British Medical Association Junior doctors’ handbook on the 2016 contract
Contents
1. Introduction ........................................................................................................................................................... 2
2. Training appointments and educational approval ................................................................................. 3
3. Learning and development .............................................................................................................................5
4. Recruitment to specialty training – advice for applicants .................................................................. 7
5. Contracts of employment ................................................................................................................................ 9
6. Pay ........................................................................................................................................................................... 13
7. Work Scheduling ............................................................................................................................................... 24
8. Hours of work and WTR ................................................................................................................................... 31
9. Exception reporting, work schedule reviews, and the Guardian of Safe Working .................. 36
10. Indemnity ............................................................................................................................................................. 41
11. Transition arrangements ...............................................................................................................................44
12. LTFT (less than full-time) training ...............................................................................................................46
13. Locum work in the NHS .................................................................................................................................. 50
14. Study and professional leave ....................................................................................................................... 53
15. Annual leave ........................................................................................................................................................ 56
16. Maternity, paternity and shared parental leave .................................................................................... 59
17. Sick leave .............................................................................................................................................................. 70
18. NHS pension scheme ......................................................................................................................................73
19. Travelling and other expenses ..................................................................................................................... 74
20. Removal expenses ............................................................................................................................................ 78
21. Accommodation and catering .................................................................................................................... 84
22. OOP (Out of Programme) Experiences ....................................................................................................87
23. Medical academic doctors ............................................................................................................................ 90
24. Overseas doctors and international medical graduates .................................................................. 96
25. Revalidation.........................................................................................................................................................98
26. Raising concerns and whistleblowing ..................................................................................................... 99
27. The regulatory framework ..........................................................................................................................103
28. The British Medical Association and its structures .........................................................................107
2 British Medical Association Junior doctors’ handbook on the 2016 contract
1. Introduction
The Junior doctors’ handbook on the 2016 contract
This handbook is your guide to the main contractual issues that may arise in junior doctors’
employment, and on which you may need to seek advice. The guidance in this handbook
covers junior doctors working under the new 2016 terms and conditions of service and
includes all contractual updates that were introduced as part of the 2018 contract review.
The 2016 contract only applies to junior doctors working in England. Any junior doctors
working in Scotland, Wales or Northern Ireland should continue to refer to the 2015
handbook which can be found on the BMA’s website.
The handbook has been produced to provide information to help junior doctors
understand their terms and conditions of service and matters arising in the course of their
employment. Every eort was made to check accuracy at the time of publication but there
may have been later changes. Members should also check the BMA website for updates
since the time of publication.
BMA members may seek advice on specic problems relating to the terms of their
employment by contacting our team of advisers on 0300 123 1233 or suppor[email protected].
The BMA is happy to receive any comments on the handbook, or any suggestions on how to
improve the services provided for junior doctor members. Comments should be sent to the
junior doctors committee at info[email protected].
The handbook can also be found on the BMA website:
bma.org.uk/pay-and-contracts/contracts/junior-doctor-contract/bma-handbook-for-
junior-doctors-in-england
April 2021,
Version 2.0
3British Medical Association Junior doctors’ handbook on the 2016 contract
2. Training appointments and educational approval
Summary
This chapter covers the key approvals required before a post can be recognised
for training. It explains which organisations hold responsibility for approving
training programmes and posts, as well as the types of posts that may not count
towards a CCT.
All training posts must have educational and dean’s approval and this should be clearly
stated in advertisements. Junior doctors should be aware that non-approved or non-
standard posts will not count towards a CCT (certicate of completion of training). Junior
doctors who have any concerns about a post should always seek advice from their local
Health Education England team. All specialty training and xed-term training appointments
must adhere to national person specications, which are available on the Health Education
England website specialtytraining.hee.nhs.uk/Recruitment/Person-specications.
NHS training posts must be of an acceptable standard and accord with NHS workforce
agreements. The following key features must apply to all training posts:
– a post or programme must have educational approval and approval by the postgraduate
dean, or it cannot be designated a training post or programme
– placements or programmes in NHS training grades for doctors and dentists can only be
advertised if they have the valid educational and dean’s approval.
– all recruitment procedures should comply with equality and diversity policies.
A post not in a recognised NHS training grade (eg ST level Trust grade post/clinical fellow/
FY3/Locally Employed Doctor (LED)) cannot be regarded as a recognised training placement
or programme. You cannot assume that experience in such non-training posts will count
towards the completion of specialty or general practice training.
Employers must seek permission from the postgraduate dean whenever it is proposed to
advertise a training placement or programme. Before the advertisement can appear, the
postgraduate dean must conrm that:
– there is valid educational approval
– it has the current postgraduate dean’s approval
The following two elements must be met for a post to obtain the postgraduate
dean’s approval:
– posts must meet agreed standards on training, supervision, contractual terms,
compliance with contractual working hour limits, accommodation and catering, and their
local human resources strategy
– where there is a national or specialty-specic target for the number of doctors or dentists
to be trained, the dean’s approval must not be granted to placements that may cause
these targets to be breached
GMC (General Medical Council) approval of experience
All formal training posts in the UK, that meet the above criteria and are part of a GMC-
assured training programme, will now result in a Certicate of Completion of Training (CCT).
Previously, training programmes that doctors entered later (eg at ST3), or in cases where the
doctor had a certain amount of pre-existing experience, would allow them to leave training
with a Certicate of Eligibility for Specialist Registration (CESR) – this is now no longer the
case, and completing a GMC-assured training programme will result in a CCT.
Prospective approval of posts
The GMC does not retrospectively approve non-training posts for doctors hoping to gain a
CCT. However, doctors in training can ask to have their previous experience counted, as long
as it can be demonstrated and it meets UK curriculum and practice requirements.
4 British Medical Association Junior doctors’ handbook on the 2016 contract
For further information on OOP (Out of Programme Experience) see chapter 22. Educational
and training approval from the GMC is also needed for those placements not funded by the
postgraduate dean but by other bodies, eg universities, charitable institutions, or research
bodies, non-NHS providers etc.
Honorary appointments
An honorary appointment gives a doctor formal status with an NHS employer for the
purpose of NHS indemnity and the employer safeguarding processes. An honorary
contract is issued for a specic purpose eg gaining experience, observing clinical practice,
undertaking clinical research work whilst employed by an academic institution. An honorary
contract does not give the doctor status as an employee with a salary or employee benets.
Employers oering honorary NHS appointments to doctors wishing to gain experience
in order to pursue clinical specialist training must obtain the dean’s approval before the
placement is advertised or the appointment conrmed.
LASs (Locum Appointments for Service)
Locum doctors and dentists should not be appointed to training grades where there
is no substantive placement to be covered. Locum appointments (apart from Locum
Appointments for Training – LATs2) will not normally be recognised for training purposes.
Applicants should be told before appointment that, although the substantive placement
may attract the relevant approvals, a locum appointment should not be assumed to count
towards a CCT. Advice about prospective approval of training for locum hospital placements
should be sought from the GMC and the postgraduate dean.
Non-standard grades
If the title of the post is Trust StR or Trust Specialist Registrar then this is a non-standard
grade and unlikely to count towards your CCT. Members considering applying for these posts
should check with their local HEE oce or the Trust’s Director of Medical Education.
Responsibility for educational approval
FY1 grade
The learning objectives for this year are set by the GMC. In order to attain full
registration with the GMC, doctors must achieve specic competences by the end
of this year. The postgraduate dean normally undertakes responsibility for approving
trainees’ competencies.
FY2 grade, specialty training grades and xed-term specialty training appointments
The GMC is required to recognise and approve placements and programmes for the
foundation programme, core training programmes, and for all specialty training leading
to the award of a CCT. The GMC will take advice from the relevant medical royal college
or faculty, which approves placements on its behalf. However, not all placements/
programmes conrmed by the dean as having educational and postgraduate dean’s approval
automatically lead to the award of a CCT, eg Locum Appointments for Training and core
training programmes. For detailed information on specialty training please read A guide to
postgraduate training in the UK, also known as the Gold Guide – this is available for all years
at www.copmed.org.uk/gold-guide.
Further information
2021 Guidance for Foundation Schools
Rough guide to the foundation programme
5British Medical Association Junior doctors’ handbook on the 2016 contract
3. Learning and development
Summary
This chapter provides information on learning and development support, tips on
choosing a specialty, and career progression. Making a choice of which career path
to pursue requires considerable thought. Personal choice needs to be aligned with
strengths, values and interests, as well as the extent of competition for, and the
availability of, opportunities.
The BMA is committed to supporting doctors throughout their careers and provides a
wide range of specialist non-clinical learning and development services. We recognise the
importance of continued professional skills development in helping doctors to advance their
careers, and help demonstrate further valuable learning for appraisal and revalidation.
As a BMA member, your access to these services currently ranges from free medical careers
information available 24/7, through to free webinars and e-learning modules. This includes
online training, medical careers information, top tips and guides on how to choose a
specialty, training recruitment processes and timelines, and links to other careers sites.
Career development webinars
We deliver a range of webinars that provide real-time teaching delivered live to your
computer from a careers expert on topics which are aligned to your training, including:
– Assertiveness in the workplace
– Negotiating and inuencing
– Work, stress and positivity
– Presenting skills
– Dealing with conict
– Interview skills for specialty posts
We recognise that while in-person teaching is ideal, work and other commitments don’t
always allow for this. Webinars provide a exible learning approach to career development
– if you attend the live webinar, you can post questions to the speaker. Alternatively, the
recorded version allows you to watch it at your leisure.
e-learning module resources for junior doctors
The BMA – in partnership with BMJ Learning – have developed a series of non-clinical
e-learning modules that oer exible learning that can be accessed anywhere, anytime.
These e-learning modules have been written in response to needs expressed by medical
students and doctors at all levels – and many have been written in with input and insight
from doctors. They oer tailored guidance and practical learning support on a range of
helpful topics that support your personal and professional growth.
Modules in the series include:
– Workload and time management
– Application to specialty training
– Interview skills for specialty roles
– Medical CVs and Application forms
– Career planning
– Developing an eective personal development plan
– Preparing eectively for the Multi-Specialty Recruitment Assessment (MSRA)
– Building professional relationships
– Dealing with pressure in your foundation years
Access these exclusive and valuable modules at learning.bmj.com/BMA.
6 British Medical Association Junior doctors’ handbook on the 2016 contract
Specialty explorer
With 65 specialties in the UK to choose from, it can be hard to make a decision about what
the right one is for you. The BMA’s Specialty explorer can help you consider elds you may
not otherwise have considered. Answer a series of questions to receive a personalised report
of the top 10 medical specialities that match your preferences.
The questionnaire takes around 10 minutes to complete. Remember, the result acts as a
guide for your consideration – it is not a replacement for formal career guidance.
To access the site or for further information please visit bma.org.uk/myspecialty.
More career progression benets from the BMA
BMA members are entitled to a wide range of benets from the BMA and the BMJ. Make sure
you support your continued non-clinical learning and career progression needs with:
– BMA Library: Access to a range of facilities, both in person and online, including
thousands of online journals and e-books; expert literature search; and, research support.
Visit bma.org.uk/bma-library.
– BMJ Learning: Free access to an extensive range of CPD and postgraduate training
modules. Visit learning.bmj.com/BMA.
– The BMJ: an international peer-reviewed medical journal. As a member you are entitled to
a free subscription to The BMJ in print and online. Visit BMJ.com to nd out more.
– BMJ OnExamination: a leading provider of quality medical exam preparation. Prepare
with questions that reect the curriculum and test and improve your knowledge. For
more information and the latest discounts available visit
onexamination.com.
– BMJ specialty journals: As a BMA member you are entitled to discounted subscriptions
to more than 50 of BMJ’s specialty journals, some of which are the most inuential titles in
their eld. Visit journals.bmj.com to nd out more.
7British Medical Association Junior doctors’ handbook on the 2016 contract
4. Recruitment to specialty training – advice
for applicants
Summary
Applications for specialty training are made to lead deaneries, HEE local oces or
Royal Colleges. The specialty training website gives detail on person specications
and application processes.
All applications to specialty training programmes are managed through the online
application portal Oriel.
For most specialties, recruitment is coordinated on a UK-wide basis and led by a specic
deanery or royal college. However, this may change for some elements of higher specialty
or sub-specialty training. It is crucial to ensure that you are up to speed for the process and
requirements of your chosen specialty.
The vast majority of specialty training programme-specic information can be found on the
Specialty Training website; you should also check the relevant college, HEE local oce or
deanery website for information about training programmes and their application processes.
You should also ensure that you meet the criteria listed in the person specication for the
training programme to which you will be applying.
You can apply to training programmes during the vacancy window by searching for
vacancies on the relevant college, HEE local oce or deanery website, NHS jobs online or
on the Oriel website. You will be shortlisted for interview against the criteria listed in the
person specication.
HEE (Health Education England) has produced guidance for applicants that includes dates of
vacancy windows. Its website also links to specic programme descriptors and competition
ratios for each specialty.
Applications to the Foundation Programme also use the Oriel system.
If you are in doubt, please check the oriel website or the specialty training website
(specialtytraining.hee.nhs.uk) for up to date information on applying to specialty
training programmes.
Further information
Oriel
HEE specialty training
NHS Jobs
UKFPO for Foundation Training
Recruitment to general practice
The National Recruitment Oce coordinates recruitment of doctors to general practice.
More information is available on the National Recruitment Oce website at
gprecruitment.hee.nhs.uk.
Code of Practice: Provision of information for postgraduate
medical training
The Code of Practice has been adopted across the UK. The Code lays out the agreed
set of information that recruiting organisations and employers should provide to
doctors in training at each stage of the recruitment process, including the rst post and
subsequent rotations. Under the Code, employers should share the following information
well in advance:
– Contact details
– Location of work
– Hours and out-of-hours rota
– Basic pay and any supplementary pay
– Pension arrangements
– Leave rules and entitlement
8 British Medical Association Junior doctors’ handbook on the 2016 contract
The key dates for the provision of information are set out below:
Information to be provided Key dates
Recruiting organisation to provide
application information to employer once
oer of training programme has been
accepted and general information has been
provided to applicant.
Minimum of 12 weeks prior to start of post.
Employer to provide doctor specic
information about the post being oered.
Minimum of 8 weeks prior to the start of the
1st placement.
Employer to provide the doctor with their
rota in the generic work schedule.
Minimum of 8 weeks prior to the start
of the placement.
The duty roster will be made available at 6
weeks before commencement of post.
Minimum of 6 weeks prior to the start
of the placement.
Employer to issue statement of particulars
and employment contract to doctor.
At the start of the post, if not before. It is
now a legal requirement for an employer
to provide you with a full statement of
particulars by day one of employment.
Many junior doctors are still not receiving sucient notice. In these cases, you should rst
contact your prospective employer or recruiting organisation to address the problem. If this
does not resolve the issue, then contact the BMA. The BMA is also working to improve the
content of the Code and its implementation at a national level.
As part of the above eorts, as part of the 2018 Review outcome it has become a contractual
requirement for employers to provide trainees with work schedules (and other associated
information) eight weeks prior to commencement, and their duty roster six weeks prior
to commencement. This means employers are now contractually required to meet these
timeframes. However, there are number of circumstances, set out within the TCS, which
would mean these requirements would not apply.
Further information
Terms and Conditions of Service, Introduction, paragraph 8 & Schedule 4, paragraphs 10
and 24. More information about the Code – including timescales, links to the national
versions, and updates as they occur – is available on the BMA website: bma.org.uk/advice-
and-support/career-progression/training/code-of-practice-in-england.
Recruitment to an Academic Clinical Fellowship/Clinical Lectureships
An overview of the academic training programmes across the UK, including links for further
information, is available on the National Institute for Health Research website.
Top tips on applying for a specialty training post
– Read the programme descriptors carefully.
– Read the person specications to ensure your skill set matches with the role you are
applying for.
– Check you know which level you should apply for.
– Check the competition ratios for each specialty.
– Check you can back up your experience with sucient evidence.
– Review the application requirements on the specialty training website, or for higher
specialty training, check with your royal college or local information.
– Check the application deadlines (late applications will not be accepted under
any circumstances).
– Find out if you have to submit an application online, and how long this will take you.
– Start planning your applications early: download the application form and ensure you
have all the information you need.
– Read the Specialty Recruitment Applicant Handbook on the specialty training website
(specialtytraining.hee.nhs.uk) for help and advice on how to best present your skill set
and experience in your application. For other nations, please check the relevant websites
for further information.
9British Medical Association Junior doctors’ handbook on the 2016 contract
5. Contracts of employment
Summary
This chapter covers model contracts of employment, individual contracts of
employment, job descriptions, and notice periods. It explains the dierent types
of employers and provides some information on the circumstances where local
variations can be made to the national terms and conditions of service. It also includes
a brief summary of the FY1 shadowing period.
Each time you rotate to a new employer, you should receive a contract. The only exception
to this is if you are employed by a lead employer organisation, which holds all the contracts. If
you have a lead employer, this normally means you will have just one employer while rotating
within that deanery/HEE local oce area.
Either on or before your rst day of employment with a new employer, you should receive
a written statement of particulars of employment. This will normally be a contract of
employment and a job description. Further information is available in the Code of practice:
Provision of Information for Postgraduate Training bma.org.uk/advice-and-support/career-
progression/training/code-of-practice-in-england.
If you haven’t received this contractual information, contact our team of advisers
on 0300 123 1233.
Once you have received your contractual information, get it checked by the BMA before
you sign, either by submitting an online form or use our FREEPOST: bma.org.uk/pay-and-
contracts/contracts/contract-checking-service/contract-checking-service
Model contracts of employment
One model contract is designed to be applicable to all junior doctors in the training
grades in England. Doctors who carry out academic work should also refer to the medical
academics section, chapter 23, for information on medical academic employment
contracts. The model contract covers the specic terms of each employment contract
and is subject to the TCS (Terms and Conditions of Service for NHS Doctors and Dentists
in Training (England) 2016). The model contract can be found on NHS Employers’ website,
there is also a variation of the model contract to be used for junior doctors who are
employed under a lead employer contract.
Individual contracts of employment
A contract of employment is an important legal document. Once signed, the contents are
binding, and it may be impossible to make changes. Contracts should follow the national
models, but some employers include clauses that dier from those national agreements.
These should be no less favourable than the model contract. If you are concerned that your
contract falls below the minimum terms and conditions set out in the model, contact the
BMA for advice. The BMA contract checking service (above) should identify any areas that
dier from the nationally agreed terms and conditions of service.
Honorary contracts
An honorary contract is distinct from a substantive contract of employment. It gives a
doctor formal status with an employer. It can provide opportunities to undertake paid work
and access appropriate expenses, but it does not provide a salary or regular employment.
An honorary contract with an NHS employer might be held by a doctor who works primarily
in an academic institution but remains clinically active. An honorary contract with an
academic employer might be held by a doctor who works primarily within the NHS but who
also undertakes academic research. It is highly recommended that you obtain an honorary
contract with the NHS, when holding a substantive contract outside the NHS, to maintain
your continuity of employment. This chapter discusses substantive contracts.
10 British Medical Association Junior doctors’ handbook on the 2016 contract
Contract Checking service
We oer members a free contract checking service. The JDC urges that junior doctors who
are BMA members seek this professional advice from our team of advisers before signing a
contract. Getting your contract checked can save you having to deal with problems in the
future. If a contract does not conform to the national model, juniors should give written
notice to their employer that they do not accept a non-standard contract and they should
not sign it without rst seeking advice. You can call our team of advisers on 0300 123 1233
or go to our website for more information: bma.org.uk/pay-and-contracts/contracts/
contract-checking-service/contract-checking-service.
Further information
BMA website: bma.org.uk/pay-and-contracts/contracts/junior-doctor-contract/junior-
doctor-contract-in-england.
Model contract: www.nhsemployers.org/pay-pensions-and-reward/medical-sta/doctors-
and-dentists-in-training/terms-and-conditions-contracts/model-contracts-for-the-2016-
contract.
Job descriptions
A job description should accompany the contract and forms part of the contractual
relationship between the junior doctor and the employer. Ideally, the doctor should be given
a copy of the job description on application for the post. The job description should provide
an accurate picture of the post and dene the hours (including details of the rota) and duties
of the job. As mentioned in chapter 4, the requirement for a duty roster to be provided at
least 6 weeks prior to commencement of the post was contractualised as part of the
2018 review.
Alterations to the job description should be by mutual agreement. Contact our team of
advisers on 0300 123 1233 before signing, if in any doubt.
Further information
BMA website: bma.org.uk/advice-and-support/career-progression/training/code-of-
practice-in-england.
Notice periods
The notice period is the amount of notice that you or your employer must give if either party
wishes to terminate your contract of employment. The following minimum periods of notice
should apply, (schedule 11 paragraph 5, Terms and Conditions of Service) unless there is an
agreement between both parties that a dierent notice period should apply:
Foundation Year 1 1 month
Foundation Year 2 1 month
Dental Foundation Training 1 month
Specialty registrar (xed-term) 1 month
Specialty registrar (core training) 1 month
Dental Core Training 1 month
GP specialty trainee 3 months
Specialty registrar (run through) 3 months
Specialty registrar (higher specialty
training)
3 months
Specialist registrar 3 months
11British Medical Association Junior doctors’ handbook on the 2016 contract
Employment documentation
It is worth remembering to obtain the relevant documentation when starting work with a
new employer. A sta transfer form, a P45, a recent payslip and proof of hepatitis B status
would all, if readily available, help facilitate a smooth start in your early days in a new job.
Junior doctors’ employers
Junior doctors’ contracts are made with and held by individual NHS employers, such as NHS
Trusts. This means that employers are distinct from the organisations ultimately responsible
for junior doctors’ educational provision. Chapter 2 discusses how these bodies exercise
their duties to ensure the educational value of training posts.
Doctors in training therefore do not have an employment relationship with Health Education
England. In order to ensure that junior doctors are aorded legal protection if they are
subjected to detrimental treatment by HEE as a result of whistleblowing, the BMA has
reached an agreement with HEE to ensure that junior doctors have equivalent protections
from such actions by HEE as they would have if they had a formal employment arrangement.
Foundation programme employers
The JDC recommends that doctors in the foundation programme are employed by
one employer acting as a ‘host employer’ during the two-year programme. The host
employer would usually be the employer where a trainee is based for the majority of their
programme. The host employer would then second the foundation trainee to any other
employers that form part of the programme. Even where this arrangement does not exist,
foundation trainees will need to be seconded from their last employer to a GP practice when
undertaking a GP placement.
Lead employers
It is open to employers to join together to agree an arrangement whereby one employer
administers contracts on behalf of a group of employers. In such cases, the ‘lead’ employer
may hold all contracts and second junior doctors from that employer to other ‘host’
employers. Such arrangements should assist in better planning and organisation of training
rotations, and are strongly supported by JDC. Members oered contracts in which they will
be seconded from one employer to another should seek advice from our team of advisers on
0300 123 1233 before signing the contract.
Variations to national agreements on contracts and terms of service
Although employers are asked to employ junior doctors on national terms and conditions of
service, they have some exibility to introduce variations to the national model contracts for
specialist and specialty registrars. However, this exibility should only be at the margins of
terms and conditions of service, and usually involve additions or modications to enhance
rather than reduce existing rights. It is intended that juniors should hold a uniform contract
throughout a rotational training programme, with only the employer’s identity changing as
they move between posts in the rotation.
Any local variations to national agreements on contracts and terms of service must meet the
following important conditions:
– they have been negotiated with local junior doctors’ representatives, and through the
LNC (Local Negotiating Committee);*
– the postgraduate dean is satised that they will not adversely aect the quality of their
training; and
– they are agreed by all the employers in the rotational training programme.
*For more information on LNCs, including how you can become involved, see the BMA website: bma.org.uk/what-
we-do/local-negotiating-committees
12 British Medical Association Junior doctors’ handbook on the 2016 contract
It is essential that junior doctors’ representatives are involved at all stages in any
negotiations aimed at seeking variations to national agreements, and that the above
safeguards are met. Generally, discussions will be held at deanery level and proposals will
need to be endorsed by each employer and its LNC. It is therefore crucial that the LNC has a
junior doctor representative who is able to attend meetings.
Regional JDCs may have appointed negotiators who take the lead in any discussions at
deanery or lead employer level. Junior doctors should seek advice from our team of advisers
on 0300 123 1233 if they are aware that changes are being considered without any junior
doctor input.
Vacant posts
The terms of any job description can be reviewed in light of the level of service required
where posts fall vacant. Proper consultation must, however, take place, and the employer
is required to consult those most closely involved with the posts, including the consultants
and other junior doctors on the shi/rota and, so far as possible, the previous incumbent.
Any changes can only be made as a result of these consultations, but the new incumbent
may seek an immediate review if the revised allocation of duties is unrealistic. You can seek
advice from our team of advisers on 0300 123 1233.
FY1 shadowing
Shadowing is an arrangement where a prospective doctor observes an existing FY1
(foundation year one doctor) undertaking the usual activities required of their role before
taking over the role themselves. It helps forthcoming FY1 doctors become more familiar
with working practices and hospital systems, gain condence and professional skills,
and helps to improve patient care. It can also provide an opportunity to develop working
relationships with the clinical and educational supervisors they may work with in the future.
All new FY1s across the UK should receive at least four days paid shadowing at the basic
hourly FY1 salary rate for the hours undertaken. The BMA believes that this should be
calculated on the basis that the hours undertaken in a four-day shadowing period (32 hours)
are four hs of the full hours (40 hours) for which an FY1 doctor is paid in a week. If your
new employer says they will not be paying you for shadowing, or if it is not calculated at this
rate, please call the BMA on 0300 123 1233 or email suppor[email protected].
There are no nationally agreed contractual arrangements in England for FY1s
undertaking paid shadowing placements. JDC believes that the best approach is for a full
employment contract to be used as this allows new FY1s to engage fully in clinical activity
whilst shadowing.
The 2016 terms and conditions of service state that the terms should not be used for
the period of shadowing and that separate arrangements should be made (introduction,
paragraph 3). A copy of the 2016 TCS with this clause removed can be used for this purpose
for the F1 shadowing period.
Comprehensive information on shadowing is available on the BMA website.
Further information
HEE guidance: www.nwpgmd.nhs.uk/sites/default/les/HEE%20Shadowing%20
Guidance%202014_0.pdf.
NHS Employers advice: www.nhsemployers.org/your-workforce/recruit/national-medical-
recruitment/foundation-programme/foundation-programme-shadowing-payment-
arrangments-2018.
13British Medical Association Junior doctors’ handbook on the 2016 contract
6. Pay
Summary
This chapter provides information on pay for junior doctors, including information on
salary scales; the importance of checking payslips; starting salaries; transitional pay
protection; additional payments such as London weighting; and private fees.
Junior doctors are paid on national pay scales which are set each year. The Doctors and
Dentists Review Body (DDRB) receives evidence from the BMA, the UK Health Departments
and NHS Employers. The DDRB then reports to the Secretary of State for Health and to the
equivalent for Scotland, Wales and Northern Ireland with their recommendations on how to
set the pay scales for the year. The report is later made public, with each government making
their own nal decision on whether to implement it in each of the four nations. Any change is
usually eective from 1 April each year.
If an announcement is made aer the 1 April, then any increase will typically be backdated
to that date. The DDRB may recommend an increase to the pay scales, but it may also
recommend that pay should remain the same. Each of the health departments then has the
ability to accept the recommendations of the DDRB or, as is sometimes the case, reduce
what is recommended due to the availability of funding.
However, as part of the 2018 review of the junior doctor contract in England, trainees
received a guaranteed pay upli of 2% per year for the next four years, up to and including
the nancial year of 2022/23, alongside other nancial investment into contractual
changes. In the most recent pay award, the DDRB did not recommend an additional upli
for junior doctors.
Further information
Pay Circulars for England: www.nhsemployers.org/pay-pensions-and-reward/medical-sta/
pay-circulars.
Check your payslip
You should always check your payslip when you change post, or change employer, as this is
when most errors tend to occur. The key things to look for on your payslip are basic salary,
superannuation, NI (National Insurance) number and your tax code. Your salary may change
for a number of reasons:
– Pay supplements – Your pay supplements remunerate you for additional work you
undertake over your basic hours, on-call availability, weekend working and for antisocial
hours such as night shis, or a exible pay premium where applicable. See below for
further detail on these. They are also detailed fully in schedule 2 of the terms and
conditions of service.
– DDRB award – Each year the DDRB considers evidence from the BMA, the UK Health
Departments and the employers, and then issues a report outlining its recommended
pay award for the next 12 months. Although the DDRB report is published in the spring,
it takes time for new pay scales to be issued. Assuming there is a pay award for that year,
you normally will not see it in your payslip until May. You will normally receive pay on the
new scale one month, followed by arrears of pay for preceding months back to April in the
following month. It cannot be guaranteed that the DDRB will recommend a pay increase
every year, but on those years that an increase in basic pay is recommended, make sure
you check your payslip carefully. If junior doctors are subject to a multi-year pay deal, as
they currently are until April 2023, then unless an additional pay award is recommended
then there will not be a DDRB pay award recommendation.
– Other deductions – The main deductions are income tax and National Insurance
contributions, as explained above, as well as student loan and pension contributions.
However, you may also have other deductions on your payslip – eg for a car parking
permit, or childcare vouchers. These additional deductions can only be made by your
employer with your consent. You should raise any queries regarding these directly with
your employer (normally the payroll department).
14 British Medical Association Junior doctors’ handbook on the 2016 contract
Terms and conditions of pay are set out in schedule 2 of the TCS. There is also detailed
guidance on the BMA website which can help you check your payslip and details how pay
changes and what to look out for, particularly when changing post: bma.org.uk/pay-and-
contracts/pay/payslips/understanding-your-payslip-junior-doctors-on-the-2016-contract.
Pay supplements
Under the 2016 terms and conditions of service, pay is made up a number of elements. Basic
pay, with values as set out in the pay circular, is for the average 40 hour working week (for full
time trainees).
The pay scale is comprised of ve nodal points, linked to the stage of training the junior
doctor is working at, they are;
– FY1 Nodal point 1
– FY2 Nodal point 2
– CT1-2/ST1-2 Nodal point 3
– CT3/ST3-5 Nodal point 4
– ST6-8 Nodal point 5
The h nodal point was introduced in October 2020 for trainees at ST6 and above, in order
to recognise the signicantly high service contribution these trainees make. This nodal point
is being introduced through a staggered approach from October 2020, as follows:
– In October 2020, the value will be £3,000
– In October 2021, the value will increase to £6,000
– In April 2022, the value will increase to £7,200
Pay under the 2016 contract is typically calculated based on the generic work schedule for
the post you are working in.
Additional hours
You can have up to 8 additional hours of work rostered into your work schedule up to an
average of 48hrs per week, and these are paid in addition to the basic salary, at a rate of
1/40th of weekly whole-time equivalent for each additional hour worked.
Weekend allowance
The way weekends are paid is that instead of having certain time periods dened as meriting
a pay enhancement, such as ‘plain’ versus ‘enhanced’ time, instead the enhanced pay for
work done at the weekend is determined by the number of weekends that a doctor has to
work over the course of the generic work schedule. As such there are two denitions of
‘weekend’, one for the purposes of pay and one for the purposes of working hour limits.
A doctor rostered to work at the weekend (dened as one or more shis/duty periods
beginning on a Saturday or a Sunday) at a minimum frequency of 1 in 8 across the length of
the rota cycle will be paid an allowance.
