1. Junior doctors’ contract The new 2016 contract Junior Doctors’ 2016 Contract Engagement Events

2. Junior doctors’ contract The new 2016 contract Why do we need change?  A new contract needs to be introduced that is safe, fair and effective for both doctors and employers.  The current contract has significant weaknesses :  safety: does not support safe working practices  training: does not support the educational and training needs of doctors  pay: has perverse incentives that do not recognise or effectively reward hours being worked or the intensity of work being done.

3. Junior doctors’ contract The new 2016 contract Timeline Review: 2011 Negotiations: 2012 to 2014 DDRB: 2015 ACAS: November 2015 Dalton: January 2016 Intention to Impose: February 2016

4. Junior doctors’ contract The new 2016 contract Safeguards Appointment of Guardian of Safe Working to oversee robust work schedule review process and address concerns relating to hours worked and access to training opportunities. Safe care for patients through protection and prevention measures to stop doctors working excessive hours New system of financial penalties to be applied where doctors are working excessive hours Training New terms to support training and education include: ensuring proper notice of deployment to rotational placements; exception reporting applying to missed educational opportunities; and a review of access to more flexible training Key features of the new contract

5. Junior doctors’ contract The new 2016 contract Pay Cost neutral – not looking to save money from new contract reforms Pay for doctors and employers more stable and predictable; better financial management for employers Pay progression linked to responsibility and point of training – no longer time served Reward targeted at doctors working onerous rotas and unsocial hours; supports staff deployment to meet needs of patients on evenings and weekends (including those who work most Saturdays) Key features of the new contract

6. Junior doctors’ contract The new 2016 contract Junior Doctors who opt out of the working time regulations will be required to offer ‘first refusal’ to employer for any additional shifts they may wish to work. This work would be done via the host organisation’s / employer’s locum bank, rather than via an agency. This work is to be paid as per national terms and conditions, set out in the pay circular each year. Pay: Locums

7. Junior doctors’ contract The new 2016 contract Board Assurance Appointment of Guardian Rota Design Engagement with Doctors in your Trust Job Offers Longer term

8. Junior doctors’ contract The new 2016 contract Implementation Timetable DateGrade(s)Rotation(s) / Training programmes Aug-16 F1All ST1/2/3GP trainees undertaking practice placements AllPsychiatry; Public Health SeptST1+ Paediatrics (Core, higher and all sub-specialties) ; dentists OctCT 1-3 /ST3+All surgical specialties (including orthodontics) Nov Dec Jan-17 Feb ST3+ Anaesthetics / ITU / Emergency Medicine / Obstetrics and Gynaecology ST1-2 Core Medical Training /remaining Core Surgical Training / ACCS / Anaesthetics MarST3+Any remaining Paediatrics trainees AprST3+Any remaining surgical and all higher medical specialties May Jun Aug-17 Any trainees not already included above 8 Implementation of new 2016 contract, as trainees enter F1 or as contracts of employment expire as trainees move through training. Note: Any trainee (e.g. F2; GP trainee in a hospital setting) sharing a rota with the above will move to the new contractual (and where applicable, pay protection) arrangements at the same time as those trainees.

9. Junior doctors’ contract The new 2016 contract Implementation Actions 9 DateAction Apr 2016Deanery confirmation to employers of F1/F2 placements in AugustHEE End Apr 2016 C 60-70% of rotas remapped against new shift rules and amended where required Trusts End May 2016Work schedules for all posts agreed and signed offTrusts 11 May 2016Deanery confirmation to employers of ST1+ placements in AugustHEE May 2016Deaneries plan details of September rotationsHEE Jun 2016ESR release of payroll upgrade to employers (next window: September)ESR Jun 2016Deaneries plan details of October rotationsHEE 8 Jun 2016 Deadline for employers to offer jobs to doctors for August, with work schedules and details of pay and rotas Trusts 8 Jun 2016Deanery confirmation to employers of ST1+ placements in SeptemberHEE 6 Jul 2016Deanery confirmation to employers of ST1+ placements in OctoberHEE 6 Jul 2016 Deadline for employers to offer jobs to doctors for September, with work schedules and details of pay and rotas Trusts 2 Aug 2016 Deadline for employers to offer jobs to doctors for October, with work schedules and details of pay and rotas Trusts 3 Aug 2016New placements/contracts commenceTrusts Late Aug 2016First payroll run under new systemTrusts 5 Sep 2016New placements/contracts commenceTrusts 5 Oct 2016New placements/contracts commenceTrusts

