The current contract for doctors and dentists in hospital training was introduced in 2000. The key aims of the contract were to reduce the number of hours junior doctors worked and to ensure minimum rest breaks were provided.
In July 2015 the Review Body on Doctors’ and Dentists’ Remuneration group chaired by Professor Paul Curran issued recommendations for proposed changes to the contracts of doctors and dentists in training. If implemented, the changes, will take effect in August 2016. The main call for the changes is the view that the current contracts are no longer fit for purpose.
Presently, junior doctors have an incremental salary scale which they progress through automatically on an annual basis. The proposed change to a ‘nodal’ system would mean that salary increases will correspond with stages of training, which in turn corresponds with increases in responsibility. In the proposed new system, a junior doctor who takes a career break or time out of training may not be paid at the same rate as a colleague with continuous employment.
In addition, the new contract proposals will see junior doctors’ normal working hours extend to 10pm every day except Sunday. The normal working hours are presently 7am to 7pm Monday to Friday within a standard 40 hour week. The effect of this change is that junior doctors will be paid at the basic rate in the evening and on Saturdays, rather than the previous higher rate.
The proposed amendments would also see basic pay increased at a rate of 15.3%, with the redefining of unsocial hours as 10pm to 7am Monday to Saturday and all day Sunday.
It should be noted that junior doctors currently provide the vast majority of medical services at night and over the weekend. Junior doctors do not, as consultants do, have the ‘opt-out’ clause in their contracts which allows them to opt-out of working at night or at weekends.
The government states that one of the benefits of the proposals will be the improvement of the range of clinical services available throughout the week, thereby moving to a seven day NHS. A number of organisations, including the British Medical Association, question the effect the proposals will have on junior doctors in terms of morale, exhaustion and decreased pay.
A further change will see General Practitioner (GP) trainees paid on the same basis as hospital trainees. At present, GP trainees receive a supplement to their salaries which ensures they are not financially disadvantaged compared with their hospital counterparts. The proposals may mean that the salary parity between GP trainees and hospital trainees ends as there is far less scope for working unsocial hours.
Junior doctors are increasingly concerned that the proposals will have a direct impact on patient safety, as their working hours will be increased.
The medical profession is demanding. Caring for patients whilst rewarding is not an easy task. There have to be controls over the hours doctors work to ensure that they are able to perform their roles at the optimum level, and thereby act in the best interests of their patients. In addition, junior doctors should be suitably rewarded for their work and any proposals to amend their salaries should take into consideration the vital function they play within the NHS.
Aside from the aforementioned matters, if junior doctors are to work longer hours, they will equally need increased supervision and access to resources. Junior doctors should not be left in a position whereby they are facing burgeoning responsibility without access to senior staff to assist as and when required.