (all grades).
Premia will also be payable to doctors who return to clinical training after successfully undertaking a pre-agreed period of approved academic research, to those who train in oral and maxilla-facial surgery (OMFS) and, in some circumstances, to those who take time out of training to undertake other recognised activities that may be of benefit to the wider NHS.
The full criteria for flexible pay premia are set out in the terms and conditions in Schedule 2 paragraphs 18-44, with the values of those premia set out in Annex A.
In future years, evidence will be provided to the Doctors and Dentists Review Body (by Health Education England and other stakeholders) about hard-to-fill training programmes and other uses for flexible pay premia, to allow them to review the use of the payments and make recommendations on their application and value.
Q5. If a doctor has chosen to undertake academic research between training programmes (for example between finishing core training and applying for higher training) eligible for a flexible pay premium when they return to training?
The 2016 terms and conditions of service (TCS) state that to be eligible for an academic flexible pay premia (FPP), the doctor must return to the same training programme that they left to undertake the academic activity. However, there is no intention to withhold a flexible pay premia from those doctors who made the decision to undertake academic research between training programmes prior to the publication of the full 2016 TCS. Therefore, those doctors who have accepted an appointment to start an academic activity prior to 31 March 2016 without having secured a place on a GP or specialty training programme, who would otherwise qualify for a flexible pay premium on their return to training under the 2016 TCS, will be considered as being eligible for the appropriate flexible pay premium. To be eligible, they must enter a nationally recognised specialty training programme (excluding foundation programme) at the first available opportunity, in line with the national specialty training recruitment timetable, following the successful completion of that academic or leadership work. This provision will only be extended to those who have made the decision to take up such an academic programme prior to 31 March 2016. Employers should ask doctors to provide evidence of the date upon which they accepted this academic or leadership work in order to be awarded the FPP.
Q6. How should additional contracted hours be paid?
Basic pay will be for a 40-hour week, including paid breaks. Additional rostered hours, up to maximum of eight hours can be additionally contracted and reflected in the work schedule. Such additional hours will be paid at the basic hourly rate with appropriate enhancements payable for any hours which fall into the unsocial hour periods.
Q7. How can work done on-call be prospectively estimated and paid?
The arrangements set out in the TCS for paying for work undertaken while on-call, are similar to those which are currently used for speciality doctors and consultants.
Employers already have an understanding of the typical hours of work already done by doctors across the full range of specialties, as they currently need to estimate this for the purposes of scheduling rest breaks for doctors under the 2002 New Deal TCS. Employers can also use historical data from diary card monitoring to support their estimates. Where there is no data available, or where such data is not sufficiently robust, doctors currently in post and clinical and service managers can be consulted to validate this information for work schedules.
On-call frequency and prospectively estimated work done while on-call will be outlined in work schedules upon which a doctor’s pay is based. Should working patterns vary from the schedule, this should be addressed through the work schedule review process and pay adjusted accordingly.
Q8. What elements of pay will be pensionable under the 2016 contract?
Pension arrangements are set out in Schedule 2 paragraphs 57-59 of the TCS as follows:
The following pay elements of the 2016 contract fall into the definitions contained in the NHS Pension Scheme Regulations 2015 (as amended):
- all hours worked up to 40 hours per week on average and paid at the basic pay rate
- London weighting
- pay protection amounts outlined in Schedule 2 para 46-52 of the 2016 terms and conditions (excludes transitional pay protection set out in Schedule 14).
Q9. Will there still be annual cost of living increases in pay rates?
The review body on doctors' and dentists' remuneration (DDRB) advises the government on rates of pay for doctors and dentists and are given a remit each year from the Secretary of State for Health. This process will continue following the introduction of the 2016 contract, although in the future, the DDRB may also be asked to review the value and application of flexible pay premia and other aspects of the new pay system.
Q10. What should we do for doctors who have only received offers of employment for their first placement who ask for confirmation of their salary for mortgage/property rental agreement purposes?
NHS Employers have always advised that doctors should not rely on variable pay (eg banding supplements and other supplements and allowances) for mortgage applications. Basic pay is confirmed in the pay circular, so F1s on the new contract from December know they will not be earning less than £26,350. As soon as you are in position to offer employment to F1s on the 2016 contract on placements from December there is no reason why you cannot send offers out including template work schedules.
