ACAS settlement in Junior Doctor Dispute Report

With news today that the BMA and Department of Health have reached agreement on a new Junior Doctor Contract we are sure many of you are wondering what has changed to bring about agreement. The new terms & conditions of service are published at the end of May, however, ACAS has published a statement on their website detailing some of the key features.

Broadly speaking the negotiations have centred around: Equality, The Guardian role, Recruitment & Retention and Terms of service.


Agreement has been reached on a nodal pay system (different to the previously published one). In an attempt to avoid discrimination against parents, academics, less than full time trainees and carers, there has been agreement on “Accelerated Training Support”. This would give access to mentors, additional study budgets and specially developed training inputs. There will also be availability to link applications for married or civilly partnered couples, a review into good rostering and increased protection for training doctors with caring responsibilities, all of which will be overseen by the hospital guardian.

The Guardian of Safe Working

The guardian role will now report to the hospital board on a quarterly basis, this will include staffing levels, and hence gaps, which should be in accordance with the trusts quality account, this will have to be signed off from the chief executive as acceptable. Fines levied by the guardian will be used for our educational benefit be it expanded study budget, IT provision or other resources. Fines must be detailed in the trusts annual financial report.

We particularly welcome the involvement of a BMA representative in the final stage of appeal against a guardian decision and that guardians will have to show adequate performance through 360 appraisals from trainees.

Recruitment & Retention

Flexible pay premia have been bulked up substantially; for those specialties awarded them their trainees will get an extra £20,000 over the duration of training. Currently this would include Oral and Maxillofacial surgery, A&E and Psychiatry.

HEE will again fund a 6 month period of grace for post-CCT trainees, which was previously axed completely.

Changes in specialty due to unforeseeable circumstances, e.g. becoming a carer or moving to a specialty with recruitment problems, will not incur a drop in nodal pay.

Terms of service

Payment for additional hours can take the form of money or time in lieu, which must be taken within 3 months of the unscheduled overtime. It does not mention who can authorise this but that it must be authorised.

The basic pay rise has fallen from 13.5% to 10-11%

Agreement has been reached on “fidelity to the NHS” where locum medical work in your own time will be owed to the NHS staff bank, not private locum agencies. You will receive basic pay +22% in payment for such work.

As mentioned above the nodal system is due to change, the 5th node has been removed and the money allocated to that pay point will now be used to supplement the salaries of trainees that take on a “senior decision making role” although this role has not been clearly defined yet.

On a positive note night shifts are now more clearly defined as any shift of 8 hours or more starting after 20:00 and finishing before 10:00 are classed as night shift attracting a 37% increase on basic pay.


This table shows that the maximum pay uplift for weekend daytime work will be 10% of basic (110% total). This includes both Saturdays and Sundays.


This table shows the available uplift for NROC availability. There is little detail on how this works but we assume that on weekend days for example you would be paid basic + weekend supplement whilst onsite doing the trauma list etc. however once you are due to go home you would be paid 8% of basic unless called in.

Lastly, compulsory zero-hours days are the same as the previously released TCS, however if you have worked 3 or 4 nights this has changed to a peculiar 46 hours of rest.

This document provides a brief summary of the 13 page ACAS file available from their website. BOTA urges all members to await full terms & conditions of service prior to deciding on the new contract. Like many of you the BOTA committee is comprised of orthopaedic registrars and a core trainee and will share many of your worries about the published report. Our BMA rep, James Shelton, will be raising these points at the specialty update on the 23/05/16 and also attending the BMA JDC meeting on 03/06/16 which will be after the release of full terms & conditions of service.

If you have any questions, please email botabma@gmail.com