What is the new contract?
The Government introduced new terms and conditions of service for junior doctors in August 2016, which come into full effect this month. While still opposed to the new contract, the BMA has agreed new work scheduling guidance with NHS Employers in the new contract.
Which practices will implement the new contract?
GP practices in non-lead employer areas are free to choose which contract they offer. Those in lead employer areas are not compelled to implement the new contract, but it is being strongly recommended by the Department of Health and NHS Employers.
Which trainees are affected?
The contract, where implemented, applies to new starters from this month. GP ST2s and GP ST3s could also be switched to the new contract when there is a change or break in their existing contract, for example when moving from one employer to another.
Some GPST2s and GPST3s were issued with ‘hybrid contracts’ in August 2016, meaning they were on the old contract until rotated to a job where the host trust or practice is ready to implement the new contract.
What are the key changes?
The main change affecting practices relates to the work scheduling guidance. The differences are that out-of-hours work is now included as part of the 40-hour working week, averaging approximately 1.5 hours a week, there is a new system of ‘exception reporting’ for when the agreed schedule is deviated from, and trainees are to be assigned ‘guardians of safe working’. Guardians of safe working have an important role and review exception reports for hours breaches and unsafe working. They have the ability to fine employers and host organisations that breach defined safety limits.
How rigidly do trainers have to stick to the suggested timetable?
There is flexibility, as long as practices stick to the required working hours, including a 70:30 split in clinical versus education time, and sufficient breaks. Templates should be personalised to reflect the trainee’s learning needs and practice’s working arrangements. Trainees can work over four days if needed.
What are the rules on time in lieu around out-of-hours work?
Trainees should give sufficient notice of any out-of-hours sessions; they should not need to cancel in-hours clinics at short notice for this purpose.
For exceptional breaches of rest periods (for example, where a sick patient needs urgent care), the trainee submits an exception report to their supervisor and guardian of safe working, so they can take time off in lieu and have sufficient rest before returning to work.
When is an exception report justified?
Exception reporting is a vital new feature of the contract, which allows trainees to ensure that their training needs are met, and is also an important safeguard against unsafe working and unpaid overtime. It is also crucial to help build a clear, evidenced picture of the reality of trainee working patterns, documented in quarterly guardian reports.
We believe all exceptions should be reported. Being required to stay late or to miss a break may not seem significant at the time, but could breach safety limits if it happened regularly.
How might exception reporting impact on practices?
If a work schedule is drawn up realistically, in line with the contractual guidance, a trainee should not need to exception report. Where trainees work over their stated hours, for example when dealing with an acutely unwell patient, this could result in time off in lieu or payment from the practice, which would be mutually agreed.
Should working hours and safety limits be breached the practice can be fined four times the hourly rate – for example if a trainee misses 25% of breaks or works over the 48-hour average weekly hour limit.
Dr Samira Anane is chair of the GPC’s training committee
1. NHS Employers. Work scheduling templates and guidance.