This government is completely committed to the values of the NHS – the same values that encourage aspiring doctors to take up a career in medicine.
Junior doctors are the backbone of the NHS, but the current contract has failed to prevent some working unsafe hours, and doesn’t reward them fairly. We know also that they feel unsupported because consultants and diagnostic services are not always available in the evenings and at weekends.
Today a firm offer for a new contract has been published by NHS Employers. The new contract will be fairer for doctors, safer for patients and juniors alike, better for training, and will better support a seven day NHS.
This offer builds on the cast-iron guarantees that I have previously offered the British Medical Association (BMA) including that we would not remove a single penny from the junior doctors’ pay bill, and we would maintain average earnings for junior doctors. The proposals offer an 11% increase to basic pay, with further increases linked to progressing through training and taking on roles with greater responsibility –instead of being based on time served.
Our ambition for the NHS to be the safest healthcare system in the world is underpinned by reducing, not increasing, the number of hours junior doctors work each week. Juniors will be supported by improved contractual safeguards – the best protection junior doctors have ever had against working long, intense and unsafe hours. For example, no junior will be required to work more than a weekly average of 48 hours without consent and those who opt out of that legal limit in the European Working Time Directive will not be able to work more than a weekly average of 56 hours. The number of hours that can be worked in any single week by any junior will be limited to 72, down from 91; there will be a 13 hour limit on shifts; and there will be no more than 5 consecutive long days or 4 consecutive nights, compared to the current contract which permits 7 consecutive night shifts or up to 12 consecutive day shifts.
Putting patients first is the responsibility of employers and staff. Where doctors are asked to work in conditions that they believe are unsafe, including being asked to work patterns that put patient safety at risk, they will be asked to use reporting mechanisms available to them to raise the issue with the Board of their Trust, and reporting data will now be available for the Care Quality Commission (CQC) to use during inspections. We would expect Trust Boards to look at any such report and decide how to respond to it; and we would expect the CQC, when it carries out an inspection, to look at how the Board has responded to this and other data reporting safety incidents and concerns – a tough new measure to ensure safe working.
In order to better support a seven day NHS, basic pay will increase by 11% to compensate for an extension in plain time working on Saturdays during the day and on week-day evenings, and there will be a enhanced rates for hours worked at nights, on Saturday evenings and Sunday. The Government has also decided that plain time will be extended only to 7pm on Saturdays - instead of 10pm on Saturdays - and wants to improve training and ensure better clinical supervision from consultants as well.
We will offer new flexible pay premia for those training in hard-to-fill training programmes where there is the most need - such general practice, emergency medicine and psychiatry, and we will protect the salaries of those who return or switch to training in these programmes. Junior doctors who take time off for academic research that is part of their NHS training, or which contributes to the wider NHS and improvements in patient care, will get additional pay premia to make sure they don’t lose out.
Today, I have also written to all junior doctors in England confirming that no junior doctor working legal hours will receive a pay cut compared to their current contract during transition. Around three quarters will see an increase in pay and the rest will be protected. The exception to this is those who currently receive up to a 100% salary boost as compensation for working unsafe hours. Instead, new contractual safeguards will ensure they are not required to work unsafe hours at all. To see how the offer affects them, junior doctors can now log on to a pay calculator published by NHS Employers where they can calculate projected take home pay.
Our preference throughout has been, and continues to be, to reach agreement through negotiations. We have maintained that, in reforming the contract, we must put patients right at the heart of everything the NHS does every day of the week. A fair, sustainable contract with stronger safeguards, together with the greater availability of consultants at the weekends and evenings, is good for patients and good for junior doctors.
The details published today represent the Government’s offer in England, which will be for doctors and dentists in postgraduate training programmes overseen by Health Education England.
Since they withdrew from negotiations in October 2014 – despite agreeing the need for change as far back as 2008 – the BMA have refused to return to the table. In light of today’s announcement we hope that the BMA will now agree to return to negotiations.
This statement has also been made in the House of Lords: