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Medicine Interview Hot Topics: Junior Doctor Contracts


Key Information

The UK government worked in association with the British Medical Association from 2013 to 2016 to negotiate a new contract that would be more suitable for modern day doctors than the existing contracts that had been first introduced in the 1990. However, there were sticking points that led to a protracted debate that spilled into the mainstream media as junior doctors decided to strike over the contracts being forced into law. 


The Main Points
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The government’s principal motivation was reducing the cost of employing doctors on the weekends - in line with their plan to introduce a ‘7 day NHS.’ In order to do this, they would seek to reduce the extra pay that doctors received for overtime work, and instead introduce a slightly higher overall salary. They outlined that in doing so they were looking to reduce the total hours worked - the new contract prevented doctors working more than 72 hours in one week.


Pay

The new contract included an increase in basic pay of between 10% and 11%. However, in reality this varied between 4% and 32% depending on the grade of the doctor. There was an additional allowance for working on the weekend, for working between 9pm and 7am, and an allowance for being on call. However, doctors claimed that they would see a decrease in overall pay, being heavily reliant on a 40-50% increase in pay for weekends and overtime worked. Additionally, the new contract saw the removal of a pay system that increased with years worked, and the implementation of a new system that provided increased pay with each new stage of training reached - creating difficulties for doctors that worked part time, especially mothers. 


Working Hours

Under the new contract, working hours were reduced from 91 hours maximum over a week to 72 hours. Average working hours remained at 48 hours per week. The contract also introduced a ‘guardian of safe working hours,’ who would oversee hours and proper pay. Doctors could now not be asked to work more than four nights in a row, or more than five long days in a row. 


What happened?

In July 2013, negotiations began officially between the BMA and the UK government. From autumn 2014 to summer 2015, a series of negotiations happened, with the BMA repeatedly refusing the government’s offer, and eventually refusing to re-enter negotiations with the government. In September 2015, and continuing to November 2015, doctors protested outside Westminster, leading to a series of strikes in January 2016. In April 2016, the first ever all-out doctor’s strike in NHS history happened. Junior doctors in all departments went on strike. In May 2016, an amended contract was released and approved by the BMA’s Junior Doctor Chair. In June 2016 BMA members voted against the new contract. However, in August 2016 the UK government acted unilaterally to impose the contract.

Public opinion shifted against the junior doctors, despite initially being for their cause through the rounds of cancellations of elective procedures and hospital appointments. Striking that affected A+Es would be the chief motivator of this shift in opinion. The public perceived that doctors were going against their sworn duty to care for others, and acting in their own best interests.
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Doctors were demoralised by the decision, with 9 out of 10 junior doctors considering walking away from the NHS, and one in two choosing not to continue their training in the country after foundation. 


Potential questions which may be asked in the interview
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  • What do you know about the new junior doctors’ contracts?
  • What can you tell me about the dispute over junior doctors’ contracts?
  • What were the sticking points that led to the government and doctors disagreeing over their new contracts in 2015 and 2016?
  • Do you think that the government was right to impose a new contract on doctors?
  • Do you think that doctors’ choice to strike can be condoned?
  • What problems do you think might arise, or have arisen, as a result of the government choosing to impose a contract on doctors?
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How to answer questions on Junior Doctor Contracts

Remember to show a concern for patients and their well-being first and foremost, with concern for junior doctors’ working hours, and their likelihood of fatigue or burnout being important as well. Try not to focus on financial or political issues/arguments.