There are two denitions of ‘weekend’, one for the purposes of pay and one for the purposes
of working hour limits. For the purpose of calculating pay, a weekend is considered to be
worked if a doctor works any shi that begins on a Saturday or Sunday in a given week.
15British Medical Association Junior doctors’ handbook on the 2016 contract
The weekend allowances are set as a percentage of full-time basic salary in accordance with
the rates set out in the table below:
Frequency Percentage
1 weekend in 2 15%
Less frequently than 1 weekend in 2 and greater than or equal to 1
weekend in 3
10%
Less frequently than 1 weekend in 3 and greater than or equal to 1
weekend in 4
7.5%
Less frequently than 1 weekend in 4 and greater than or equal to 1
weekend in 5
6%
Less frequently than 1 weekend in 5 and greater than or equal to 1
weekend in 6
5%
Less frequently than 1 weekend in 6 and greater than or equal to 1
weekend in 7
4%
Less frequently than 1 weekend in 7 and greater than or equal to 1
weekend in 8
3%
Less frequently than 1 weekend in 8 No allowance
A doctor working less than full time will also be entitled to be paid this allowance when
working on a rota where the doctors working full time on that same rota are in receipt of
such an allowance. The allowance paid to the doctor working less than full time will be
paid pro rata, based on the proportion of the full-time commitment to the weekend rota
that has been agreed in the doctor’s work schedule. For example, a doctor making a 50%
contribution to the rota would be paid 50% of the value of the availability allowance paid to
a doctor making a 100% contribution to the rota. If a LTFT doctor works the same number of
weekends as a full-time doctor on the same work schedule, they should receive the full-time
weekend supplement.
On-call availability allowance
A doctor on an on-call rota who is required by the employer to be available to return to work
or to give advice by telephone, but who is not normally expected to be working on site for
the whole period, shall be paid an on-call availability allowance. The value of the allowance is
8% of full-time basic salary for the relevant grade, and will take the form of a cash sum that is
paid for all on-call duty periods in the doctor’s work schedule.
Resident on-call – being required to be on site for the whole duration of an on-call shi - is
not generally a feature of the 2016 terms and conditions of service, and the denition of ‘on-
call’ is restricted to non-resident on-call (NROC), not including the more informal uses of the
term, such as ‘holding the on-call bleep’ while working a normal shi at your place of work.
For doctors employed on a less-than-full-time basis, in any grade, the value of the on-
call availability allowance shall be paid pro rata, based on the proportion of full-time
commitment to the rota that has been agreed in the doctor’s work schedule. For example,
a doctor making a 50%contribution to the rota would be paid 50% of the value of the
availability allowance paid to a doctor making a full contribution to the rota.
Payment for work undertaken whilst on-call
Doctors shall be paid for their average hours of work done while on-call, in addition to the 8%
availability allowance for the whole duty.
The hours paid will be calculated prospectively across the rota cycle, and the estimated
average hours at each rate of pay will be set out in the work schedule. There must be
separate prospective estimates for anticipated work which will occur during plain time and
enhanced time. Such work includes any actual clinical or non-clinical work undertaken
either on or o site, including telephone calls; actively awaiting urgent results or updates;
any travel time arising from any such calls; and, handover of patients at the end of the shi.
16 British Medical Association Junior doctors’ handbook on the 2016 contract
For the purposes of pay, these total estimates shall be converted into equal weekly amounts
by dividing the total number of prospective hours at each rate by the number of weeks in the
rota cycle.
The weekly amount will then be turned into an annual gure and the doctor shall be paid
1/12th of the annual gure for each complete month, or a proportion thereof for any partial
months worked. If, across the rota cycle, the doctor works a greater number of hours than
the prospective average estimate, the individual doctor will be additionally paid for
these hours.
Hours that attract a pay enhancement
An enhancement of 37% of the hourly basic pay rate shall be paid on any hours worked
between 21.00 and 07.00, on any day of the week.
Where a shi is worked which begins no earlier than 20.00 and no later than 23.59, and is
at least 8 hours in duration, an enhancement of 37% of the hourly basic rate shall also be
payable on all hours worked up to 10.00 on any day of the week. Where such a shi begins
before 20.00, rostering guidance must be adhered to, as dened in schedule 3 paragraph 6
of the TCS.
This is in order to ensure that shis, which are ostensibly ‘night shis’, are paid at the
enhanced rate in full, whereas any individual hours worked during the night period, as part
of a shi which started earlier, will receive the enhanced rate as well. Employers should not
start night shis slightly earlier, for example at 19.30, in order to avoid paying the enhanced
rate for the whole shi. The contract explicitly refers (schedule 3 paragraph 6) to the need
to ensure shis with hours worked during the night period are rostered in the correct way –
check the BMA’s rota design guidance, available online, if you need help with this.
Where a shi ends aer 00.00 and before 04.01, the entirety of the shi will attract an
enhancement of 37 per cent of hourly basic rate. These shis are typically referred to as
‘twilight’ or ‘disco’ shis.
The number of hours in the rota for which an enhancement is paid will be assessed across
the length of the rota cycle (as set out in the work schedule), and converted into equal
weekly amounts by dividing the total number of hours to be paid at each rate by the number
of weeks in the rota cycle. The weekly amount will then be turned into an annual gure and
the doctor will be paid 1/12th of the annual gure for each complete month, or a proportion
thereof for any partial months worked. This means you will receive your enhanced hours
supplement averaged across the rotation, not in the particular months where you work
these enhanced hours.
LTFT allowance
Any doctor training LTFT and paid under the 2016 TCS pay system (which excludes section
2 pay protected trainees) will be paid £1,000 a year, for as long as they train LTFT. This is to
account for the relative additional costs of training as LTFT doctor compared to full time
doctors (i.e. non pro-rata subscription costs, membership costs, xed exam costs).
Flexible pay premia
These are annual pay supplements of varying amounts that are awarded to certain types of
trainee. This can be for various reasons, including to address current recruitment shortages
in a particular specialty by making the specialty more nancially attractive, or to address a
pay disparity between one specialty and others. These are referenced in Annex A of the 2016
terms and conditions of service, and they will be published annually, with pay circulars to
take into account any changes in recruitment levels, for example.
17British Medical Association Junior doctors’ handbook on the 2016 contract
Below values correct as of 27 April 2021, taken from Pay and Conditions Circular (M&D)
1/2021 (Published 12 March 2021):
Name of premium Applicable training
programme
Eligibility Full time annual
value (£)
General Practice
Premium
General Practice
Payable to ST1, ST2,
ST3, ST4 during
general practice
placements only.
8,965
Hard to ll training
programme
Emergency
Medicine
Payable to ST4 and
above only.
Dependent on
length of training
programme, see
below table
Psychiatry
Payable to
Psychiatry Core
Trainees.
3,645
Payable to
Psychiatry Higher
Trainees.
3 year higher training
programme: 3,645
4 year higher training
programme: 2,734
Dual qualication
-OMFS
Oral and
Maxillofacial
surgery, as per
paragraph 42-44 of
Schedule 2 of the
TCS
Payable to ST3 and
above only
Dependent on
length of training
programme, see
below table
Histopathology Histopathology
Payable to ST1 and
above only
4,374
Academia
As per paragraphs
36-41 of Schedule 2
of the TCS
Upon return to
training following
successful
completion of
higher degree.
4,374
Length of training programme* Full time annual value (£)
3 years 7,289
4 years 5,467
5 years 4,374
6 years 3,645
7 years 3,124
8 years 2,734
* This is the length of the eligible training programme as specied by the curriculum. It is not the number of years
that any particular trainee has remaining on their eligible training programme. For example, trainees joining an
eligible training programme part way through will be entitled to the annual value according to the length of the
full training programme, not the length of the training programme that they have le to complete.
A doctor must have a national training number to be eligible for exible pay premia. A doctor
can receive more than one exible pay premium where the eligibility criteria for more than
one premium has been met. A doctor cannot be eligible for the same exible pay
premium twice.
18 British Medical Association Junior doctors’ handbook on the 2016 contract
Flexible pay premia will be xed at the rate applicable at the point in time at which the doctor
becomes eligible, and shall continue to be paid at that same rate for the remaining period in
which the doctor is working in a post as part of the training programme that attracts
the premium.
Flexible pay premia are additional to basic pay, and are not included for the purpose of
calculating any other allowances or enhancements. Where exible pay premia are payable,
these will be paid to less-than-full-time trainees pro rata to their agreed proportion of full-
time work.
For full details of eligibility for exible pay premia, see schedule 2 paragraphs 21-47 of the
2016 terms and conditions of service.
Academic Flexible Pay Premium
The academic FPP is available for doctors who are either on an integrated clinical academic
pathway (eg NIHR), or doctors who have taken time out of training to pursue a research
degree, and upon successful completion of the degree has returned to training.
Payment for the premium continues until you exit your training programme.
For doctors on an integrated clinical academic pathway, they shall be eligible to receive the
FPP upon successful completion of the degree and return to the same training programme.
For doctors taking time out of training in pursuit of a degree, this can either take the form
of either a formal Out of Programme Research experience (OOPR), or changing to training
LTFT to pursue the degree on a less than full time basis. To be eligible, you must have been
appointed to and commenced in a core, higher or run through training programme prior to
taking time out of training. You must also return to, or continue in, a training programme.
Protection of salary on changing training path
Where a doctor chooses to switch directly from one training programme (other than a
Foundation programme) into an agreed hard-to-ll training programme (identied in Annex
A as being one where a exible pay premium applies for this purpose) the doctor may be
eligible for pay protection. To be eligible for protection, the doctor must take up the rst
appointment on the new training programme no later than 12 months aer leaving the
original training programme. This period of time could as a reasonable adjustment be
extended in the event that a doctor is disabled (for the purposes of the Equality Act 2010),
and/or could be extended to account for sickness absence or parental leave.
Where a doctor opts to switch into a hard-to-ll specialty having achieved an Outcome 1,
Outcome 2, Outcome 6, or Outcome 7 in their most recent ARCP, and would have otherwise
progressed to the next grade had they not switched specialty, their pay protected amount
will be based on the basic salary for the grade they would otherwise be at had they
not switched.
Where a doctor opts to switch into a hard-to-ll speciality part-way into a training year
without having achieved an Outcome 1, Outcome 2, Outcome 6, or Outcome 7 in their most
recent ARCP, or where a doctor opts to switch into a hard-to-ll speciality before their ARCP,
their pay protected amount will be based on the basic salary for the grade they were at prior
to switching speciality.
The amount of pay protection due to a doctor described will depend on their ARCP outcome,
and the doctor will continue to progress up the pay scale whenever they successfully
progress onto the next grade as if they had not switched specialties. For example, if a doctor
switches into GPST1 and is pay protected at the ST2 pay point, and successfully progresses
to GPST2, their pay protected amount will increase accordingly and be based on the ST3
nodal point. Pay for additional hours, hours at enhanced rates, or any other amounts will be
based on this higher salary amount. The doctor will receive the relevant exible pay premium
in addition to this.
19British Medical Association Junior doctors’ handbook on the 2016 contract
Where a doctor is pay protected and does not progress onto the next grade, their salary will
not automatically increase to the value of the next grade’s pay point. For example, where a
doctor switches into GPST1 and is pay protected at the ST2 pay point and remains at GPST1
the following year, their pay protection will continue to be based on the ST2 pay point for as
long as they remain at GPST1. The doctor will need to progress to GPST2 in order for their
pay protection to increase to the ST3 salary. Pay for additional hours, hours at enhanced
rates, or any other amounts will be based on this basic salary amount. The doctor will receive
any relevant exible pay premium on top of this.
Where a doctor, for reasons directly or indirectly linked to a disability (for the purposes of
the Equality Act 2010), or to caring responsibilities, switches directly from one training
programme (other than a Foundation programme) into another training programme,
whether or not that programme is an agreed hard-to-ll training programme (identied in
Annex A as being one where a exible pay premium applies for this purpose), and the doctor’s
basic pay is reduced as a result of the switch, they will have their pay protected (dependent
on their ARCP Outcomes).
In addition to the hard-to-ll training programmes identied in Annex A, for doctors
changing specialties only, the JNC(J) will determine and maintain a list of additional
specialities to which pay protections applies (‘Dicult to Recruit Specialities’). A list of these
dicult to recruit specialities appears at www.nhsemployers.org. Those choosing to switch
directly from one training programme (other than a Foundation Programme) to a dicult to
recruit speciality shall have their pay protection assessed and calculated in accordance with
schedule 2, paragraphs 50 to 53 of the TCS.
Protection of salary on re-entering training from career grade
Where a doctor already employed in the NHS in a nationally recognised career grade (ie
an appointment on national terms and conditions of service other than those for doctors
and dentists in training) chooses to return to training in a hard-to-ll training programme,
and, as a result, their basic pay would be lower than received in the previous career grade
job, they shall be eligible for pay protection. For the purposes of this, the composition
of basic pay in the career grade job will exclude any pay for additional hours/sessions,
excellence awards or similar payments, on-call or other allowances, pay premia, or any
other supplementary payments.
To be eligible for the pay protection, the doctor must have at least 13 months continuous
service in the same nationally recognised career grade prior to re-entering training, and
must move immediately into the hard-to-ll training programme.
Where a doctor is already employed in a recognised NHS career grade post, re-enters
training for reasons directly or indirectly linked to a disability (for the purposes of the
Equality Act 2010) re-enters training into another programme, including those that are not
designated as ‘hard-to-ll’, they will also be eligible for pay protection as outlined above.
Such doctors, as outlined above, will have pay protection calculated by comparing the basic
salary received whilst employed in the previous career grade post with the sum total of the
nodal point applicable to the level they are re-entering training in the hard-to-ll training
programme, alongside any additional payments due in that role (including; pay for additional
rostered hours, any enhanced rates for hours worked that attract enhancements, any on-call
availability allowance, any weekend allowance, and any exible pay premium).
Where the basic salary in the previous career grade post exceeds the sum of pay outlined
in the new post upon re-entering training, the doctor will have their basic salary protected
on a mark-time basis, and will receive an amount to increase the total salary so that it
equals the higher amount previously paid. The protected basic salary will not be taken into
consideration in calculating pay for additional hours, hours at enhanced rates, or any other
amounts. These will continue to be based on the actual basic salary for the post in which the
doctor is employed.
Further information
Terms and conditions, schedule 2 paragraphs 48-61.
20 British Medical Association Junior doctors’ handbook on the 2016 contract
London weighting
Junior doctors should be paid London weighting if their hospital is within a specied area.
There are two zones – a London zone and a fringe zone – and dierent rates apply to each.
The categorisation of the London weighting zones needs updating however as all NHS
workplaces within the M25 pay the higher rate.
Members may obtain further information or clarication on whether their hospital is within
a particular zone by contacting our team of advisers on 0300 123 1233.
Overpayment or underpayment of salary
There may be occasions where salaries have either been over or underpaid. Where
overpayment has been established, the BMA would expect there to be a negotiated
repayment schedule, rather than repayment in a lump sum, to avoid any nancial hardship.
The employer should provide a breakdown of the sums due. We would advise you not to
agree any repayment until the breakdown is obtained. No monies should be deducted
without consent, and no interest should be charged on the monies owed. If a repayment
schedule is negotiated then it should normally be over the same period as the overpayment
took place. We would however expect that any underpayment be repaid at the earliest
opportunity and in full.
In both situations, members are advised to contact our team of advisers on 0300 123 1233.
Changes to the work schedule aecting pay
Where pay is increased as a result of changes to the work schedule, pay will be altered from
the date that the change is implemented. Other than in exceptional circumstances, such
changes to pay will usually be prospective.
Where changes to the work schedule are required by the employer and total pay would be
decreased as a result, the doctor’s total pay will be protected and so remain unchanged until
the end of the particular placement covered by that work schedule. This protection will not
extend to any subsequent placement, including a placement where the doctor returns at a
later date to the same post.
Where changes to the work schedule are requested by the doctor and agreed by the
employer, and total pay would be decreased as a result, the doctor’s total pay will be reduced
in line with the change in the work schedule, from the date that the change is implemented.
Exception reporting
Because of unplanned circumstances, a doctor, in their professional judgement, may
consider that there is a duty to work beyond the hours described in the work schedule,
in order to secure patient safety. In such circumstances, employers will appropriately
compensate the individual doctor for such hours, if the work is authorised by their clinical
manager. This authorisation would be given before or during the period of extended working,
or aerwards if this is not possible.
When possible and practicable, doctors will use reasonable endeavours to seek approval
from their clinical manager before or during the event. However, it is recognised that a
doctor may not be able to gain prior authorisation due to circumstances at the time. This
should not prevent the doctor from submitting an exception report. Once an exception
report has been submitted by the doctor, it must be validated and an outcome agreed within
7 days to allow payment to be made for the additional hours worked.
Compensation should be by additional payment (at the basic hourly pay rate, uplied by any
enhancements that apply at the time that the unscheduled work takes place), or by time o
in lieu, or by a combination of the two. Where safe working hours are threatened by such an
extension of working hours, time o in lieu will be the preferred option.
21British Medical Association Junior doctors’ handbook on the 2016 contract
If the additional hours of work have caused a breach of rest requirements, the time o in
lieu must be taken within 24 hours, unless the doctor self declares as t for work and the
manager agrees, in which case it can be accrued. Time o in lieu arising from breaches of
hours but not rest can be accrued.
Where time o in lieu is agreed by the doctor and the report’s actioner as the outcome of
an exception report, there will be a four week window from the outcome being agreed for
the doctor and rota manager to discuss and allocate time o in lieu to a future shi in their
working pattern, before the end of that rotation. Where this does not occur, the time o in
lieu should automatically be converted by the employer to pay aer that four week period. At
the end of a rotation, any untaken time o in lieu will be converted into pay.
Where a manager does not authorise payment, the reason for the decision will be fed back
to the doctor and copied to the guardian of safe working hours for review. Where a doctor is
paid for additional hours worked while ‘acting down’, their pay will reect their current nodal
point and not the lower nodal point of the grade at which they are ‘acting down’.
Where such additional hours are in breach of the Working Time Regulations limit of a 48-
hour average working week, or of the absolute contractual maximum of 72 hours worked in a
consecutive 168 hour period, or where the minimum rest requirement of 11 hours between
shis has not been achieved, or where eight hours of total rest per 24 hour non-resident
on-call shi has not been achieved, or where ve hours of continuous rest has not been
achieved between 22.00 and 07.00 during an NROC shi, the hours worked which caused
these breaches will attract a penalty rate as described in chapter 9 of this handbook.
Medical academic sta
Provided junior doctors have an honorary NHS contract in addition to their university
contract, they should be eligible for the above provisions. Those with university contracts
only may nd their conditions vary according to each university.
Refer to the medical academics section, chapter 22, for more details, or see the BMA’s
Medical academic handbook.
Private fees for junior doctors
Junior hospital doctors can earn fees for their services to private patients in some
circumstances. It is their responsibility to advise their employer of any regular commitments.
Where junior doctors attend private patients outside their contracted hours, they are
entitled to receive payment. However, they should make their trainee status clear on each
occasion. In carrying out private work, junior doctors’ total hours of work should not exceed
the contractual limits.
If the attendance is arranged privately – the fee is negotiated between doctor and patient
– junior doctors should be aware that medical insurers will usually only pay for consultant
services, and all such income is taxable.
If the work is required by the employer as part of its general arrangements for the treatment
of private patients, payment is the responsibility of the employer under the normal
contractual arrangements, and no additional fees are payable.
Fee paying work
Junior doctors, like other hospital doctors, may charge a fee for certain types of medical work
(i.e. Cremation forms, DVLA forms, Section 12 assessments). However, such activities should
normally be carried out in the time in which the doctor is not being paid by their employer.
The employer may agree that fee-paying work can be undertaken in work hours, provided
that either;
– the doctor remit the total value of the fee to employing organisation, or
– the doctor retains the fee and allows the employer to reclaim the time that the fee-paying
work was undertaken from their basic salary, or
– the doctor agrees to carry out additional NHS work outside of their work schedule to
make up that time at a later date
22 British Medical Association Junior doctors’ handbook on the 2016 contract
If you have any problems with private or fee paying working, contact our team of advisers on
0300 123 1233.
Further information
Terms and conditions of service, schedule 8.
Payment of annual salaries
The annual salaries of full-time employees will be apportioned as follows:
– for each calendar month: one-twelh of the annual salary
– for each odd day: the monthly sum divided by the number of days in the particular month.
The annual salaries of less than full time doctors should be apportioned as above, except
in the months in which employment commences or terminates, when they should be paid
for the hours worked. JDC disagrees with the calculation method used for odd days, as it
is viewed as undervaluing the value of a single day. JDC intends to discuss this with NHS
Employers and agree an alternative, more accurate calculation method.
Where full-time doctors terminate their employment immediately before a weekend and/
or a public holiday, and take up a new salaried post with another NHS employer immediately
aer that weekend and/or that public holiday, payment for the intervening day or days, ie
the Saturday (in the case of a ve-day working week) and/or the Sunday and/or the public
holiday, shall be made by the rst employer.
Locum pay
Where a doctor carries out additional work for the employer through a locum bank, such
work will be paid at the rates determined by that NHS sta bank.
Transitional pay protection
As part of the 2016 contract deal, junior doctors who worked under the 2002 contract
or applied for their training programme ahead of the 2016 contract implementation are
normally entitled to pay protection. There are two types of pay protection available to this
group of doctors. These are outlined below.
Section 1 pay protection
– Available for doctors who were at the earlier stages of their training at the time of
implementation of the 2016 contract. (see eligibility criteria below)
– Based on the basic salary and banding that you were earning on the day prior to starting
work under the new contract.
Section 2 pay protection
– Available for doctors at later stages of the training programme (see eligibility
criteria below).
– Doctors on section 2 pay protection are paid a basic salary on the pay scale (MN37) on
which they were previously paid under the 2002 T&Cs.
– Doctors receive annual increments on the anniversary of their previously agreed
incremental date until they exit training or until 6 August 2025, whichever is sooner.
Pay protection eligibility
The eligibility criteria for pay protection is set out in schedule 15 of the junior doctors T&Cs.
They are complex, so you are encouraged to read them in full and contact the BMA for
bespoke advice.
23British Medical Association Junior doctors’ handbook on the 2016 contract
An overview of eligibility is provided below.
Section 1
The following doctors shall be entitled to transitional pay protection under the arrangements
described in Schedule 15 at paragraphs 5 to 26, with eect from 3 August 2016:
a. All doctors commencing F1 on 3 August 2016.
b. All doctors remaining on F1 or remaining on F2 as at 3 August 2016.
c. All doctors entering F2 directly from F1 or from other training programmes on
3 August 2016.
d. All new entrants to core or run-through speciality training (CT1 / ST1) from F2 or from
other training programmes on 3 August 2016.
e. All doctors moving into CT2, ST2 or CT3 grades from the grade immediately below or from
other training programmes on 3 August 2016.
f. All doctors remaining in the CT1, ST1, CT2, ST2 or CT3 grades as at 3 August 2016.
g. All doctors progressing directly from core training or from other training programmes
to higher training at ST3 point (or for doctors entering higher training in psychiatry or
emergency medicine at the ST4 point) on 3 August 2016.
Additionally, pay protection also applies to doctors who complete a training programme
on 2 August 2016, having already accepted the oer of their next training programme, but
who, as either a direct result of the diering start dates of dierent training programmes,
or as a result of an agreed deferral of their start date, did not commence their next training
programme on 3 August 2016.
Section 2
The doctors identied below will be granted transitional pay protection under the
arrangements described in this Schedule at paragraphs 27-41, with eect from
3 August 2016:
a. Doctors already at ST3 or above on a run-through training programme on 2 August 2016.
b. Doctors already in higher specialty training programmes on 2 August 2016.
c. Specialist registrars (SpRs) on a pre-2007 training programme.
You can also use our interactive tool to nd out what level of pay protection you may be
entitled to.
Further information
See schedule 15 of the terms and conditions of service.
The BMA’s transitional pay protection tool may also be helpful to help determine if you are
eligible for pay protection. bma.org.uk/pay-and-contracts/pay/transitional-pay/transitional-
pay-protection.
24 British Medical Association Junior doctors’ handbook on the 2016 contract
7. Work Scheduling
Summary
This chapter looks at work scheduling and the processes for designing a work
schedule. It also looks at rota planning and the rules for full shis and on-call duty
periods, setting out the necessary rest requirements and hourly limits that must be
adhered to.
The pattern of work, the length of duty period, and the frequency of unsocial hours work
undertaken by junior doctors are key features in deciding a doctor’s working arrangements.
It is important to ensure that the correct working arrangement is adopted for the actual work
involved and the amount of rest that can be taken during duty periods.
Junior doctors should always be involved when a rota pattern is drawn up, and educational
supervisors must ensure that any working pattern provides adequate opportunity for
accessing training. It is particularly important to remember that colleagues will be taking
annual and study leave throughout the duration of the rota.
Principles and objectives of work scheduling
Employers must design work schedules that are safe for patients and doctors and ensure
that they are adhered to. Normally, a work schedule will apply for the duration of a training
placement and will identify the distribution of the doctor’s contracted hours.
The training and service commitments of junior doctors are interdependent. Work
schedules should therefore be designed to meet both the service delivery needs of the
organisation, and the educational and training needs of the doctor. When designing the
work schedule, employers are expected to refer to jointly agreed national guidance on
good rostering practice.
For doctors on integrated academic pathways, the academic components of the placement
should be reected in the work schedule in accordance with Follett principles. See Chapter
23 for more information for medical academics.
Developing a generic work schedule
A generic work schedule must be provided to a doctor at least 8 weeks before they start
a placement. It should feature intended learning outcomes, scheduled duties, time for
quality improvement and patient safety activities, periods of formal study, and the doctor’s
contract hours.
Specically, the generic work schedule should include:
– A description of the hours to be worked and any shi or on call arrangements.
– Clinical care and service duties, specic training, and work in or for other organisations
(if applicable).
– Expected requirements to contribute to a duty roster and/or on-call rota (if a doctor has a
service commitment to unscheduled, urgent or emergency care). This may include duties
throughout the 24 hour day and seven day week, including work on statutory and public
holidays, and an estimate of anticipated actual work during the on call period.
– For trainees working in a GP practice setting, the work schedule should reect the 2012
COGPED guidance (or any successor document) on the session split during the average
minimum 40-hour week.
25British Medical Association Junior doctors’ handbook on the 2016 contract
Key criteria
– Standard full-time work schedule: Minimum of 40 hours and maximum of 48 hours per
week. This is averaged over a reference period which is dened as the length of the rota
cycle, length of the placement, or 26 weeks – whichever is shorter.
– Less-than-full-time work schedule: Maximum of 40 hours per week, averaged over the
same reference period.
– To calculate average total hours, the average number of days leave to be taken by the
doctor will be deducted from the rota, and the remaining hours will be divided by the
remaining weeks in the cycle. An eight week cycle with six days leave deducted would
therefore involve dividing the total remaining hours by 6.8 weeks.
Developing a personalised work schedule
The personalised work schedule should be agreed between the junior doctor and
educational supervisor, in accordance with the Gold Guide and/or other relevant documents.
The doctor and educational supervisor are jointly responsible for personalising the work
schedule according to the doctor’s learning needs and opportunities within the post. This
must include adequate allocated time for the doctor to achieve all expected educational
outcomes for the post.
The personalised work schedule must be agreed before or within four weeks aer the
commencement of the placement during scheduled hours of work. Where the personalised
work schedule has not been agreed within four weeks aer the commencement of the
placement, the doctor may submit an exception report.
In some cases, employers may need to make changes to the work schedule in light of
signicant changes in facilities, resources or services. It is expected that every eort should
be made to anticipate and agree on such changes.
Further information
Terms and Conditions of Service, Schedule 4.
Follett review principles: webarchive.nationalarchives.gov.uk/20060715150140/http://
www.dfes.gov.uk/follettreview.
The Gold Guide: www.copmed.org.uk/images/docs/gold_guide_8th_edition/Gold_
Guide_8th_Edition_March_2020.pdf.
Maintaining the work schedule
– As a minimum, there should be an educational review and work schedule discussion at
the beginning and end of the placement.
– The personalised work schedule should be agreed at the rst formal meeting between
the doctor and the educational supervisor. This should occur before or within four weeks
aer the commencement of the placement.
– If the personalised work schedule has not been agreed within four weeks of the
commencement of the placement, you may submit an educational exception report.
– The doctor and educational supervisor should regularly consider progress against agreed
learning and service objectives.
– Work schedule discussions should take place to establish if any changes in support,
resources, or planned service duties are needed.
– Discussions should take place if the employer or doctor consider that training
opportunities, duties, responsibilities, accountability arrangements or objectives have
changed or need to change signicantly.
– If agreement is not reached regarding the work schedule, the doctor may request a work
schedule review (schedule 5, Terms and Conditions of Service).
– A work schedule review can also be requested at any time during the placement if it
becomes apparent that the current work schedule does not allow for sucient
training opportunities.
26 British Medical Association Junior doctors’ handbook on the 2016 contract
Planning a rota
Limits on working hours
The contractual limits on working hours and protected rest periods are vital for ensuring the
safety of patients and junior doctors, and are mutually agreed between the BMA and NHS
Employers. In relation to this, employers must have a guardian of safe working hours. This
role is outlined in more detail in schedule 6 of the Terms and Conditions of Service and in
chapter 8 of this handbook.
When planning a work schedule, it is imperative that employers and junior doctors take into
account the contractual limits on working hours. There are also separate rest requirements
for on-call periods.
Further information
Terms and Conditions of Service, Schedule 3, paragraphs 7-20.
Weekend working
All junior doctors will be required to work on the weekend at some point during their
postgraduate training. For numerous trainees, weekend working will be a regular occurrence
throughout the course of their training.
To limit the anti-social impact of weekend working on trainee’s personal lives, the TCS places
limits on the frequency at which trainees can be scheduled to work on weekends.
All reasonable steps should be taken to avoid rostering doctors to work at the weekend at
a frequency of greater than 1 in 3 weekends. Weekend work for this purpose is dened as
any shis or on-call duty periods where any work takes place between 00.01 Saturday and
23.59 Sunday. The limit on weekend working does not mean that doctors can’t work on
consecutive weekends, but rather that they cannot work weekends at a frequency greater
than 1 in 3 across the length of their rota.
A weekend with one shi scheduled on either the Saturday or Sunday would count towards
the rota’s weekend frequency the same as a rota with shis scheduled on both the Saturday
and the Sunday. A shi which starts on a Friday and nishes on a Saturday would count
towards the rota’s weekend frequency for the purposes of the safety limit on the frequency
of weekend working. However, such a shi would not count towards the weekend working
frequency, where there are no other shis scheduled on that weekend, for the purposes of
calculating the weekend pay allowance for the rota.
Trainees that wish to work at a frequency greater than 1 weekend in 3, by undertaking
additional work, for example as a locum, are able to independently agree to do so, but must
not work an average weekend frequency of greater than 1 weekend in 2.
Exemption from 1 in 3 weekend working limit
The 1 in 3 weekend working frequency limit can be more problematic to introduce on some
rotas than others. The introduction of this limit could require the recruitment of additional
doctors or other healthcare professionals to ll the gaps le on the rota, which may not
always be immediately possible. Therefore, by exception, authorisation for a rota using a
pattern with a weekend working frequency greater than 1 in 3 can be granted if there is a
clearly identied clinical reason.
This clinical reason must have been agreed by the relevant clinical director for that rota and
deemed appropriate by the Guardian of Safe Working Hours. This justication should be
clearly set out and shared with the aected doctors.
27British Medical Association Junior doctors’ handbook on the 2016 contract
Junior Doctor Forums have the ability to challenge the clinical justication provided by
an employer, if they do not believe it to be valid, and/or suggest alternative solutions for
consideration. The JDF can request that further evidence is provided for the requested
exemption. However, JDFs do not have unilateral authority to veto an evidenced clinical
justication provided by an employer and the guardian. JDFs cannot reject an appropriately
justied exemption on the basis of the collective preference of doctors working on a rota
being to not work a clinically necessary higher weekend frequency.
Following the clinical justication being provided by the employer and being reviewed by the
JDF, rotas which exceed the 1:3 weekend frequency should be co-produced with the aected
doctors and agreed via the junior doctor form. All rotas which exceed the 1:3 weekend
frequency limit should be reviewed annually as a minimum, but earlier review dates may be
deemed appropriate when agreeing the exemption in order to assess progress in addressing
the need for a weekend frequency of greater than 1 in 3 weekends, and to assess whether it
is still necessary for the exemption to be retained.
As long as there are no safety implications for both patients and doctors, then it is possible
that a rota could remain in place with a weekend frequency above 1:3 where necessary and
clinically justied.
Regardless of any clinical justication, there is an absolute limit on weekend working
frequency of 1 in 2 weekends. No doctor can be rostered for work at the weekend at a
frequency of greater than 1 week in 2. If you are asked to work at a frequency greater than 1
in 2 weekends, please contact the BMA for advice.
Opting out of the WTR
A junior doctor may choose to voluntarily opt out of the WTR average weekly limit of 48
hours. If they do, all other safety and rest limits set out in the WTR and TCS (including the
maximum average of 56 hours per week and maximum of 72 hours over a 168 hour period)
will still apply. This agreement to opt out is subject to prior agreement, and can apply to
either a specied period or indenitely. You should be mindful that, should you later wish to
opt back into this restriction a notice period will apply.
Further information
Terms and Conditions of Service, Schedule 3, paragraphs 47-51.
On-call periods
An on-call period is one where a junior doctor is required by their employer to be available
to return to work or give advice by telephone, but is not normally expected to be working on
site for the whole period. A doctor carrying an ‘on call’ bleep whilst already present at their
worksite would not be considered to be working an on-call period.
On-call periods cannot be worked consecutively, other than at the weekend when two
consecutive on-call periods (beginning on Saturday and Sunday respectively) are permitted.
Longer runs of consecutive on-call periods, covering up to a maximum of seven consecutive
days, may be agreed locally where both the employer and the doctor agree that it is safe and
acceptable to both parties to do so, and where such an on-call pattern would not breach any
of the other limits on working hours or rest.
Where a work schedule contains on-call arrangements, then all non-resident on-call duties
must be rostered as separate shis within a rota, and on-call shis cannot contain within
them a resident shi.
Calculation of prospective estimates for anticipated work during on-call shis
Work schedules should include an average amount of time for anticipated on-call work. This
should include both clinical and non-clinical work undertaken either on or o site, such as
telephone calls and travel time arising from these calls. Any period of time a doctor is not
undertaking such work during the on-call period will not count as working time.
28 British Medical Association Junior doctors’ handbook on the 2016 contract
A work schedule should include an indication of the amount of the expected predictable and
unpredictable work during enhanced hours and unenhanced hours.
– Predictable work refers to routine activities which will occur at specic times during an
on-call shi. This may include ward rounds, anticipated duties and clinical handovers.
Such activities, along with the expected hours of work required, should be specied
within a work schedule.
– Unpredictable work refers to unscheduled activities that occur at unspecied times
during an on-call shi, including telephone calls, actively awaiting urgent results or
updates and travel time arising from any such calls. For these activities, the employer
must provide a prospective estimate of the average amount of unpredictable on-call work
that will occur during an on-call shi, using the calculation method described below.
To inform the calculation of the prospective estimate of the average amount of work
performed during an on-call shi, employers should use all relevant available data. This
includes activity data; calls through switchboard; bleeps; admissions; feedback from
colleagues in the department; feedback from sta previously and currently rostered for on-
call duties on the relevant rota; previous exception reporting data for the relevant rota; and
recent diary activities or monitoring data.
Prospective hours should be calculated by totalling the number of hours of on-call work
performed across an actual (and typical) week of on-call shis across the rota reference
period of a rota cycle, placement length or 26 weeks, whichever is shorter. From this, an
average amount of work for each weekday (Monday to Friday) and weekend (Saturday and
Sunday) can be calculated. The total hours should then be divided by the number of on-call
shis from which the total number of hours were drawn to provide an average amount of on-
call work - at both the plain time rate and enhanced rate - a doctor can expect to undertake
during their rostered on-call shi(s).
All rostered on-call shis must have a prospective estimate of unpredictable work a doctor
can expect to perform, even if it is a very low intensity shi pattern, with 15 minutes being
the minimum prospective estimate for an individual on-call shi.
Where a doctor, or doctors, on an on-call rota are regularly exceeding or signicantly below
the prospective estimate for on-call shis, a work schedule review is required. Where
the prospective estimate is regularly being exceeded, consideration should be given to
alternative arrangements, including having an additional doctor on the on-call rota; reducing
the workload covered by the on-call doctor; or converting the on-call working pattern to a
full-shi working pattern.
On-call handovers
The maximum length of an individual on-call duty period is 24 hours. However, the maximum
length of an on-call shi can be extended by between 15 minutes and one hour to allow shi
overlap and ensure there is adequate time for clinical handover.
Overlap of on-call shis is crucial within rotas, as this is critical to the safe transfer of patient
information to deliver continuity of care and good quality patient management. Most
services will require a minimum handover of 15 to 30 minutes. Some services may need to
allow for 60 minutes or in rare cases even longer. Coming in specically to attend handover
or undertake telephone handover is classed as working time and is part of the duty period.
Handover cannot be scheduled to overlap with other duties (i.e. clinic / theatre list), it must
have dedicated time.
Further information
Terms and Conditions of Service, Schedule 3, paragraphs 24-46 & Schedule 4,
paragraphs 16-17.
The BMA’s and NHS Employers’ joint Good Rostering Guide, see Non-resident on call
rotas (pg 17-21) www.nhsemployers.org/case-studies-and-resources/2018/05/good-
rostering-guide.
Working Time Regulations 1998 (as amended): www.legislation.gov.uk/uksi/1998/1833/
contents.
29British Medical Association Junior doctors’ handbook on the 2016 contract
On-call patterns and the Working Time Regulations
The EWTD, and the SiMAP and Jaeger rulings imposed limits on working hours and
requirements for rest breaks. These limits on working hours have been incorporated into
the 2016 terms and conditions of service for NHS doctors and dentists in training. With
regards to on-call working, if a junior doctor is required by their employer to be resident in
the workplace, the entire period of residence will count as working time for the purposes of
the Working Time Regulations. This and other provisions surrounding safe working hours are
embedded into the 2016 terms and conditions of service, meaning that they would continue
to apply if the regulations were repealed. Therefore, ‘on-call’ in the terms and conditions of
service refers to non-resident on-call.
Further information
NHS Employers’ report covering the impact of the SiMAP and Jaeger rulings.
Preventing shadow rotas
The 2016 terms and conditions of service include a clause prohibiting the use of ‘shadow’
rotas, when an additional doctor is rostered to do an on-call shi for what should be a full
shi in order to save money (the availability allowance for on-call duty is 8% of basic pay).
If a junior doctor is required to work a night shi or a shi on a weekend as part of a rota, the
employer cannot roster a second doctor working that same rota to be available as a non-
resident on call for the same night or weekend. The exception is if there is a clearly identied
clinical reason agreed by the clinical director, and the work pattern is agreed by both the
guardian as being safe and by the DME as being educationally appropriate.
If a junior doctor is asked to work such a rota and feels that it is inappropriate, they should
submit an exception report and request a work schedule review, and contact the BMA for
individual advice.
Locum work
If a junior doctor intends to undertake hours of paid work as a locum in addition to the hours
set out in the work schedule, they must rst oer these additional hours to the service of the
NHS via an NHS sta bank. The service oered should be commensurate with the doctor’s
grade and competencies.
There is no obligation for juniors to do locum work, nor to opt out of the Working Time
Regulations, to increase the spare hours they have for such work. However, if they do choose
to do locum work, they must oer their hours to the service of the NHS rst via an NHS sta
bank of their choosing.
If the doctor oers hours of locum work to the sta bank but there is no suitable work
available, they are then released from the terms of schedule 3 paragraph 52 and given
permission to nd locum shis elsewhere (for example, through an agency).
For work to be suitable, it must be at the grade and competency level of the doctor. If the
only locum work available through the sta bank would involve the doctor acting down, they
do not have to accept this, and can be free to locum elsewhere.
LTFT doctors are equally entitled to undertake locum work in the same manner as full time
trainees, which is conrmed in HEE guidance.
Further information
Terms and Conditions of Service, Schedule 3, paragraph 52-53 & 47-51.
30 British Medical Association Junior doctors’ handbook on the 2016 contract
How to plan a rota
– A workload study should be undertaken; this will also provide useful documentary
evidence to justify a change in working practices.
– Junior doctors should be involved in designing the rota.
– Consultants should be involved, with their support being crucial.
– Other aected sta groups should be involved (eg nurses, managers).
– It is essential to build in teaching sessions and handover time.
– Any shi should comply with the required rest periods.
– The planned shi should be piloted and then evaluated; oen the nal rota has to be
redesigned several times.
Further information
The BMA’s and NHS Employers’ joint Good Rostering Guide, see Roster design (p.g. 6-12)
www.nhsemployers.org/case-studies-and-resources/2018/05/good-rostering-guide.
31British Medical Association Junior doctors’ handbook on the 2016 contract
8. Hours of work and WTR
Summary
This chapter explains the contractual and legislative restrictions on the hours that
junior doctors can work. It covers the limits on hours and the requirements for rest
laid out in the junior doctors contract and in the WTR (Working Time Regulations), and
explains what to do if posts breach either of the regulations.
From 2016, there are two dierent protection frameworks in place to impose limits on
working time and rest requirements for junior doctors. The 2016 terms and conditions
of service features a new comprehensive list of hours limits and rest requirements which
match, and in many cases supersede, the statutory protections imposed by the WTR
(Working Time Regulations).
The EWTD is a European Union initiative, which is known as the WTR in British law. However,
there are in some cases dierent rules in the contract for those who have chosen to ‘opt out’
of the WTR, so it is important to understand the law as well as the contractual rules. If the
WTR legislation was to be changed or revoked, the working protections in the contract would
continue to apply.
WTR
Background and history
The European Working Time Directive, which came into force in the UK as the Working
Time Regulations (WTR) on 1 October 1998 for consultants and other career grade hospital
doctors, originally excluded junior doctors. Agreement was later reached to extend the
directive to doctors in training, and it has applied in full to juniors since August 2009.
WTR provisions
The regulations were designed to protect the health and safety of workers by restricting
the number of hours an individual can work, and by imposing minimum rest requirements
for all workers. It imposes a limit on doctors’ working hours of 48 per week on average,
calculated over a maximum period of six months. The requirements for taking rest breaks
are set out below.
WTR rest requirements
The rest requirements are as follows:
– a minimum of 11 hours’ continuous rest in every 24-hour period.
– a minimum rest break of 20 continuous minutes aer every six hours worked.
– a minimum period of 24 hours’ continuous rest in each seven-day period (or 48 hours in a
14-day period).
– a minimum of 28 days or 5.6 weeks paid annual leave.
– a maximum of eight hours’ work in each 24 hours for night workers.*
*A night worker is someone who works at least three hours of their daily working time during night time. Junior
doctors are unlikely to be classied as night workers. However, this should not be assumed, and where there is any
doubt, each case should be considered on an individual basis.
Opting out of the hours limit
The WTR is enshrined in UK legislation, and is therefore not optional for employees in the UK.
However, an individual junior doctor can voluntarily sign a waiver and ‘opt out’ of the limit
on working hours if they wish. This does not opt them out of the rest requirements. The JDC
would urge caution where anyone is considering opting out of the hours limit. As a result of
the additional contractual limits on working time (see ‘New Deal’ section later in this chapter
for further information), junior doctors can only opt out to work a maximum of 56 hours in
any case.
Employers must not pressurise workers to sign an opt out, and they must continue to keep
accurate records of the working hours of all doctors, including those who have opted out.
You should be mindful that, should you later wish to opt back in, a notice period will apply.
Further guidance for junior doctors on opting out is available on the BMA website.
32 British Medical Association Junior doctors’ handbook on the 2016 contract
Medical academic doctors
Junior academic doctors with a substantive NHS contract should be covered by the working
time directive where they undertake academic work on a day release basis. They have the
same obligation to provide continuity of care for patients as their junior doctor colleagues.
The BMA believes that all time spent working either in the NHS or at the university
(aggregated) should count towards the weekly hours limit and rest requirements. However,
members should be aware that universities have been resistant to the local application of
the WTR for academic work.
WTR denition of working time
The way in which working time is dened under the regulations has had important
implications for junior doctors’ working arrangements in the UK. Two important European
Court of Justice rulings (the ‘SiMAP’ and ‘Jaeger’ cases) have meant that, currently,
working time includes all time spent at the place of work and available to the employer.
This includes periods when the doctor is not actually working, for example resting during
resident on-call periods.
Further information
Working Time Regulations 1998: www.legislation.gov.uk/uksi/1998/1833/contents.
The Working Time (Amendment No 2) Regulations 2009: www.legislation.gov.uk/
uksi/2009/2766/contents/made.
See our guidance for extensive guidance: bma.org.uk/pay-and-contracts/working-hours/
european-working-time-directive-ewtd/doctors-and-the-european-working-time-directive.
The junior doctors contract
The 2016 terms and conditions of service for junior doctors includes a range of contractual
limits on working hours, as well as rest requirements which match, or in many cases
go beyond, the legal limits as prescribed in the WTR. Many of the principles are similar.
This includes the maximum number of hours worked per week, which is averaged out
across a certain period, so sometimes the terms of the contract and the WTR will apply
simultaneously. However, where the contract includes requirements or restrictions that are
not part of the WTR, or go beyond the minimum in the WTR, the contract takes precedent,
and the more favourable rules will apply.
Enforcement of rules
It is vital for doctor and patient safety that trainees do not work beyond the rostered hours
agreed in their work schedule and breach the safe working limits enshrined in the contract.
The terms and conditions of service include mechanisms to prevent this, and – where this is
not possible – to compensate doctors with rest and, where necessary, pay to address
the breach.
These are set out in chapter 7 (work scheduling) and chapter 9 (exception reporting, work
schedule reviews, and the Guardian of Safe Working).
Working hours
General limits
– Normally a minimum of 11 hours continuous rest between shis. Breaches of this rest
are subject to time o in lieu (TOIL) which must be within 24 hours. If this rest period is
not achieved, the doctor will be paid for the additional hours worked at a penalty rate
(schedule 2 paragraph 77, Terms and Conditions of Service), and will not be expected
to work more than ve hours the following day. Their pay will not be deducted for the
resultant time o.
– A maximum of seven shis on consecutive days. Aer the seventh consecutive shi or
day of work, a minimum of 48 hours rest must be rostered.
– By agreement of the doctors on a rota, this limit can be increased to a maximum of
eight consecutive days or shis.
– No doctor should be rostered to work more than 1 in 2 weekends. A frequency of above
1 in 3 can only be rostered with approval from the Junior Doctor Forum (JDF) in instances
where there is a clear clinical reason.
33British Medical Association Junior doctors’ handbook on the 2016 contract
Maximum hourly limits
– A maximum of 48 hours on average of work per week.
– A maximum of 72 hours of work in any period of 168 hours (7 days)
– A maximum shi of 13 hours (for non-resident on-call periods, the maximum is 24 hours,
except where the ability to extend beyond 24 hours for handover purposes is utilised).
Consecutive shis
– A maximum of four ‘long shis’ (a long shi is one lasting longer than 10 hours) on
consecutive days. A minimum of 48 hours rest must be rostered immediately following
the fourth long shi.
– By agreement of the doctors on a rota, this limit can be increased to a maximum of ve
consecutive long shis.
– A maximum of four long shis nishing aer 23.00. A minimum of 48 hours rest must be
rostered immediately following the fourth long shi.
– A maximum of four long shis where at least three hours of work fall between 23.00 and
6.00 on consecutive days. Where night shis (as dened above) are rostered singularly, or
consecutively, then there must be a minimum 46-hour rest period rostered immediately
following the conclusion of the shi(s).
Breaks
A junior doctor must receive:
– at least one 30 minute paid break for a shi rostered to last more than ve hours;
– a second 30 minute paid break for a shi rostered to last more than nine hours; and
– A third 30 minute paid break for a night shi (as dened above) rostered to last 12 hours
or more.
These breaks should be taken separately. If they are combined into one, the break should
take place towards the middle of the shi. Breaks should not be taken in the rst hour of the
shi, or at the end of a shi.
On-call periods
An on-call period is one where a junior doctor is required by their employer to be available
to return to work or give advice by telephone, but is not normally expected to be working on
site for the whole period. A doctor carrying an ‘on call’ bleep whilst already present at their
worksite would not be considered to be working an on-call period.
Work schedules should include an average amount of time for anticipated on-call work. This
should include both clinical and non-clinical work undertaken either on or o site, such as
telephone calls and travel time arising from these calls. Any period of time a doctor is not
undertaking such work during the on-call period will not count as working time.
Planning an on-call period
On-call periods can only be worked consecutively at the weekend when two (beginning on
Saturday and Sunday respectively) are permitted. Longer runs (up to a maximum of seven
consecutive days) can be agreed locally, provided that this doesn’t breach any other limits on
working hours or rest.
Rest during and aer on-call shis
Whilst on-call, a doctor should expect to get eight hours rest per 24-hour period, of which
at least ve hours should be continuous rest between 22.00 and 07.00. Where this is not
expected to be possible, rostered work on the day following the on-call period must not
exceed ve hours.
The day following an on-call period (or following the last on-call period, where more than
one 24-hour period is rostered consecutively) must not be rostered to last longer than
10 hours.
34 British Medical Association Junior doctors’ handbook on the 2016 contract
Where during an on-call period, your expected overnight rest is signicantly disrupted,
causing you to not achieve at least ve hours of continuous rest, undisturbed by work,
between 22.00 and 07.00, you must inform your employer immediately, or as soon as
reasonably practicable, and arrangements must be made for you to take appropriate rest.
Time o in lieu must be taken within 24 hours. If for any reason this is not achieved, then
the additional hours will be paid according to the exception reporting and guardian
nes provision.
If, as a result of actual hours worked during the on-call period, your rest has been
signicantly disrupted, as dened in the paragraph above, the default assumption by your
employer should be that it may be unsafe for you to undertake work because of tiredness.
If this is the case, you must inform your employer that you will not be attending work as
rostered, other than to ensure the safe handover of patients. No detriment to pay can result
from such a declaration. Arrangements for dealing with this issue must be agreed locally.
Hourly limits
– The maximum length of an individual on-call period is 24 hours, except where the ability
to extend beyond 24 hours for handover purposes is utilised.
– A maximum of three on-call periods can take place in seven consecutive days (unless
otherwise agreed locally).
– The day following an on-call period (or following the last on-call period if more than one is
rostered consecutively) must not be rostered to last longer than 10 hours. If the 5 hours
continuous rest requirement during an NROC shi is breached, then a doctor can only
work 5 hours the following day.
Low intensity on-call
Low intensity duty is one where a junior doctor’s on-call duty at the weekend contains three
or less hours of work per day, and three or less episodes of work per day. Under this working
pattern, a maximum of 12 days can be rostered consecutively.
Tips for designing a compliant rota
While formal enforcement processes are available (see chapter 9), the following could also
be considered in any eort to resolve problems with non-compliant rotas:
Total hours
It might be possible to reduce hours by redistributing workload.
Frequency of out-of-hours work
The rst step should be to identify what work is being done out of hours. In both problem
areas, the following might assist:
Bleep policies
– For example, ltering of calls by other practitioners, eg senior ward nurse; additional
channelling through juniors on full shi; or no juniors to be bleeped during organised
training session.
Organisational changes
– Bringing more work back into daylight hours, eg emergency theatre lists or emergency
admissions unit.
– Encouraging moves towards a consultant-delivered service. For example, evening ward
rounds by consultants on-call can resolve many acute problems which might otherwise
disturb juniors at night. Consultants working in an identied admissions unit can also
provide an instant focus for clinical input.
– Avoiding duplication of tasks, eg multiple clerking of patients by dierent grades.
– Use of a bed bureau to locate beds.
35British Medical Association Junior doctors’ handbook on the 2016 contract
Skill mix initiatives
– Ensuring adequate stang levels in support services, both in the daytime and out
of hours.
– Sharing of tasks with other suitably trained sta, eg nurse practitioners.
– Working to identify which tasks can be appropriately delivered by other sta. Possible
examples include the administration of IV drugs; carrying out requested investigations
(bloods, ECGs, arranging X-rays etc); and catheterisation. There must also be mechanisms
in place to ensure that, in the event of stang pressures, these jobs do not default back
to juniors.
Reorganisation
– Increasing cross-cover of working patterns where appropriate so that, for example,
doctors on a night shi may be able to relieve an on-call doctors’ workload.
– More team working.
– Possible merging of services between smaller units.
– Introduction of the ‘Hospital at Night’ model.
New working patterns
– When all the above have been implemented, and as long as there is an appropriate
number of doctors on the rota to facilitate a working pattern change, some alternative
forms of working patterns may be investigated.
Further information
The BMA’s and NHS Employers’ joint Good Rostering Guide www.nhsemployers.org/case-
studies-and-resources/2018/05/good-rostering-guide.
36 British Medical Association Junior doctors’ handbook on the 2016 contract
9. Exception reporting, work schedule reviews,
and the Guardian of Safe Working
Summary
This chapter explains some of the key safeguards in the contract, designed to protect
junior doctors from excessive working hours and to provide means of redress
when working limits are repeatedly breached. It will cover the process of exception
reporting, requirements around reviewing work schedules, as well as explaining the
role and powers of the Guardians of Safe Working. If used eectively, these three
provisions will ensure that junior doctors are able to maintain safe and sustainable
working patterns.
Junior doctors’ work is oen varied and requires a certain amount of exibility. if an individual
nds that the work they are actually doing diers from what is set out in their work schedule
– either because it is signicantly dierent or regularly varies from what has been agreed –
they should raise this with their employer as soon as possible so that immediate steps can be
taken to address the issue.
If concerns about individual working patterns cannot be resolved in discussions, then
a work schedule review can be requested by either the junior doctor or the employer,
to address any concerns through an appropriate process. The same process, of a work
schedule review, can be used if a junior doctor is working in line with their work schedule,
but a change to the schedule has been proposed and the matter cannot be resolved
through an informal discussion.
Exception reporting
This is the process for a junior doctor to report any individual variations from the actual
work schedule, on a per shi basis. For example, if a junior doctor is required to work
past their scheduled nish time for patient safety and other reasonable purposes, or
the training opportunities during the shi are not in line with the expectations listed
in the work schedule, then these ‘exceptions’ to the work schedule must be logged
through your employer’s exception reporting process. The exception report is then used
to assess how common the issue is and how the doctor will be compensated for the
exception, which highlights the importance of ensuring an appropriate exception report
is completed and submitted within the relevant deadlines, or this will cause issues with
the compensation aspect.
Once an exception report has been submitted by the doctor it must be validated and an
outcome agreed within 7 days to allow for payment for any additional hours worked; or time
in lieu is provided, especially if the additional hours have breached contractual or statutory
safe working provisions.
Your employer should explain to you when you start in your post what the process is
for exception reporting in your place of work. The contract species it must allow for a
technological method of submission and response, and many trusts may use a mobile
phone app for this. The form will require your details (name, specialty and grade), the name
of your educational supervisor, details about the variation, and an outline of the steps taken
to address the issue before escalation. This report will then be sent to your educational
supervisor who will decide how the issue can best be resolved. When the concerns relate
to training issues, such as lack of support or resources, then the report will be copied to the
Director of Medical Education (DME); where the concerns relate to safe working, such as for
total number or pattern of hours worked, the report should be copied to the Guardian of Safe
Working (see below).
The educational supervisor will discuss with the junior doctor what action is required to
address the concerns highlighted. They will then send a formal electronic response, setting
out an agreed outcome of the exception report. The DME and/or Guardian will review the
outcome and, if necessary, make further recommendations.
37British Medical Association Junior doctors’ handbook on the 2016 contract
Breaches, nes and immediate safety concerns
When the guardian is reviewing all safe working exception reports that have been copied
to them by junior doctors, they will have to make a decision about whether a breach has
occurred which will incur a nancial penalty. This centres around the safeguards set out in
Schedule 3 of the Terms and Conditions of Service, and applies to:
– A breach of the 48-hour average working week (across the reference period agreed for
that placement in the work schedule).
– A breach of the maximum 13 hour shi length.
– A breach of the maximum of 72 hours worked across any consecutive 168 hour period.
– Where 11 hours rest in a 24 hour period has not been achieved (excluding on-call shis).
– Where ve hours of continuous rest between 22.00 and 07.00 during a non-resident
on-call shi has not been achieved, then all the episode(s) of the work which occurred
during 22.00 and 07.00 will be subject to a guardian ne and the doctor will be paid at the
applicable penalty rate.
– Where 8 hours of total rest per 24 hour non-resident on-call shi has not been achieved.
Where the guardian determines that the concerns raised in the exception report are valid
and correct, the junior doctors aected will be paid for the additional hours at penalty
rates. See the relevant tables below (set out in Annex A of the TCS). The guardian will also
be responsible for levying a ne against the department employing that doctor for the
additional hours worked.
The below penalty rates and nes for hours worked at the basic hourly rate:
Nodal
Point
Total hourly gure (£)
(Basic hourly rate x 4)
Hourly penalty rate
paid to the doctor (£) *
Hourly ne paid to
the guardian of safe
working hours (£) **
1 63.56 23.83 39.73
2 73.56 27.59 45.97
3 87.04 32.64 54.40
4 110.32 41.38 68.94
5 117.08 43.91 73.17
The below penalty rates and nes for hours worked at the enhanced hourly rate (See
schedule 2, 16-19):
Nodal
Point
Total hourly gure (£)
(Enhanced hourly rate
x 4)
Hourly penalty rate
paid to the doctor (£) *
Hourly ne paid to
the guardian of safe
working hours (£) **
1 87.08 32.64 54.44
2 100.78 37.79 62.99
3 119.25 44.72 74.53
4 151.14 56.68 94.46
5 160.40 60.15 100.25
* The penalty rate paid to the doctor is based upon 1.5 x the 2019 NHS Improvement hourly locum rates for that
grade of doctor.
** The hourly amount paid to the guardian is the balance aer the hourly penalty rate paid to the doctor has been
deducted from the total hourly gure.
Additionally, in instances where breaks have been missed on at least 25% of occasions
across a four week reference period, the guardian will levy a ne at twice the relevant hourly
rate for the time in which that break was not taken.
38 British Medical Association Junior doctors’ handbook on the 2016 contract
It has been agreed that the money raised through nes must be used specically to
benet the education, training and working environment of trainees. The guardian will be
responsible for collaborating with the relevant Junior Doctors Forum (or a local equivalent) to
decide how funds raised through nes levied should be disbursed to benet junior doctors.
However, it is important to note that these funds cannot be used to supplement any facilities
or resources that the employer should be expected to provide anyway. In order to ensure
that doctors can place their trust in this system, details of expenditures will be included in an
annual report, which will be open, accessible and subject to audit.
While we expect these processes to improve safety over time, there will be occasions where
an exception report highlights an immediate and substantive risk to the safety of patients
and/or individual doctors. In such instances, it will of course be necessary for more urgent
steps to be taken. Where these concerns exist, they should be raised straight away in a
conversation with the relevant senior clinician responsible for the service, rather than with
the guardian. This conversation should be followed up with an electronic exception report
to the educational supervisor within 24 hours. The responsible clinician who receives
the report must comply with one of the following actions, set out in detail in Schedule 5,
paragraph 21 of the 2016 terms and conditions of service:
– grant immediate time o from an individual’s agreed work schedule,
– ensure immediate provision of individual support.
– require an immediate work schedule review be undertaken by the educational supervisor.
Work schedule reviews
One of the guardian’s most important functions is to ensure that no further breaches occur.
As such, in addition to the other processes, they are likely to require that a work schedule
review take place to address outstanding issues that might otherwise lead to further
breaches in the future.
While a guardian or educational supervisor is able to require a work schedule review, they
can also be requested by an individual doctor or their manager.
The process of work schedule reviews is as follows:
Written request for work schedule review submitted
Education supervisor engages with doctor within seven working days
Conversation results in one or more of the following outcomes
No change to
work schedule
required
Prospective
changes
made to
the work
Compensation or
TOIL
awarded
Organisational
review required
Organisational changes, such as a review of ward round timings, may take longer to be
enacted. However, temporary alternative arrangements, including amendments to pay, may
be necessary. Whatever the outcome of the conversation, this will be communicated to the
aected doctor in writing.
39British Medical Association Junior doctors’ handbook on the 2016 contract
Further work schedule reviews
If a junior doctor is unhappy with the outcome of the conversation, they are entitled to
request a level 2 work review within 14 days of being notied of the decision. This request
would need to outline areas of disagreement and the outcome that the individual is seeking.
Where the doctor is appealing a decision previously taken by the guardian of safe working
hours, the hearing panel will include a representative from the BMA or other recognised
trade union nominated from outside the employer/host organisation, and be provided by
the trade union within one calendar month.
A level 2 work review involves a meeting with their educational supervisor, a service
representative, and a nominee of the director of postgraduate medical education (where
the request pertains to training concerns) or of the guardian (where the request pertains to
concerns about safe working). At the meeting, the previous review and its outcomes will be
considered. The level 2 review will then either uphold the previous decision or will result in
one or more of the four previous work review outcomes.
There is a nal stage of appeal that can be requested within 14 days of being notied of the
level 2 work review decision. This review will be a formal hearing, held in accordance with the
nal stage of the employer’s local grievance procedure, before a panel including the Director
of Medical Education (or a deputy). Where the appeal concerns a decision made by the
guardian of safe working hours, a representative of the BMA will need to be involved in the
panel. The decision of this panel will be nal.
Further information
Terms and Conditions of Service, Schedule 5.
Guardian of safe working
The Guardian’s role within a trust is to provide assurance, both to sta and employers,
that junior doctors are working in compliance with the safe hours requirements set out
in the contract, and to make recommendations for how these issues can be quickly and
appropriately addressed. An employer or host organisation must appoint a guardian – it is
not an option to not recruit one. The guardian will be a senior appointment and will not hold
any other managerial role with the employer.
As set out in Schedule 6, para 10 of the 2016 terms and conditions of service, the Guardian’s
duties are to:
– Act as the champion of safe working hours.
– Provide assurance that rostering is safe and compliant with the restrictions set out in
Schedules 3, 4 and 5.
– Receive copies of exception reports relating to safe working, allowing them to
monitor compliance.
– Escalate concerns about working hours breaches with executive directors, where a
resolution has not been found at department level.
– Intervene in urgent situations to mitigate identied risks to junior doctors or patients.
– Require work schedule reviews where safe working hours are regularly breached.
– To levy and distribute nancial penalties for safe hours breaches.
– To liaise with the local Junior Doctors Forum to determine the disbursement of nes.
The guardian will also be responsible for producing quarterly reports to the Board of the
employing trust, which will include data on rota gaps and details of any escalated issues
which have not been addressed.
The appointment process
The guardian will be appointed by a panel of four, made up of the trust medical director,
HR director and two junior doctor representatives. We encourage junior doctors to take up
oers to be involved with the guardian’s appointment in their trust, to ensure that the person
appointed has the condence of junior doctors and is able to carry out this important role in
a truly independent way.
40 British Medical Association Junior doctors’ handbook on the 2016 contract
The panel must reach consensus on its appointment - if the junior doctor representatives
do not agree with the decision taken by others on the panel, the panel cannot proceed with
the appointment. It is a contractual requirement that 50% of the panel be made up of junior
doctors, and that consensus be reached.
Despite the seniority of others on the panel, junior doctors have an equal right to be on
the panel, and their opinion counts equally. If the junior doctors on the panel are unhappy
with the candidates, they should not feel pressurised to appoint, and the position should
be re-advertised.
We would advise junior doctors to identify the director within the trust that the guardian will
be reporting to and meet with them to discuss the role and their expectations.
Guardians for trainees in non-hospital settings
No trainee should be denied access to a guardian of safe working, regardless of their
specialty or the location of their working. There are specic provisions within the contract to
ensure that individuals in all non-hospital work settings will also be linked with a guardian.
For those who work under a lead/host employer arrangement, the guardian role will be
established by the host employers under provisions agreed between the two employers.
For GP trainees, however, the lead employer will be responsible for employing a guardian
who is familiar with the issues faced by GPs working in practice settings. If there are no lead/
host employer arrangements, and a practice employs a GP trainee directly, they will then be
expected to appoint an independent guardian themselves.
There is never an excuse for employers to deny a trainee access to a guardian. Smaller
employing organisations, such as GP practices, will still be expected to make arrangements.
Where the employer has fewer than 10 trainees, they can club together with other
employers to appoint a guardian, or they can contract a neighbouring NHS Trust to take on
this role for their trainees.
Further information
Terms and Conditions of Service, Schedule 6.
NHS Employers’ Guardian for safe working job description.
41British Medical Association Junior doctors’ handbook on the 2016 contract
10. Indemnity
Summary
It is essential for all doctors to ensure they have sucient indemnity. This chapter
provides a summary of the dierent types of indemnity and what is covered by these.
Clinical negligence indemnity
NHS bodies and organisations are nancially responsible for the clinical negligence of their
employees. All NHS Trusts / Health Boards in England, Scotland and Wales are members
of state-backed NHS medical schemes. In Northern Ireland, each health and social care
trust provides its own indemnity, funded by the Department of Health, Social Security and
Public Safety.
The legal and professional requirement that all individual doctors hold adequate and
appropriate clinical negligence indemnity cover is fullled through their Trust/Health
Board’s membership of an NHS scheme, or directly through a separate arrangement by the
Trust/Health Board. The GMC’s website gives further details of the legal and professional
requirement for indemnity.
For GP trainees should have their indemnity covered by Health Education England and their
employer or lead employer should be notied of this.
It is important that doctors understand what is NHS work and what is not. Doctors need to
arrange separate clinical negligence indemnity cover for any clinical work not covered by the
scope of NHS indemnity. Clarication should be sought from your employing organisation,
or directly from the NHS indemnity schemes’ administrators if you are unsure whether you
are fully covered by NHS indemnity.
Whilst NHS indemnity provides sucient clinical negligence indemnity cover for most
trainees across specialities, it does not provide sucient cover for several medical
specialities where training placements take place predominantly, or partially, outside of the
NHS. These include:
– Public Health (PH).
– Palliative Medicine (PM).
– Occupational Medicine (OM).
– Community Sexual Reproductive Health (CSRH).
– Genitourinary Medicine (GM).
– Sport and Exercise Medicine (SEM).
– Aviation and Space Medicine (ASM).
However, Health Education England (HEE), through central contracts with medical defence
organisations, will continue to provide sucient and appropriate clinical negligence
indemnity cover for these trainees. From August 2022, HEE is also expected to provide
indemnity cover for trainees undertaking stage 2 internal medicine training specically
during palliative medicine placements in hospices.
Examples of what is and is not usually covered by NHS indemnity are given below.
Work covered:
– work which falls strictly under the doctor’s contract with their employer (this includes
where junior doctors work in independent hospitals as part of their NHS training, as
a requirement under their NHS contract).
– foundation work in general practice.
– family planning in hospitals.
– hospital locum work (including through a locum agency).
– clinical trials authorised under the Medicines Act 1968 or subordinate legislation.
– care of private patients in NHS hospitals where it is part of the junior’s contract.
– private practice carried out by junior clinical academic sta on the same basis as above.
– work in a hospice if the doctor is seconded from a contract with an NHS employer.
– work in a prison if part of the doctor’s NHS contract.
42 British Medical Association Junior doctors’ handbook on the 2016 contract
Work not covered:
– category 2 work, for example completing cremation certicates.
– defence of medical sta in GMC disciplinary hearings.
– stopping at a roadside accident, or other ‘good Samaritan’ acts.
– clinical trials not covered under legislation.
– work for other agencies on a contractual basis or for voluntary or charitable bodies.
– work overseas.
– work where a crime has been alleged.
Junior hospital doctors need separate cover if they undertake any category 2 work, which
includes: completing cremation certicates; examinations and/or reports on patients for
courts, insurance companies, or Department for Work and Pensions etc.; and making court
appearances. For more information on category 2 fees see chapter 6. Private practice or
work in independent hospitals which is not covered above also requires separate indemnity.
Junior doctors who are required either by their employer, or by their consultant to perform
work which takes them over the hours limits set down in the contract and WTR, would be
covered by NHS indemnity and defence organisation cover.
Professional indemnity
The BMA advises all doctors to hold membership of a medical defence organisation (MDO) to
provide indemnity cover for clinical negligence related to non-NHS work, and professional
(non-clinical negligence) issues, including: support in GMC investigations and representation
at hearings, assistance with criminal investigations arising from your clinical practice,
representation and assistance in coroner inquests, protection for good Samaritan acts, and
help responding to patient complaints.
For historical reasons HEE will continue to provide all GP specialty trainees with professional
(non-clinical negligence) indemnity fully cover funded by HEE. Doctors who are thinking of
changing their MDO should discuss any potential implications of such a transfer with their
current MDO.
Junior doctors and data protection
Junior doctors who make personal manual or electronic records of patient data, for example
for training logbook purposes, should be aware of the provisions of the Data Protection Act
1998. If patient data are recorded on, for example, personal computers, and that data can
identify a patient, then the data must be held subject to the provisions of the Data Protection
Act. This would require the doctor to be registered for this purpose. Further information on
the Act can be found on the Information Commissioner’s website at ico.org.uk.
The Information Commissioner enforces and oversees the Data Protection Act 1998,
and has a range of duties, including the promotion of good information handling and the
encouragement of codes of practice for data controllers: that is, anyone who decides how
and why personal data (information about identiable, living individuals) are processed.
The BMA advises junior doctors not to record data that identies a patient, for example
a patient’s name, though data which can be matched to a patient only through use of a
hospital record system or separate second data set is lawful on an unregistered computer.
For example, a hospital number can only identify a patient if cross-referred with the hospital
records system.
43British Medical Association Junior doctors’ handbook on the 2016 contract
Further information
The Medical Defence Union
W; www.themdu.com
T: 020 7202 1500
The Medical and Dental Defence Union of Scotland
W; www.mddus.com
T: 0333 043 4444
The Medical Protection Society
W; www.medicalprotection.org/uk
T: 020 7399 1300
44 British Medical Association Junior doctors’ handbook on the 2016 contract
11. Transitional pay protection arrangements
Summary
The 2016 terms and conditions of service became eective on 3 August 2016. The
contract was introduced with a phased implementation, completed by October 2017.
During this period, and up until 2022 or 2025 dependent on the type of transitional pay
protection, there are temporary arrangements in place to allow current junior doctors
to transition to the new contract, including pay protection. This is set out in the
temporary schedule 15 ‘Transition arrangements’ of the terms and conditions.
Pay protection arrangements
The new contractual arrangements include an initial period of pay protection for some
existing doctors. Schedule 15 of the terms and conditions of service deals with the
arrangements which are aimed at ensuring no current junior doctor receives a pay cut as
a result of the new contract. The arrangements are complex. If you are unsure how this
may aect you, we would encourage you to use the BMA’s interactive pay protection tool
available on our website.
The principle is that junior doctors who were employed on the 2002 terms and conditions
will have their pay protected to ensure they do not see any drop in pay as a result of the
introduction of the new contract. Given that the transition to the new contract took place
from October 2016, this includes new FY1s, who started on the 2002 TCS in August 2016
before moving to the new one once it starts being used later in the year.
Eligibility categories
There are two categories for pay protection - one covering doctors in Foundation, core, GP
and the initial stages of run-through training programmes; the other covering those already
in higher training programmes and the later stages of run-though training (ST3 and above).
The rst category will have their pay protected against a ‘cash oor’, based on the basic
salary the doctor was earning on the day before they transitioned to the new contract and
the banding for the rota they were working the day before transition, based on the value of
that banding supplement as at 31 October 2015.
The cash oor is calculated once, and your pay cannot drop below this point, but it will not
be calculated again, except for LTFT trainees for whom separate arrangement for cash oor
calculations apply. Your pay is protected against the cash oor until such time as your pay on
the new contract would be greater, at which point pay protection stops and you are just paid
under the new contract as normal.
The second category, doctors already at ST3 or above on a run-through training programme
on 2 August 2016, will have their pay protected by continuing to be paid under the old pay
system, including increments and banding (but not band 3). For the purposes of their pay
only, the old denitions of ‘plain’ and ‘premium’ time will apply.
The 2016 terms and conditions include detailed instructions as to how the old pay system
will work with the new contractual terms, including how these doctors can make use of
the new exception reporting system under the guardian of safe working. If you qualify for
section 2 protection and earn less under the old contract pay system than you would under
the new contract, you still get paid under the old contract i.e. the lower amount.
Pay will be protected either until you complete the training programme, or until four years of
continuous employment have elapsed (pro rata for those LTFT or taking time out), or until 6
August 2025, whichever is sooner.
Transition of trainees on lead employer contracts
Following the conclusion of the 2018 Review, it was agreed that all trainees who had not yet
been transitioned onto the 2016 TCS, due to being employed on lead employer contracts
for the duration of their training, would be transitioned over to the 2016 TCS by 5 February
2020. Trainees absent during this period (eg maternity leave, approved out of programmes,
etc.) should be transitioned on to the 2016 TCS upon their return to training.
45British Medical Association Junior doctors’ handbook on the 2016 contract
The existing transitional pay protection provisions of schedule 15 should apply in exactly the
same manner to trainees who were transitioned over to the 2016 TCS between October 2019
and February 2020. The only exception being that, for trainees who are eligible for section 1
pay protection, the value of the banding supplement of the rota the doctor was working on
the day before transitioning should be used, rather than the rota’s banding supplement as of
31 October 2015.
Arrangements for those training LTFT, on OOP or absent at the time
of transition
There are various provisions to ensure fairness in the calculation of the cash oor and the
length of protection. Those taking time out of training for maternity leave, for example,
will have this time out disregarded for the purposes of their four years of continuous
employment. LTFT trainees will also have their coverage extended pro rata – so someone
working on an 80% basis would have their four year period extended by a year. Doctors
who are out of training for maternity leave, for example, or on an approved out of
programme (OOP), at the time they would transition to the new contract, will have their
pay protected at the incremental pay point that they might otherwise have reached had
they not been absent.
Arrangements for those not in training in August 2016
If you were not in a training programme – for example, if you are a career grade doctor
planning on returning to training – you will not qualify for transitional pay protection if you
started training or returning aer 3 August 2016, even if you have been in training before.
The pay protection covers new FY1 doctors in August and doctors in training on 2 August
who either remain in that programme or progress directly to their next one. If, for example,
you take a break between core and higher specialty programmes or between foundation and
specialty training, you are not eligible.
There are some exceptions.
– A doctor who accepted a place in a training programme in a 2015 recruitment round, or
earlier, and has agreed with Health Education England to defer the entry date at that time,
will qualify for pay protection when entering that programme on the agreed date.
– A doctor who accepted a place on a training programme during a 2016 recruitment round
(prior to 30 June), and has agreed with HEE a deferral of the start date, will qualify for pay
protection when entering that programme on the agreed date.
– A doctor who has accepted an appointment to start a period of research or organised
leadership programme (eg the FMLM scheme) prior to 31 March 2016, without having
secured a place on a GP or specialty training programme, and who would otherwise
qualify for pay protection on return to training under the 2016 terms and conditions of
service. To be eligible for pay protection in this circumstance, the doctor must enter a
nationally recognised specialty training programme at the rst available opportunity, in
line with the national specialty training recruitment timetable, following the successful
completion of that academic or leadership work. This provision will only be extended to
those who have made the decision to take up such academic or leadership programme
activity prior to 31 March 2016. Doctors should be asked to provide evidence of the date
upon which they accepted this academic or leadership work to prove their eligibility for
pay protection.
This is a complex area and we recommend you read schedule 15 in full along with the
detailed guidance available on the BMA website.
Further information
Interactive pay protection tool: bma.org.uk/pay-and-contracts/pay/transitional-pay/
transitional-pay-protection.
Terms and Conditions of Service, Annex B – Transitional banding questionnaire for
Schedule 15.
NHS Employers’ Transition to the 2016 TCS guidance: www.nhsemployers.org/pay-
pensions-and-reward/medical-sta/doctors-and-dentists-in-training/transition
NHS Employers’ Pay protection FAQs: www.nhsemployers.org/pay-pensions-and-reward/
medical-sta/doctors-and-dentists-in-training/transition/copy-of-pay-protection-faqs-
updated-july.
46 British Medical Association Junior doctors’ handbook on the 2016 contract
12. LTFT (less than full-time) training
Summary
This chapter explains what LTFT training is, the eligibility criteria for working LTFT, the
application process, appealing decisions, the types of post available, and how to nd
out more.
Less than full time training allows doctors and dentists to work part time in posts that are
fully recognised for training. It covers any arrangement with reduced working hours. All
those in training are able to apply for LTFT training.
There are many reasons, including domestic commitments, disability or ill health, or the
undertaking of a particular activity outside of medicine, which may mean you wish to
train less than full time. Your training programme and some elements of your contract
of employment will be determined to reect your individual circumstances, and should
reect the formal guidelines referred to below. Access to LTFT training will be dependent
on individual circumstances and the availability of LTFT places in your training location.
However, the BMA is working with training authorities to improve access to exible working
opportunities, including LTFT training. As a result of these eorts, HEE agreed to implement
Category 3 LTFT training. This allows trainees to go LTFT without needing a health reason or
caring responsibility to justify the request. Further information on category 3 LTFT training
can be found here.
During the 2018 contract review, the BMA negotiated for all employers and host
organisations to be required to appoint a Champion of Flexible Training. Joint guidance about
how the role should function is available here.
The BMA has produced guidance as a single resource to answer your questions relating
to LTFT training. It takes you through the basic principles, explains your rights and
responsibilities, and what you can expect from your employer and training organisation (HEE
local oce or deanery). It aims to ensure you know how to apply, what it is like to train less
than full time, possible problems you might run into, how to deal with them, as well as what
support is available to you.
If you feel that working and training less than full time is right for you, the BMA will support
you wherever possible. We suggest you read the full guidance, which will reect changes as
they occur. If you need information quickly, have an application that you need advice about,
or are a less than full time trainee with questions, get in touch with an adviser through
bma.org.uk/contact-bma.
The rest of this chapter outlines the basics of the current arrangements.
Criteria
To aid the prioritisation of those wishing to apply, deaneries or HEE local oces are advised
to review applications based on ‘well founded individual reasons’, which are divided into
three categories. The categories are not exhaustive, and applications may be considered for
other reasons. However, this will be dependent on the particular situation and the needs of
the specialty in which the doctor is training or applying to train. All LTFT training requests
should be treated positively.
Category 1
– Disability or ill health (this may include IVF programmes).
– Responsibility for caring (irrespective of gender) for children.
– Responsibility for caring for an ill or disabled partner, relative or dependent.
– Category 1 applicants are treated as ‘priority’ applicants.
47British Medical Association Junior doctors’ handbook on the 2016 contract
Category 2
– Unique opportunities for personal professional development, such as training for
national or international sporting events, or short-term extraordinary responsibility (eg
a national committee).
– Religious commitment (eg involving training for a particular religious role which requires a
specic amount of time commitment).
– Non-medical professional development.
– Category 2 applicants are treated on their individual merits.
Category 3
– This is for trainees who choose to train LTFT as a personal choice that meets their
individual professional or lifestyle needs. No justication, beyond it being personal
preference is required for category 3 LTFT training, but approval of applications will have
to take into account service considerations.
– As of April 2021, category 3 LTFT is currently only accessible to trainees in the following
specialties; Paediatrics, Obstetrics and Gynaecology, Emergency Medicine, Higher
Physicianly, Radiology, Psychiatry, and ICM trainees.
– See the HEE guidance for further information.
Application process
To make the application process run as smoothly as possible, there are a number of things
that you need to consider in advance of your application:
– Determine how you t into the categories and, where possible and/or appropriate, gather
as much supporting evidence to demonstrate your circumstances.
– Speak to other colleagues who work LTFT and ask them about their experiences (even if
you are about to move deaneries). Useful things to know would include the below:
– Find out how many hours they are contracted to work per week.
– Find out how they agreed their training programme to incorporate the full range of
training opportunities available to full-time trainees. Perhaps they have worked one
half of the week for six months and the other half for another six months.
– Find out what the full-time trainees do each week, eg what proportion of time do they
spend covering ward work, clinics, theatre, emergencies etc. Remember to include
time for audit/protected teaching time/research etc.
– If you are applying through open competition and it is your rst time applying for a LTFT
training post, it may be hard for you to get all this information. Familiarise yourself with
similar information in your current work place so you know what you should be looking for
when you discuss your programme in your new role.
There are a number of steps to the application process, and it can take up to three months.
If you wish to train LTFT in a post, it is recommended that you start this process as soon as
possible. The steps to take when applying are as follows.
1. Seek advice on eligibility from your associate postgraduate dean with a responsibility for
LTFT training as to your eligibility. Find out who to contact by looking on your HEE local
oce/deanery website.
2. If you are not already working within the specialty or grade that you wish to train LTFT
in, you should apply through competitive entry to a full-time post. If you are already in a
full-time training post and wish to train LTFT within that same post, you will not have to
reapply for training.
3. Once your application for LTFT training has been accepted, you need to agree your
training programme with your HEE local oce/deanery.
4. The Regional Specialty Education Committee or Training Programme Director will then
obtain approval of the training programme on behalf of the dean and royal college.
5. Finally, funding approval will be given by the deanery and the employer.
When applying for a training post, be assured that it is not part of an appointment
committee’s job to consider whether a candidate wishes to train LTFT on taking up a post or
in the future, and candidates do not need to state in their application that they wish to train
in this way.
48 British Medical Association Junior doctors’ handbook on the 2016 contract
However, it is suggested that potential applicants discuss with the postgraduate deanery
their intention to train LTFT at the earliest opportunity.
If your application to train LTFT is refused, you have the right to appeal this decision. You can
also use this process if you are refused access to LTFT training, i.e. you are told you are not
eligible to apply.
The application process is outlined in fuller detail within our LTFT guide bma.org.uk/advice-
and-support/career-progression/training/exible-training
Appeals
The appeals process should only be required on rare occasions, as discussions with your
HEE local oce/deanery before applying should help inform you of whether you are eligible
for LTFT training. Before starting the full appeals process, you must rst attempt to resolve
issues informally by discussing your concerns with your deanery.
You should also contact the BMA for support and advice if you have had your application for
LTFT training rejected.
You are allowed and encouraged to have a representative in these discussions, and the BMA
will provide support for members throughout the whole of the pre-appeals and appeals
process. If the matter is resolved informally, this must be conrmed in writing. If not, you are
then entitled to progress with the full appeals process.
Appeals are heard by an appeals panel who consider your application, your concerns, and
your reasons for the appeal, in addition to the deanery’s case. The appeals panel will then
make a nal decision regarding your access to LTFT training.
In order to register your appeal, you should follow these steps:
– Submit your appeal in writing using the ‘notication of appeal’ form, which is available
from your HEE local oce/deanery’s associate postgraduate dean with responsibility for
LTFT training.
– Send a copy of the notication of appeal form to your postgraduate dean within 30
working days of the decision about which you are appealing.
– Send a copy of your notication of appeal form to the LTFT training administrator at your
HEE local oce/deanery.
For more information about appeals, see the section in our LTFT guide bma.org.uk/advice-
and-support/career-progression/training/exible-training
Types of LTFT training post
Deaneries in principle oer dierent ways of incorporating LTFT training into rotas. There
are three ways in which doctors can train LTFT: slot-sharing; supernumerary posts; and job
sharing. However, access to these dierent post types is variable.
Slot share
A training placement can be divided between two trainees, so that all duties of the full-time
post are covered by two trainees. In a slot share, two LTFT trainees are employed and paid as
individuals (oen for 60% or more) and work together. The two trainees share an educational
post but not a contract, and may overlap sessions.
Reduced hours in full-time post
This is where a doctor only undertakes some of the hours available within an existing full-
time post. This can result in the remaining hours being carried over as a gap in the rota, or
the extra hours le over being shared between other doctors on the rota (where agreed).
Job-share
In job-share arrangements, it is usual for two trainees to share a full-time salary, work half the
hours, and receive 50 per cent of the training opportunities.
49British Medical Association Junior doctors’ handbook on the 2016 contract
Supernumerary post
Supernumerary posts can be oered when LTFT trainees cannot be placed in a slot-share
because there is not a suitable partner, or where LTFT training is needed at short notice.
Supernumerary posts are additional to a normal complement of trainees, and increasingly
are only oered for those who require LTFT at short notice. Many deaneries no longer oer
supernumerary posts as a standard form of training.
Information about postgraduate training is available from your local postgraduate dean’s
oce. Usually, one associate dean has a designated responsibility for LTFT training in
the region.
Pensions for LTFT trainees
It should be noted that any less than full-time working will have pension implications. For
more information, please see chapter 18.
Further information
BMA guidance on LTFT training: bma.org.uk/advice/career/applying-for-training/exible-
training.
BMA guidance on LTFT pay: bma.org.uk/pay-and-contracts/pay/lt/less-than-full-time-
trainees-pay-explained.
StRs should refer to ‘A reference guide for postgraduate specialty training in the UK’ (the
Gold Guide).
Principles underpinning the new arrangements for exible training (2005) and Equitable
pay for exible medical training (2005), relevant only for trainees in receipt of section 2
transitional pay protection, available at www.nhsemployers.org/pay-pensions-and-reward/
medical-sta/doctors-and-dentists-in-training/junior-doctors-dentists-gp-registrars/less-
than-full-time-training.
The BMA’s and NHS Employers’ joint Good Rostering Guide, see Good rota design and
rostering recommendations for LTFT doctors (pg. 22-25) www.nhsemployers.org/case-
studies-and-resources/2018/05/good-rostering-guide.
50 British Medical Association Junior doctors’ handbook on the 2016 contract
13. Locum work in the NHS
Summary
This chapter provides information on locum work in the NHS, and explains the terms
and conditions of service for locum doctors directly employed by the NHS. There are a
number of issues to think about when considering working as a locum, including how
this work relates to the EWTD, pay, and other terms and conditions of service such as
annual leave, sick leave and notice periods.
Junior doctors employed on a locum basis in the NHS can be subject to the terms and
conditions of service for hospital medical and dental sta, or under a separate contract for
the NHS sta bank they are working for. If a doctor is employed directly by a locum agency, it
is not possible to give advice on the terms which agencies may oer, as these vary between
agencies. It should be noted that locum posts do not usually attract recognition for training
except in certain circumstances.
Locum cover
Employers are obliged to obtain a locum to cover a junior doctor’s annual and/or study
leave, unless prospective cover (internal cross-cover among doctors on the rota) is in
use on the rota. Locum cover must be organised to cover sick leave and maternity leave,
except in emergencies as explained below. Employers should rst try to arrange an
external locum. Where this is not possible, and junior doctors agree to cover for colleagues
as an internal locum, and this cover takes place outside of their contracted hours, they
should receive either an equivalent o-duty period in lieu or be paid at the prevailing local
sta bank locum rate.
You will be expected to be exible and to cooperate with reasonable requests to cover
for your colleagues’ absences where you are competent to do so, and where it is safe and
practicable for you to do so.
Cover in emergencies
Your employer should not ask you to cover for absent colleagues on a long-term basis.
However, there are specic circumstances where you may legitimately be asked to cover
the ‘occasional brief absence of colleagues’ (as well as in exceptional emergency scenarios),
and that ‘sick colleagues will normally be covered only for short periods of absence’, and we
interpret this short period to be 48 hours in length. This would not apply to foreseeable short
or long term rota gaps.
Such emergency cover should be recognised with either compensatory time o in lieu or
with pay.
Lastly, academic trainees can be a special case as they may have additional commitments
within the university or department. These should be protected and respected. This could
also be the case with doctors who have multiple employers.
If your situation is not covered here, or you need more information, please contact our team
of advisers on 0300 123 1233 for advice.
Further information
Terms and Conditions of Service, Schedule 1, para 3-4.
Spare professional capacity and rst refusal
No doctor should be rostered to work for more than a maximum average of 48 hours per
week (or up to 56 hours per week if the doctor has opted out of the WTR). This means junior
doctors will have an average 8 additional hours in the week during which they could work but
would not be scheduled to work by their main employer.
51British Medical Association Junior doctors’ handbook on the 2016 contract
There is now a contractual requirement for junior doctors to give rst refusal on these
additional hours to the service of the NHS via an NHS sta bank. This is limited to work
commensurate with the grade and competencies of the doctor, rather than work at a lower
grade than the doctor currently employed to work at.
Where a doctor intends to undertake hours of paid work as a locum, additional to the
hours set out in their work schedule, they must initially oer such additional hours of work
exclusively to the service of the NHS via an NHS sta bank.
You do not need to oer space capacity to your employer when the additional work you
intend on undertaking in the specied time is voluntary or communal in nature, including
event and expedition medicine; work for medical charities; non-prots; humanitarian and
similar organisations; or sports and exercise.
The employer can, but is not obliged to, oer the doctor the opportunity to carry out
additional activity up to a maximum average of 48 hours per week (or up to 56 hours per
week if the doctor has opted out of the WTR).
The employer will agree with the LNC local processes for the doctor to inform an NHS sta
bank of their intention to carry out such work.
Only aer the employer has declined the doctor’s oer to work additional hours as a locum
should the doctor enter into any agreement to carry out any additional work for any other
employer, whether directly or indirectly (for example through an agency or limited company).
Please note up to 40 hours of work per week are pensionable in the NHS.
Further information
Terms and conditions of service, Schedule 2, paragraph 84 and Schedule 3, paragraphs 47-
51 & 52-53.
External locums
External locums engaged through an agency are paid according to the rate negotiated by
the agency; employers are allowed to negotiate locally the best arrangements for their
particular circumstances.
The rate is appropriate to the grade of the doctor being covered (not the locum’s own grade).
Internal locums
Junior doctors employed on an internal locum basis in the NHS are subject to the Terms and
Conditions of service for hospital medical and dental sta.
Under internal locum arrangements, employers will typically pay junior doctors providing
locum cover at locum rates agreed by local sta bank for the whole time they are on duty,
provided that such work is undertaken when the doctor would otherwise have been o duty.
Part-time locums
A junior doctor engaged as a locum for less than 40 standard hours per week without a
regular appointment is paid on the same basis as internal or external locums above.
LATs (locum appointments for training)
Junior doctors in LATs are excluded from the pay arrangement detailed above. Doctors in
LAT posts are paid at the incremental point to which they are entitled because of previous
experience, not the mid-point.
52 British Medical Association Junior doctors’ handbook on the 2016 contract
Other terms and conditions of service
Locums are entitled to the same terms and conditions of service as regular appointments,
except in the following areas:
– Notice periods
Locums are not entitled to the minimum periods of notice for regular appointments. An
employer is required by statute to give a minimum of one week’s notice to terminate the
employment of a locum who has been employed for at least four weeks.
– Annual leave
Junior doctors acting as locums under NHS terms and conditions are entitled to 27
days leave (rising to 32 days aer ve years’ completed NHS service). This may dier for
doctors employed as locums via a sta bank, however, at a minimum they are entitled
to the statutory leave provisions. ‘Continuous locum service’ means service as a locum
in the employment of one or more employer uninterrupted by the tenure of a regular
appointment, or by more than two weeks during which the junior doctor was not
employed in the hospital service. Wherever possible, leave should be taken during the
occupancy of the post. If this is not possible, leave may be carried forward to the next
succeeding appointment, or payment in lieu of leave earned and not taken may be made.
In practice, the latter is more common.
– Sick leave
Although the sick leave provisions of the terms and conditions of service apply to
locums, a locum contract cannot be extended to cover sickness that continues aer the
contract has expired. For the purpose of sickness absence allowances, a doctor’s previous
contracted NHS locum service shall be recognised, subject to a minimum of three
months’ continuous NHS locum service.
– Travelling expenses
Where a locum travels between their place of residence and their hospital, travelling
expenses are paid in respect of any distance by which the journey exceeds 10 miles each
way. Where a locum takes up temporary accommodation at or near the hospital, the initial
and nal journeys are paid.
53British Medical Association Junior doctors’ handbook on the 2016 contract
14. Study and professional leave
Summary
This chapter covers junior doctors’ entitlements to time o and expenses for study
leave, and explains what can be done if problems are encountered.
Study leave is leave that allows time, inside or outside of the workplace, for formal learning
that meets the requirements of the curriculum and personalised training objectives. This
includes, but is not restricted to, participation in:
– Study (linked to a course or programme).
– Research.
– Teaching.
– Taking examinations.
– Attending conferences for educational benet.
– Rostered training events.
– Regional educational events (where the time is protected).
Attendance at statutory and mandatory training (including any local departmental training)
is no longer counted as study leave. This means that juniors will no longer have to use their
study leave to attend obligatory training.
Professional leave is leave in relation to professional work. Professional work is work done
outside of the requirements of the curriculum and/or the employer/host organisation for
professional bodies such as Royal Colleges, Faculties or the GMC/GDC. Non-trade union
activities undertaken by for a recognised trade union, for example work on an Ethics
Committee would count as professional work, however trade union duties and activities are
covered through recognition agreements.
Job interviews for NHS, public health, academic, NHS commissioned community health
and hospice appointments should be considered professional leave, with time o
accommodated appropriately and a doctor should not be required to take annual or study
leave to attend such interviews. Doctors should provide rota coordinators with as much
notice as possible to eectively plan the roster.
Funding for study leave ensures that doctors continue to be paid for the time spent absent
from their place of work. With prior agreement, reasonable expenses incurred by the trainee
for approved study leave should also be reimbursed by the deanery.
