What are the major sticking points?

I have now had an opportunity to scrutinise the letter from Sir David Dalton to the Health Secretary Mr Jeremy Hunt detailing the gains and sticking points from the ACAS negotiations. They are summarised below:-


As doctors we feel morally obligated to ensure that our patients are well looked after and this includes having medical staff available who are fresh and up to the challenge, not too exhausted to decide whether to have tea or coffee never mind make life changing decisions. The latest proposals offered go beyond the EWTD to ensure that no junior doctor works more than 48 hours in a week averaged over a 26 week period. There will also be a contractual limit of 56 hours even for those who opt out of the EWTD agreement e.g. all of us that do locums in addition to regular work.

Maximum runs of nights will be limited to 4 consecutive night shifts from 7 nights presently and maximum runs of long days will be limited to 5 consecutive days in a row. Consecutive days in a row will be limited from 12 to 8 days in a row.

The guardian role would be able to fine trusts who do not adhere to the new contractual agreements but any fines are put into a study fund not delivered to overworked trainees.

Whilst this all sounds great both myself and the BMA believe the only way to ensure that trusts stick to the contract is to ensure fines are paid to the trainees and to a study fund in respect of payment for all work done.

Education and training:

The DoH suggests contractual assurances for adequate notice of deployment to new trusts, a exception reporting system for missed educational opportunities and a review of flexible training.

I’m pretty sure that these points are already in our contracts but are poorly enforced – after all who has ever actually got the on call rota 6 weeks in advance of starting a job?


Agreement has been made on a front loaded 5 pay point progression system from the BMA, this way whilst coming in line with the governments needs we will not receive an pay cut over the duration of training in terms of money earned over the totally course of training. GP’s will continue to receive a flexible pay premia to keep them in line with hospital trainees. Academic trainees and trainees moving to a new specialty will have pay protection.

Outstanding issues with pay:

The government has offered 07:00 – 21:00 Monday to Friday (07:00 – 19:00 on current contract) as plain time previous offer 07:00 – 22:00. With regard to Saturday working the new offer is 07:00 17:00 (current contract Saturday is NOT plain time) previous offer 07:00 – 19:00 Saturdays.

The BMA has stated that this is a line in the sand they will not cross – Saturdays are not standard working days according to British culture they are time for family and social events.

Non-resident on calls – current offer is 10% of basic salary for ‘on call availability’ with top ups for hours of actually attendance or disturbance. The BMA is negotiating for a 20% basic salary payment for availability. As a current non-resident on call registrar I do not feel this fairly reflects the commitment. I have to be within 20 mins of the hospital which means staying on site and cannot drink or attend any events that I cannot leave immediately within 20mins of the hospital – it is not sitting at home doing nothing. A system of prospectively having ‘exceptional events’ documented and paid for would likely result in unpaid work.

Sir David does not believe negotiations can restart until the BMA are willing to negotiate on Saturday hours – get ready for a long haul.

I hope this information is useful to you the letter to Jeremy hunt should also be available on this link

Best wishes and stay strong

James Shelton

BOTA BMA Observer


Letter to Secretary of State for Health – 1 February