Agreement at last on the junior doctors’ contract

On the 18 May 2016 ACAS confirmed that the BMA, NHS Employers and the health secretary had reached an agreement on the terms for a new contract for junior doctors.

Background to the dispute

This agreement was reached over two and a half years after the parties had first entered into negotiations in October 2013. The negotiations stalled a year later as the BMA was unhappy with the reassurances it was receiving from the government in respect of doctors’ welfare. In response the government commissioned a report
by the Doctors and Dentists Review Body (DDRB). The DDRB report was published in July 2015 and supported the government’s position that both the junior doctor and consultant contracts needed reform. The BMA still refused to re-enter negotiations and in November 2015 balloted junior doctors on industrial action. Junior doctors voted overwhelmingly in support of industrial action and this led them undertaking a series of strikes in early 2016; the first time doctors had taken industrial action since the 1970s.

Following the first round of strikes and the breakdown of negotiations in February 2016, the health secretary Jeremy Hunt took the unprecedented decision to impose a new contract on junior doctors without agreement. The contract that was to be imposed was published and that looked like being the end of the negotiations until a cohort of Royal Colleges asked the parties to step back from the breach and have one further round of talks.

After ten days of intense talks the parties were at last successful in reaching an agreement. This is not the end of the story, however, as the deal is subject to the approval of a ballot of BMA members with the result expected to be announced on 6 July 2016.

Key terms of the deal

The agreement reached provides some victories for both sides. On the government side the key victory will be the acceptance of the extension of plain time working across the weekend. Importantly this will enable the government to claim they have fulfilled their manifesto commitment to “deliver a truly 7 day NHS”.

The counter balance to this from the BMA’s perspective will be the introduction of new allowances for doctors working more than one in six weekends and improved rest periods and working hours.

To reassure doctors that protections will be put in place to ensure safe working hours and conditions the role of the guardian of safe working (proposed in the contract that the government had originally planned to impose) has been strengthened to require the guardian to report to the trust’s board at least once a quarter and include in his/her report data on all gaps in the rota.

In addition to changes to the key contractual terms of pay and hours, there are also a number of other notable contractual and non-contractual proposals for change. These include requiring doctors who wish to undertake additional work as locum doctors, to offer their additional hours exclusively to the NHS via an NHS staff bank and the extension of whistleblowing protections to doctors who raise concerns regarding Health Education England.

Addressing equality issues

One of the major concerns about the original contract was the impact on doctors who trained less than full time or took time out from their career. As part of a package designed to address these equality concerns, the parties have agreed an accelerated training support programme to help those who take time out for reasons such as maternity or caring responsibilities to catch up with colleagues. This support will include mentorships, tailored teaching and extra funding for study leave. Only time will tell if these reassurances will be enough to placate the concerns of many doctors about these issues.

Key Points

  • The long running negotiations have led to a settlement – but it is far from clear that it will be accepted by juniors.
  • Trusts need to appoint guardians of safe working.
  • The delay in implementation until October means doctors joining in August will get pay protection.

Next Steps

There are no guarantees that junior doctors will vote for the deal negotiated by the BMA, as the dispute has left many of them feeling angry and undervalued. The government will be hoping that the majority will be swayed by the deal and accept that it is
time to move on from a dispute that has taken up so much time and energy.

Assuming the ballot of BMA members approves the deal, the transition to the new contract will commence in October 2016. The delay in the commencement of the transition to the new contract from August will mean the foundation doctors commencing their first jobs in August will also benefit from the pay protection package that has been agreed for all doctors working on the current terms and conditions.

The transition to the new contract will be a complicated process for trusts to manage particularly where they have to run old and new rota requirements in parallel whilst all of the doctors in a particular cohort are transitioned onto the new terms.

The agreement between the BMA, NHS Employers and the health secretary looks like being the beginning of the end for this dispute. If it is, all eyes will turn next to the renegotiation of the consultant contract which is still ongoing. Everyone will be hoping that those negotiations are more successful and reach a resolution far faster than that for their junior colleagues.

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