Study leave and reimbursement of related expenses will be granted in line with existing HEE
national policy (more information can be found on your local oce website), or deanery in
the devolved nations.
Entitlement
Study leave up to the limits described below will normally be granted exibly and tailored to
individual needs, in accordance with the requirements of the curriculum.
Grade Days per annum
Foundation Doctor Year 1 15 days
All other doctors in training 30 days
A doctor on a contract of employment of less than 12 months’ duration is entitled to study
leave on a pro rata basis.
Study leave for Foundation Year 1 doctors will take the form of a regular scheduled teaching/
training session (or similar arrangement), as agreed locally.
54 British Medical Association Junior doctors’ handbook on the 2016 contract
Study leave for doctors at Foundation Year 2 and above will include periods of regular
scheduled teaching/training sessions. It may also, with approval from the educational
supervisor and service manager, include undertaking an approved external course and /
or periods of sitting (or preparing for) an examination for a higher qualication where it is a
requirement of the curriculum, as well as taster days in certain specialties.
The Gold Guide states that:
1. Trainees must be made aware of how to apply for study leave and be guided as to what
courses would be appropriate and what funding is available.
2. Trainees must be able to take study leave up to the maximum permitted in their terms
and conditions of service.
3. The process for applying for study leave must be fair and transparent, and information
about a deanery-level appeals process must be readily available.
Less than full-time trainees
Less than full-time trainees are eligible for study leave. If the LTFT doctor is required to
undertake a specic training course required by the curriculum which exceeds the pro
rata entitlement to study / professional leave, the employer will make arrangements for
additional study leave to be taken, provided that this can be done while ensuring the safe
delivery of services.
When teaching, courses and educational opportunities fall on a LTFT doctor’s non-working
day, and where study leave approval is granted, the LTFT doctor must be compensated with
TOIL, or payment if the doctor prefers.
Medical academic doctors
Study, sabbatical and other leave are determined by the substantive employer, and will be
agreed in consultation with the NHS where there may be an impact on clinical services.
Applications
The administration of how you can access the funding and time o for study leave varies
between nations of the UK. When starting a training programme, junior doctors should
check the deanery’s policy on study leave. Postgraduate deans have overall responsibility
for managing study leave budgets within their areas and will have specic local processes for
how these will be accessed.
It is not the responsibility of the junior doctor to nd or arrange any locum cover during the
study leave period. Junior doctors should contact the human resources department to nd
out the procedure for applying for study leave in their hospital.
Expenses
Doctors may be entitled to reimbursement of reasonable study leave expenses, in
accordance with local and national policies, which must meet the minimum standards for
provision set out in the Learning and Development Agreement (or any successor document)
between the employer / host organisation and HEE.
However, there are circumstances where this could be unreasonable, for example, where
expenses are met wholly or partly by a sponsoring body, or where a doctor holds a contract
with more than one employer.
In deciding what are ‘reasonable expenses’, employers have been told by the Department of
Health that ’it would not, in our view, be reasonable for an authority to pre-determine a given
level of expenses which it was prepared to approve in connection with applications for study
leave‘. In other words, when employers grant study leave, they must grant pay and expenses.
Professional leave for overseas conferences
HEE has specic policy relating for conferences overseas, but only when required by the UK
curriculum in order to undertake these. It is important that you open discussions with your
educational supervisor and training programme director as soon as possible should this be a
requirement of your training programme.
55British Medical Association Junior doctors’ handbook on the 2016 contract
Accommodating time o for study leave
All requests for study leave will be properly considered by the employer. Any grant of
study leave will be subject to the need to maintain NHS Services (and, where the doctor
is on an integrated academic pathway, academic responsibilities) and must be authorised
by the employer.
Requests for study leave will be viewed positively in most circumstances, but with a view
to ensuring that the needs of service delivery can be safely met. Applications must also be
made in plenty of time in order to increase the chances of their being accepted.
Requests for study leave in excess of the limits above should be considered fairly where
circumstances indicate such requests to be reasonable, and may be granted by the
employer provided that the needs of service delivery can be safely met.
Study or professional leave must be used for the purpose for which it was granted.
Safeguards on hours and rest, as set out in Schedule 3 of the 2016 terms and conditions of
service, will continue to apply.
The BMA strongly advises junior doctors to get involved with rota planning. As study leave
will normally be agreed a minimum of four to six weeks in advance, it should be able to be
incorporated into the rota. If study leave is not granted because of rota shortages or poor
rota design, this should be raised with the clinical tutor, director of medical education or
the guardian.
Appeals
If a trainee has reason to believe that their study leave application was processed unfairly or
incorrectly, they are able to request a review of the process by which their application was
considered by making a written submission to their individual Deanery in accordance with
local policy. This should include the reasons for their complaint and any evidence to support
their appeal.
All written submissions must be sent via email or as an attachment, with the original
application form and outcome received. This should be emailed to the relevant Deanery, and
must be made within 10 working days of being notied of their outcome.
BMA members should seek advice from our team of advisers on 0300 123 1233 before
embarking on an appeal.
Study leave for GP trainees
The GP trainees subcommittee of the GPC has an agreed policy on study leave for GP
registrars. The guidance note regarding study leave for GP registrars is available on the
BMA website: bma.org.uk/pay-and-contracts/leave/annual-leave-entitlement/gp-trainee-
annual-leave-sick-leave-and-study-leave
Further information
Terms and Conditions of Service, Schedule 10, paragraphs 30-43.
The BMA’s and NHS Employers’ joint Good Rostering Guide, see Managing leave requests
in rotas, rosters and work schedules (pg. 13-16) www.nhsemployers.org/case-studies-and-
resources/2018/05/good-rostering-guide.
Rough guide to foundation programme – for all foundation year 1 and foundation year 2
trainees. www.foundationprogramme.nhs.uk – See Key Documents.
Local Employer Policy – BMA also advise trainees check the relevant employer’s local policy
on study / professional leave to ensure the correct application form for requesting this
type leave is being used. If there is diculty in acquiring the policy, please contact the BMA
directly for further support.
‘A reference guide for postgraduate specialty training in the UK’ or the Gold Guide – All
specialty trainees or StRs (including general practice trainees, those in core training, LTFT
training and trainees in academic programmes) should refer to the Gold Guide.
56 British Medical Association Junior doctors’ handbook on the 2016 contract
15. Annual leave
Summary
This chapter explains the basic annual leave entitlements for junior doctors and
how to calculate annual leave entitlements. The chapter also details public holiday
entitlements, and what to do if you become sick while on annual leave.
Basic entitlement
Annual leave will now be stated in days, rather than weeks. The annual leave entitlement for
a full-time doctor is as follows, based on a standard working week of ve days:
On rst appointment to the NHS: 27 days.
Aer ve years’ of completed NHS service: 32 days.
Where the doctor’s contract or placement is for less than 12 months, the leave entitlement is
pro rata to the length of the contract or placement.
Annual leave for LTFT trainees will be pro-rata.
Principles
It is in the interest of doctors’ health and wellbeing and the continued safety of patients in
their care, that they take their full annual leave entitlement. The employer and the doctor
must make every eort to work together to ensure that the doctor is able to take the full
annual leave entitlement.
The employer should, where possible, respond positively to all leave requests, and should
normally agree reasonable requests.
Employers must allow annual leave to be taken for life-changing events, provided that the
doctor has given a minimum six weeks’ notice to the employer.
Further information
Terms and conditions of service, Schedule 10, paragraphs 1-23.
The BMA’s and NHS Employers’ joint Good Rostering Guide, see Managing leave requests
in rotas, rosters and work schedules (pg. 13-16) www.nhsemployers.org/case-studies-and-
resources/2018/05/good-rostering-guide
Payment for annual leave
Pay is calculated on the basis of what the doctor would have received had the doctor been
at work, based on the doctor’s work schedule, and on any reference period that may be
applied locally.
Purchase of additional annual leave
Where the employer oers a local scheme for the purchase of additional annual leave, a
doctor will be permitted to seek participation in such a scheme, subject to any training
requirements. The impact of any additional leave must be considered by the HEE local oce
and agreed on behalf of the postgraduate dean. Any such agreed additional annual leave can
only apply to the placement with that specic employer.
Daytime work cover
Some departments engage locums for daytime work; some expect juniors of the same
grade to cover; some expect juniors of dierent grades on the same rm to cover; and some
have ‘oating’ juniors. Whichever method is used, junior doctors should ensure that they do
not feel exploited or overworked by their colleagues’ absence. If this is the case, members
should consult our team of advisers on 0300 123 1233.
57British Medical Association Junior doctors’ handbook on the 2016 contract
Leave year
The annual leave year runs from the start date of the doctor’s appointment.
Untaken leave
In cases where exceptional circumstances or service demands have prevented a doctor from
taking the full leave allowance, up to ve days of leave per annum (pro rata for contracts or
placements of less than 12 months’ duration or for doctors who work less than full time) may
be carried forward to the next post or placement with the same employer. This must be with
the agreement of the relevant department, in line with the employer’s local policy.
With the agreement of the employer, and in line with local policy, payment in lieu can be
made for up to ve days’ annual leave (pro rata as appropriate) which could not be taken
before a move to a new employer.
Transferring leave from post to post
Carry over of leave from one post to another is oen contentious, and should be agreed
in advance with the new employer. The previous employer is responsible for notifying the
next employer about the outstanding leave, although it is prudent to check that this has
been done.
Notication of leave
A doctor shall normally provide a minimum six weeks’ notice of annual leave to be
approved in accordance with local policies and procedures. If, due to circumstances
beyond the doctor’s control, a reasonable request is made for leave outside the minimum
six weeks’ notice period, then the employer will fairly consider this while paying due regard
to service requirements.
Fixed leave
In exceptional circumstances where agreement on planning leave is not possible despite the
best reasonable eorts of the doctor and the employer, some leave may need to be allocated
to ensure that all doctors are able to take their full leave entitlement while maintaining safe
coverage of services. However, leave should not be xed into a working pattern for this or any
other reason without agreement.
Sickness during annual leave
If a junior doctor falls sick during annual leave and produces a statement to that eect at
the time, (eg a self-certicate) the junior doctor should be regarded as being on sick leave
from the date of the statement. Where the rst statement is a self-certicate, that statement
should cover the rst and any subsequent days up to and including the seventh day of
sickness. Medical statements should be submitted to cover the eighth and subsequent
calendar days of sickness where appropriate. Further annual leave should be suspended
from the date of the rst statement.
Public holidays
Full-time junior doctors are entitled to eight paid public holidays each year as follows: New
Year’s Day; Good Friday; Easter Monday; May Day; Spring Bank Holiday; Late Summer Holiday;
Christmas Day; and Boxing Day. This is in additional to annual leave entitlement.
A doctor working LTFT is entitled to paid public holidays at a rate no less than pro rata to
the number of public holidays for a full-time doctor, rounded up to the nearest half day.
Public holiday entitlement for LTFT doctors shall be added to annual leave entitlement,
and any public holidays shall be taken from the combined allowance for annual leave and
public holidays.
Working on public holidays
If a junior doctor is required to be present in the hospital (or other place of work) at any time
(from 00.01 to 23.59) on a public holiday, or is rostered to be on call on a public holiday, they
will be entitled to a standard working day o in lieu. If it is not feasible to take these days in
lieu, then pay in lieu can be given.
58 British Medical Association Junior doctors’ handbook on the 2016 contract
Public holidays and zero hour days
Where a doctor’s working pattern includes scheduled rest days (sometimes known as zero
hours’ days), and such a day falls on a public holiday, the doctor will be given a day o in lieu
of the public holiday.
Further information
Terms and conditions of service, Schedule 10, paragraphs 24-29.
Annual leave for locums
Information on annual leave for locums is available in the ‘Locum work in the NHS’ section of
the handbook (see chapter 13).
59British Medical Association Junior doctors’ handbook on the 2016 contract
16. Maternity, paternity and shared parental leave
Summary
This chapter provides a summary of the eligibility criteria for maternity and paternity
leave, and provides details of how they are calculated. Information is also provided on
maternity pay and the contractual and training rights when on maternity leave.
Following the birth of a child, the rights to paternity leave and pay give eligible employees
the right to take paid leave. There is an NHS scheme and a statutory scheme. New
legislation regarding shared parental leave allows both parents to take leave concurrently
or sequentially.
Eligibility
An employee working full time or part time will be entitled to paid and unpaid maternity
leave under the NHS contractual maternity pay scheme if:
– They have 12 months’ continuous service with one or more NHS employers at the
beginning of the 11th week before the EWC (expected week of childbirth).
– They notify their employer in writing before the end of the 15th week before the expected
date of childbirth (or if this is not possible, as soon as is reasonably practicable thereaer)
of their intention to take maternity leave and of the date they wishes to start their
maternity leave.
– That they intend to return to work with the same or another NHS employer for a minimum
period of three months aer their maternity leave has ended and provides a MATB1 form
from their midwife or GP giving the expected date of childbirth.
For doctors on visas, consideration needs to be given as to the timing of maternity leave and
the implications this may have on visa status. The visa rules do allow for maternity leave,
but there are certain requirements that need to be met. If you are a BMA member, you can
contact the BMA Immigration Advice Service for more information.
Changing the maternity leave start date
If the employee subsequently wants to change the date from which they wish their leave to
start, they should notify their employer at least 28 days beforehand (or, if this is not possible,
as soon as is reasonably practicable beforehand).
Conrming maternity leave and pay
Following discussion with the employee, the employer should conrm in writing:
– the employee’s paid and unpaid leave entitlements under this agreement (or statutory
entitlements if the employee does not qualify under this agreement).
– unless an earlier return date has been given by the employee, their expected return date
based on their 52 weeks’ paid and unpaid leave entitlement under this agreement; and
– the length of any period of accrued annual leave and accrued leave for public holidays
which it has been agreed may be taken following the end of the formal maternity
leave period.
– the need for the employee to give at least 28 days’ notice if they wish to return to work
before the expected return date.
Keeping in touch
Before going on leave, the employer and the employee should also discuss and agree
any voluntary arrangements for keeping in touch during the employee’s maternity
leave including:
– any voluntary arrangements that the employee may nd helpful to help them keep in
touch with developments at work and, nearer the time of their return, to help facilitate
their return to work.
– keeping the employer informed of any developments that may aect their intended date
of return.
60 British Medical Association Junior doctors’ handbook on the 2016 contract
Keeping in touch (KIT) days
KIT days have been introduced to help make it easier for employees when it is time to
return to work aer a period of maternity leave. KIT days may be used for training or other
activities that enable the employee to keep in touch with the workplace. However, they are
not compulsory, and any such work must be by agreement and neither the employer nor the
employee can insist upon them.
An employee may work for up to a maximum of 10 KIT days, excluding the rst two weeks
of compulsory maternity leave immediately aer the birth of the baby, without bringing
their maternity leave to an end. Any days of work will not extend the maternity leave period,
but will be paid at the employee’s basic daily rate for the hours worked, less appropriate
maternity leave payments.
Paid maternity leave
Amount of pay
Where an employee intends to return to work the amount of contractual maternity pay
receivable is as follows:
– for the rst eight weeks of absence, the employee will receive full pay, less any SMP
(statutory maternity pay) or MA (maternity allowance) (including any dependants
allowances) receivable
– for the next 18 weeks, the employee will receive half of full pay plus any SMP or MA
(including any dependants allowances) receivable providing the total receivable does not
exceed full pay
– for the next 13 weeks, the employee will receive any SMP or MA that they are entitled to
under the statutory scheme.
By prior agreement with the employer, this entitlement may be paid in a dierent way,
including a combination of full pay and half pay, or a xed amount spread equally over the
maternity leave period.
Calculation of maternity pay
Full pay will be calculated using the average weekly earnings rules used for calculating SMP
entitlements, subject to the following qualications.
In the event of a pay award or nodal pay point advancement being implemented before the
paid maternity leave period begins, the maternity pay should be calculated as though the
pay award or nodal pay point advancement had eect throughout the entire SMP calculation
period. If a pay award was agreed retrospectively, the maternity pay should be re- calculated
on the same basis.
In the event of a pay award being implemented during the paid maternity leave period,
the maternity pay due from the date of the pay award should be increased accordingly. If
a pay award was agreed retrospectively, the maternity pay should be re- calculated on the
same basis.
In the case of an employee on unpaid sick absence or on sick absence attracting half pay
during the whole or part of the period used for calculating average weekly earnings in
accordance with the earnings rules for SMP purposes, average weekly earnings for the
period of sick absence shall be calculated on the basis of notional full sick pay.
In the event that, upon return from an approved period of time out of programme, the
continuity of service provisions mean an employee is eligible for maternity leave and pay.
However, the reference period for calculating maternity pay would mean the resulting value
of contractual maternity pay would be nil. The level of pay will be calculated from their last
paid employment in a training post held immediately prior to going out of programme.
61British Medical Association Junior doctors’ handbook on the 2016 contract
Unpaid contractual maternity leave
Employees will also be entitled to a further 13 weeks’ unpaid leave, bringing the total leave to
52 weeks.
Commencement and duration of leave
An employee may begin their maternity leave at any time between the 11th week before
the expected week of childbirth and the expected week of childbirth provided they give the
required notice.
Sickness prior to childbirth
If an employee is o work ill, or becomes ill, with a pregnancy-related illness during the
last four weeks before the expected week of childbirth, maternity leave will normally
commence at the beginning of the fourth week before the expected week of childbirth
or the beginning of the next week aer the employee last worked whichever is the later.
Absence prior to the last four weeks before the expected week of childbirth, supported
by a medical statement of incapacity for work, or a self- certicate, shall be treated as
sick leave in accordance with normal sick leave provisions. Where sickness absence is
unrelated to pregnancy, the normal sickness provisions will apply up until the date notied
for the start of maternity leave.
Odd days of pregnancy-related illness during this period may be disregarded if the
employee wishes to continue working until the maternity leave start date previously
notied to the employer.
Pre-term birth
Where an employee’s baby is born prematurely, the employee will be entitled to the same
amount of maternity leave and pay as if their baby was born at full term.
Where an employee’s baby is born before the 11th week before the expected week of
childbirth, and the employee has worked during the actual week of childbirth, maternity
leave will start on the rst day of the employee’s absence.
Where an employee’s baby is born before the 11th week before the expected week of
childbirth, and the employee has been absent from work on certied sickness absence
during the actual week of childbirth, maternity leave will start the day aer the day of
the birth.
Where an employee’s baby is born before the 11th week before the expected week
of childbirth and the baby is in hospital, the employee may split their maternity leave
entitlement, taking a minimum period of two weeks’ leave immediately aer childbirth and
the rest of their leave following their baby’s discharge from hospital.
Still birth
Where an employee’s baby is stillborn aer the 24th week of pregnancy, the employee will be
entitled to the same amount of maternity leave and pay as if the baby was not stillborn.
Miscarriage
Where an employee has a miscarriage before the 25th week of pregnancy, normal sick leave
provisions will apply as necessary.
Health and safety of employees pre- and post-birth
Where an employee is pregnant, has recently given birth, or is breastfeeding, the employer
should carry out a risk assessment of their working conditions. If it is found, or a medical
practitioner considers, that an employee or their child would be at risk were they to continue
with their normal duties, the employer should provide suitable alternative work, for which
the employee will receive their normal rate of pay. Where it is not reasonably practicable to
oer suitable alternative work, the employee should be suspended on full pay.
These provisions also apply to an employee who is breastfeeding if it is found that their
normal duties would prevent them from successfully breastfeeding their child.
62 British Medical Association Junior doctors’ handbook on the 2016 contract
Return to work
An employee who intends to return to work at the end of their full maternity leave will not
be required to give any further notication to the employer, although if they wish to return
early, they must give at least 28 days’ notice.
An employee has the right to return to their job under their original contract and on no less
favourable terms and conditions.
Returning on exible working arrangements
If at the end of maternity leave the employee wishes to return to work on dierent hours, the
NHS employer has a duty to facilitate this wherever possible, with the employee returning
to work on dierent hours in the same job. If this is not possible, the employer must provide
written, objectively justiable reasons for this and the employee should return to their
original contractor to a post at the same grade and work of a similar nature and status to that
which they held prior to their maternity absence.
If it is agreed that the employee will return to work on a exible basis, including changed or
reduced hours, for an agreed temporary period, this will not aect the employee’s right to
return to their job under their original contract at the end of the agreed period.
Sickness following the end of maternity leave
In the event of illness following the date the employee was due to return to work, normal sick
leave provisions will apply as necessary.
Failure to return to work
If an employee who has notied their employer of their intention to return to work for the
same or a dierent NHS employer in accordance with the regulations fails to do so within
15 months of the beginning of their maternity leave, they will be liable to refund the whole
of their maternity pay, less any SMP, received. If there is no right of return to be exercised
because the contract would have ended if pregnancy and childbirth had not occurred, the
repayment provisions set out above will not apply. In cases where the employer considers
that to enforce this provision would cause undue hardship or distress, the employer will have
the discretion to waive their rights to recovery.
Employees not returning to NHS employment
An employee who satises the required eligibility conditions but who does not intend to
return to work with the same or another NHS employer for a minimum period of three
months aer their maternity leave is ended, will be entitled to pay equivalent to SMP, which is
paid at 90 per cent of their average weekly earnings for the rst six weeks of their maternity
leave and to a at rate sum for the following 33 weeks.
Employees with less than 12 months’ continuous service
If an employee does not satisfy the eligibility conditions for contractual maternity pay, they
may still be entitled to SMP. SMP will be paid regardless of whether they satisfy the eligibility
conditions above. If their earnings are too low for them to qualify for SMP, or they do not
qualify for another reason, they should be advised to claim MA from their local Job Centre
Plus or social security oce.
Fixed-term contracts or training contracts
Employees subject to xed-term or training contracts which expire aer the 11th week
before the expected week of childbirth, and who satisfy the required conditions, shall have
their contracts extended so as to allow them to receive the 52 weeks, which includes paid
contractual and statutory maternity leave and the remaining 13 weeks of unpaid maternity
leave. Absence on maternity leave (paid and unpaid) up to 52 weeks before a further NHS
appointment shall not constitute a break in service.
Employees on xed-term contracts who do not meet the 12 months’ continuous service
condition set out above may still be entitled to SMP.
63British Medical Association Junior doctors’ handbook on the 2016 contract
Rotational training contracts
Where an employee is on a planned rotation of appointments with one or more NHS
employers as part of an agreed programme of training, they shall have the right to return to
work in the same post or in the next planned post irrespective of whether the contract would
otherwise have ended if pregnancy and childbirth had not occurred. In such circumstances,
the employee’s contract will be extended to enable the doctor to complete the agreed
programme of training.
Contractual rights
During maternity leave (both paid and unpaid), an employee retains all of their contractual
rights, except remuneration.
Salary advancement
Maternity leave, whether paid or unpaid, will not be considered in the criteria for
advancement to a higher nodal pay point, and will result in a delay in the time taken to
progress between pay points.
Accrual of annual leave and public holidays
Annual leave will accrue during maternity leave, whether paid or unpaid. Where the amount
of accrued annual leave would exceed normal carry over provisions, it may be mutually
benecial to both the employer and employee for the employee to take annual leave before
and/or aer the formal (paid and unpaid) maternity leave period. The amount of annual
leave to be taken in this way, or carried over, should be discussed and agreed between the
employee and the employer.
Public holidays will also accrue during maternity leave.
Pensions
Pension rights and contributions shall be dealt with in accordance with the provisions of the
NHS Superannuation Regulations.
Ante-natal care
Pregnant employees have the right to paid time o for ante-natal care. Ante-natal care may
include relaxation and parentcra classes, as well as appointments for ante-natal care.
The pregnant employee’s partner is entitled to unpaid leave to attend two ante natal
appointments. Unpaid leave, up to a maximum of six and a half hours per appointment can
be accessed.
Post-natal care and breastfeeding mothers
Employees who have recently given birth should have the right to paid time o for post-natal
care. Employers are required to undertake a risk assessment and to provide breastfeeding
employees with suitable private rest facilities, and should consider requests for exible
working arrangements to support breastfeeding employees at work.
Continuous service
For the purposes of calculating whether the employee meets the 12 months’ continuous
service with one or more NHS employers qualication set out above, the following provisions
shall apply:
– NHS employers includes health authorities, NHS Boards, NHS Trusts, primary care
organisations and the Northern Ireland Health Service
– a break in service of three months or less will be disregarded (though not count
as service).
64 British Medical Association Junior doctors’ handbook on the 2016 contract
The following breaks in service will also be disregarded (though not count as service):
– employment under the terms of an honorary contract.
– employment as a locum with a GP (general practitioner) for a period not exceeding
12 months.
– a period of up to 12 months spent abroad as part of a denite programme of postgraduate
training on the advice of the postgraduate dean or college or faculty adviser in the
specialty concerned.
– a period of voluntary service overseas with a recognised international relief organisation
for a period of 12 months which may exceptionally be extended for 12 months at the
discretion of the employer which recruits the employee on their return.
– absence on an employment break scheme in accordance with the provisions of the
hospital terms and conditions of service.
– absence on maternity leave (paid or unpaid) as provided for above.
If your break in service is not covered by the list above but spans a period approved as an
OOPE (Out of Programme Experience for Clinical Experience), it may also be possible to have
it disregarded. If you are in this situation, contact the BMA for advice.
Employment as a trainee with a general medical practitioner in accordance with the
provisions of the Trainee Practitioner Scheme shall similarly be disregarded and will count
as service.
Employers have the discretion to count other previous NHS service or service with other
employers, and to extend the periods specied above.
University or honorary contracts
Doctors holding university and NHS honorary contracts will be subject to the maternity
leave scheme that is in operation at their place of employment. A university contract, with
or without an NHS honorary contract, does not count as continuous service under the NHS
maternity scheme.
However, where an employee has a university contract with an NHS honorary contract this
period of employment will not constitute a break in service, although it cannot be counted
towards service for the purposes of further maternity leave.
Unfair dismissal
Regardless of length of service or hours of work, it is unlawful for an employer to dismiss an
employee or to select them for redundancy, solely or mainly because they are pregnant or
have given birth, or for any other reason connected with their pregnancy or childbirth.
Defence body and professional subscriptions
Doctors who take parental leave should contact the bodies they hold subscriptions with, as
special benecial arrangements oen apply.
Further information
Further guidance on maternity leave and pay, including specic guidance for junior doctors,
can be found on the BMA website: bma.org.uk/pay-and-contracts/maternity-paternity-and-
adoption/nance/your-maternity-leave-entitlements-under-the-nhs-scheme. If you feel
that you are being denied your employment rights, contact our team of advisers on 0300
123 1233 in the rst instance. They will assess your circumstances and provide support. If
necessary, they will arrange for local representation.
65British Medical Association Junior doctors’ handbook on the 2016 contract
Paternity leave
NHS scheme
The scheme applies equally to biological and adoptive fathers, nominated carers and same-
sex partners.
Eligibility
Employees must have 12 months’ continuous service with one or more NHS employers at
the beginning of the week in which the baby is due in order to qualify for the NHS paternity
leave scheme. More favourable local arrangements may be agreed with sta representatives
and/or may be already in place.
Benets
The occupational paternity scheme entitles you to two weeks’ leave at full pay, less any
statutory paternity pay (SPP) for which you are eligible.
Full pay will be calculated on the basis of the average weekly earnings rules used for
calculating occupational maternity pay entitlements, which reects the statutory maternity
pay entitlements calculation method. Only one period of occupational paternity pay is
ordinarily available when there is a multiple birth. However, NHS organisations have scope
for agreeing more favourable arrangements on an individual basis where they consider it
necessary, or to arrange for further periods of unpaid leave.
Local arrangements should specify the period during which leave can be taken, and whether
it must be taken in a continuous block or may be split up over a specic period.
An employee must give their employer a completed form SC3 ‘Becoming a parent’ at least
28 days before they want leave to start. The employer should accept later notication if
there is good reason.
Reasonable paid time o to attend ante-natal classes will also be given.
Statutory scheme
Those with insucient NHS service to qualify for the occupational scheme may still be
eligible for the statutory paternity pay scheme, as set out on the government website.
Eligibility
Employees must satisfy the following conditions in order to qualify for paternity pay and
leave. They must:
– have or expect to have responsibility for the child’s upbringing.
– be the biological father of the child or partner of the mother, or the intended parent in the
case of surrogacy.
– have worked continuously for the same employer for 26 weeks ending with the 15th week
before the baby is due, or be employed up to and including the week your partner was
matched with a child for adoption.
– must be earning an average of the lower earnings limit a week (before tax).
Employers can ask their employees to provide a self-certicate form SC3 (becoming a
parent) as evidence that they meet these eligibility conditions.
Length of paternity leave
Eligible employees can choose to take either one week or two consecutive weeks of
paternity leave (not odd days). They can choose to start their leave:
– from the date of the child’s birth (whether this is earlier or later than expected); or
– from a chosen number of days or weeks aer the date of the child’s birth (whether this is
earlier or later than expected); or
– from a chosen date later than the rst day of the week in which the baby is expected
to be born.
66 British Medical Association Junior doctors’ handbook on the 2016 contract
Leave can start on any day of the week on or following the child’s birth, but must be
completed within 56 days of the actual date of birth of child; or if the child is born early,
within the period of the actual date of birth up to 56 days aer the expected week of birth.
Only one period of leave is available to employees, irrespective of whether more than one
child is born as the result of the same pregnancy.
Statutory paternity pay
During their paternity leave, most employees are entitled to statutory paternity pay (SPP)
from their employers.
SPP is paid by employers for either one or two consecutive weeks as the employee has
chosen. The rate of SPP is the same as the standard rate of SMP.
Notice of intention to take statutory paternity leave
Employees must inform their employers of their intention to take paternity leave by the end
of the 15th week before the baby is expected, unless this is not reasonably practicable. They
must tell their employers:
– the expected week the baby is due.
– whether they wish to take one or two weeks’ leave.
– when they want their leave to start.
Employees can change their mind about the date on which they want their leave to start,
providing they tell their employer at least 28 days in advance (unless this is not reasonably
practicable). Employees must tell their employers the date that they expect any payments of
SPP to start at least 28 days in advance, unless this is not reasonably practicable.
Self-certicate
Employees must give their employers a completed self-certicate as evidence of their
entitlement to SPP. A model self-certicate for employers and employees to use is available
on the BIS website. Employers can also request a completed self-certicate as evidence
of entitlement to paternity leave. The self-certicate must include a declaration that the
employee meets certain eligibility conditions, and must provide the information specied
above as part of the notice requirements.
By providing a completed self-certicate, employees will be able to satisfy both the notice
and evidence conditions for paternity leave and pay. Employers will not be expected to carry
out any further checks.
Contractual benets
Employees are entitled to the benet of their normal terms and conditions of employment,
except for terms relating to wages or salary (unless their contract of employment provides
otherwise), throughout their paternity leave. However, most employees will be entitled to
SPP for this period. If the employee has a contractual right to paternity leave as well as the
statutory right, they may take advantage of whichever is the more favourable. Any paternity
pay to which they have a contractual right reduces the amount of SPP to which they
is entitled.
Return to work aer paternity leave
Employees are entitled to return to the same job following paternity leave.
Protection from detriment and dismissal
Employees are protected from suering unfair treatment or dismissal for taking, or seeking
to take, paternity leave. Employees who believe that they have been treated unfairly should
contact the BMA for advice.
