JUNIOR DOCTORS ROW - THE DISPUTE EXPLAINED By Nick Triggle BBC Health correspondent January 2016 Ministers and junior doctors are locked in an increasingly fraught dispute in England. But what exactly is this row about? What has caused the dispute? Junior doctors' leaders are objecting to the prospect of a new contract in England. The government has described the current arrangements as "outdated" and "unfair", pointing out they were introduced in the 1990s. Ministers drew up plans to change the contract in 2012, but talks broke down in 2014. The government has indicated it will impose the new contract in England and the British Medical Association (BMA) has responded by initiating the industrial action process. So does this just involve new doctors? No. The term junior doctor is a little misleading. It covers medics who have just graduated from medical school through to those who have more than a decade of experience on the front line. The starting salary for a junior doctor is currently just under £23,000 a year, but with extra payments for things such as unsociable hours, this can quite easily top £30,000. Junior doctors at the top end of the scale can earn in excess of £70,000. But it's important to remember these doctors can be in charge of teams, making life-and-death decisions and carrying out surgery. They are really behind only consultants in seniority. In total, there are 55,000 junior doctors in England - representing a third of the medical workforce. The BMA has just over 37,700 members. How does your pay compare to a junior doctor? What exactly do junior doctors do? How is the contract changing? There are many elements to what is being proposed - and the details have been tweaked as the dispute has rumbled on. In November the government made a fresh offer to doctors. It included an 11% rise in basic pay for junior medics. But that came at a price: other elements of the pay package are to be curbed. For example, the number of hours during the working week that are classed as unsociable - and therefore attract an extra payment - is to be cut by 25%. Guaranteed pay increases linked to time in the job are also to be scrapped and replaced with a system linked to progression through set training stages. This, the BMA argues, would affect people who take time out to have a baby, for example. The union is also concerned some doctors will end up being paid less and that the restrictions on the number of hours being worked by doctors are not strong enough, potentially compromising patient safety. The government and BMA entered new talks in December, but they still haven't reached a deal. To start with, it seems not many will. Ministers have said three-quarters will actually be better off - although this is likely to be by only a small amount. Of the rest, only 1% will earn less - and these are the doctors who do lots of extra hours and therefore currently qualify for more of the premium payments that are going to be scrapped. That leaves just under a quarter of doctors who will earn about the same. But a number of these - the government is not saying how many - are only escaping a cut because they are going to have their pay packets topped up. That is to ensure Health Secretary Jeremy Hunt can keep his promise that no doctor working a normal number of hours will end up worse off. But these changes are not just about winners and losers on day one. They have partly been designed to make it cheaper to roster extra doctors on at weekends. Therefore, medics are likely to find they are working more weekends, which, under the existing contract, would have led to extra pay. What is more, some of the changes will take time to have an effect. For example, the ending of guaranteed pay rises linked to time-in-the-job will mean some doctors find their pay will go up more slowly during their time as a junior medic. Yes. You may have noticed the government in England is intent on improving the range of services that are available seven days a week. It has already found itself at loggerheads with the BMA over plans to change the consultants' contract - talks are under way on that. Junior doctors already work weekends - in fact, they provide the bulk of the medical staffing on Saturdays and Sundays. But the financial benefit of extending what constitutes "normal hours" to a Saturday is obvious. http://www.bbc.co.uk/news/health-34775980

• published: 12 Jan 2016
• views: 273