10. Junior doctors’ contract The new 2016 contract The contract is cost neutral with small additional transitional cost, met from the global NHS pay budget. The cost neutrality has been modelled at a national level and there will be different implications depending on the deployment of junior doctors. The phased implementation will allow for tracking of the additional cost or saving to your organisation. The government agreed an increase in predictable basic pay when negotiations were approved in 2012: this does increase pension contributions for both the employer and the doctor (an advantage to the latter in a career average scheme). NHS England and NHS Improvement are sighted of these implications over the three year transitional period, and these costs must also be tracked. Finance

11. Junior doctors’ contract The new 2016 contract The new contract will: support the delivery of safer care to patients – achieved through the provision of a new and comprehensive package to address concerns raised by doctors, with additional safeguards and restrictions on the hours that doctors are required to work include new contractual terms and additional pledges from Health Education England that support the training needs and experience of doctors deliver a new model for pay that is fairer, more transparent and is financially sustainable, while ensuring that the average pay across the junior doctor workforce remains unchanged. It reflects agreements reached with the BMA in the discussions held in December 2015 and January 2016. Summary: Safer care for patients and a fair deal for doctors and employers

12. Junior doctors’ contract The new 2016 contract Appendix One July: November: February Note The terms and conditions of the 2016 contract are being finalised and are subject to review and amendment by the Secretary of State. Advice within this session and other documents regarding likely content of the terms and conditions should be considered with this is mind.

13. Junior doctors’ contract The new 2016 contract Safety: Restrictions on excessive hours Current contract:November offer:Final contract: Twice-yearly hours monitoring exercisesException reports to replace hours monitoring Departmental rotaIndividual work scheduling Work schedules for GP trainees in practices to reflect COGPED guidance on work plans Work schedule reviews on requestWork schedule reviews on request and when required by the guardian Rigid on-call rules with limited flexibilityMore flexible on-call arrangements linked to intensity or work Limits on on-call working:  No more than three rostered on-calls in seven days except by agreement  Guaranteed rest arrangements where overnight rest is disturbed Rigid paid rest break requirementsPaid 30 minute rest breaks at intervals in line with working time regulations Paid rest breaks: 30 minutes if shift exceeds 5 hours, 2 x 30 minutes if shift exceeds 9 hours, taken flexibly across the shift Best practice guidance on rostering Financial penalty levied on employer for breaches of WTR 48-hour average working hours or contractual 72 hour weekly limit.

14. Junior doctors’ contract The new 2016 contract Safety: Restrictions on excessive hours Current contract:November offer:Final contract: Maximum average 56 hour working week Maximum average 48 hour working week Opt out capped at maximum average of 56 working hours per week Maximum 91 hours’ work in any seven day period Maximum 72 hours’ work in any seven day period Maximum shift length of 14 hoursMaximum shift length of 13 hours Maximum of 7 consecutive long shiftsMaximum of 5 consecutive long shifts Maximum of 7 consecutive night shiftsMaximum of 4 consecutive night shifts Minimum 11 hours rest after final night shift Minimum 48 hours rest after a run of either 3 or 4 consecutive night shifts

15. Junior doctors’ contract The new 2016 contract Safety: Restrictions on excessive hours Current contract:November offer:Final contract: Maximum of 12 consecutive long, late evening (twilight into night) shifts Maximum of 5 consecutive long, late evening (twilight into night) shifts Maximum of 4 consecutive long, late evening (twilight into night) shifts Minimum 11 hours rest after final long, late evening (twilight into night) shift Minimum 48 hours rest after 4 consecutive long, late evening (twilight into night) shifts Maximum 12 consecutive shifts Maximum 8 consecutive shifts 48 hours’ rest after 12 consecutive shifts 48 hours’ rest after 8 consecutive shifts

16. Junior doctors’ contract The new 2016 contract Training: November offer:Final contract: Work schedule to be linked to the educational curriculum Training needs to be identified and included in the work schedule HEE commitment to performance manage deaneries against code of practice on notice of deployment HEE to establish benchmark standards for educational facilities Contract will facilitate both “standard” and lead employer models HEE commitment to identify ways of reducing the costs of training through centralised provision and other means Improved access to less than full time training Enhanced continuity of service provisions to ensure that trainees returning from OOP are not unfairly deprived of occupational maternity pay Fixed leave to be replaced by a mutual obligation for employers and doctors to appropriately manage leave arrangements

