Posted 05 July 2016
Joint Statement on the Junior Doctors' contract referendum result

In response to today’s announcement by the BMA regarding the junior doctors’ contract, the Royal College of Anaesthetists (RCoA), The Association of Anaesthetists of Great Britain and Ireland (AAGBI) and the Faculty of Intensive Care Medicine (FICM) made the following joint statement.

"The Royal College of Anaesthetists, The Association of Anaesthetists of Great Britain and Ireland, and the Faculty of Intensive Care Medicine have always been clear in our support for junior doctors, that each individual member must make their own decision in the BMA contract referendum.  We all hoped this dispute could be resolved, but rejection of the contract shows continued dissatisfaction with what’s proposed, and ongoing concerns over issues such as training, rotas and morale. In times of such national political uncertainty, we call for trainees and their leaders, the wider profession and government to work together constructively and urgently progress these issues, for the good of junior doctors, their patients and the NHS. We will continue to support our trainee colleagues through these difficult times and build on the progress that has been made to date to ensure that their outstanding concerns are addressed."

Dr Liam Brennan, President, Royal College of Anaesthetists (RCoA)
Dr Andrew Hartle, President, The Association of Anaesthetists of Great Britain and Ireland (AAGBI)
Dr Anna Batchelor, Dean, Faculty of Intensive Care Medicine (FICM)


Posted 8 June 2016
Trainee update on the Terms and Conditions for Junior Doctors' Contract released on 27 May 2016

GAT was pleased that further contract negotiations, mediated by ACAS, resumed between the Department of Health and the BMA, and that a contract agreed by both sides would be put to members.  The GAT Committee is studying the full terms and conditions of the contract, FAQ documents, and following the BMA webchats to understand better what the contract means for current and future junior doctors, particularly those in anaesthesia and ICM; we’re sure you are similarly considering what the contract means for you.

The BMA has stated that this is the best possible negotiated contract that is achievable.  We welcome the improvements to the contract, particularly relating to the Guardian role which will be the key to ensuring safe working hours, and now includes an emphasis on trainee engagement and inclusion of annual reporting of rota gaps.  How robust a system this will be in practice is not known and is likely to vary according to local appointment and practice.


Pay calculation remains complex, although we understand a pay calculator and/or some worked examples will be released soon.  In particular, the arrangements for pay for those working LTFT are unclear, although we understand all elements will be pro-rata.  We understand that no further Equality Impact Assessment will be performed and we remain concerned that the extent to which this group will be disadvantaged will remain unknown.  We anticipate more information from the BMA regarding this, including the joint guidance with NHS employers regarding flexible working. BMA has produced a comparison of the 3 different contracts (current; March (imposed) and May (agreed)), which can be found here.


The next steps are as follows:

  • BMA roadshows to explain the details of the contract to as many junior doctors as possible.  Find your nearest roadshow here, and please go and ask questions.
  • A referendum of all junior doctor BMA members in England (and final year and penultimate year medical students) will occur between 17 June and 1 July.
  • The result will be released on 6 July.  If the contract is agreed, it will be implemented from October 2016.  If it is not agreed, the next steps are not clear.

 

Whatever the outcome of the vote, no matter which contract is implemented or imposed, everyone affected must get involved in the process of rota design and implementation, and all the other systems that must be developed to ensure safe and fair working arrangements.  We encourage each of you to do as much of this as possible (there isn’t a second go!).
Please, read the contract, and if you have queries about it, contact the BMA.  The  specific email address for questions is juniorscontract@bma.org.uk. If you have any difficulty getting an answer please contact us on gat@aagbi.org and we will do our best to help.  We have prepared a brief summary which highlights our understanding of some key changes from the previous contract and the steps to calculate pay. The contract will have different implications for everyone and we cannot recommend or advise you how you should think or vote.