Employers recovery of payments
Employers can recover the amount of SPP they pay out in the same way as they can claim
back SMP. Employers can claim back 92 per cent of the payments they make, with those
eligible for small employers relief able to claim back 100 per cent plus an additional amount
in compensation for the employers portion of national insurance contributions paid on SPP.
67British Medical Association Junior doctors’ handbook on the 2016 contract
Further information
Further guidance on paternity leave can be found on the BMA website: bma.org.uk/pay-and-
contracts/maternity-paternity-and-adoption/leave/paternity-leave-for-doctors.
Shared parental leave
Shared parental leave provides eligible parents, of either sex, greater exibility in how they
share the care of their child in the rst year following birth or adoption. You can use shared
parental leave all in one go or take blocks of leave between periods of work. You can choose
to be o work at the same time as the other parent or choose to stagger the leave and pay
between you.
Shared parental leave is a statutory right, meaning that everyone who is eligible can claim
it, regardless of their particular terms and conditions of service. However, as part of the
2018 review the BMA negotiated for junior doctors to have access to the NHS Sta Terms
and Conditions of Service provisions for enhanced shared parental leave and pay; these
provisions mark a signicant improvement to statutory provisions.
Entitlements under the occupational scheme
Entitlements for shared parental leave
Employees can choose to end their maternity or adoption leave early to access shared
parental leave. All employees will have the right to take 50 weeks of shared parental leave
(minus any maternity or adoption leave already taken).
Shared parental leave can be taken at any time within one year from the birth or placement
for adoption, providing the compulsory two weeks’ maternity or adoption leave has
been taken.
Entitlements for shared parental pay
The entitlement to Shared Parental Pay is that proportion of maternity or adoption pay not
already taken. Where such pay (excluding pay during the compulsory two-week maternity/
adoption leave period) has been received by either parent, the maximum joint entitlement
set out below will reduce proportionate to the amount of maternity or adoption pay which
has either been taken and paid to either parent.
It is also a requirement that employees return to work for the NHS for a minimum of three
months aer the ShPL period; failure to do so is likely to mean having to repay the entire
shared parental pay.
Process for taking shared parental leave
In order to access enhanced shared parental leave employees will be required to complete
the appropriate forms produced by ACAS and available on the Government website (see
resources section). Some employers may provide their own standard forms for employees
to use.
To start shared parental leave, the mother or primary adopter must either return to work
following maternity or adoption leave, or provide notice conrming that they intend to bring
their maternity or adoption leave and pay entitlements to an early end.
Following notication of their intention to take shared parental leave, an employee should
provide a minimum of eight weeks’ notice to book a period of leave. An employee can
provide up to three notices to book leave. This includes notices to vary a previously agreed
pattern of leave. Each of the three notices to book leave may include a single, continuous, or
discontinuous block of leave. Requests for single blocks of leave cannot be refused, though
employers are not bound to agree to discontinuous leave pattern.
To be eligible for NHS occupational shared parental leave provisions, it is not a requirement
for both partners to work for the NHS. When a couple is considering using shared parental
leave, they should assess and compare the shared parental leave provisions of both of their
employers, if not both working for the NHS, as the non-NHS employer may have a more or
less favourable shared parental leave policy.
68 British Medical Association Junior doctors’ handbook on the 2016 contract
NHS Employers guidance provides examples of how leave could be shared, for further details
please see the link in the resources section.
Eligibility
To qualify for shared parental leave you must share responsibility for raising the child at the
time of birth or adoption with the other birth parent or adopter or your partner (married, civil
partner or co-habiting).
To be eligible for shared parental leave you must:
– be an employee with a minimum of 26 weeks’ service with your employer by the end of
the 15th week before the due date or matching date for adoption and meet the minimum
earnings threshold.
– the other parent must also meet the statutory ‘employment and earnings test’ by being
an employed in the UK for a total of 26 weeks (not necessarily continuously) in the 66
weeks preceding the week the child is due to be born or matched for adoption. The other
parent must have earned at least an average of £30 (gross) a week in 13 of those 26 weeks
(not necessarily continuously).
Continuous service for the purposes of qualifying for leave includes service with one or more
NHS employers.
For more detail and to check whether you meet the statutory requirements visit Gov.uk
eligibility checker.
Breaks in service
As per paragraph 15.106 of the NHS Sta TCS, the following breaks in service won’t aect
your eligibility for ShPL but don’t count towards your total NHS continuity of service for
other entitlements:
– a break in service of three months or less
– employment under the terms of an honorary contract
– employment as a locum in a general practice setting for a period not exceeding
12 months
– a period of up to 12 months spent abroad as part of a denite programme of postgraduate
training on the advice of the postgraduate dean or college or faculty advisor in the
speciality concerned
– a period of voluntary service overseas with a recognised international relief organisation
for a period of 12 months, which may exceptionally be extended for 12 months at the
discretion of the employer which recruits the employee on their return
– absence on an employment break scheme in accordance with the provisions of Section
34 of this Handbook
– absence on maternity leave, adoption leave, or shared parental leave (paid or unpaid)
– for doctors and dentists in training, time spent outside of NHS employment in an Out of
Programme (OOP) placement approved by the Postgraduate Dean
– for doctors and dentists in training, time spent employed in the health service of a UK
Crown Dependency as part of an approved training programme
Insucient continuous service due to rotation
The NHS Terms and Conditions of Service Handbook (15.88) claries the process for when
an employee changes employer because their training programme has required them to do
so, and this means they do not have enough statutory continuous service with their current
employer to access statutory shared parental pay. Provided that an employee would have
otherwise had sucient statutory continuous service, the value of statutory shared parental
pay must be paid by their current employer.
69British Medical Association Junior doctors’ handbook on the 2016 contract
Shared Parental Leave in Touch Days or ‘SPLiT Days’
SPLiT days are intended to facilitate a smooth return to work for employees returning from
shared parental leave. To enable employees to take up the opportunity to work SPLiT days,
employers should consider the scope for reimbursement of reasonable childcare costs or
the provision of childcare facilities.
An employee may work up to a maximum of twenty SPLiT days without bringing their shared
parental leave to an end. Any days of work will not extend the shared parental leave period.
This will enable employees on shared parental leave to work either continuously or on odd
days without bringing an end to their shared parental leave and pay.
Any SPLiT days are voluntary and to be negotiated with the employer and paid at the basic
hourly rate for the hours worked, less any SPL pay. Time o in lieu must be arranged on the
return to work, for a full day or a half day, depending on when the work is done.
Further information
Gov UK applying for leave and pay (form)
NHS Employers occupational shared parental leave guidance
NHS Sta Handbook Section 15: leave and pay for new parents
70 British Medical Association Junior doctors’ handbook on the 2016 contract
17. Sick leave
Summary
This chapter provides details on sick leave allowances, including the scale of the
allowance, the calculation of allowances, notication of sickness and statutory
sick pay.
Scale of allowance
Junior doctors absent from duty owing to illness, injury or other disability receive the
following sick leave allowances.
During the rst year of service
one month’s full pay and two months’ half
pay
During the second year of service
two months’ full pay and two months’ half
pay
During the third year of service
four months’ full pay and four months’ half
pay
During the fourth and h years of service
ve months’ full pay and ve months’ half
pay
Aer completing ve years of service six months’ full pay and six months’ half pay
Full pay will include regularly paid enhancements, allowances, premia and London weighting
based on the previous three months at work, or any other reference period that may be
locally agreed.
Employers can extend these allowances in exceptional cases. Because these periods
are relatively short, junior doctors should also seek independent nancial advice on
income protection.
Calculation of allowances
The amount of sick leave allowance, and the period for which it is to be paid, are worked
out by taking the junior doctor’s sick leave entitlement as on the rst day of sickness and
subtracting the total sick leave taken in the 12 months prior to the current absence. When
calculating total periods of absence, days taken as unpaid sick leave are not counted towards
the nal gure. Specic conditions apply to absence due to injury, disease or other health
conditions resultant through the discharge of duties in employment, and injury resulting
from a violent crime. For the purposes of calculation of the allowance, 26 working days are
equivalent to ‘one month’.
Previous qualifying service
All previous NHS service, (including continuous NHS locum service exceeding 3 months),
university, local authority or civil service employment without any break of more
than 12 months, is aggregated for sick leave purposes. There are several exceptional
circumstances in which a break of more than 12 months does not mean a break in
previous qualifying service.
Where a junior doctor on a recognised training programme goes overseas or on an out
of programme appointment for clinical training (OOPT), clinical experience (OOPE) or
research (OOPR), their previous NHS or other approved service should be taken fully into
account in assessing entitlement to sick leave allowance. This is provided that the employer
considers that there has been no unreasonable delay between the training abroad or out of
programme appointment ending, and the commencement of the subsequent NHS post.
Limitation of allowance when insurance or other benet is payable
Sickness allowance, when added to sickness benet, severe disablement allowance,
invalidity benet, statutory sick pay, compensation payments or other social benets
receivable, may not exceed the junior doctor’s normal salary for the period, and the
occupational sick leave allowance would be restricted accordingly.
71British Medical Association Junior doctors’ handbook on the 2016 contract
Notication of sickness
A junior doctor who is incapable of working because of illness should as soon as practicable
notify their employer under the circumstances specied by the employer. If the sickness
absence continues beyond the third calendar day, the doctor must submit a statement of
the nature of the illness within the rst seven calendar days of absence. Further statements
must be submitted to cover any absence extending beyond the rst seven calendar days.
They should take the form of medical certicates completed by a doctor, other than the
sick doctor. Exceptionally, the employer may require statements to be submitted at more
frequent intervals.
A junior doctor admitted to hospital must submit a doctor’s statement on entry and on
discharge in substitution for periodical statements. However, if the period of absence is less
than seven calendar days, only a self-certicate is required.
‘Fit notes’ have now replaced sickness certicates. If you have any concerns about your sick
leave or payment during this period, contact our team of advisers on 0300 123 1233.
Injury sustained on duty
It is important to note that a period of absence due to injury that is sustained by junior
doctors in the actual discharge of their duties, and is not their own fault, is not recorded
for the purpose of the scheme. It is essential that all such injuries are recorded at the rst
opportunity in the accident book or other mechanism for recording adverse incidents that
may be in place.
Termination of employment
When a junior doctor is receiving the sick leave allowance at the time of expiry of their
contract in a regular appointment, the allowance continues to be paid during the illness,
i.e. aer the contract would have been terminated, subject to the maximum entitlements
set out in the ‘Scale of allowances’ section. This is an important provision of the sick pay
arrangements, which is oen overlooked by employers.
Accident due to sport or negligence
Sickness allowance is not paid in a case of accident due to active participation in sport as
a profession, or in a case in which contributory negligence is proved, unless the employer
decides otherwise.
Recovering damages from a third party
A junior doctor who is absent as a result of an accident is not entitled to an allowance if
damages are recoverable from a third party, but the employer may advance to the junior
doctor a sum not exceeding the sickness allowance which would have been payable, subject
to the junior doctor undertaking to refund any damages received.
Where a refund is made in full, the period of absence does not count against the sick leave
entitlement. These provisions do not apply to compensation awarded by the Criminal
Injuries Compensation Authority.
Medical examination
The employer may at any time require a junior doctor who is unable to perform their duties
as a result of illness to submit to an examination by a doctor nominated by the employer.
Forfeiture of rights
If it is reported to the employer that a junior doctor has failed to observe the conditions of
this scheme, or has been guilty of conduct prejudicial to their recovery, and the employer
is satised that there is substance in the report, the payment of the allowance can be
suspended until the employer has made a decision. Before making a decision, the employer
must advise the doctor of the terms of the report, and provide an opportunity for the doctor
to submit their observations and appear or be represented at a hearing.
72 British Medical Association Junior doctors’ handbook on the 2016 contract
SSP (statutory sick pay)
SSP is paid by the employer to employees. The sick pay paid by an employer will usually
include both SSP and occupational sick pay entitlements. Where a doctor is entitled to
occupational sick pay allowance equivalent to half pay and to SSP, the occupational sick pay
allowance is increased by an amount equivalent to the amount of SSP due, except that the
sum of the occupational sick pay allowance and SSP payable should not exceed the doctor’s
normal pay for the period.
Medical academic doctors
For trainees employed by higher education institutions, the policies concerning sickness
absence (including any qualifying period of service that may apply) are determined by
the university employer, who should be informed as soon as practicable according to
local arrangements.
Carrying over annual leave as a result of sickness related absence
Doctors unable to take their statutory annual leave allowance as a result of sickness related
absence are permitted to carry over the remaining leave to a subsequent leave year where
employment is continuous. The leave must be used within 18 months from the end of the
leave year from which it was carried over. Where the doctor changes employer before taking
this entitlement, the leave will be compensated through pay. This provision only applies to
leave within the statutory entitlement. Any additional allowance exceeding this will lapse if it
is not taken within the leave year in which it accrues.
Further information
Terms and conditions of service, schedule 10 paragraphs 44-68.
NHS terms and conditions of service handbook (amendment number 41) 2015, section 14 &
22 www.nhsemployers.org/tchandbook.
Employment Relations Act 1999: www.legislation.gov.uk/ukpga/1999/26/contents
Maternity and Parental Leave Regulations 1999 amended by Maternity and parental leave
(amendment) Regulations 2002 and 2001: www.legislation.gov.uk/uksi/1999/3312/
contents.
73British Medical Association Junior doctors’ handbook on the 2016 contract
18. NHS pension scheme
Summary
This chapter provides an overview of the new NHSPS (NHS Pension Scheme), which
was introduced on 1 April 2015. Most junior doctors will join this new scheme (unless
they had membership of either the 1995 or 2008 sections of the NHS pension scheme
previously and were within 13.5 years of the section’s relevant normal pension age as
at 1 April 2012), and all new employees will enter the new scheme automatically unless
they opt-out.
On 1 April 2015, the new NHSPS (NHS Pension Scheme) was introduced for all new
employees, and all current employees more than 13.5 years from normal pension age. All
new employees will be automatically enrolled into the scheme on commencement
of employment.
The scheme provides career average revalued earnings, meaning that each year 1/54
(equivalent to 1.85%) of the pensionable earnings accrue towards the pension. It is
necessary to have in place a mechanism for revaluing previous years’ earnings so that they
do not lose value. Each year’s accrual is revalued by the Consumer Prices Index plus 1.5%.
The total of all the annual pension accrual amounts are added together at retirement to
calculate the nal pension.
Under this scheme, the pensionable age is linked to the state pension age. Please therefore
refer to the government state pension age calculator to nd out when you would be eligible
to receive your NHS pension.
Example
If you earn £75,000 in pensionable income this year and the CPI rate is 3%, your pension
accrual for this year would be 1/54 x £75,000 = £1,389. This accrual would be increased by
the revaluation rate (CPI 3% + 1.5%) to £1,452. Every year, the total of the previous years’
pension accrual will be increased by the relevant rate for that year.
Comprehensive information is available on the NHS Business Services Authority website,
including how the 2015 pension scheme will aect you, how it is dierent to the existing
scheme, and information about opting-out.
The following will be pensionable in the NHS Pension Scheme:
– all hours worked up to 40 hours per week on average and paid at the basic pay rate.
– London weighting.
– pay protection amounts as described in Schedule 2 paragraphs 48-61.
If you have not been able to nd the answer you need on our website’s guidance pages, you
can contact the BMA’s pensions department if you need further help at
74 British Medical Association Junior doctors’ handbook on the 2016 contract
19. Travelling and other expenses
Summary
This chapter covers the expenses that junior doctors are entitled to claim in respect of
travel on NHS business. It explains the NHS lease car system, and the reimbursement
rates for subsistence when doctors are away from home on NHS business.
References are made throughout this section to paragraphs in the NHS Terms and
Conditions of Service Handbook.
Junior doctors who are required to travel on NHS business are entitled to receive certain
mileage allowances, or may be oered a lease car. The circumstances under which juniors
may receive mileage allowances are set out in Schedule 12 of the Terms and Conditions of
Service and the NHS Terms and Conditions of Service Handbook. The following is a brief
summary of the provisions.
Junior doctors working in the NHS who are required by their employer to travel on ocial
business receive mileage allowances for the following journeys:
– principal hospital to any destination on ocial business.
– home to principal hospital, when the junior doctor is called out in an emergency.
– home to principal hospital in certain other circumstances when there is a subsequent
ocial journey.
– home to any destination other than the principal hospital, on ocial business, subject to
certain conditions.
The mileage payable for such journeys is usually subject to a maximum allowance. Schedule
12, paragraph 15 of the terms and conditions of service sets out the entitlement in detail.
Further information
Terms and Conditions of Service, Schedule 12.
NHS Terms and Conditions of Service Handbook, Section 17: www.nhsemployers.org/
tchandbook.
NHS Employers’
Guidance for GP trainee mileage.
GP trainee home-to-base mileage
Doctors working in a GP practice setting who are required to use their own vehicle on the
expectation that home visits may be required to be undertaken shall be reimbursed for the
cost of mileage from home to principal place of work, and any associated allowances.
Further information
Terms and Conditions of Service, Schedule 12, paragraphs 16 and 23.
NHS Employers GP trainee mileage guidance: www.nhsemployers.org/pay-pensions-and-
reward/medical-sta/doctors-and-dentists-in-training/2018-review-of-the-junior-doctor-
contract/guidance-for-gp-trainee-mileage.
Rates of mileage allowances
Junior doctors who use their own car on NHS business are entitled to reimbursement
at the appropriate rates shown in Table 7, Section 17 of the NHS Terms and Conditions
of Service Handbook.
This rate will be reviewed each year soon aer the new AA guides to motoring costs
are published, normally in April or May. You should therefore check the NHS Terms and
Conditions of Service Handbook to ensure your reimbursement rate is up to date.
Insurance
Junior doctors who use their own car on NHS business should ensure that the car is
insured for business use.
You need business car insurance if you are using your car during work hours. Business
use doesn’t include commuting to and from work, but travelling between dierent work
locations or driving to see patients would be classed as business use.
75British Medical Association Junior doctors’ handbook on the 2016 contract
Reserve rate of reimbursement
The reserve rate of reimbursement, 28 pence per mile, as set out in Table 7 above will apply if
a junior doctor uses their own vehicle for business purposes in the following situations:
– when suitable public transport (eg rail or bus) is available, subject to a maximum of the
public transport cost which would have been incurred, and in accordance with the rules
on eligible miles in paragraph 15, schedule 12 of the 2016 TCS and table 8 in Section 17 of
the NHS Terms and Conditions of Service Handbook.
– when a doctor is required to return to work on any day and thereby incurs additional travel
to work expenses.
– If a doctor unreasonably declines the employer’s oer of a lease vehicle. In this situation,
reasonableness should be determined by a joint agreement between the employer and
doctor as to whether a lease vehicle is appropriate, and the timeframe for which the new
arrangements will apply. All the relevant circumstances of the doctor and employer will
be considered, including the doctor’s personal need for a particular type of car and the
employer’s need to provide a cost eective option.
For the agreed principles underlying local lease vehicle policies, see Annex 13 of the NHS
Terms and Conditions of Service Handbook.
If an employee uses public transport for business purposes, the cost of bus fares and
standard rail fares should be reimbursed.
In all other circumstances, the standard rates apply.
Carriage of ocial passengers
A junior doctor carrying passengers who are employed by an NHS employer on NHS
business, is entitled to receive a passenger allowance, at the rate outlined in Table 7 in the
NHS Terms and Conditions of Service Handbook.
Garage expenses, tolls and ferries
Garage and parking expenses, and charges for tolls and ferries, will be reimbursed to junior
doctors using their cars on ocial business on the production of receipts, whenever these
are available. Overnight garaging or parking charges will only be reimbursed if the junior
doctor is entitled to night subsistence allowance. This does not include reimbursement of
parking charges incurred as a result of attendance at the doctor’s principle place of work.
Pedal cycles
Ocial journeys undertaken by pedal cycle attract expenses at 20 pence per eligible mile.
The Crown/lease car scheme
A Crown or lease car is any vehicle owned or contract-hired by an employer. The Crown/lease
car scheme was introduced for hospital doctors in 1990. Although the outline of the scheme
has been agreed nationally and is applicable to all employers, it is operated locally and may
vary considerably between employers.
Eligibility
The default position is that junior doctors will use their own vehicles for travel in the
performance of their duties, except where the employer has made a specic alternative
provision. Use of a lease vehicle should be considered whenever it is expected that the
business miles travelled in a year will exceed 3,500 miles.
Junior doctors are not automatically entitled to a lease car, but may be oered one if the use
of a vehicle is essential to the job. The details of written lease vehicle policies are for local
partnerships to design and agree.
Types of car
If a junior doctor chooses a vehicle not on the employer’s list of approved vehicles, any
excess costs compared with the use of the approved vehicle are met by the individual
junior doctor.
76 British Medical Association Junior doctors’ handbook on the 2016 contract
The arrangements for reimbursing junior doctors the costs of using the vehicle on NHS
business must be made clear to the doctor. If the doctor is reimbursed fuel costs at a rate per
mile, this rate must be reviewed regularly to ensure that it takes into account uctuations on
fuel prices.
Implications of declining a lease car
A junior doctor may be asked to have a lease car by an employer as it is more economical for
them to provide a car rather than reimburse travelling expenses at standard rate. If the junior
doctor unreasonably declines the request, they will be reimbursed at a reserve rate set out in
table 7 of the NHS Sta Handbook.
Taxation
As far as HM Revenue & Customs is concerned, private use of Crown/lease cars constitutes
a tax benet, and their treatment is therefore the same as a company car given to any
employee. Junior doctors interested in Crown/lease cars should be aware that the scheme
will only be economically advantageous to some individuals, depending on variables such as
private and business mileage, size of car, and the tax position. They are therefore advised to
proceed with caution. BMA members should seek advice from our team of advisers on
0300 123 1233 and/or their accountant.
Further information
Terms and Conditions of Service, Schedule 12 paragraphs 8 & 17.
NHS Terms and Conditions of Service Handbook, Annex 13: www.nhsemployers.org/
tchandbook.
Subsistence allowances
Subsistence allowances are payable in addition to travelling and other expenses when junior
doctors are required to be away from their home. For example, they can claim in relation to
periods of approved study leave, or in connection with removal expenses during a search for
suitable permanent accommodation in a new area, subject to the terms of the employer’s
removal expenses policy.
The following allowances are currently payable:
Night subsistence – commercial accommodation
When a junior doctor stays overnight in a hotel or other commercial accommodation with
the agreement of the employer, the overnight costs will be reimbursed as follows:
– the actual receipted cost of bed and breakfast up to a normal maximum limit of £55; plus
– a meal allowance of £20 to cover the cost of main evening meal and one other
daytime meal.
In exceptional circumstances where the maximum limit is exceeded (eg the choice of
hotel was not within the claimant’s control or cheaper hotels were fully booked), additional
assistance may be granted at the discretion of the employer.
Night subsistence – non-commercial accommodation
Where a junior doctor stays for short overnight periods with friends or relatives, a at rate of
£25 is payable. This includes an allowance for meals. No receipts are required.
Junior doctors staying in accommodation provided by the employer or host organisation are
entitled to an allowance to cover meals which are not provided free of charge up to £20.
Where accommodation and meals are provided without charge, an incidental expenses
allowance of £4.20 is payable. All payments of this allowance are subject to the deduction of
income tax and NI through the payroll system.
Travelling overnight
The cost of a sleeping berth (rail or boat) and meals, excluding alcoholic drinks, will be
reimbursed subject to the production of receipts.
Short-term temporary absence travel costs
Travel costs between the hotel and temporary place of work are reimbursed on an actual
costs basis.
77British Medical Association Junior doctors’ handbook on the 2016 contract
Day meal allowances
A meal allowance is payable when a junior doctor is absent from home and more than ve
miles from headquarters, by the shortest practical route, on the business of the employer.
The rates are as follows:
– lunch allowance – £5 (more than ve hours away from base including the lunchtime
between 12 noon and 2pm)
– evening meal allowance – £15 (more than 10 hours away from base, returning aer 7pm).
The above allowances are not paid where meals are provided free at the temporary place
of work.
A day meal allowance is only paid when a junior doctor spends more on a meal/meals than
would have been spent at the junior doctor’s headquarters. A junior doctor is required to
certify accordingly on each occasion for which a day meal allowance is claimed, but a receipt
is not required.
Junior doctors may qualify for both lunch and evening meal allowance in some
circumstances. There will be occasions where, due to the time of departure, it will be
necessary to take a meal but the conditions relating to the time absent from the base are
not met. This, and any other exception to the rules, may be met at the discretion of t
he employer.
Late night duties expenses
A junior doctor may also receive, in addition to a day meal allowance, an evening meal
allowance of £3.25. This is paid at the discretion of the employer and is subject to income tax
and NI contributions.
Receipts
The subsistence rates above are payable in full when junior doctors are away from home on
ocial business. There is no requirement under the NHS Terms and Conditions of Service
Handbook that sta should produce supporting vouchers/receipts, except in the case
of claims for very long absence allowance, overnight bed and breakfast costs, train meal
allowances or for abnormally high expenses. However, local policies (which do exist) may
require receipts, and the position should be checked before claiming.
Further information
Terms and Conditions of Service, Schedule 12, paragraphs 36-44.
NHS Terms and Conditions of Service Handbook, Annex 14: www.nhsemployers.org/
tchandbook.
Telephone and postage expenses
Any expenditure incurred by doctors on postage or telephone calls in the service of their
employer is reimbursed by the employer, subject to evidence of expenditure.
Further information
Terms and Conditions of Service, Schedule 12, paragraph 45.
78 British Medical Association Junior doctors’ handbook on the 2016 contract
20. Relocation and excess travel expenses
Summary
This chapter covers the expenses that junior doctors are entitled to claim when
moving to satisfy training needs, including the reimbursement of removal expenses,
legal costs and other services.
The principle behind the provision of relocation & excess travel expenses is that a trainee
should not be nancially disadvantaged by reasonable costs incurred through relocating
in fullling the requirements of their training. However, trainees are not expected to
prot materially from public funds used for reimbursement in respect of relocation and
associated expenses.
Relocation & excess travel expenses are a much underutilised entitlement that junior
doctors have. Given the personal nancial costs that trainees can incur from relocating and
travelling in pursuing their training. JDC highly recommends that junior doctors familiarise
themselves with their entitlements under relocation & excess travel expenses policies, to
ensure they are reimbursed for any eligible costs.
Introduction of National Relocation & Excess Travel Framework
There is now a national relocation & excess travel framework that has been agreed between
Health Education England and the BMA. This national framework replaced the previous
regional policies or local employer relocation & excess travel policies that existed.
Previously the scheme for reimbursement of removal expenses gave employers discretion
on the scope and level of removal expenses that they may reimburse. However, in many
regions and localities the BMA had negotiated and agreed policies for junior doctors at the
employer or within the region. In some regions have established removal expenses policies
covering all employers in the region.
In October 2019, HEE brought a proposal to the BMA to consider the development of a single
national framework for Relocation & Excess Mileage Arrangements for doctors and dentists
in training. This was supported in principle, as JDC was concerned by the lack of consistency
in provision between local / regional policies. This national approach provides clear,
reasonable and consistent assistance to all trainees who face the nancial costs of moving
house to take up training and who are disadvantaged as a result of training programmes
which cover large geographical areas.
Following HEE’s initial engagement with the BMA on a national level regarding the
introduction of this policy, signicant improvements were made to the policy to address the
concerns JDC had raised.
The implementation of the national policy occurred in November 2020, following
JDC’s approval.
The national policy replaced existing local policies or arrangements for doctors who started
new training programmes from August 2020 onwards. As a condition of JDC’s support for the
national policy, it was agreed that regional agreement by regional BMA structures – typically
Regional JDCs - would be required for the national policy to replace any existing regional
policies which covered trainees who began their programmes prior to August 2020.
Almost all regions in England have agreed that the national policy should replace the existing
regional / local policy for trainees who started a training programme in the region prior
to August 2020. Therefore, it is very likely that the below guidance is applicable to you,
however, if you are uncertain contact your local BMA representatives or advisors or your
employer’s medical stang department to receive conrmation.
Further information
HEE: New national arrangements for the payment of relocation and expenses costs.
BMA: Relocation expenses boost for juniors.
79British Medical Association Junior doctors’ handbook on the 2016 contract
Scope of National Framework
This national policy supports a trainee in moving into a HEE training region from other parts
of the country, or from a devolved nation, to take up a training programme or a trainee
already living in the region where they are training to move to a more central location which
facilitates commuting to the majority of the prospective educational placements on the
training programme.
Where a trainee relocates to a geographical location further away, in terms of travel time or
distance from their training place of work they will not be entitled to claim any additional
excess mileage incurred unless it can be demonstrated that the new residence is closer to
the majority of the remaining placements for their training programme.
The following groups are eligible to claim expenses under this framework:
– Medical Trainees from Foundation Year One onwards including trainees in academic
training programmes
– Dental Trainees from Dental Core Training onwards including trainees in academic
training programmes
– Public Health Trainees including trainees in academic training
Trainees who are on an out of programme (OOP) experience will not be eligible to claim
relocation, temporary accommodation or excess mileage payments whilst they are out of
programme but may claim expenses in order to support them returning to their training
programme. The exception to this is trainees on approved OOPT (Out of Programme for
Training) experience, who are able to claim expenses whilst on their OOP.
Trainees appointed to single-site training programmes (ie they do not change geographical
location during the entirety of the training programme) will not be eligible to claim excess
mileage payments, but can claim relocation expenses.
The national framework and the maximum nancial allowance payable do not include any
costs incurred as a result of accommodation provided following night duty shis and on
call commitments, etc which should be provided by the placement organisation under
appropriate Trust Health & Safety policies and in accordance with the requirements of
schedule 12 and 13 of the 2016 national Terms and Conditions of Service.
Total available allowance
The total maximum sum that you are able to claim up to throughout your training is £10,000.
This is for the entire period of your postgraduate training and is not proportioned for trainees
working less than full time. This maximum sum applies to all eligible expenses.
The maximum sum is based upon an assumption of 8 years reckonable service in any
approved HEE training programme.
Exceptions to the maximum allowance limit
Trainees who exceed this period of training, for example trainees whose CCT is awarded
aer completion of ST7/8 and trainees working less than full time, who have exhausted the
£10,000 maximum allowance will be entitled to continue to claim for excess mileage and/
or removal expenses, with the expectation that any claims they submit over and above the
maximum allowance will be treated in the same manner as those under submitted by the
trainee whilst under the £10,000 limit.
Individual trainees who can demonstrate exceptional circumstances, for example married or
cohabiting trainees who ‘shared’ removal costs; or signicantly long/expensive commutes
due to rotation placements or other exceptional personal circumstances (including trainees
with disabilities) will be able to apply for additional recompense via the Postgraduate Dean.
Where a trainee’s designated place of work for their current placement, or a prospective
placement, is changed due to reasons beyond the control of the trainee (eg reconguration
of services, removal of training places, redeployment due to emergency service pressures,
etc.), then any eligible relocation or excess travel expenses shall be reimbursed in
accordance but not count towards a trainee’s overall maximum expenses limit.
80 British Medical Association Junior doctors’ handbook on the 2016 contract
In adherence with the Armed Forces Covenant, any eligible costs incurred by a trainee due
to their, or their partner’s, active military service shall be claimable. Any expenses paid to a
trainee, which are related to military service, will not count towards an individual trainee’s
£10,000 maximum allowance.