17. Junior doctors’ contract The new 2016 contract Pay: Base pay - old and new

18. Junior doctors’ contract The new 2016 contract Proposed by BMA in negotiations. Informed by clinical and educational input. Clear change in responsibility between F1 (provisionally registered) and F2 (fully registered). Clear change in responsibility when moving from the Foundation Programme to Specialty Training (core or run- through), following a competitive recruitment process before being appointed. The first two years of Specialty (ST)/Core Training (CT) are similar in the degree of responsibility required of the trainee, and are therefore grouped into one node. There are two further nodal points at ST3-7 and ST8, reflecting the sub- specialised nature of work at ST8. This allows for a flatter pay structure minimising the impact on those on academic pathways or taking a break from training. Accordingly, we agreed with the BMA for this option as being the one that best suited the majority of training programmes. Pay: Why five nodal points?

19. Junior doctors’ contract The new 2016 contract Pay: Unsocial hours enhancements 9pm to 7am every day of the week – 50 per cent pay enhancement Saturday 5pm to 9pm and Sunday 7am to 9pm – 30 per cent pay enhancement Trainees who work shifts beginning on Saturdays 1:4 weeks or more frequently will additionally receive a 30 per cent pay enhancements for any work done on Saturday 7am-5pm

20. Junior doctors’ contract The new 2016 contract Pay: On-call availability allowance On-call availability allowance is a percentage of basic pay for being on call when not at work. Hours actually worked will be included in the work schedule and paid at the normal basic rate plus any enhancements applicable. Frequency required to be on-call Rate paid 1 in 4 or more frequently10 per cent Less frequently than 1:45 per cent

21. Junior doctors’ contract The new 2016 contract November offerFinal contract Academia 1 £3,125Academia£4,000 Emergency medicine training programmes at ST4 and above £1,500 Emergency medicine training programmes at ST4 and above £1,500 General practice 2 £8,200General practice£8,200 Oral and Maxillofacial Surgery £1,500 Psychiatry training programmes at ST1 and above £1,500 Psychiatry training programmes at ST1 and above £1,500 Pay: FPP Indicative Values

22. Junior doctors’ contract The new 2016 contract Afternoon Session A practical, interactive session for medical workforce and medical education staff

23. Junior doctors’ contract The new 2016 contract This afternoon’s agenda 1.30 Registration/Coffee in our “Ask the Expert Zone” - Allocate, Capsticks, ESR, Skills for Health, NHS Employers Medical Pay and Workforce Teams 2.00 Plenary –Welcome and introductions 2.15 Workshop 1 Group A – Safe working / rota rules Group B – Work schedules, exception reports, work schedule reviews and the guardian of safe working hours

24. Junior doctors’ contract The new 2016 contract This afternoon’s agenda 3.15 Coffee in “Ask the Expert” Zone 3.45 Workshop 2 Group A (Insert Room) - Work schedules, exception reports, work schedule reviews and the guardian of safe working hours Group B (Insert Room) – Safe working / rota rules 4.45 Next steps/Plenary Closing

25. Junior doctors’ contract The new 2016 contract Steps towards a final contract The terms and conditions of the 2016 contract are being finalised. They are subject to review and amendment by the Secretary of State. Advice within this session and other documents regarding the likely content of the terms and conditions should be considered with this in mind.

26. Junior doctors’ contract The new 2016 contract Steps towards a final contract Any contract implementation requires an equality impact assessment to meet our public sector equality duty Guidance will be provided to trusts on what they need to do when the final terms and conditions are made available No contracts of employment under the proposed new TCS can be issued until the Secretary of State has signed off on the TCS and they have been formally published

27. Junior doctors’ contract The new 2016 contract Steps towards a final contract To be able to issue contracts under the proposed new TCS (when approved), an employer must: 1)Assess the working pattern against the new rules and make any necessary adjustments 2)Prepare a work schedule for the post 3)Assess the pay associated with the work schedule 4)Issue the offer letter, together with the work schedule

28. Junior doctors’ contract The new 2016 contract Indicative timeline For doctors being offered the new contract for posts commencing in August: 22 April – all rotas reworked 24 May – all work schedules completed 31 May – pay assessed for all work schedules 8 June – deadline for issuing offers and work schedules 3 August – doctor commences in post

29. Junior doctors’ contract The new 2016 contract Breakout session Group A (Insert room) – Safe working / rota rules Group B (insert room) – Work schedules, exception reports, work schedule reviews and the guardian of safe working hours Coffee and ask the expert at 3-15

