Today I have attended the BMA full JDC meeting primarily concerned with the Junior Doctor contract. It was apparent today that the executive feel that in the current climate this is likely to be the best offer on the table however were quite clear that they aim to present a clear account of the strengths and weaknesses of the contract offer during the regional roadshows.
The meeting opened with a discussion around the whatsapp group leak within the JDC group, this has been a damaging episode and we must reflect as a profession in the use of terminology and language whilst engaging in professional business. This is something that we in BOTA adopted in Ernest this year under Muzzy’s leadership.
We then had a breakdown of the pay structure from one of the BMA’s chief negotiators not one of the executive. This was both interesting and informative, I was pleased to be able to confirm the pay modelling I have used in my contact summary in terms of fixed pay are correct. I directly took him through the formula I have used and he confirmed the calculations sounded correct.
Stephen also fleshed out a couple of decisions on the pay structure and we talked about who would be the winners and losers in this contract. The non resident on call supplements was set at 8% of annual salary as it is costly enough to trusts to ensure safe working patterns but does not overtake the payment of doctors working resident out of hours shifts of higher intensity. Unfortunately a single pay structure does not benefit all and a balance had to be found between shifting money into basic pay that improved the lot of LTFT trainees and those with minimal out of hours commitments but disadvantages those who do lots of OOH such as A&E and shifting pay into OOH which improves the lot of those working a highly OOH rota whilst strongly disadvantaging LTFT trainees and those in low intensity OOH.
The LTFT payments whilst fairer on an hourly rate will undoubtably disadvantage such trainees financially. At present LTFT is calculated on a table based on percentage worked so for example take a trainee on 60% work the would do 48 hours / 100 X 60 = 28.8 hours per week. The 28.8 hours a week on the table is paid at 70% of the full salary plus banding. This has classically offset the fixed training costs such as your GMC registration, indemnity etc. That you cannot buy 60% of your fees. Under the new contract pay for work done is the motto and hence if you work 60% of the rota then you will get 60% of the pay. If you do additional hours on top of your 28.8 e.g if you are on the on call rota then the additional hours get lumped into a total LTFT basic before the percentage premiums are added pro rata for NROC and weekend allowance.
The BMA feel this will work out ok for trainees going LTFT at or after ST3 but will likely reduce the career average earnings of trained going LTFT before that stage. THE BMA are currently looking at the use of flexible pay premia to fill this gap but it is an ongoing issue.
The removal of the 5th pay node will remain in the pay envelope, essentially at present it will pay for the pay protection of senior trainees but as they come off the top this can be reinvested back into the system and used to uplift any areas found lacking in the 2018/2019 review of the contract. A proportion will go to senior decision makers but this still isn’t overly clear how this will work.
The rota management software is unlikely to be ready for implementation and hence the initial transitional period will likely still look like banding but as these IT systems go online then the contract will begin to work in a more personalised nature.
London weighting if you apply for the full premium will next year push those trainees receiving it who are ST3-8 into the higher pension contribution bracket (9.3% to 12.3%) however with the projected rises over 3 years all will be in this group the year after.
With regard to specific questions from the membership I asked:
Is there any negotiation that could be done to ensure a free room is available for every NROC shift as in most deaneries there is nowhere to live for the whole rotation that you can get to every hospital on the rotation within 20 mins?
At present there is no contractual obligation to be a certain time away nor to have a room available. This has not changed in the new contract, however, many hospitals do it as they want their T&O registrar close enough to come in and do fasciotomies at short notice, if the department want this then the hospital LNC need to negotiate it on a local basis.
The contract puts a lot of onus on those working NROC rotas to push for correct pay is there going to be any guidance on changing culture to allow this to be an easier process?
The short answer is not really. The BMA are hoping that after a year of discontent and industrial action that the junior doctor body has toughened up a bit and will show strength locally as well as nationally. My advice would be to take all you can and if we get any grief from the employer or the consultants we can all say this is what the government wants and they are a higher power then the management that will be leaning on the consultant body.
Is there any way to ensure the guardians have enough PA’s to deal with the likely high demand when the contract is implemented?
Unfortunately the junior doctor contract will only have influence on junior doctors so in essence no.
When other public sector workers lost incremental pay rises this was offset with performance related pay is there any scope in this model for us?
We actually go through very little assessment of performance and passing the ARCP will work up the nodes but this isn’t being formally looked into as the BMA doesn’t feel that the ARCP process is robust enough to base financial bonuses on.
Lastly I asked Ellen McCourt about her project on the flexible learning/accelerated training pathway, not much has been done here except getting the GMC involved as a major stakeholder which should allow the project to be driven forward.
Hopefully this in conjunction with the contract summary will answer most of your questions about how this will affect T&O if it is voted through, I will take any other queries by email and attempt to answer them or find out about it
British Orthopaedic Trainees Association