Taxation of expenses
Expenses used for removal and relocation are exempt from income tax as per the relevant
HMRC guidance up to a maximum of £8,000 per claim.
Excess mileage claims will likely be subject to tax, as it is considered to represent ‘ordinary
commuting’. This may not be the case if you are employed under a lead employer model and
your excess mileage claims could be exempt from tax. Trainees should clarify their personal
position with their employer.
Please be aware that to be eligible for tax relief, your expenses must be incurred, or the
benets provided, before the end of the tax year following the one in which you start your
new job (a tax year runs from 6 April one year to 5 April the next).
Further information can be obtained from our team of advisers on 0300 123 1233. Your local
tax oce will also be able to help.
Further information
HMRC : www.gov.uk/expenses-and-benets-relocation.
www.gov.uk/hmrc-internal-manuals/employment-income-manual/eim61017.
Removal expenses
Eligibility criteria
In order to be eligible for removal expenses, trainees should relocate their primary residence
at least 30 miles from their old residence or at least one hour’s travel time, in normal trac,
and live within a ‘reasonable commute’ distance from the majority of the anticipated
prospective hospitals/placements on their training programme. A reasonable commute
distance is deemed to be no further than 20 miles in radius.
Where the rst placement of a trainee’s training programme is considered to be located on
the periphery of where the rest of the trainee’s placements are due to be, or anticipated to
be. Then the trainee will be eligible to claim removal expenses (up to a maximum of £500) if
they choose to relocate within 20 miles of their place of work for this rst placement. In this
scenario, a trainee’s residence does not need to be within 20 miles of the majority of the
placements for their training programme.
Eligible expenses
The property for which reimbursement of removal and associated expenses are being
claimed for should be of a broadly comparable standard.
Trainees who are buying their rst property or are moving from one rental property to
another can only claim the cost of removal of furniture and eects (up to a maximum of
£500) and for expenses relating to a search for accommodation. No other expenses will be
reimbursed in these circumstances. House purchase costs will not be reimbursed to rst
time buyers or applicants whose existing property is not being sold.
The above two limitations exist, as the purpose of the policy is not to support trainees in
getting on to the property ladder, but is rather to reimburse them for reasonable costs
they incur in the fullment of their training. Reimbursement of costs associated with the
purchase of a rst property, would be providing nancial assistance to trainees in getting on
to the property ladder, which they would not receive if they were in normal circumstances.
One failed purchase may be reimbursed where the trainee is not responsible for the
abandonment of the transaction, or the trainee’s withdrawal is entirely reasonable. However,
this reimbursement will be included in the maximum limit for reimbursement.
81British Medical Association Junior doctors’ handbook on the 2016 contract
Below is a list of the relocation expenses that can be claimed for, this is not an exhaustive list
and you should review the national policy to check whether you are eligible to claim
for a certain expense:
– Search for new accommodation
– Cost of two preliminary visits to the area of their new employment in search of
accommodation
– Expenses for preliminary visits may be reimbursed; accommodation and subsistence
for a maximum of four nights and return travel at public transport rate or standard rail
fare, for the trainee and their immediate family.
– House sale fees
– House purchase fees
– Storage costs
– Removal fees
– Travel expenses on removal
– Continuing commitments (eg ongoing mortgage / rent costs of old property up
to 12 mths)
– Nursery registration fees
– Re-direction of mail
Excess mileage expenses
Most training programmes will involve trainees working at numerous placements over a
period of many years which may cover a signicant geographical area and it is recognised
that it is not reasonable or practicable to expect trainees to relocate upon every rotation.
Therefore, the national framework allows trainees to claim for excess mileage expenses,
payable at the reserve rate – 28p per mile, incurred as a result of rotation.
Eligible mileage
Trainees can claim for mileage costs from home to the place of work less 17 miles each way.
Trainees are not eligible for reimbursement of mileage costs for the rst 17 miles of their
journey as this is not dened as ‘excess travel’.
GP trainees working in a GP practice setting who are claiming home to base mileage cannot
claim concurrently for excess mileage for the same mileage under this framework.
Trainees appointed to single-site training programmes are not eligible to claim excess
mileage as they are expected to live within a reasonable commute, less than 20 miles, of the
place of work.
Where a trainee’s permanent residence is outside of the relevant HEE regional footprint and
they choose not to relocate, there is no entitlement to excess mileage payments unless
it can be demonstrated that their residence is within reasonable commuting distance of
the majority of the placements on their training programme. Otherwise, agreement of
any nancial assistance will be subject to the agreement of the Postgraduate Dean on the
grounds of exceptional personal circumstances.
Trainees who use public transport for journeys can claim expenses based on the equivalent
mileage that would have been incurred if performing the journey by car. The trainee will be
reimbursed for the ‘excess mileage’ incurred as per the Reserve mileage rate.
Trainees who travel to work by bicycle, can claim excess mileage for journeys over and above
17 mile each way. Mileage will be payable at 20p per mile.
82 British Medical Association Junior doctors’ handbook on the 2016 contract
Cap on excess mileage
Excess mileage claims should be limited to 53 paid miles each way per day (ie a total journey
of 70 miles each way). It is however recognised that regional geographies and travel systems
as well as individual circumstances will vary and therefore trainees who wish to exceed these
normal limits should discuss their personal position with the employer in the rst instance.
Payment of excess mileage claims should not be agreed where, in the judgement of the
employer and following agreement with HEE via the Postgraduate Dean the journey time
and/or the distance involved exceeds the normal limit for daily commutes and is likely to
be detrimental to the safety of the trainee, and/or to the satisfactory performance of the
trainee’s duties/where patient safety will be aected.
Temporary accommodation
Where a trainee, who does commute long distances which are deemed to be acceptable
normally, identies a day, or a run of days, where they would prefer to stay in temporary
accommodation close to their place of work, in anticipation of working the next day, rather
than commuting back to their home they can claim for the cost of their normal return
journey excess mileage and use this to fund the cost of their accommodation for that
night(s). A trainee cannot claim twice.
Where daily travel distances are agreed to be excessive, temporary accommodation
expenses can be agreed. These expenses will be included within the maximum allowance
payable of £10,000 except in exceptional circumstances. The regional maximum monthly
allowances are set out below:
HEE Region Regional Temporary Accommodation Allowance
North West £735 / mth
North East & Yorkshire £680 / mth
Midlands £735 / mth
South West £715 / mth
South East £820 / mth
London £890 / mth
East of England £740 / mth
These maximum temporary accommodation allowances are calculated based upon the BCIS
(Building Cost Information Service) data for regional property rental costs.
Process for claiming expenses
You should complete the application form which will be available from your HEE Local Oce
Website and/or the employer. You should submit a request for conrmation of eligibility for
reimbursement as soon as possible and before incurring any costs.
Re-imbursement will not normally be made until you commence working in the
appointment. You should submit actual expenses claims within three months of the
expenditure being incurred.
Where a trainee has relocated, and incurred eligible expenses in advance of commencing
in a prospective training programme placement due to extraneous circumstances (eg
relocating from abroad, relocating in advance to align with school years, etc.), then a trainee
will be able to submit claims for eligible expenses within three months of commencing in
their post, rather than three months from when the expense was incurred.
Original receipts in respect of removal expenses will be required as proof of expenditure.
Reimbursement will not be made to third parties.
83British Medical Association Junior doctors’ handbook on the 2016 contract
Receipts are not required for excess mileage claims.
Trainees claiming reimbursement of excess mileage or temporary accommodation should
complete the relevant claim form on a monthly basis. Claim forms will be available from
your employer.
Regional exibilities
In recognition of each region’s dierent geography, economies and travel systems. There is
some exibility within each region to address this in terms of commuting times, toll charges,
temporary accommodation and public transport charges.
These exibilities include:
HEE Region Regional exibility
Midlands M6 toll with agreement of the Postgraduate Dean
East of England Dartford Dart/Tunnel crossing charges
London Cost of travel into TFL Zones 1-3
Dartford Dart/Tunnel crossing charges
North West Mersey Tunnel and the Mersey Gateway Bridge toll charges
South East Isle of Wight ferry charges
Dartford Dart/Tunnel crossing charges
South West Tamar Bridge and Torpoint Ferry tolls
Yorkshire & the Humber and
North East
Humber Bridge and Tyne Tunnel toll charges
Further information
HEE: Funding arrangements for the payment of relocation and expenses
www.hee.nhs.uk/our-work/doctors-training/enhancing-working-lives/funding-
arrangements-payment-relocation-expenses.
84 British Medical Association Junior doctors’ handbook on the 2016 contract
21. Accommodation and catering
Summary
This chapter covers entitlements to accommodation, overnight accommodation
when on-call, and working full-shi Rota patterns, accommodation standards and
catering provisions.
If a doctor’s duties require them to be resident, either because they are resident on-
call or to maintain emergency response times, then the employer is required to provide
accommodation. In addition, if a doctor, for good reason, cannot obtain suitable
accommodation and whose recruitment and retention would otherwise prove dicult,
the employer may provide accommodation.
There is no longer a statutory requirement in the UK for FY1 doctors to be resident, which in
turn means that hospital accommodation no longer needs to be provided without charge to
FY1s in England.
Overnight accommodation when on-call
No charge should be made for on-call accommodation for junior doctors who are required
to work overnight in the hospital on a resident on-call working pattern. This is detailed in
Schedule 13 paragraph 13 of the terms and conditions of service.
Where a doctor is rostered to work on a non-resident on-call working pattern, and the doctor
elects voluntarily, subject to the availability of accommodation, to be resident during the
on-call duty period, a charge for any such accommodation shall be made and, provided that
prior consent has been given, shall be deducted from the doctor’s salary.
When necessary to be resident for non-resident on-call because of emergency response
requirements, employers must provide accommodation without charge.
Where a doctor is rostered to work on a non-resident on-call working pattern and is
required to return to work during the night period, and the doctor considers it unsafe to
undertake the return journey home due to concerns over tiredness, the employer shall,
where possible, provide an appropriate rest facility if requested, where the doctor can rest,
without charge. In this situation, the hours where the doctor is resting in hospital will not
count as working time.
Where the provision of an appropriate rest facility is not possible, the employer must cover
the cost of alternative arrangements for the doctor’s safe travel home. Where necessary,
the employer must also cover reasonable expenses as determined through locally agreed
policies for the doctor’s return journey to work.
A judgement in the ECJ (European Court of Justice), known as the Jaeger judgement, ruled on
the way in which on-call work should be regarded. It notes the specic case of the removal
of accommodation during duty periods and the permitting of sleep while on duty on the
hospital site. The JDC recognises that accommodation facilities are frequently unfavourable
to restful sleep and that, with cross-cover arrangements within a full-shi arrangement,
there is less likelihood of sleep being possible while on duty.
This opinion, as well as conrming the position in SiMAP, goes further by suggesting that
a bed provided to a doctor on duty to enable him to rest from time to time contributes to
protecting his health and to ensuring that they are able to attend properly to their patients.
More details on the Jaeger judgement can be found in the EWTD section of this handbook.
85British Medical Association Junior doctors’ handbook on the 2016 contract
Accommodation for doctors on long shis
Even with the EWTD provisions and new contractual limits on hours in place, a junior
doctor could still be working 5 consecutive days consisting of 13-hour shis. In addition
to this, travel time to and from work following a 13-hour shi results in severely depleted
opportunity to sleep, potentially exacerbated by lengthy journeys for doctors in rotations
that cover large geographical areas.
A substantial body of research has been carried out into the negative eects of working
long hours. If a junior doctor feels unable to travel home following a long late shi due
to tiredness, they should inform their employer. The employer should then provide an
appropriate rest facility where the doctor can sleep. If this is not possible, the employer
must ensure that there are alternative arrangements in place for the doctor’s safe travel
home. In this situation, the hours where the doctor is resting in hospital will not count as
working time.
Further information
Terms and conditions of service Schedule 13, paragraphs 9-13.
NHS Employers’ report covering the impact of the SiMAP and Jaeger rulings.
Accommodation between duty periods
In circumstances where intervals between duty periods make it unreasonable for the junior
doctor to travel to their home or usual residence, for example between shi duties, hospital
employers do have a duty of care to ensure the safety of their employees and, as best
practice, should oer to provide free accommodation.
For those doctors who feel unable to travel home following a night shi due to tiredness, an
appropriate rest facility should be made available in order for the doctor to sleep. If this is not
possible, the employer must ensure that there are alternative arrangements in place for the
doctor’s safe travel home. In this situation, the hours where the doctor is resting in hospital
will not count as working time.
Many hospital employers only provide a rest room with a chair or a recliner. This should not
be considered adequate when there is a requirement for proper rest.
Standards of catering
Junior doctors required to work during the overnight period must be able to access both hot
and cold food and drink. If restaurant facilities are closed, there should be a range of foods
available from vending machines or other means. Employers should make reasonable eorts
to cater for various dietary requirements.
If catering facilities are limited, organisations should identify local establishments that can
provide food during the night. They may also wish to provide facilities for preparation and
storage of food brought by junior doctors.
Junior doctors rostered to work a night shi must have access to a space for taking meals
and other rest breaks. This should be an area away from patients where possible.
Guidance on hospital accommodation and catering
Fatigue and Facilities charter
Most NHS Trusts have signed up to the BMA Fatigue and Facilities charter. This outlines the
minimum requirements for access to food out of hours, rest facilities and mess provision. If
you believe your work sites facilities are not up to standard, contact suppor[email protected].
The below are the provisions of the charter - even if your employer has not signed up to the
charter, you should consider these to be reasonable minimum standards.
86 British Medical Association Junior doctors’ handbook on the 2016 contract
Rest facilities for doctors working on-call
An employer should make sleep facilities available free of charge for all sta who are rostered
or voluntarily resident on-call at night. An individual room should be provided, with:
– a bed, of good quality, with linen changes every three days and for every new occupant.
– an independently controlled source of heating - towels, changed daily and for every
new occupant.
– a telephone with access to hospital switchboard.
– electrical power points.
– adequate sound and light-proong to allow good quality sleep day and night.
Catering
A catering facility should be:
– open 365 days a year.
– provide adequate, varied, eciently served and freshly prepared meals.
– oer healthy eating and vegetarian options, as well as options for a range of cultural and
dietary requirements.
– serve hot food for extended meal times for breakfast, lunch and dinner, where possible
with a minimum late opening until 11pm, and a further two-hour period between 11pm
and 7am.
– Make hot food available if the canteen is closed, through a supply of microwave meals or
a similar arrangement. Supplies should be enough for all sta on duty, readily accessible
to doctors in training, and regularly restocked. Oer card payment or change machines
where necessary.
Mess facilities
An employer should provide an easily accessible mess for junior doctors with appropriate
rest areas, which are accessible 24 hours a day, seven days a week, allowing sta to nap
during breaks.
Nap/rest areas should be separate from food preparation or routine break areas, and the
mess should not be used for organised shi handovers or other clinical work. It should be an
area of rest and not a clinical environment.
An employer should provide these areas on site for sta (not necessarily exclusively junior
doctors), wherever is most appropriate:
– lounge (with power points, telephone connection and TV aerial).
– oce/study area (with power points, telephone connection and internet access) .
– kitchen (with sink, hotplate, microwave, toaster, fridge, freezer, kettle, coee machine and
supply of tea, coee, milk and bread).
– changing facilities and showers.
– storage area including lockers for doctors.
– secure cycle storage.
87British Medical Association Junior doctors’ handbook on the 2016 contract
22. OOP (Out of Programme) experiences
Summary
This chapter explains the dierent types of OOP options, application details and how
to return to training.
The purpose of time spent on OOP experiences is to allow trainees to take up
opportunities that their training programme would otherwise prevent. Depending on
the activity, time spent OOP may or may not contribute towards the CCT (Completion of
Training Certicate), as the nature of the activity will determine for how long a training
programme should be extended.
Dierent types of OOP
OOPC Out of Programme Experience for a career break (eg to work in industry, or for
ill-health reasons).
OOPE Out of Programme Experience for Clinical Experience (which has not received
approval from GMC for contribution towards a trainees CCT). An OOPE is for gaining
professional skills that would enhance future practice eg enhancing skills in
medical leadership, academia, medical education or patient safety, or enhancing
clinical skills related to but not part of the curriculum. Such experience may benet
the doctor (eg working in a dierent health environment/country) or may help
support the health needs of other countries (eg with Médecins Sans Frontières,
Voluntary Service Overseas, global health partnerships). Note OOPE is not
applicable in foundation training.
OOPP Out of Programme Pause is new opportunity where trainees can step o
training to undertake NHS work or similar patient facing work in the UK. They can
potentially accrue skills and capabilities which will count towards their training.
OOPP has been piloted in other regions and, because of the pandemic, is being
rolled out nationally.
OOPR Out of Programme Experience for Research (including a registerable higher
degree) can be up to three years.
OOPT Out of Programme Experience for Training, which has approval from the GMC
and will contribute towards obtaining your CCT.
OOP and CCT
An OOP will only count towards CCT if it is undertaken as an OOPT. In this instance, approval
will be provided in advance from the GMC.
Application details
Application processes vary depending on the deanery/HEE local oce. It is therefore
recommended that you check the specic deanery/HEE local oce website for guidance
specic to the region.
If OOPT is being undertaken, the deanery/HEE local oce will apply for approval to the GMC.
The GMC is the only body which can give, amend, or withdraw training approval for any OOP
intended to lead to the award of CCT.
Full details of the approval process are on the GMC website at www.gmc-uk.org/education/
standards-guidance-and-curricula/guidance/out-of-programme.
The GMC will not accept applications for OOP directly from the trainees or the
respective colleges.
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Application timeframes
The deanery/HEE local oce will normally expect trainees to have been in their current
training programme for at least a year before they can apply for time OOP. Those in core
training programmes are not normally aorded time out for OOP. Deferring the start of a
training programme is dierent, and deans will not normally agree to deferment except on
statutory grounds like maternity, or for time to complete a higher degree. However, more
exible deferment may be available for those with an oer for GP training.
Duration of OOP
This will depend on the nature of the project/task being undertaken. There will need to be
a declaration of the return date in the application to the deanery/HEE local oce. The Gold
Guide states that an OOP will normally be up to one year, but exceptionally can be up to two
years. However, for longer periods, and with OOPR, discussions should take place with the
deanery/HEE local oce at the time of making an application. The deanery/HEE local oce
will then be able to conrm if the trainee will retain their NTN number.
Returning to training
It is important to adhere to guidelines set by the deanery/HEE local oce to ensure that the
training post is still available once the OOP has nished, in particular to the specications
imposed by your deanery and GMC with regards to the nature of your work undertaken OOP,
and your obligations to keep the deanery/HEE local oce up to date (including for ARCP
purposes) during the time OOP. You must ensure adequate notice of the intention to return
to work, and provide at least six months’ notice of the intended return to work.
SuppoRTT
SuppoRTT was developed by HEE, with input from the BMA, to provide targeted assistance
to help doctors get back ‘up to speed’ when they return to training. The Supported Return to
Training strategy and investment plan outlines HEE’s ten commitments to support trainees
with their return to training.
A trainees’ time out of programme is coordinated by local HEE oces; including before,
during and aer. Doctors returning to training can access personalised advice and support
through their local HEE oce. HEE have created resources for everyone returning to
training, a trainee will develop their individualised ‘return to training’ package with their
appropriate Educator/Supervisor using their local HEE SuppoRTT Team processes.
Each regional HEE oce oers a slightly dierent ‘menu’, but because the programme is
individually tailored, there is room to request things which a trainee requires, providing it is
approved by their Supervisors/Educators. SuppoRTT can oer:
– A period of enhanced supervision
– Refresher courses and simulation training
– Mentoring or professional coaching
– Conferences and workshops
– Funding for other courses or development, as individually required.
Further information regarding SuppoRTT is available here, along with details for local HEE
SuppoRTT teams.
Application refusal
If the application for time OOP is refused, or the GMC will not approve time OOP for
contribution towards CCT, the following course of action is recommended. Write to the
deanery/HEE local oce to request written conrmation of the reasons the application for
OOP was refused and written conrmation of the amendments to the application that would
satisfy their criteria for an OOP request.
Upon receipt of the letter from your deanery/HEE local oce, nd out if it is possible to
amend the application for time OOP to full the criteria set. If you have any problems,
contact our advisers on 0300 123 1233 or at suppor[email protected].
89British Medical Association Junior doctors’ handbook on the 2016 contract
Further information
The Gold Guide sets out the rules for undertaking time OOP. Prior to making an application
for time OOP, please refer to the guides in detail.
The Gold Guide contains more specic details on the process and most deaneries/HEE local
oces follow this process. The deanery/HEE local oce website will have guidance specic
by region.
The BMA website has further information available at: bma.org.uk/advice-and-support/
career-progression.
Thinking of working abroad?
The BMA international department has published guidance on working abroad and working
in the EEA, which is available on the BMA website: bma.org.uk/advice-and-support/career-
progression/working-abroad/working-abroad-as-a-doctor.
This guidance includes information about the key points to consider before you go, including
deciding where to go, and how you can apply.
The BMA also has guidance on its website about working in developing countries:
bma.org.uk/advice/career/going-abroad/volunteering-abroad.
This guidance aims to support doctors at all stages in their careers, from trainees, specialty
doctors and associate specialists, to consultants and GPs, in successfully taking time out
from working as a doctor in the NHS to gaining professional experience in developing
countries. It also aims to support deans and employers in the NHS to understand how best to
support doctors as part of the wider workforce.
The BMA international department also works with BMA regional services to provide advice
to individual members on integrating overseas work with an NHS career, including specic
issues such as registration and immigration procedures and working for agencies, as well as
steps to take before leaving and returning to the NHS to help avoid problems.
For further information, please contact the BMA international department at
90 British Medical Association Junior doctors’ handbook on the 2016 contract
23. Medical academic doctors
Summary
This chapter provides more information about training and working as a medical
academic. It also outlines what you might expect to encounter in the medical
academic workplace, including information on contracts and pay.
What is a medical academic?
A medical academic is a doctor that undertakes teaching and/or research, and may also be
involved in the management of those activities. Many medical academics also undertake
clinical work, usually as part of a joint academic and clinical role, with each aspect of the role
informing and enhancing the others. This may be via an integrated programme or through a
separate academic post or qualication.
Trained doctors undertaking these roles can be employed by universities or other higher
education institutions, and may work in medical schools or in postgraduate medical centres.
They usually have an honorary contract with a local NHS organisation, though the honorary
contract for Senior Academic GPs in England is held by NHS England. They spend roughly
half their time undertaking clinical sessions, though the proportion of time or allocation of
academic blocks can vary between posts and between stages of the career. Those doctors
also with clinical commitments are known as clinical academics, and should be on a pay
scale equivalent to that in the NHS. Additional pay premia may also be available following the
completion of such a post or qualication.
Training opportunities in academic medicine
The ‘Integrated Academic Training Pathway’ clearly denes the key entry points to academic
medicine, and outlines a transparent career structure where the stages of progression are
identiable from the outset. Starting at foundation level – which gives trainees a taster of
academic medicine – and progressing through two specialty phases and oen a period ‘out
of programme’, or alternatively with academic training time allocated alongside reduced
clinical components, the Pathway is intended to be the dominant career route for medical
academics. Of the training opportunities oered, the majority will be research focused, with
some concentrating on medical education.
It is important to note that, although dened as the principal career pathway into academic
medicine, it is not the only route. Opportunities are available to enter the academic career
structure at dierent stages of a clinician’s career, even as a consultant.
The BMA would argue that the Follett Review Principles should apply even from FY1 level.
ACFs in England should, therefore, hold honorary university contracts, and the BMA
advises that an honorary contract may also be useful for juniors on academic foundation
programmes. These, however, are by no means automatically forthcoming and we would
encourage members with any questions to seek support or have their contract checked by
the BMA.
Follett Review Principles
All medically qualied academic sta working for both the NHS and a higher education
institution should be employed subject to the principles recommended by Professor
Sir Brian Follett in September 2001 in his Review of appraisal, disciplinary and reporting
arrangements for senior NHS and university sta with academic and clinical duties. The
recommendations are broadly accepted by both sectors and are known as the Follett Review
Principles. The key principle is for NHS and university organisations involved in medical
education and research to work together jointly to integrate the separate responsibilities.
The application of these principles to junior doctors has recently been explicitly agreed to by
NHS Employers.
91British Medical Association Junior doctors’ handbook on the 2016 contract
Academic foundation programmes (AFPs)
Academic foundation programmes (AFPs) oer a unique training opportunity for those
interested in a career in academic medicine. The programme is delivered in the foundation
year 2 (FY2), either as an academic rotation or integrated throughout the entire year. Under
the scheme, trainees receive a comprehensive introduction to academic medicine as part
of their foundation programme. They will be employed by the NHS and paid under the same
terms and conditions as apply to other foundation trainees. There are currently around 450
AFPs, and they are oered by all foundation schools across the UK.
For further information see the Rough guide to the academic foundation programme
(UKFPO): foundationprogramme.nhs.uk/programmes/2-year-foundation-programme/
academic-training.
Academic clinical fellowships (ACFs)
The ACF is the rst phase of specialist academic training in England, and usually leads to the
undertaking of a higher degree by means of a competitive peer-reviewed research fellowship
or educational training programme. General clinical training and practice will still form the
majority of the responsibilities of those on the fellowships, with 25 per cent of a trainee’s
time protected for sessions aimed at developing the necessary academic skills required
to develop ideas for and prepare applications to more substantive clinical fellowships or
funding to do a higher degree.
A maximum of three years (four years for a GP) is allowed to secure a research/teaching
fellowship – although it is expected that one may be secured in less time – with a further
three years for the completion of the higher degree. Part-time opportunities of a longer
duration may also be available. If they have previously completed an MD or PhD, trainees
may apply to continue postdoctoral research under the ACF, as long as they meet the entry
requirements for the specialty.
Successful applicants to an ACF will be employed by the NHS under the national terms and
conditions agreed for junior doctors. They are classed as trainee members of the National
Institute for Health Research (NIHR) faculty. ACFs should also have honorary academic
contracts with the relevant university in order to have ease of access to HEI facilities and
some further training.
NIHR ACF posts are allocated partnerships made up of the HEE local oce, the university and
relevant NHS trust. The local oce manages the recruitment process, with advertisements
usually appearing from October. Applications are made through Oriel, and a specic ACF
application form will need to be completed.
Aer shortlisting the candidates, the local oce will organise interviews towards the end of
the year. The interview will assess both clinical and academic potential. The candidates will
then be ranked. More guidance on the NIHR process can be found here.
Out of programme research
Success in obtaining a research training fellowship, or a place on an educational programme
which leads to a higher degree, is usually seen as the end of the ACF period. At this point,
trainees, with the agreement of their postgraduate dean, will take time out of their clinical
programme to complete the MD, PhD or equivalent higher degree.
Clinical lectureships (CLs)
CL posts are the second phase of specialist academic training in England, and are designed
to enable trainees to complete clinical training in conjunction with postdoctoral research or
higher educational training. The CL phase lasts up to four years, and a trainee’s continued
academic career development will be the responsibility of the organisation in which they
are based.
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The programme enables the trainee to undertake a substantial piece of postdoctoral
research or educationalist project and, in secondary care, leads to the attainment of a
Certicate of Completion of Training (CCT) and the end of clinical training. Clinical lecturers
are also classed as trainee members of the NIHR faculty.
Clinical lecturers will be employed primarily by the higher education institution in which they
hold a post. As the clinical academic timetable split will be half and half, a clinical lecturer
should also have an honorary contract with the NHS to cover their clinical duties. A separate
contract may be needed to cover out-of-hours work.
The BMA’s view is that the honorary contract should mirror the substantive junior doctor
contract as much as possible. However, we have not yet been able to agree this with NHS
Employers. We therefore advise that you have your honorary contract checked before
signing it.
We have, however, agreed a Clinical academic trainee induction and governance checklist
with NHS Employers. NHS Employers advises that the employing trust completes the
checklist to help give trainees clear and consistent information about issues including
supervision arrangements, local policies and governance structures, how to raise concerns,
induction and honorary contract arrangements.
The only variance to the contract guidance is for academic GPs. They will normally have
gained their CCT at the end of the ACF. This means that the pay rates agreed for academic
trainees, based on these in secondary care, do not provide anything like parity with the pay
of newly qualied GPs. The BMA is working with the Society for Academic Primary Care on
this barrier to GP participation in academic trainee. However, NIHR has agreed informally
that GP CLs should be paid on the old consultant pay-scale (see section 7 of the pay circular
for England-based medical academics on the BMA website). GP CLs are advised to seek to
ensure that they receive this rate as a minimum, and to build in this pay rate and increments
into bids for funding.
Other routes
Although the three training programmes are seen as the dominant pathway for a career in
academic medicine, there is exibility, with other entry points and routes into the career
framework. Other academic training posts that are not funded from the NIHR are also
available. For more information, see the Medical Academic Handbook.
Academic and clinical progression
The progress of all trainees who undertake postgraduate specialty training is formally
assessed through the Annual Review of Competence Progression (ARCP), which reviews
evidence both for a trainee’s progression and the appropriateness of their clinical and
academic training programmes. The BMA’s view is that adherence to Follett Principles should
mean that the review process is done jointly, though we recognise that it may not always
be possible to get both supervisors in the same room at the same time for the ARCP. One
supervisor dialling in for at least their part of the review would be an acceptable compromise.
Full details regarding the monitoring of clinical progress and the roles and responsibilities
of both trainee and supervisor are set out in the MMC’s ‘Reference guide for postgraduate
specialty training in the UK’, known as the Gold Guide. Academic progress is assessed by
the academic supervisor across three generic domains – generic and applied research
skills, research governance, and communication/education.
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Supervisors
For all research projects, but particularly PhDs, the role of the supervisor is critical. Hence,
the choice of supervisor is key. They will be a senior member of the academic community,
and you should ensure that the two of you are compatible, with the right balance between
supporting your creativity and the supervisor having a practical eye on supporting you
delivering the work on time. A checklist of what can be expected from a supervisor can be
found on page 164 of the Medical Academic Handbook.
Mentoring
Given the long duration of academic training and its coupling with higher specialist
training, early career medical academics particularly need support in developing a career.
Mentoring schemes should be as exible as possible, and should allow either party to seek an
alternative partner should they feel the mentoring relationship is not working. The Academy
of Medical Sciences has established a mentoring scheme for senior academic trainees
(acmedsci.ac.uk/grants-and-schemes/mentoring-and-other-schemes), and the local
deanery may also be able to oer support in identifying a mentor.
Role of postgraduate deaneries
The BMA fully expect postgraduate deaneries to be involved in ensuring the clinical element
of training accords with national standards. The deanery oce can be approached for advice,
and we would urge trainees to establish a good relationship with clinical and education
supervisors early on.
Terms and conditions
All institutions should provide information about their human resource policies to
prospective employees. Terms and conditions of medical academic contracts may dier
from NHS contracts. Look out for the details regarding pension schemes, annual leave
and maternity leave. If you are in doubt, contact the BMA to have your contract checked
before signing.
The extent to which terms and conditions vary from NHS contracts depends on the
grade of doctor, whether the doctor undertakes clinical work and, because HEIs are
incorporated under individual statutes which govern their operations, the university
employing the academic.
The research funders have agreed to a set of Principles and Obligations all UK institutions
and clinical trainees in receipt of nationally competitive funding for clinical academic
research training. This includes obligations regarding contracts. It is worth noting though
that the contracts of employment are with the university or the NHS not the funder (www.
nihr.ac.uk/documents/clinical-principles-and-obligations/21858).