30. Junior doctors’ contract The new 2016 contract Breakout session Group B (insert room) – Work schedules, exception reports, work schedule reviews and the guardian of safe working hours Group A (Insert room) – Safe working / rota rules Final thoughts in plenary at 4-45

31. Junior doctors’ contract The new 2016 contract Safe working / rota rules

32. Junior doctors’ contract The new 2016 contract Safe working Weekly hours Weekly average hours – maximum of 48 Weekly average hours if opting out of WTR – maximum of 56 Absolute limit on hours – maximum 72 in any seven calendar days Maximum shift length – 13 hours Note The terms and conditions of the 2016 contract are being finalised and are subject to review and amendment by the Secretary of State. Advice within this session and other documents regarding likely content of the terms and conditions should be considered with this is mind.

33. Junior doctors’ contract The new 2016 contract Safe working Consecutive shifts Night shifts (more than 3 hours between 2300 and 0600) – maximum 4 shifts Long shifts (more than 10 hours) – maximum 5 shifts Long late shifts (more than 10 hours, finishing after 2300) – maximum 4 shifts All shifts (any length or combination of lengths) – maximum 8 shifts Weekends (Saturday and Sunday) - no consecutive weekends without agreement; no more than 1:2 Note The terms and conditions of the 2016 contract are being finalised and are subject to review and amendment by the Secretary of State. Advice within this session and other documents regarding likely content of the terms and conditions should be considered with this is mind.

34. Junior doctors’ contract The new 2016 contract Safe working Rest Paid meal breaks – 30 mins if shift exceeds 5 hours; 2 x 30 mins if shift exceeds 9 hours After 3 or 4 consecutive night shifts – 48 hours minimum rest After 5 consecutive long shifts (more than 10 hours) – 48 hours minimum rest After 4 consecutive long late shifts (more than 10 hours, finishing after 2300) – 48 hours minimum rest All 8 consecutive shifts - 48 hours minimum rest Any other shift – 11 hours minimum rest Note The terms and conditions of the 2016 contract are being finalised and are subject to review and amendment by the Secretary of State. Advice within this session and other documents regarding likely content of the terms and conditions should be considered with this is mind.

35. Junior doctors’ contract The new 2016 contract Safe working On-call duty Length of on-call duty – maximum 24 hours Rest whilst on-call – minimum 8 hours (minimum 5 continuous) Consecutive on-call duties – maximum of 1 duty period (maximum of 2 if first one begins on a Saturday) Shift on day following an on-call duty (or 2 nd on-call duty if 2 are rostered consecutively) – maximum 10 hours (maximum 5 hours if overnight rest not likely to be achieved) Frequency of on-call duties – maximum 3 in seven days unless by written agreement Note The terms and conditions of the 2016 contract are being finalised and are subject to review and amendment by the Secretary of State. Advice within this session and other documents regarding likely content of the terms and conditions should be considered with this is mind.

36. Junior doctors’ contract The new 2016 contract Questions Will there be software to help assess rotas against the new rules? How do we assess the amount of work done whilst on-call? How do we manage rotas with both new and old contract doctors on them?

37. Junior doctors’ contract The new 2016 contract Questions Does locum work count toward the new rules? Some of the rules are creating strange working patterns that the doctors don’t like - why have we agreed these rules?

38. Junior doctors’ contract The new 2016 contract Questions ?

39. Junior doctors’ contract The new 2016 contract Work scheduling, exception reports, work reviews, and the guardian of safe working hours

40. Junior doctors’ contract The new 2016 contract Steps towards a final contract The terms and conditions of the 2016 contract are being finalised. They are subject to review and amendment by the Secretary of State. Advice within this session and other documents regarding the likely content of the terms and conditions should be considered with this in mind.

41. Junior doctors’ contract The new 2016 contract Work schedules Are they job plans for juniors? No…but there are similarities. They will set out the expected service commitments and relevant training opportunities required / available in the post. Each doctor will have a personalised work schedule which they will discuss at the regular meetings with their educational supervisor. These discussions may lead to a change to the work schedule.