Junior Doctors’ Contract May 2016:  changes from the previous contract and arrangements for pay
The “Dalton contract”1  released earlier this year, contained measures designed to ensure safe rostering with a reduction in maximum weekly working hours and more stringent specification of rest requirements.  Additional changes we have noted in the May contract2  compared with the previous version are:

  • Further development of the Guardian of safe working hours role, which will now include  annual reporting of rota gaps and a regular junior doctor forum.
  • The introduction of a weekend allowance:  a % supplement of basic pay which varies according to the frequency of weekends worked.  For example, 1 in 4 weekends attracts a 7.5% supplement.
  • A 37% supplement on hours worked overnight (21:00h to 07:00h, or on all hours up to 10:00h if the shift starts between 20:00h and 23:59h).
  • Extension of pay protection for ST doctors for 4 years (extended pro-rata for LTFT doctors; a doctor working at 60% would have 4 years extended to 6.6 years) or until 2022 (whichever is sooner).
  • An additional type of pay protection for doctors in FY1 or 2 or CT1 or 2 called a ‘cash floor’. 
  • A change of the first refusal of locum shifts from a junior doctors’ current employer to NHS Staff banks. 
  • The introduction of a Senior Decision Maker supplemental pay from 2019.  Which roles qualify for this will be locally negotiated and the funding level for this has not been announced.
  • The introduction of accelerated training for those who take time out.  The details of this are currently unclear, including how this will work in practice to ensure that it does not unfairly advantage those who have taken time out.


Calculation of pay
For doctors working resident on call rotas, pay can be calculated using the following steps:

  1. Basic pay (for 40 hours per week) is according to a nodal point: F1 / F2 / CT1-2 / ST3-7
  2. Additional pay at basic rate for any additional hours over 40, up to a maximum of 48 hours. (If 8 asditional hours are worked this will be 8/40 (20%) of basic pay.)
  3. A weekend supplement as described above, if weekends are worked at a frequency of 1 in 8 or more. (If 1 in 4 weekends are worked, this will be 7.5%)
  4. A supplement of 37% above basic pay for all hours worked at night (as described above).


For non-resident on call rotas the following steps can be used:

  1. Basic pay (for 40 hours per week) is according to a nodal point: F1 / F2 / CT1-2 / ST3-7
  2. A weekend supplement as described above, if weekends are worked at a frequency of 1 in 8 or more.
  3. An on call availability allowance of 8% of basic pay.
  4. Pay for additional hours worked based on a prospective average calculation and paid at basic rate or a night time supplement, depending on which hours are worked.
  5. If additional hours are worked above this average calculation, they will also be paid.


The arrangements for pay for those working LTFT are not clear although we understand all elements will be pro-rata.  


1Terms and Conditions of Service for NHS Doctors and Dentists in Training.  Version 1.  31 March 2016. 

2 Terms and Conditions of Service for NHS Doctors and Dentists in Training. Version 1. 27 May 2016.  Available at:  http://www.nhsemployers.org/news/2016/05/2016-doctors-in-training-contract


Disclaimer
This information is provided in good faith by the members of the GAT committee who have read and appraised the terms and conditions and supporting documents.  We feel that much of the detail in the contract remains open to interpretation and dependent on how the contract is implemented.  The BMA FAQs help to clarify points and we have also studied these, but if you believe that we have made mistakes then please let us know asap.  Please also bear in mind that the final financial impact of the contract will also be affected by changes to pension contributions, student loans, and other personal allowances.  On that subject, remember to take full advantage of any personal tax allowances for professional subscriptions (for e.g. GMC, AAGBI, BMA, RCOA, medical indemnity and GiftAid) and also RCoA examination fees.  More information about claiming examination fees can be found here.

 

Posted 12 February 2016

GAT was disheartened and disappointed to hear the Secretary of State for Health (SoS) confirm his intention to impose a contract on junior doctors in England from August 2016.  Imposing a contract, especially when progress has been made via negotiation, is a huge backward step.