Despite all that, we would still advise members to have both their substantive and honorary
contracts checked by First Point of Contact before signing them.
Doctors working primarily in the NHS who also undertake research and/or education at a
higher education institution should hold a substantive contract of employment with an NHS
employer. They should also hold an honorary academic contract that outlines the rights
and responsibilities of both the employee and the employer in respect of the academic
work carried out. The honorary contract will also provide trainees with ready access to the
university library and other facilities.
Intellectual property
Both employers will have rules about intellectual property, which are normally agreed
between the university and the employer. Whatever rules apply must be made explicit to the
clinical academic trainee, in all cases.
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Pay
Junior academics employed by higher education institutions should have pay parity with
their NHS colleagues. They should be paid equivalent to a specialty trainee. Further guidance
regarding medical academic pay is available here.
Clinical academics below the level of consultant are paid on a clinical lecturer and senior
clinical lecturer/reader scales, which draws on the pay scale for specialist registrars
working in the NHS. For more experienced trainees, it may be more appropriate to use the
UCEA salary scale below the level of consultant as it contains a number of additional points
on the scale.
Medically qualied academics who do not undertake clinical work will be subject entirely
to the terms and conditions of the HEIs. This includes junior doctors who have secured
grant funding for research (including from the MRC or the Wellcome Trust), but who hold a
contract of employment with an academic institution.
Junior doctors taking time out of a training programme to complete a period of research will
be paid according to university pay scales or in accordance with grant funding. Trainees are
advised to try and build the agreed pay and incremental points into the pay-scale and ensure
agreement in meeting any pay awards. As the grant may be a xed amount divided equally
between each year, the funder may want to pitch the amount for pay at the mid-point of the
pay-scale, eectively over-paying the employer at the start and under-paying at the end.
Moving between sectors
NHS doctors planning to move into the academic sector should note that an honorary
contract with an NHS Trust/health board should be oered jointly with the contract with
the substantive university employer. Retaining an honorary contract while working in a
university provides for some important employment protections, especially if the doctor
intends to return to the NHS. The BMA recommends that all those working in the higher
education sector, especially junior doctors undertaking a period of research OOP, hold
honorary contracts with the NHS where possible.
A+B contracts
Some medical academics are employed on ‘A+B contracts’. They are then employed:
on a part-time basis, with both a medical and dental school or MRC and an NHS organisation
(in which case, the consultant will be treated as part time by both the university and the
NHS employer).
Short-term or xed-term contracts
Medical academics can sometimes be oered short-term or xed-term contracts by higher
education institutions. Doctors who are employed on short-term contracts (or more
accurately, xed-term contracts) are in a relatively more vulnerable position. However, they
do have certain rights under the law. These are enshrined in the Fixed-Term Employees
(Prevention of Less Favourable Treatment) Regulations, 2002.
Under the Regulations, xed-term employees cannot be treated less favourably than
comparable permanent employees, unless the dierent treatment can be objectively
justied. If xed-term employees believe that their rights under these Regulations have been
infringed, they should contact the BMA.
Trainees are advised to check the pay rates oered under these contracts and the
arrangements for returning to the NHS before accepting these contracts.
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Pension
If you stop working for the NHS and take up an academic post with a university, you may
be able to continue to pay into the NHS pension scheme via what is known as a ‘direction’
arrangement. Further guidance is available on the BMA website: bma.org.uk/pay-and-
contracts/pensions/leaving-the-nhs-pension-scheme/moving-between-nhs-and-
university-employment-and-your-pension.
You are advised to seek independent nancial advice on the relative merits of the NHS
Pensions Scheme and the Universities Superannuation Scheme.
Leave and pay for new parents
For medical academics employed by a university, terms and conditions are determined by
the type of contract they have. Universities are independent employers, and will have their
own policies dealing with leave and pay for new parents who are employees. You will have
the same statutory entitlements as any other worker, but your contractual entitlement may
dier from those with contracts with another employer or with the NHS.
Redundancy
As with parental leave and pay, universities are independent employers, and will have their
own policies dealing with the possibility of redundancy in relation to all sta. You will have
the same statutory entitlements as any other worker, but your contractual entitlement may
dier from those with contracts with another employer or with the NHS.
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24. Overseas doctors and international medical
graduates
Summary
The UK immigration system is a points-based system, introduced on the 1 January
2021. The system applies to both non-EEA and EAA nationals entering the UK to work
aer that date. The immigration system is not enacted through legislation so the UK
Government can, and does, change the system on a regular basis.
As the rules change frequently it is important to check the BMA website for the most up-to-
date information at: bma.org/International doctors
International students and graduates
Under the immigration system, a student visa route is available for EU, EEA and Swiss citizens
and non-EU nationals. Applicants can apply for a visa to study in the UK if they:
– have been oered a place on a course by a licensed student sponsor.
– have enough money to support yourself and pay for your course - the amount will vary
depending on your circumstances.
– can speak, read, write and understand English.
From the summer of 2021, international graduates who have completed their degree can
work, or look for work, in the UK at any skill level for up to 2 years, or 3 years for
PhD graduates.
International medical graduates on the Foundation Programme
In December 2020, the skilled worker route replaced the Tier 2 (general) worker route,
and the UK government announced an exemption for health and care professionals to the
immigration health surcharge from 31 March 2020. The immigration route for international
medical graduates on the UK Foundation Programme is:
– A student visa is needed to take up a Foundation Programme post.
– At the end of the Foundation programme, the doctors will transfer onto the Health
and Care Worker visa under the Skilled worker route in order to take up a core specialty
training post.
International medical graduates are eligible to apply for a FY2 standalone programme, as
long as they can demonstrate they have the right to work as a doctor in training in the UK.
Applications from doctor who require sponsorship under the Health and care visa will be
considered alongside other applications.
You can nd further information from the following sources;
UKFPO
F2 Stand-alone Applicant Guidance 2021
HEE
International medical graduates and the Health and Care visa
Doctors working in healthcare will be eligible to apply for the Health and Care visa. Those
currently on a Tier 2 visa who need to extend their visa can switch onto the Health and Care
worker visa. They can apply and pay for their visa online. It is cheaper to apply for and they do
not need to pay the immigration health surcharge.
Once they have submitted all of the required documentation, they will usually get a decision
on their visa within 3 weeks.
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Members should always check with the BMA Immigration Advice Service before switching to
a dierent visa or changing training pathway, to make sure they meet all the requirements,
and to ensure they make the best choices for their route through training. The Service can
advise any member who is a doctor subject to the immigration rules whether they are a
graduate of a UK university, already working in the UK, or looking to move to the UK. It is
important to seek advice when considering taking any time out of training, as this can have
an impact on visas and future eligibility for re-entering training.
BMA immigration advice service
If you are a BMA member, you are entitled to access our immigration advice service which
provides free, basic immigration advice in connection with your employment and/or study
in the UK. If you contact us via the below, we will send you a form to ll out, which will then be
sent on to our specialist advisors to review.
T: 0300 123 1233
E: suppor[email protected]
Initial free advice covers:
– Advice on applications for leave to enter or remain in the UK that are within the
immigration rules.
– Diagnosis of your need for specic immigration advice.
– One-o advice.
Further information
BMA Website: bma.org.uk/advice-and-support/international-doctors.
The UK Visa and Immigration website: www.gov.uk/government/organisations/uk-visas-
and-immigration.
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25. Revalidation
Summary
Revalidation is the process for doctors to assure the General Medical Council (GMC)
that they are up to date and t to practice. All doctors who wish to retain their licence
to practise are now legally required to be revalidated every ve years.
What is revalidation?
Revalidation is the process for doctors to positively arm to the GMC that they are up to
date and t to practise. It applies to all licensed doctors in the UK working in the NHS and the
private sector, and all branches of practice. Only doctors who have GMC registration with a
licence to practise are legally required to revalidate.
The process
Revalidation is based on an evaluation of a doctor’s practice in the workplace and their
participation in an annual appraisal process. The appraisal is based on the GMC’s Good
Medical Practice. Doctors also need to collect and reect on a range of supporting
information about their practice (including evidence of continuing professional
development and feedback from patients), to be discussed at their appraisal. Doctors are
supported through the process of revalidation by the organisation in which they work –
a ‘designated body’.
These organisations have a statutory duty to provide the doctors connected to them
with a regular appraisal, and to help them with their revalidation. Designated bodies have
a ‘responsible ocer’ who, every ve years, makes a recommendation to the GMC that a
doctor is up to date and t to practise.
More information about the process is available on the GMC’s website: www.gmc-uk.org/
doctors/revalidation.asp
As a doctor in foundation or specialty training, you will revalidate in a similar way to other
licensed doctors. Your ‘responsible ocer’ will make a recommendation to us that you are up
to date, t to practise and should be revalidated. The GMC has specic guidance for doctors
in training: www.gmc-uk.org/doctors/revalidation/12383.asp.
For junior doctors in training posts, the processes of assessment and the ARCP/RITA cycle
will provide the evidence that is required to demonstrate this. It should be noted that failure
to progress to the next stage of training does not mean that the doctor is not t to practise
at the level at which they are currently working; it means they are not ready to progress yet
from their current level.
Further information
The BMA webpages provide updates on revalidation at bma.org.uk/revalidation.
The GMC website www.gmc-uk.org/doctors/revalidation.asp.
GMC Online, a secure area of the GMC website designed to make administration easier for
doctors www.gmc-uk.org/registration-and-licensing/managing-your-registration/gmc-
online.
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26. Raising concerns and whistleblowing
Summary
Doctors working in the NHS face many, sometimes conicting, challenges on a daily
basis. This is part of daily working life. However, in some circumstances, you may nd
you have serious concerns about what is happening around you, and feel that patient
care may be under threat.
What is whistleblowing?
This is the term used to describe raising concerns in the workplace. If you are a worker and
you report a type of wrongdoing – usually something you have seen at work but not always -
and the disclosure of this wrongdoing is in the public interest, you are protected by law. You
must not be treated unfairly or lose your job because you ‘blow the whistle’ on wrongdoing
that could aect the general public. All employers should have a formal policy for raising
concerns, which will usually be known as the whistleblowing policy. You should familiarise
yourself with the local policy at an early stage when tackling a concern you have.
Why should I raise a concern?
Doctors have a professional duty, under Good medical practice, to raise concerns. Concerns
in the workplace can vary in nature, but they will all have one common factor: ensuring
patient safety. It is important to remember that raising a concern is dierent from raising a
personal complaint or grievance. Get in touch with us at the early stages, and we can guide
you through this process.
You should not become a target for poor treatment because you raised a concern. If you
do, we can help you. The Public Interest Disclosure Act 1998 gives statutory protection to
employees who disclose information reasonably and responsibly in the public interest, and
who are victimised or dismissed as a result.
Concerns about training
Concerns about training may well be bound up with patient care issues, and complaining
about training may sometimes lead to raising concerns about patient care, particularly
regarding clinical supervision. Issues with training may be a cause for concern for both
trainees and trainers, and the GMC, employing organisations, and postgraduate deaneries
are empowered to address this type of concern.
If you want to contact the postgraduate deanery/HEE local oce for this, your Training
Programme Director would be the best rst point of contact. You can and should approach
them if local routes, such as speaking to the educational supervisor, are unsuitable
or unsuccessful.
What types of concern should I raise?
It can sometimes be hard to know whether you should raise a concern. You should be guided
by this question: if you let the situation carry on is it likely to result in harm to others?
If in doubt, you should always err on the side of caution and raise your concern following
your employer’s policy.
Issues you might have concerns about could include:
– unsafe patient care or conditions.
– unsafe working conditions.
– inadequate induction or training for sta.
– inadequate response to a reported patient safety incident.
– suspicions of fraud.
– bullying towards patients or colleagues, or a bullying culture.
You can use the GMC’s raising and acting on concerns owchart to help you decide whether
to raise a concern.
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Raising concerns: the principles
– Everyone should be aware of the importance of preventing and eliminating wrongdoing at
work. You should be watchful for illegal or unethical conduct, and report anything of that
nature that you become aware of.
– Any matter raised should be investigated thoroughly, promptly and condentially, and the
outcome of the investigation reported back to the worker who raised the issue.
– No one should be victimised for raising a concern. This means that your continued
employment and opportunities for future promotion or training should not be prejudiced
because you have raised a legitimate concern.
– If you are victimised aer having made a disclosure under the Public Interest Disclosure
Act 1998, you can bring a claim at an employment tribunal. Your employer should treat
any acts of victimisation as a disciplinary oence.
– An instruction to cover up wrongdoing is itself a disciplinary oence. If told not to raise
or pursue any concern, even by a person in authority such as a manager, you should not
agree to remain silent. You should report the matter following the steps outlined in the
BMA guidance documents on this issue.
– If you make a false allegation, it may be a disciplinary oence.
– It can be hard to know whether a situation should be raised as a concern. You should be
guided by this question: if you let the situation carry on, is it likely to result in harm to
others? If in doubt, you should always err on the side of raising the concern with your
manager/immediate superior, and you should do it as soon as you can. There is no burden
on you, as the person raising the concern, to establish all the facts and provide all the
necessary evidence.
How to raise a concern
Report what has happened
You should use formal reporting methods, like Datix. Doing this can be essential to
protecting yourself legally. It may also make it more likely that your concerns will be
taken seriously.
There may be other methods for incident reporting, depending on which nation you are in
and your branch of practice.
If you don’t feel comfortable raising a concern via your employer, concerns relating to
health and safety matters can also be made to the Health and Safety Executive via its online
concerns form. Your anonymity will be maintained by the HSE if you make this clear on
the form.
Check your employer’s raising concerns policy
You should be able to nd this on your employer’s website. It may also be called ‘speaking up’
or ‘whistleblowing’. You can see what a model policy should look like in England by viewing
the examples we have on our raising concerns guidance page.
If you are unable to access your employer’s policy, the BMA can locate this on your behalf.
Approach your local BMA representative or the Local Negotiating Committee Chairman to
arrange this. Your LNC Chairman and local BMA representatives can be identied by calling
the BMA.
Follow the policy and raise your concern
When you have identied the right person to approach, you can raise your concern either
verbally or in writing. You should:
– include key information eg details of what happened, where and when it happened, and
who was involved.
– include any relevant documentation or evidence you may have, don’t worry if you do not
have evidence, it is not up to you to prove that something has happened.
– think about and, if possible, be clear about the outcome you would like to see.
– frame your concern as an opportunity for improvement and helping to address
a shared problem.
– use the right tone and remain professional.
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Make a record
It is important to keep a written record of raising your concern so you can refer to this later.
You can either put it in writing in the rst instance or, if you raised your concern verbally,
make a dated note of what you said.
What happens next?
The person you have spoken to:
– should thank you for speaking up and listen carefully.
– may need to investigate your concern.
– will decide on the most appropriate action to take.
– tell you what they are going to do.
You should not be subjected to detrimental treatment, such as unwarranted criticism,
disapproval or disciplinary action as a result of raising the concern. If you think you are in this
situation, call us for advice.
Doctors for doctors, (telephone 08459 200 169) is the BMA counselling service, which can
oer support for the emotional aspect of the dispute you may be going through.
Your legal protection
You may be protected under whistleblowing law if you have raised a concern and suered
detrimental treatment or lost your job as a result. The protection is available only in certain
circumstances, and the rules are complicated. If you think you are in this situation, call us
for advice.
Whistleblowing agreement with HEE
Trainees have a unique employment arrangement, which sees you contracted to work as
employees – of a hospital trust for example – while you are simultaneously undergoing
training in an arrangement with Health Education England (HEE). Despite it not being
established that they are your employer, HEE can have signicant inuence over your career,
ultimately having the right to terminate employment.
It is important therefore that junior doctors are able to make protected disclosures of
wrongdoing without fear of unfair treatment by HEE, yet the law on whistleblowing only
covers the employee-employer relationship.
It is vital that junior doctors are able to blow the whistle on any risks to patient safety in
their workplace, free from fear that their job security may be threatened as a result. The
BMA has worked with HEE, NHS Employers, and the Department of Health to develop a legal
agreement that will extend the whistleblowing protection within the law to the relationship
between junior doctors and HEE.
HEE have accepted that they have signicant inuence over junior doctors’ careers, and, as
a result, they have agreed to take on the legal liability for detrimental treatment linked to
whistleblowing, extending the provisions of the Employment Rights Act 1996, which apply
to the employer-employee relationship, to cover the trainee-HEE relationship as well. HEE
will be treated in law as though they were your employer specically for the purposes of
whistleblowing protection.
This agreement covers all postgraduate trainees In England, whoever their contract of
employment may be with or is intended to be with, when they commence or recommence
training. You’re also covered if you are seeking to start training, or recommence it aer
leaving, or if you’ve OOP.
If you feel that you have been treated unfairly by HEE as a result of raising concerns in the
workplace, you should contact the BMA. Our legal advisers will be able to assess whether you
have grounds to bring proceedings against HEE and, if so, to support you in bringing
this claim.
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Further information
The BMA has detailed guidance available at: bma.org.uk/advice-and-support/complaints-
and-concerns/raising-concerns-and-whistleblowing/raising-a-concern-guide-for-doctors.
Guidance on the HEE agreement is available at: bma.org.uk/media/1582/bma-hee-
whistleblowing-guidance-sept-2016.pdf.
BMA information on the Francis Inquiry and NHS Culture work: bma.org.uk/media/2034/
bma-csc-future-vision-nhs-report-sept-19.pdf.
Protect website: protect-advice.org.uk.
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27. The regulatory framework
Summary
This chapter provides a summary of the regulatory framework, and includes
information on occupational health services and sources of professional advice.
Freedom of Information Act (FOIA)
The Freedom of Information Act 2000 (the Act) provides the public with access to
information held by public authorities. Broadly, the primary purpose of the Act is to foster
an open and transparent government, and make public authorities accountable for their
actions. Public authorities include the Department of Health and Social Care, NHS Trusts,
and any person providing primary, general and personal medical services. However, health
practitioners only have to provide information related to their NHS work.
The Information Commissioner’s Oce (ICO) is responsible for implementing and enforcing
the Act. A public authority’s primary obligations under the Act are to publish information
proactively and respond to requests for information.
Under the Act, individuals are able to make a request in writing to a public authority for
information. A public authority has a duty to inform the individual whether they hold the
information requested, and to provide that information (subject to exemptions). Generally,
the public authority must comply with the request within 20 working days.
Importantly, the Act provides a number of exemptions where a public authority is not
required to comply with a request for information. However, many of these exemptions are
subject to the ‘public interest test’, involving the exercise of determining whether the public
interest in withholding the information outweighs the public interest in disclosing it.
Failure to respond to a request for information within the prescribed timeframe, or
inadequately responding to a request, may lead to a complaint to the ICO. The ICO have a
general duty to investigate the complaint.
It is a criminal oence to alter, block, destroy or conceal information: the penalty for which
is a ne. There are no penalties for failing to provide or publish information. However,
failure to comply with a decision, enforcement or information notice from the Information
Commissioner is contempt of court, and can lead to a ne or possibly imprisonment for a
senior ocer within a public authority.
FOIA and the Data Protection Act
It is important to understand the distinction between the Act and the Data Protection Act
2018 (DPA). The Data Protection Act is designed to protect the private lives of individuals and
protect one’s right to privacy, whereas the Act aims to get rid of unnecessary secrecy. These
two aims are not necessarily incompatible, but require careful consideration and judgement.
When someone makes a request for information that includes someone else’s personal
data, you should contact your employer’s information governance ocer, who will be able to
provide you with advice as to what you need to do.
Notably, the Act does not give an individual access to their own personal data, including
medical records. This information can be obtained through a subject access request
administered under the DPA, which is also overseen by the ICO.
If an information request relates to an individual’s ‘non-private’ life, for example, if it
concerns someone acting in an ocial or work capacity, this information would normally be
disclosed. However, details of an individual’s ‘private life’ (eg details of the person’s family life
or personal nances) will likely be aorded protection under the DPA.
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The terms DPA (Data Protection Act) and GDPR (General Data Protection Regulation) are
oen used interchangeably; the DPA 2018 is the UK’s interpretation of the EU GDPR. Since
the end of the transition period aer leaving the EU, the EU GDPR no longer applies to the
UK. The GDPR has now been incorporated into UK data protection law as the UK GDPR, so in
practice there is little change to the core data protection principles, rights and obligations
that existed before. The UK GDPR sits alongside the DPA 2018 with some technical
amendments so that it works in a UK-only context.
Further information
Members should familiarise themselves with local policies on freedom of information and
data protection. The ICO publish useful resources on publication schemes and responding to
FOI requests on their website.
General resources for medical professions can be found here: ico.org.uk/for-organisations/
in-your-sector/health.
A FOI guide can be found here: ico.org.uk/for-organisations/guide-to-freedom-of-
information.
We encourage our members to utilise the tools and resources provided by the ICO, and to
seek advice whenever they are unsure of their obligations under the Act.
General Medical Council (GMC)
The GMC is the regulatory body of the UK medical profession. The overarching objective of
the GMC is ‘the protection of the public’. To this end, the GMC controls entry to the medical
register, and determines the principles and values that underpin good medical practice.
Where a doctor fails to meet the standards, the GMC can take action - if necessary, by erasing
the doctor’s name from the medical register.
The GMC’s Good medical practice guidance sets out a doctor’s professional obligations
and duties, and advises on standards of good clinical care, professional relationships
with colleagues, matters of probity, and doctors’ health. The GMC can only take action
when a doctor’s tness to practise is called into question. Broadly it can act in the
following circumstances:
– when a doctor has been convicted of a criminal oence.
– when there is an allegation of serious professional misconduct that is likely to call into
question a doctor continuing in medical practice.
– when a doctor’s professional performance may be seriously decient, whether or not it is
covered by specic GMC guidance.
– when a doctor with health problems continues to practice while unt.
– when a doctor does not have the necessary knowledge of English.
– When a decision by a regulatory body either in the UK or overseas to the eect that tness
to practise as a member of the profession is impaired.
The Council published the most recent edition of Good Medical Practice in November
2020. The guidance sets out the principles and values on which good practice is founded
and standards of competence, care, and conduct expected of doctors in all aspects of their
professional work. Good medical practice sets broad standards on clinical care; teaching,
training and appraisal; relationships with patients; dealing with problems in professional
practice; working with colleagues; probity; and health.
Further information
Good medical practice, GMC (2013) www.gmc-uk.org/guidance/good_medical_practice.
asp.
GMC website: www.gmc-uk.org.
PSA website: www.professionalstandards.org.uk.
105British Medical Association Junior doctors’ handbook on the 2016 contract
Occupational health services
All NHS employers must ensure that their sta have access to condential occupational
health services, including a consultant in occupational health medicine. Where the
occupational health team is made up of an occupational health nurse and/or non-
consultant occupational health physicians, managers are obliged to ensure that there is
access to and advice from a consultant.
DHSC has provided a national policy lead on occupational health issues for some years
through The management of health, safety and welfare issues for NHS sta (1998) and The
eective management of health and safety services in the NHS (2001). In 2004, the DH
circulated a dra of the rst NHS Occupational Health and Safety Strategy for England, which
set out its vision for a safer, healthier NHS.
The strategy was developed in response to The National Audit Oce report A safer place to
work (2003). The responsibility for encouraging the implementation of good occupational
health and safety policy across the NHS has now been transferred to the NHS Employers
organisation, which will act in an advocacy and advisory role to NHS senior managers. See
www.nhsemployers.org.
Through their occupational health services, NHS employers should protect the health
of their sta from physical and environmental health hazards arising from their work or
conditions of work; reduce risks at work which lead to ill-health (physical and mental), sta
absence and accidents; and help management to protect patients, visitors and others from
sta who may represent a hazard, including from infectious disease.
The functions of an occupational health service are to advise employees and employers
about the interaction between health and work; to maximise the benecial eects of this
interaction; and to minimise the adverse eects. It should be noted that occupational
health is primarily a preventative and not a treatment service. However, much of the
output of an eective occupational health service is directly or indirectly therapeutic to
organisations and the individuals employed by them. Occupational health services provide
recommendations and guidance that employers should consider, but it is not mandatory for
the employer to implement these recommendations.
Further information
BMA advice on Occupational Health bma.org.uk/advice-and-support/nhs-delivery-and-
workforce/creating-a-healthy-workplace/supporting-health-and-wellbeing-at-work-report.
NHS Employers www.nhsemployers.org.
A safer place to work (2003) www.nao.org.uk/publications/0203/nhs_health_and_safety.
aspx.
Violence against doctors
The British Crime Survey has reported that doctors and nurses are among those most at
risk of threats and assaults in the workplace. A BMA report, Violence at work, examined the
experience of UK doctors in work, and found that a third of hospital doctors had experienced
some form of violence in the workplace in the previous year. Furthermore, it found that
doctors working in A&E, psychiatry and obstetrics and gynaecology were even more likely to
have experienced violence. The paper also noted that the under reporting of incidents was a
widespread problem.
The paper recommended training for doctors on the management of potentially violent
situations, partnerships with other relevant local agencies (such as the police), and raising
awareness of patients’ responsibilities and acceptable behaviour. The BMA has further
guidance and information regarding this issue available here.
106 British Medical Association Junior doctors’ handbook on the 2016 contract
Doctors are advised and encouraged to report violent incidents and, through their LNC,
to ensure that employers put in place protocols for recording such incidents and eective
strategies for dealing with the problem. The HSE has also produced guidance on the
assessment and management of violence against sta in the healthcare sector.
Further information
Government guidance: www.gov.uk/government/news/stronger-protection-from-violence-
for-nhs-sta.
BMA guidance: bma.org.uk/advice-and-support/nhs-delivery-and-workforce/creating-a-
healthy-workplace/preventing-and-reducing-violence-against-sta.
Sources of support
BMA Counselling is a free and condential service available 24/7, and allows doctors to speak
to a team of fully-qualied counsellors. Callers can access in the moment support and/or a
structured course of 6 counselling sessions.
The service is free to all doctors and medical students in the UK, regardless of BMA
membership, as well as to their partners and dependents (aged 16-24 in full time education).
The telephone number for the service is 0330 123 1245. The number is free from a landline,
and most mobile phone providers also list 0330 numbers as a free call. If your mobile phone
tari does not include 0330 numbers as free you can either call and ask the counsellor to
call you back, or complete the ‘Contact Us’ section here on the Health Assured website to
request a call back.
Any issue can be discussed including, but not limited to:
– workplace problems
– exam pressures
– stress and anxiety
– loss of condence
– personal and relationship diculties
– alcohol and drug misuse
– bereavement
– debt and other nancial concerns
BMA Peer support
BMA Peer support oers doctors the option of speaking in condence to another doctor
about whatever personal or professional issue may be troubling them. It’s condential peer
support with an emotional focus and our peer support doctors can provide a reective
space, working with you to gain insight into your problems.
Some of the common issues that doctors might contact this service about include issues
around their career, anxiety or stress, and following allegations or complaints.
The service is completely condential, and is not linked to any other internal or external
agencies. Simply call the same number as for the counselling service above (0330 123 1245)
and request peer support, and aer providing some basic information you will be given the
details of one of our peer support doctors for you to contact.
Please visit bma.org.uk/advice-and-support/your-wellbeing for further information or email
wellbeingsuppor[email protected].
Further information
BMA wellbeing support directory: bma.org.uk/media/3823/bma-wellbeing-support-
services-contacts-february-2021.pdf.
DocHealth: www.dochealth.org.uk.
NHS Practitioner Health: www.practitionerhealth.nhs.uk.
107British Medical Association Junior doctors’ handbook on the 2016 contract
28. The British Medical Association
and its structures
This chapter provides a brief overview of the structures of the BMA, and the work of
the junior doctors committee.
The British Medical Association
The BMA (British Medical Association) is a voluntary association set up in 1832 ‘to promote
the medical and allied sciences and for the maintenance of the honour and interests of the
medical profession’. It is the professional association of doctors in the UK and is registered
and certied as an independent trade union under employment legislation.
The BMA has collective bargaining rights for all NHS doctors employed under national
agreements, irrespective of whether or not they are members. It is also recognised by many
employers of doctors practising in other elds.
The BMA oers advice to members on contractual and professional matters, and provides
individual and collective representation at a local level through BMA regional services. As a
spokesperson for the medical profession to the public, the Government, employers, MPs,
and the media, the BMA addresses matters as wide ranging as medical ethics and the state of
the NHS.
BMA JDC (junior doctors committee)
The JDC’s purpose and remit is to consider and act in matters aecting those engaged in
hospital practice in the training grades, including matters arising under the National Health
Service Act or any Act amending or consolidating the same, and to safeguard the interests of
hospital medical sta in the training grades in relation to those Acts. bma.org.uk/jdc.
The regional JDCs welcome attendance from any junior doctor either living or working in the
respective JDC area. Contact [email protected].uk or call 0300 123 123 3 for
more information.
National and regional junior doctors committees
Junior doctors in the three devolved nations of Scotland, Wales, and Northern Ireland are
represented by their national JDCs. Junior doctors in the English regions are represented by
RJDCs (regional junior doctors committees). These committees send members to the UK
JDC, which is responsible for representing all junior doctors in the UK.
The GP trainees committee, the public health medicine registrars subcommittee and the
joint academic trainees subcommittee also send members to the UK JDC.
Joint negotiating committee juniors
It is through the JNC(J) (joint negotiating committee juniors) that the JDC Terms and
Conditions of Service and Negotiation Subcommittee negotiate with the Department of
Health and Social Care and NHS Employers on matters concerning terms and conditions of
service of hospital junior sta.
BMA divisions
BMA divisions represent members in all disciplines and branches of practice in their local
areas. Every UK member belongs to one of the 180 divisions, and each division can submit
motions for debate and send representatives to the ARM.
Regional representation
Regional councils in England are forums to discuss matters of regional interest and issues
aecting the profession across all branches of practice.
Each regional council has up to 25 voting seats, elected by BMA members whose registered
address is in that area, including UK council members from the region.
They report to UK council and can send motions and representatives to the ARM.
108 British Medical Association Junior doctors’ handbook on the 2016 contract
LNCs (local negotiating committees)
LNCs are now established in almost all NHS organisations which employ doctors. LNCs
consist of local representatives of all grades of doctor, including junior doctors employed
by the organisation who will meet regularly to identify issues for negotiation with local
management and agree their objectives.
They will meet with management representatives in a joint negotiating committee in
order to conclude and monitor the application of local agreements, and agree and monitor
arrangements for the implementation of national agreements within the organisation.
Professional and administrative support to LNCs is provided by BMA regional services
bma.org.uk/what-we-do/local-negotiating-committees.
BMA council
The council is the principal executive committee of the trade union, and sets the strategic
direction of the BMA in line with policy decided by the representative body at the annual
representative meeting. Council is responsible for the formulation of policy throughout the
year and for ensuring the implementation of that policy.
The BMA UK council currently has 60 voting members. Each is directly elected by the
membership to give a geographical and branch of practice mix. There are also a number of
ex-ocio non-voting members, including those who chair the many committees reporting
to council. bma.org.uk/what-we-do/uk-national-and-regional-councils/uk-and-national/
uk-council.
ARM (annual representative meeting)
The ARM determines the policy of the BMA. The representatives are either elected by the
BMA divisions or are appointed by the branch of practice committees.
British Medical Association
BMA House, Tavistock Square,
London WC1H 9JP
bma.org.uk
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