Q11. What is a senior decision maker?
The seven-day services clinical standards set out responsibilities for competent decision makers and senior decision makers. Where it is not specified that this role must be undertaken by a consultant, the employer may feel it is appropriate to designate a senior trainee as the decision maker for a particular shift.
The terms and conditions of service (TCS) state from 2019 there will be an allowance payable for taking on such responsibility, which will be funded from changes made to the pay system through the Acas negotiations with the BMA. More information and guidance will be available nearer to the time, and amounts will be notified in future pay circulars.
Q12. Does the fidelity to the NHS clause for locum work apply to doctors on the 2002 TCS?
No, it is a feature of the 2016 terms and conditions of service. The national locum rate is similarly a feature of the 2016 contract, however it is suggested that employers use this locum rate for all of their junior doctors employed through bank arrangements to ensure consistency and to help to control locum spend.
Q13. The work schedule templates asks for details of the number of different types of shifts, this may be different depending on the slot on the rota, how is the individual paid?
The details on the numbers of different types of shifts can be lifted from the rota. Doctors will be paid according to the rota, not their individual pattern. This is detailed in various paragraphs in Schedule 2 for the different pay elements, and also at Schedule 4 paragraph 12 of the new terms and conditions of service.
Q14. How is the £20k flexible pay premia (FPP) calculated for emergency medicine trainees?
The emergency medicine FPP is payable to emergency medicine trainees from ST4 and above. The total amount (£20,200 as per the 2017 pay circular) is divided over the eligible years of training. This means that if you are due to receive your certificates of completion of training (CCT) following completion of your ST6 year, you will receive £6,734 per annum for the three years (ST4, ST5, and ST6). Trainees will continue to be paid this annual amount until they exit this training programme, so if your CCT date is put back by a year, you should receive £6,734 for that additional year. Less than full time trainees will receive the FPP amount pro-rata.
Trainees who transition or join the programme part-way through may only receive part of the FPP. For example, those who transition into ST5 should receive £6,734 per annum for each of the remaining two years at ST5 and ST6 only, instead of the full £20,200. Trainees who are pay protected under Section 2 will not receive the FPP and continue to be paid under the 2002 pay scales.
Q15. The 2016 terms and conditions state that flexible pay premia (FPP) is fixed. Will the 1 per cent pay uplift awarded in April 2017 therefore not apply to FPP?
Schedule 2 paragraph 21 of the 2016 terms and conditions of service states:
“Flexible pay premia will be fixed at the rate applicable at the point in time at which the doctor becomes eligible, as described in paragraphs 25 to 44 below, and shall continue to be paid at that same rate for the remaining period in which the doctor is working in a post as part of the training programme that attracts the premium."
This condition was intended to ensure that trainees eligible for FPP would receive that agreed rate of FPP for the remainder of their programme, and that any future substantive changes made to the value or eligibility criteria for FPP would not adversely affect those trainees.
However, this condition was never intended to apply to changes to the FPP value as a consequence of the annual pay uplift. The 1 per cent pay uplift granted in April this year has been applied to the FPP and should be paid to all eligible doctors. These are detailed with the uplift applied in the latest pay and conditions circular (MD 2017/01) on page 7 which is available on the NHS Employers website.
Q16. Is the FPP applicable to all trainees in histopathology, for example, forensic histopathology trainees?
Yes, the FPP will be applicable to those entering training at ST1 now who are on training programmes for histopathology, forensic histopathology, diagnostic neuropathology, and paediatric and perinatal pathology. These are the eligible training programmes for this FPP.
Q17. How is the FPP applied for those at ST1 and above?
This flexible pay premium is being applied as a recruitment premium. It applies to those entering the eligible training programmes at the point the FPP is introduced, such as for those entering at ST1 from August 2018. In line with paragraph 31 of Schedule 2 of the Terms and Conditions of Service for NHS Doctors and Dentists in Training (England) 2016, the premium will continue to apply for these trainees for the duration of their training programme at the amount set out as applying to that programme at the point in time that the doctor first entered that programme (and as uprated), regardless of any subsequent changes to the premium (or removal of it) for subsequent entrants to the training programme.