The SoS has said that a new contract is needed to address the “weekend effect” and develop seven-day services.  GAT believe that the barrier to extending seven day services is not the junior doctor contract; junior doctors already regularly work weekends (as do our consultant colleagues), but rather the need for investment in all NHS staff groups.  Imposition of a contract devalues the workforce and will lead to a worsening of junior doctors’ morale and compound the already significant problem of them leaving the NHS.  The consequences of this for patients and the NHS must be acknowledged and averted.

The details of the contract that is to be imposed are not known at present.  We recognise that uncertainty can be stressful.  GAT remains committed to working with our colleagues at the BMA, the RCoA and other trainee doctors’ groups to provide timely communication to our members. We refer you to the BMA webpages and also our Joint Welfare Statement, which was written several months ago, but remains relevant.

GAT believe negotiating a contract is in everyone’s best interests. We are grateful for the support of the AAGBI Board, the RCoA and our medical and non-medical colleagues.  GAT are here for our trainee members.  If you have any questions, comments or concerns do not hesitate to get in touch: gat@aagbi.org.


The GAT committee

 

Posted 07 January 2016

GAT is saddened that negotiations between the government and the BMA about the junior doctors’ contract failed to reach agreement in time to prevent industrial action. Junior doctors in England will now take industrial action (IA) starting on 12th January 2016. In common with our colleagues in England and beyond, GAT had hoped that mediation and further talks would lead to a compromise that sustained and even promoted in the contract the core values of patient safety, staff wellbeing, fair conditions, employment safeguards, and payment for work done. Even following this latest setback we urge a return to negotiations facilitated by independent conciliation and arbitration. We hope both sides in this dispute can together reach a decision that is safe and fair, meeting the needs of the public and of our members. Each BMA member who is a junior doctor must now make a personal decision whether to participate in IA.  We trust that those decisions made by individual trainees will be respected by their colleagues and departments.

Patient safety remains our first priority, and it is vital that we all ensure this throughout the period of IA. We remind members of specific GMC guidance, which details the responsibilities of doctors taking industrial action. The latest BMA statement contains specific guidance for doctors of all grades with advice on who can (and cannot) do what as part of IA, as well as more general information for the public. Any member planning to take part in IA must be familiar with this and any subsequent guidance from the GMC and BMA before 12th January.  This is an unprecedented step in working or living memory for the vast majority of us.

It would it be a huge injustice if government imposed a contract on junior doctors in England. The negative impact on the morale of all NHS staff, struggling daily with increasing healthcare demand and limited resources would be massive. To avoid this we encourage all AAGBI members to continue lobbying MPs, and other elected officials, to stress the importance of a negotiated settlement. Please, also keep engaging with the public, friends and family to explain the facts that underpin this dispute.

Finally, we ask everyone to look out for each other. These are exceptional circumstances that affect all involved.  We draw attention once again to our joint welfare statement, which includes references to sources of support and advice.
Please do not hesitate to contact us for information, advice if you have any concerns, or even if you just want to talk to someone! (gat@aabgi.org, or telephone +44 (0)20 7631 1650, then select ‘3’ for secretariat)

 

 

Posted on 04 December 2015

We are encouraged the BMA, NHS employers and the Department of Health have agreed to return to negotiations, following facilitation by ACAS. The BMA has agreed to suspend any industrial action until the 13th January, and the Department of Health has agreed to suspend implementation of a junior doctor’s contract within this timeframe.

Patient safety and the wellbeing of junior doctors are of paramount importance, and GAT will continue to support its members.

GAT continues to fully support the BMA, and would like to thank the BMA for its ongoing work to resolve this dispute.

 

Posted on 20 November 2015

We now know that junior doctors in England have voted overwhelmingly in favour of industrial action as part of the dispute with the Government and NHS employers over a new contract.  The result indicates the enormous strength of feeling amongst them.  Yesterday the AAGBI released a statement in response to the ballot result. GAT  remains hopeful that any industrial action can be avoided by re-opening of negotiations, with an independent mediator if necessary.

