Junior Doctors in England are currently examining the terms and conditions of the new ‘negotiated contract’ between the Department of Health and the BMA Negotiating Team.
The March ‘Imposed’ Contract was widely condemned for being discriminatory. Jim Campbell Director of the World Health Organisation’s Health Workforce stated that the ‘regressive’ policies contained within the contract would contradict the United Nations Commission on the Status of Women. No pressure then on the negotiators to find a better solution.
There are two key changes to the contract which bring with them the potential for discrimination. Distribution of working hours and the loss of annual pay progression. The negotiated deal also has potentially done something very positive for maternity leave (and very unlike the BMA!) More about that further down.
Distribution of Working Hours #
A key battleground throughout the past year ‘plain’ versus ‘premium’ time has been one of the most divisive issues. This issue really matters to carers, statistically more likely to be women. Evenings and weekends really matter, as this is when caring responsibilities run into overdrive and the cost of paying someone else to take on your caring responsibility sky rockets.
With regards to weekend working this contract is a clear victory against the governments ‘regressive’ policies. By retaining a weekend banding, graded by the number of weekends worked their remains a clear financial disincentive to routine elective weekend working. Due to the fact this incentive is based on the number of weekends worked and not the hours it provides a clear disincentive for split shift Saturday working (a real risk under the imposed contract.) It also works to protect Friday evenings, for all but A&E FY2s. Another key improvement. (The exception for A&E FY2s is interesting but probably for another blog.)
Evenings however look less rosy. With ‘normal working hours’ being extended to 9pm partly offset by a rise in basic pay. This will be disruptive for those with a potential for high density evening work. (I’m looking at you A&E Docs.)
The big unknown is what impact exception reporting (the new method of hours monitoring) and its associated mechanisms will have. More pay, maybe. Better hours control, maybe.
Annual Pay Progression #
The Annual Pay Progression of our current contract has gone, to be replaced by a system of nodal points based on competency. Removing Annual Pay Progression has been a priority of this Conservative government for a long time but it has some very regressive effects. The increments contained within our contract help maintain pay parity for those who take time out of training, maternity leave, or who work less than full time. This is actually a large cohort of doctors from various different backgrounds who materially benefit our NHS. Discriminating against them is not a good thing.
The BMA negotiators have done a number of things to try and mitigate the loss of increments. They have front loaded our pay, so we earn more money as a ‘junior’ junior doctor. This means we have the money earlier in our carers, which is great for a number of financial reasons, but also means we have a flatter pay structure, so the impact of less than full time working or time out of training without increments is reduced.
Reduced but not removed completely. We should await a formal Equality Impact Assessment, and the financial modelling for a career average for those less than full time. But this contract appears to still be considerably worse for less than full time workers, and therefore discriminatory against women, the disabled and those with caring responsibilities.
Maternity Leave #
This is the most interesting section of the contract. Why? Because its not there. At all. The provisions around maternity leave are contained within the NHS Terms and Conditions of Service Handbook. This handbook relates to Agenda for Change terms and conditions. By agreeing to this contract our negotiators have tried to peg our maternity leave provisions to those of the rest of the NHS workforce.
This is interesting for a number of political reasons. But this could be vital for people taking maternity leave.
Agenda for Change staff already lost annual pay progression, but they did not lose their increments like is being proposed for us. These increments are now based on a performance review and appraisal process every year. If they are on maternity leave it is assumed they would have met the competency required and therefore receive the pay increase.
This leaves things very ambiguous. Because it is not designed or written for our new nodal pay structure. But the implication is clear, if you are on maternity leave and you go through a competency based pay point you should receive the increase.
So if you take maternity leave at Node 2 (Foundation Year 2) under normal circumstances you would have sat ARCP and progressed to Node 3, therefore when you return to work as an FY2 post maternity leave you should be paid at Node 3.
This will need to be tested legally, and ties us to the future state of Agenda for Change, but it is an interesting development that we will need more time to properly assess.
Accelerated Training #
Only mentioned in the introduction to the contract. Health Education England are looking at a programme of ‘accelerated training’ for people who take time out for various reasons. This is impossible to assess properly, as it does not exist yet. It has the potential to be a really big equalities win if it works properly. It has the possibility of being a white elephant offered by the government to placate an angry workforce who view this issues as vital to the success of the contract.
The full Equalities Impact Assessment will be vital to making a decision on these issues. There have been clear gains in some areas, but others appear to remain weaker than our current contract and are certainly not an equalities improvement. The financial modelling of the impact on less than full time trainees will also be vital, as with the front loading of the pay scale direct comparison is very difficult.