The junior doctor contract is a very likely topic to crop up during your medical interviews or MMI.
It’s something that will greatly affect your future as a doctor and show a good understanding of the trials and tribulations of becoming a doctor in the UK. It’s had a lot of coverage in the UK with debates and strikes within the NHS; here’s our (kind of) simplified guide to the whole issue.
What is the junior doctor contract?
The junior doctor’s contract is a contract created by the Department of Health. The original aim of the contract was to modernise junior doctor’s working terms and conditions, pay, and patient and doctor safety back in 2011. It was initially entered into negotiation by the BMA (British Medical Association). The last formal change was made in 2016 and left many junior doctors unhappy. 2019 is due another formal negotiation with the BMA and Department of Health to agree amendments.
The contract applies to all doctors below consultant level which makes it fairly misleading. Medical students after they graduate are “Junior” doctors for a minimum of 5 years, if they go the GP route, or a minimum 8 years if they decide to go the consultant route. It’s not unusual to stay a junior doctor for upwards of 10-12 years. This is explained by the graph below:
What is the need for a new contract?
For the government:
In 2011 the government decided the current contract was unfair. The key need was to make employment of doctors at the weekend cheaper and to reduce doctors working too many hours to no more than 72 hours over seven consecutive days.
For junior doctors:
Junior doctors working at standard times (7AM-7PM Monday-Friday) were paid a standard rate. Working outside these hours resulted in significant additional pay, usually +40-50% of their annual salary. Changes in working consecutive days (as mentioned above) and normal working days being changed to 7AM-10PM Monday-Saturday, meant restructuring of work rotas which generally meant junior doctors working more unsocial hours for less pay overall.
What was the dispute on the contract for 2016?
Disputes from junior doctors, the BMA and campaign group Just Health were mainly on these points:
- Weekend working hours – previously Monday-Friday were classed as normal working hours, with Saturdays and Sundays granting an increase in pay for hours worked on those days. The 2016 change made 7AM-10PM on Saturdays count as normal working hours. Junior doctors were, however, due to receive remuneration for working at least seven weekends a year.
- Basic pay – basic pay was due to be increased by 13.5%, but this came at the cost of increased unsociable hours e.g. working on Saturdays. The increase actually resulted in an increase of 10%-11% rather than the 13.5% promised.
- Unsafe working conditions – this is mainly due to junior doctors working excessive hours, getting over-worked, over-stressed and underpaid for those hours. These factors all have an impact on overall patient safety – a key factor in the 2016 junior doctor strikes.
What were the 2018 disputes?
Although there are many issues surrounding this, the follow issues are high profile factors:
- Pay – this continues to be an issue. Since Saturday is included as a normal working day in the current form, junior doctors are seeing an overall decrease in pay for their antisocial hours worked.
- Switching specialities – the previous contract protected doctors who decided to switch specialities halfway through their training by protecting their salary increases. The new contract states that pay banding resets if speciality is switched. This means that for example; a doctor with 3 years’ experience who switches speciality would be paid the same as another doctor starting training in that speciality, without taking into consideration the experience gained in the previous speciality.
- Patient safety – another factor that has continued to be an issue because of similar reasons as the 2016 dispute. A high profile example of this is the Bawa Garba case, a particularly good case to speak about as an NHS hot topic. Many doctors argue the new contract will increase stress and tiredness resulting in more mistakes, and thus patient care will take a hit.
- Taking time off – this relates to maternity leave and taking time to do academic research, pursuing a PHD etc. If a junior doctor takes time off to pursue any of the above, their pay progression pauses. In the old contract, this would have continued. This means doctors, especially female doctors, are deterred from making these decisions so they don’t delay their salary progression.
As you can see, this is a many-headed issue which has innately positive intentions but many negative drawbacks for both parties.
Because of this, the contract has been fiercely debated by both sides. So how exactly should you bring this knowledge into a medical interview?
Some junior doctor contract interview questions you could face:
- What is your opinion on the junior doctor’s contract?
- Do you think the junior doctor strikes were fair?
- Who does the junior doctor contract affect?
What to think about when answering these questions:
- Have an understanding about who falls under the junior doctor umbrella.
- Think about the positives and negatives of the contract, not just for you as a doctor, but also the government, patients, private hospitals etc.
- Consider the public’s perception of the issue and the media’s portrayal of it, do they match up?
- Links with other current issues such as the 7-day NHS (a topic you should definitely read up on) and Bawa Garba case.
- An understanding about the organisations involved in making these changes and organisations opposing them.
- Key areas of concern for both parties (government and doctors), what concerns are shared, what issues isolate one party from the other?
- What the impact of a doctor strike actually has on the general populace and patients?
As with answering any interview question, you must analyse the situation from your understanding succinctly and make a fair judgement based on what you know.
Although in this situation, you are far more likely to support the junior doctor’s side of the dispute, you must take into consideration the government’s issues and reasoning behind their changes. You should be realistic with your conclusion and suggestions if you decide to make any. Everything you say should be backed up by fact, analysis and data.
For example “A study published by the British Medical Journal in September found those admitted on Saturdays had a 10% higher risk of death and on Sundays 15% higher compared with Wednesdays. However patients tend to be sicker when admitted on weekends.” If you use this argument, then consider both sides of it. Less senior doctors work on weekends, thus creating a workforce with less experience which could contribute to the higher risk of death when admitted on a weekend. Conversely the argument can be made that patients admitted at weekends are generally sicker than those admitted in the week.
Overall, there is no single correct way to answer a Junior Doctor Contract interview question – but using all of the information provided here, along with your own fair judgement, will definitely help show the interviewer you are well and truly clued up on the industry you wish to spend your life working within!