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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
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.
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.
Example Interview Questions
- 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?
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.
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.
Interview Questions & Example Answers
What do you know about the new junior doctors’ contracts?
The motivation behind the introduction of the new contracts was to reduce the cost of employing doctors on the weekends - in line with their plan to introduce a ‘7 day NHS.’ Doctors would therefore receive less pay for overtime work, and instead benefit from a slightly higher overall salary. This basic pay rise of between 10 and 11% in reality varied between 4% and 32% depending on specialty, and doctors believed that they would actually see a decrease in pay, being reliant on 40-50% increases in pay for overtime and weekends. Additionally, the new contract saw the removal of a pay system that increased with years worked, alongside 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.
What can you tell me about the dispute over junior doctors’ contracts?
Negotiations began officially between the BMA and the UK government in July 2013. Negotiations continued from 2014 to 2015, with the BMA repeatedly refusing the government offer. Eventually the BMA refused to re-enter negotiations. Doctors began protesting in September 2015, continuing to November 2015, before strikes began in January 2016. In April 2016, the first ever all-out doctors’ strike in NHS history happened. Following these developments, an amended contract was released and approved by the BMA’s junior chair in May 2016, which was voted against by BMA members. In August 2016, the UK government unilaterally imposed the contract. One in two doctors chose not to continue their training in the UK in light of the decision.
What were the sticking points that led to the government and doctors disagreeing over their new contracts in 2015 and 2016?
The dispute revolved around both pay and working hours. Pay was being increased overall but decreased for hours of overtime worked - which would lead to a net decrease in doctor’s pay overall, with some newspapers even highlighting that junior doctors might expect to receive less, in real-terms for hours worked, than McDonald’s staff. Additionally, the pay system that had allowed those in the service to receive additional pay for each year worked was removed, and replaced with one based on stages - creating real problems for those that had to take time off, e.g. women having children. Working hours were changed, reduced from a maximum of 91 hours a week to 72, and a ‘guardian of safe working hours’ was to be introduced. However, doctors felt that the contract would not encourage safer working practices and was in fact an attempt to force them to work long, antisocial shifts - leaving them tired and less able to practice competently.
Do you think that the government was right to impose a new contract on doctors?
I do not believe that the government should have acted unilaterally to impose the contract on junior doctors. They ignored the protests and points made by the vast majority of those on whom they sought to impose the contract - people who are well educated, have chosen to dedicate their lives to help others, and believed that the government should listen to their concerns. The doctors were striking as much for patient safety as for their own rights, believing that the new contract would damage both doctors’ confidence in the NHS and the government, and their ability to work safely. This is borne out by the huge numbers of junior doctors who chose to leave the NHS and continue their training abroad.
Do you think that doctors’ choice to strike can be condoned?
I believe that it can be condoned. It was a true last result, and one that was not taken lightly. It was ensured that consultants would be on hand to run A&E departments and crucial parts of the hospital throughout strikes, meaning that the public was not at a hugely increased danger due to the junior doctors striking. However, it did lead to the public turning against the doctors, understandably - their duty is to protect and support patients. However, many truly believed that the new deal was worse for patients, and that in the long term their decision to strike would have a positive benefit for the patients that they must care for. I therefore believe that the decision to strike was based on the correct ethical principles, and not on selfishness.
What problems do you think might arise, or have arisen, as a result of the government choosing to impose a contract on doctors?
As one might expect, doctors became very demoralised. In one study published after the decision was made, it was found that 9 out of 10 junior doctors were considering leaving the NHS. One in two stated that they would continue their training in other countries after they finished foundation training. These figures starkly illustrate the degree to which the decision led to distrust of the government from its doctors. I believe that it is still having an impact today, alongside other decisions of the Conservative government that have arguably weakened the NHS.
What do you know about the new junior doctors’ contracts?
The motivation behind the introduction of the new contracts was to reduce the cost of employing doctors on the weekends - in line with their plan to introduce a ‘7 day NHS.’ Doctors would therefore receive less pay for overtime work, and instead benefit from a slightly higher overall salary. This basic pay rise of between 10 and 11% in reality varied between 4% and 32% depending on specialty, and doctors believed that they would actually see a decrease in pay, being reliant on 40-50% increases in pay for overtime and weekends. Additionally, the new contract saw the removal of a pay system that increased with years worked, alongside 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.
What can you tell me about the dispute over junior doctors’ contracts?
Negotiations began officially between the BMA and the UK government in July 2013. Negotiations continued from 2014 to 2015, with the BMA repeatedly refusing the government offer. Eventually the BMA refused to re-enter negotiations. Doctors began protesting in September 2015, continuing to November 2015, before strikes began in January 2016. In April 2016, the first ever all-out doctors’ strike in NHS history happened. Following these developments, an amended contract was released and approved by the BMA’s junior chair in May 2016, which was voted against by BMA members. In August 2016, the UK government unilaterally imposed the contract. One in two doctors chose not to continue their training in the UK in light of the decision.
What were the sticking points that led to the government and doctors disagreeing over their new contracts in 2015 and 2016?
The dispute revolved around both pay and working hours. Pay was being increased overall but decreased for hours of overtime worked - which would lead to a net decrease in doctor’s pay overall, with some newspapers even highlighting that junior doctors might expect to receive less, in real-terms for hours worked, than McDonald’s staff. Additionally, the pay system that had allowed those in the service to receive additional pay for each year worked was removed, and replaced with one based on stages - creating real problems for those that had to take time off, e.g. women having children. Working hours were changed, reduced from a maximum of 91 hours a week to 72, and a ‘guardian of safe working hours’ was to be introduced. However, doctors felt that the contract would not encourage safer working practices and was in fact an attempt to force them to work long, antisocial shifts - leaving them tired and less able to practice competently.
Do you think that the government was right to impose a new contract on doctors?
I do not believe that the government should have acted unilaterally to impose the contract on junior doctors. They ignored the protests and points made by the vast majority of those on whom they sought to impose the contract - people who are well educated, have chosen to dedicate their lives to help others, and believed that the government should listen to their concerns. The doctors were striking as much for patient safety as for their own rights, believing that the new contract would damage both doctors’ confidence in the NHS and the government, and their ability to work safely. This is borne out by the huge numbers of junior doctors who chose to leave the NHS and continue their training abroad.
Do you think that doctors’ choice to strike can be condoned?
I believe that it can be condoned. It was a true last result, and one that was not taken lightly. It was ensured that consultants would be on hand to run A&E departments and crucial parts of the hospital throughout strikes, meaning that the public was not at a hugely increased danger due to the junior doctors striking. However, it did lead to the public turning against the doctors, understandably - their duty is to protect and support patients. However, many truly believed that the new deal was worse for patients, and that in the long term their decision to strike would have a positive benefit for the patients that they must care for. I therefore believe that the decision to strike was based on the correct ethical principles, and not on selfishness.
What problems do you think might arise, or have arisen, as a result of the government choosing to impose a contract on doctors?
As one might expect, doctors became very demoralised. In one study published after the decision was made, it was found that 9 out of 10 junior doctors were considering leaving the NHS. One in two stated that they would continue their training in other countries after they finished foundation training. These figures starkly illustrate the degree to which the decision led to distrust of the government from its doctors. I believe that it is still having an impact today, alongside other decisions of the Conservative government that have arguably weakened the NHS.