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A summary report on the Junior Doctor Contract Review 2018-19 from the OTG

19 June 2019

Varo Kirthi, Chair OTG and Ziyaad Sultan, BMA Multi-Specialty Working Group representative have reviewed the latest update on the proposed new contract deal for junior doctors and welcome the proposed changes.

The deal the BMA have agreed with NHS Employers and the Department of Health and Social Care brings a £90 million investment for junior doctors over the next four years. The OTG support this latest update to the 2016 Junior Doctor Contract (JDC). Whilst many aspects of the JDC continue to cause concern among trainees, such as loss of RSTA sessions and split weekend rostering of on-calls, there are significant improvements in this latest contract update. This includes:

  • A responsibility for employers to provide free accommodation if non-resident on-call doctors are required to attend hospital out of hours, or voluntarily stay overnight.
  • Additional £1000 pay uplift for LTFT trainees.
  • Better guidance for employers and trainees on rostering.

Ziyaad, as the BMA MSWG representative has provided a summary of the proposed changes.


  • This is not an imposed contract update, but a negotiated improvement and enhancement.
  • This update locks doctors and employers into a 4-year agreement, if the update is accepted.
  • Voting ‘for’ the contract update will formally end the dispute between members and NHS England.
  • No further changes may be imposed by employers for 4 years.

Can I vote?

Only BMA members can vote, which opened on the 14 June.


The 2016 Junior Doctor Contract was imposed upon trainees. However, it was agreed that in 2018 the contract would be reviewed and changes made where necessary. Subsequently, the BMA formed a new joint negotiating committee (juniors), focusing on key areas of the interest, and invested in data to better inform negotiations as well as external expertise.

The original 2016 contract was promoted for its ability to save £80 million, but the reality of the contract imposed was an additional cost of £60 million. BMA negotiations with NHS England have led to the Department of Health accepting the deficit and providing an additional £90 million over 4 years to fund the contract changes/updates.

What’s new?

There are many valuable changes, which affect certain specialties more than others. For detailed information visit the BMA website.

Are these new amendments to the 2016 contract, ‘good’ for Ophthalmology Specialty Trainees?

Essentially, yes. Specifically, from a monetary perspective, a step in the right direction, with guaranteed minimum pay uplifts (2%) for 4 years, and a fifth nodal point for trainees ST6 and above. LTFT will receive an additional £1000 per annum.

Will some Ophthalmology trainees be worse off?

Unfortunately, it is possible that some trainees on the 2002 contract, in the latter stages of training would be ‘relatively’ worse off. This is, they would CCT before receiving the fifth nodal point benefit had they been on the 2016 contract.

Ophthalmology Specialty Trainee – potential key areas

All LTFT trainees:

  • Additional £1000 per annum [effective Dec 2019]

Accommodation when NROC:

  • NROC doctors if required to attend hospital, then employers must provide suitable accommodation without charge, and if not available, other suitable accommodation (hotel) must be provided.
  • ‘Too tired to drive home provisions’ – employer must cover the cost of a suitable rest facility. This can include paying for transport home AND for returning to work the next day [e.g. if you had left your car at work, and took a taxi home].


  • 2% uplift per annum
  • A fifth nodal point

A ‘senior decision maker’ [SDM] was a term mentioned in the 2016 contract, but not defined.

  • Trainees at ST6 and above, will now be defined as senior decision makers, and be appointed to a new fifth nodal point
  • In October 2020 the value will be £3,000
  • In October 2021 the value will increase to £6,000
  • In October 2022 the value will increase to £7,200

Shifts ending after midnight (‘DISCO’ shifts):

“Where a shift ends after midnight, the entirety of the shift will attract an enhancement of 37 per cent of the hourly basic rate. This change will come into effect in December 2019”

Weekend frequency allowance [effective Dec 2019]:

  • 1 in 2 weekends: 15% allowance of basic pay
  • 1 in 3 weekends: 10% allowance of basic pay
  • 1 in 6 weekend: 5% allowance of basic pay

Transitional pay protection:

  • For those on the 2002 payscales, will be protected until 2025.


  • Minimum 5 hours of continuous rest between 10pm and 7am. Otherwise, Guardian fines.

Rates of Guardian fines will increase:

  • 4 x multiplier of 2019 NHS improvements locum rates, rather than the standard hourly rate paid to the doctor.

Exception Reporting:

  • Payment for approved ER to be made within 1 month
  • Time off in lieu (TOIL) to be taken within 1 month, or payment in lieu.