42. Junior doctors’ contract The new 2016 contract What might a work schedule look like? Example Work Schedule Specialty:Training Programme: Grade:Placement length: Clinical Lead/Rota Co-Ordinator:Educational Supervisor: Start date:End date: Employing Trust: Host Trust (if above is a lead employer): Site(s): Medical Staffing Contact Details:

43. Junior doctors’ contract The new 2016 contract Continued… Continued on next slide… Working pattern: Basic hours only / Shift /On-call rota (delete as appropriate) Rota: to be appended (note that in the new system, slots on the rota could be different if you choose, so it will be important to attached the working pattern that the individual doctor is working) Average Weekly Hours of Work: to insert (as now, your rota software will provide this) Pay for Role* (select elements as appropriate) Basic Pay (Nodal Point): [Nodal Point] = [cash amount] (e.g. Nodal point 4, ST/CT3-7 = £48,000) On-call availability supplement : [%] = [cash amount] (e.g. 5% = £2,400) Enhanced pay rates: [Average number of hours per week] at [#%] (e.g. 9 hours at 50% enhancement, 5 hours at 30% enhancement) Flexible Pay Premia: [Type] and [cash amount] (e.g. Emergency Medicine premium = £1,500) Total Annual Pay: £ *Please note- if you are entitled to pay protection in line with Schedule ##, Paragraphs ## of the TCS and the total pay detailed above is less than your personal cash floor, your salary for this placement will be protected at the amount of your personal cash floor.

44. Junior doctors’ contract The new 2016 contract Continued… Training Opportunities: This section is completely new, the current contract is largely silent on training. Completion should be aided by the GMC “Form B” (Approval of Training), which should identify responsibilities, training commitments, formal education, study sessions, and any additional relevant information. The educational and clinical supervisor for the post should review the Work Schedule, and may wish to make additions or amendments to the training opportunities. The doctor will review their training opportunities at their regular discussions with their educational supervisor.

45. Junior doctors’ contract The new 2016 contract Questions? Will NHS Employers will be producing guidance on work scheduling? Will the TCS will include details on work schedules?

46. Junior doctors’ contract The new 2016 contract Questions? Will there be a template that employers can use? Will we still have to carry out diary monitoring?

47. Junior doctors’ contract The new 2016 contract Exception reporting Compulsory hours monitoring is not likely to be a feature of the proposed 2016 contract. Instead, trainees will raise exception reports where their work schedule does not reflect the reality of what they are doing, in terms of service or training. The purpose is to ensure a work schedule remains fit for purpose, where informal discussions may have failed to resolve concerns. Exception reports give employers real time information and should help to identify patterns and pick up any issues quickly.

48. Junior doctors’ contract The new 2016 contract Work schedule reviews Could be triggered by exception reports, or requested at any time. Hopefully an informal discussion will resolve the issue, and everyone will agree either a change to the individual work schedule, or that no further action is required. If this is not possible, a formal meeting will be convened with the doctor. If no agreement can be reached there will be a final level appeal process, modelled on the employer’s final stage grievance appeal. At no point will their be the need to convene external panels like in the current contract.

49. Junior doctors’ contract The new 2016 contract The guardian of safe working A completely new role that will need to be in place for August. Not to be confused with the Caldicott Guardian, or Freedom to Speak Up Guardian. Designed to oversee the safeguards outlined in the proposed 2016 contract, and provide assurance that working hours and practices are safe. Where problems have not been resolved doctors can escalate their concerns to the guardian who will be empowered to require departments to take necessary action.

50. Junior doctors’ contract The new 2016 contract The guardian will: Act as the ‘champion’ of doctors’ safe working hours. Provide assurance that doctors are both rostered safely and actually working safely. have sight of all exception reports, and undertake regular reviews of exception reports and work schedule reviews to ensure that hours remain safe. Ensure that work schedule review processes are followed. Require a work schedule review to be undertaken where there are regular or persistent breaches in safe working hours, which have not been addressed. escalate issues to the Board where concerns over working hours have not been addressed locally.

51. Junior doctors’ contract The new 2016 contract Who will the guardian be? The guardian should be someone who commands the respect and confidence of both doctors and management (including the board, who they will be accountable to). This is likely to be a senior medical professional.

52. Junior doctors’ contract The new 2016 contract Appointing a guardian The guardian must be appointed in line with the TCS, which will specify the appointment process, term of office, and performance management processes. A sample job description and person specification will be provided by NHS Employers. There will be flexibility, where all parties agree, to appoint a regional guardian as opposed to a local guardian.

53. Junior doctors’ contract The new 2016 contract Questions ?

54. Junior doctors’ contract The new 2016 contract The terms and conditions of the 2016 contract are being finalised and are subject to review and amendment by the Secretary of State. Advice within this session and other documents regarding likely content of the terms and conditions should be considered with this is mind.