Doctors' Working Hours: The basics
What is the Junior Doctors New Deal?
The New Deal is an agreement between the government and the British Medical Association, which sets out the requirements for working hours, living and working conditions for training grade doctors. These doctors (House Officers, Senior House Officers and Specialist Registrars) are currently exempt from the full effect of the European Working Time Directive, although the implementation starts in 2004, and is phased in order to bring them fully in line with these regulations by August 2009.
(See European Working Time Directive section).
Under the current phase of the New Deal, junior doctors are allowed to be on duty (including on call) for up to 72 hours per week, but can only carry out actual work for 56 hours per week. In addition, there are regulations about length of shifts, rest breaks and out of hours work, which vary according to shift pattern. These are listed in Part C of the DH's guide to the new system.
Pay banding
Banding supplements are paid as a proportion of basic salary, according to the number of hours and proportion of unsocial hours that doctors work. However, the intensity of work does not usually affect banding. Banding normally applies to a rota, rather than to an individual post. (For basic salary scales, please see the most recent Medical and Dental pay circular.)
A very general guide to the bands:
3 (100%) - all doctors who are non-compliant with New Deal requirements.
2a (80%) - Over 48 hrs work per week, more than 1/3 of hours unsocial
2b (50%) - Over 48 hrs work per week, less than 1/3 of hours unsocial
1a (50%) - 40-48 hrs work per week, more than 1/3 of hours unsocial
1b (40%) - 40-48 hrs work per week, less than 1/3 of hours unsocial
1c (20%) - 40-48hrs work per week, low frequency non-resident on call
Basic salary (no band) - 40 hours or less per week, all between 8am and 7pm.
(Unsocial hours = 7pm-7am Mon-Fri and all weekend duties.)
However, this is only a general guide; these are not the only criteria for pay banding. Please see the DH's document Pay Banding Criteria for full details.
Flexible Trainees
Flexible trainees work part time and have their own banding system.
The contract was changed in June 2005. Previously, trainees on band FA or FB would get uplift to full time plus a 25% or 5% banding respectively. Flexible trainees on band FC would get no supplement.
Under the new contract, flexible trainees have both an F number and an F letter. The F number reflects their actual working hours, which includes both basic sessions and actual work (not duty) out of hours. Flexible trainees are paid an extra session for every additional 4 hours per week, so a doctor working 70% of full time who had a very heavy out of hours commitment, who was assessed at working an average extra 8 hours per week, would be F9. The F letter reflects their frequency of on call and proportion of unsocial hours.
F numbers: F5 to F9
F letters:
FA - 50% of pro rata pay - most onerous
FB - 40% of pro rata pay - less onerous
FC - 20% of pro rata pay - least onerous
Flexible trainees are not allowed to take part in non-compliant rotas, so applications for flexible status from doctors will not be accepted by the Deanery or the Trust unless the doctor is on a compliant rota.
See the Flexible training page for more details, and this document for a full explanation of the new flexible trainee pay system.
Changing the band of a rota
In order to change the banding of a rota, a formal process must be undertaken and documentation submitted to the local SHA or relevant organisation. A typical Approval to Change Band template can be found in the Downloadable Documents section.
Pay Protection
Please also see the NHS Employers guidance on pay protection for junior doctors for a comprehensive explanation of how pay banding protection works.
Changes can occur to the pay supplement that a particular post attracts, either because the rota has been altered, or because the rota is shown as compliant or non-compliant with New Deal, following diary monitoring.
When this happens, all postholders (doctors who are currently in post, or have accepted a post) are entitled to pay protection. In a nutshell, when the banding of a post changes, the postholder's pay supplement is protected at the total value of the basic pay + banding which was applicable at the time the banding was changed. (The exception is band 3 non-compliant posts, which are pay protected based on 80% banding rather than 100%.)
The pay protected salary is effectively frozen on a mark time basis at the time of rebanding, and will increase only by increments to the basic salary on the old scale. (The "old scale" is interpreted by NHS Employers to mean the scale applicable at the time of appointment.) In other words, any subsequent government pay awards will not increase the total salary, and increments will only be applied to basic salary, not banding. (In practice, the basic salary will have to increase in line with any government pay awards and will increment on the new payscale, in order not to affect the doctor's pension. So the supplement will have to be adjusted downwards to compensate.) NHS Employers provides worked examples within the pay protection guidance.