The BMA has stated that to avoid industrial action it requires the following:

  • Withdraw the threat to impose a new contract.
  • Proper hours safeguards protecting patients and their doctors.
  • Proper recognition of unsocial hours as premium time.
  • No disadvantage for those working unsocial hours compared to current system.
  • No disadvantage for those working less than full time and taking parental leave compared to the current system.
  • Pay for all work done.

If negotiations do not reopen and industrial action takes place, we hope that the decisions made by our trainee members are respected by their colleagues and departments. As always, patient safety remains our first concern and we must all work together to ensure this is maintained throughout any periods of industrial action. 

The ballot result raises practical questions relating to the processes involved in taking industrial action.  We would point our members towards advice given by both the BMA and the GMC about who can and cannot take industrial action, and what steps can be taken by individuals to minimise disruption to patients:

Junior doctors
Hospital doctors
GMC advice for doctors considering industrial action
GMC response to BMA ballot result

These resources are useful for all doctors, not just BMA members.  We will also keep the AAGBI and GAT web pages up to date with information and links to useful resources. 

We hope that meaningful negotiations can resume and industrial action can be avoided.  We encourage members to continue to raise the contract issue with their MPs; if necessary contact them again to stress the importance of a negotiated, rather than imposed, contract. Patients will also be concerned and it is also important to continue engagement with the public to explain the issues.

Finally, we remind everyone that we must look after each other during this  stressful time.  We would like to draw attention once again to our joint welfare statement, which includes references to sources of support and advice.
If any of you are struggling to get information please do not hesitate to contact us (gat@aabgi.org).

 

Posted on 02 October 2015

In the last week there have been several developments in the contract negotiations.

Firstly, at the BMA JDC meeting last weekend a new Chair of the committee was elected:  Dr Johann Malawana.  At the same meeting the decision was made for the BMA to ballot its English members regarding taking industrial action as a protest against the impending imposition of a contract.  As the Welsh and Scottish Governments have agreed not to impose a contract at present, then the BMA divisions in Scotland and Wales are not in a trade dispute and therefore no such ballot will occur for these members.   A decision from the Government in Northern Ireland is awaited.

The AAGBI is a membership organisation and not a trade union and therefore cannot comment on industrial action.  We direct you towards the BMA; you may wish to consider joining if you are not already a member.  https://bma.org.uk/membership

Following these events the Secretary of State asked to meet the new BMA JDC chair.  In the light of this, NHS Employers cancelled all of its planned meetings with junior doctors.  Two of these were scheduled for this week – London on Monday 28 September and Manchester on Tuesday 29 September.  Despite the meetings being cancelled, junior doctors united to protest against the contract, with a march in London to Downing Street and another in central Manchester.

Almost 50 000 doctors from all specialties have joined a closed facebook group about the Junior Doctors Contract:  “Junior Doctors Contract Forum”.   A second protest march in London is planned for Saturday October 17th from 1400h - 1800h. Please read more about the Junior doctors’ contract below. 

Press coverage
Coverage about the junior doctor contract negotiations has increased in the media.  The marches were covered by the BBC and there was a piece on Newsnight on Thursday 1 October about the contracts.

GAT and the AAGBI have been doing all they can to raise awareness.  The Chair of GAT and President of the AAGBI were co-signatories of a letter to the Guardian last week, and GAT supported the letter to the Secretary of State by the AoMRC Trainee Doctors Group (ATDG).  Dr Hartle gave an interview to the Independent.  There are many other letters and articles available and much action on Twitter; #juniorcontract.

http://www.theguardian.com/society/2015/sep/23/junior-doctors-new-contract-is-a-disaster
http://www.theguardian.com/society/2015/sep/24/nhs-contract-shortage-junior-doctors-jeremy-hunt-healthcare
http://www.independent.co.uk/life-style/health-and-families/health-news/new-nhs-junior-doctor-contract-would-discriminate-against-women-senior-medics-warn-10516885.html

Welfare Statement
As information has spread about the proposed details of the contract and how it might impact on trainees, so has anxiety about what this means for their future.  Training in anaesthesia is already not without stress and GAT, the AAGBI, and the RCoA and FICM recognise that uncertainty regarding contracts is likely to add to this.  This week a Joint Welfare Statement written by trainee and consultant leaders of these organisations was released to acknowledge this and to highlight the support services available.  Most importantly, it reminds us to look out for each other.