Pay protection for doctors currently in post
If a compliant rota is rebanded downwards, the doctors currently on that rota will remain pay protected for the duration of their post or placement, unless the new band overtakes the level of pay protection.
For instance, if a group of doctors is currently on band 2a rota, they will be receiving 80% of basic salary. If this rota is changed to a band 2b, they will be pay protected.
If a non-compliant rota is rebanded to a compliant band, all the doctors on this rota will move from band 3 (100%) to band 2a (80%) and will be pay protected on the payscale applicable at that point.
Pay protection for future posts / rotations
Doctors are also pay protected once they have accepted an offer of a future post from the employer. If the banding has been reduced since they accepted the post, they will be pay protected based on the banding payable at the date of acceptance, unless the post was provisionally rebanded before this date.
The European Working Time Directive
The EWTD is a Health and Safety Law which was adopted by the UK in 1998. It is enforced by the Health and Safety Executive. Certain groups are currently exempt, e.g. long distance lorry drivers and junior doctors in training. The EWTD already applies in full to non training grade doctors (i.e. Consultants, Clinical & Research Fellows, Trust grades, Staff grades, and Associate Specialists).
The Junior Doctors New Deal is intended as a transitional process in the reduction of junior doctors hours, which will eventually achieve full compliance with the Working Time Directive as determined for doctors in training.
Main aspects of the European Working Time Directive:
48 hour maximum working week (average)
11 hours continuous rest every 24 hours
24 hours continuous break every week, or 48 hours every fortnight
8 hours maximum night shift length (for some jobs - unlikely to apply to junior doctors)
20 minutes break for every 6 hours worked
Free health assessments for night workers
4 weeks paid leave a year after having worked 13 consecutive weeks
The timetable for implementation is as follows:
August 2004
Maximum hours reduced to 58 (including all rest hours during resident on call and partial shifts). This is likely to mean the end of resident on call work. (See The SiMAP Ruling, below.)
Low intensity, nonresident on call rotas may still be viable, since doctors who are nonresident on call will be regarded as working only if they are actually answering a call.
Rest provisions from August 2004
- 11 hours' continuous rest in every 24 hour period
- Minimum 20 minute break when shift exceeds 6 hours
- Minimum 24 hour rest in every 7 days or
- Minimum 48 hour rest in every 14 days
- Minimum 4 weeks' annual leave
- Maximum 8 hours work in 24 for night workers (if applicable)
August 2007
Maximum hours reduced from 58 to 56.
August 2009
48-hour week applies to all junior doctors.
Opting out
Workers may choose to opt out of the maximum hours limit, and/or they may sign a collective workforce agreement to opt out of the other parts of the EWTD (rest breaks, shift lengths etc). However, it is not possible for junior doctors to opt out of the New Deal - these requirements are compulsory.
Also remember that at present, even under a collective agreement to opt out of the rest requirements, you would still have to take immediate compensatory rest. So to all intents and purposes, there is no opt out of the EWTD rest requirements.
Most Trusts will discourage doctors from opting out of the 58 hour maximum, because they are likely to breach New Deal requirements. The opt-out is strictly voluntary - the EU is currently reviewing this issue because of concerns over British workers being forced to sign an opt-out.
The SiMAP ruling
This is a ruling in the European court which defines all time spent on duty on Trust premises as work. This means that while a doctor is on duty, all rest which is taken on the Trust site (eg when resident on call) is counted as work.
The full text of the SiMAP ruling is accessible via the Legislation page.
The Jaeger ruling
This ruling in the European court confirmed the SiMAP judgement and also recommended that when 11 hours continuous rest was not possible, compensatory rest should be taken "immediately". The implications of this ruling are still under discussion.
The full text of the Jaeger ruling is accessible via the Legislation page.
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Further information on junior doctors' pay and conditions is available from .