 

Posted on 24 September 2015

Junior doctors’ contract

There has been an increase in activity in the contract negotiation process for both junior doctors and consultants in the past few weeks.  GAT has been following events closely and we have put together a brief commentary of events and a list of relevant documents to help inform our members.

Draft heads of terms for negotiations of a new junior doctor contract were agreed in June 2013 and negotiations opened in October that year.  They stalled one year later due to concern from the BMA JDC about the removal of key safeguards in the Government’s proposed changes. At that point the Dentists and Doctors Review Body (DDRB) were commissioned to write an independent report into the contract negotiations and they sought evidence from the BMA and key stakeholders, which included GAT and the AAGBI.

The DDRB report was released in July 2015 and GAT reviewed the report and the recommendations within it and shared our concerns in a statement for members.  The BMA JDC sought opinion from its members regarding the proposed changes and for numerous reasons including:

  • Removal of contractual safe guards
  • Extension of routine working time to 7am to 10pm Monday to Saturday
  • Reduced pay progression
  • Concerns about discrimination against LTFT trainees and those taking time out of training for other reasons
  • Lack of equality between specialties

The JDC elected to not reenter the negotiations.

GAT had hoped that there would be a way forward to move towards an agreed, rather than an imposed, contract. However, as we now know this is not the case in England, and the Government and NHS Employers have confirmed that a contract is to be imposed. We have serious concerns over the impact of an imposed contract and on the 16 September we released a joint committee statement in support of the decision by the Scottish Government not to impose a new contract. Interestingly the Welsh Government have subsequently stated they will also not impose a contract and the statement has been updated accordingly.

The GAT committee is currently working on several aspects:

  1. Informing our members about what is happening. Please find a list of key documents to download below. Many of these have been sent already via Trainee Network Leads and our other communication channels. Please share these with your colleagues.
  2. Working with our consultant colleagues and other organisations to express our alarm about the implications of an imposed contract.  We have close links with the BMA, the RCoA Trainee Committee (and through them the AoMRC ATDG) and other trainee organisations and we are committed to a unified response to the Government.

We are still waiting to discover the details of the proposed contract.  Several options were presented in the DDRB report and each option will affect pay differently.  Some financial modelling has been done on each of these options and is included in the list of documents below.  However, even this is speculation until we are given more information.

We are committed to working towards solution so that we can ensure our own health and well-being, the future of the NHS, and above all safe patient care.  We also realise that it is important to support each other at this time of uncertainty.

What can you do? Here are some ideas.

  • Write to your MP and encourage friends and family to do the same, asking for a u-turn on the imposition of a contract. Find out who your MP is at http://www.theyworkforyou.com
  • Engage in the conversation on social media #juniorcontract.
  • Attend one of the NHS Employers workshops if / when they are rescheduled.
  • Contact GAT gat@aagbi.org. and/or the BMA JDC jdcchair@bma.org 

Kind regards,
The GAT committee

Key documents

Draft heads of terms View PDF >
BMA Reasons negotiations stalled View PDF >
DDRB report View PDF >
GAT response to the DDRB report View PDF >
Reasons why the BMA JDC said no Coming soon
Joint Committee statement on contract negotiations View PDF >
Financial model View PDF >
AAGBI statement on junior doctor contract negotiations Find out more >
Letter from NHS Employers inviting to engagement events View PDF >

Useful links

http://bma.org.uk/working-for-change/in-depth-junior-and-consultant-contract/junior-doctor-contract-negotiations-home

https://www.rcoa.ac.uk/news-and-bulletin/rcoa-news-and-statements/joint-statement-the-rcoa-and-ficm-the-proposed-trainee