We wrote to all junior doctor members in Wales last month telling you that we would shortly be able to provide some more news on the contract negotiations in which we have been engaged with Welsh Government and NHS Wales Employers for the past two years.

We are pleased to let you know that, a few days ago, we reached agreement with NHS Wales Employers on a contract reform deal that the Welsh junior doctors committee feels is sufficiently attractive to present to the membership for further consideration. 

Therefore, on 3 October, we will be issuing a consultative referendum on the contract package so junior doctor members in Wales can have their say on the deal we’ve agreed. From 26 September onwards, we will be undertaking contract ‘roadshows’ in hospital sites across Wales to explain the deal to junior doctors. All junior doctors are welcome to attend the roadshows but only members will be able to vote in the referendum, so please encourage your colleagues to join the BMA today.

In spring 2020, we heard from hundreds of junior doctors in Wales which informed our priorities for these talks. Contract reform has been about safe working conditions, about recognition, and about making sure trainees can get on with training, alongside providing vital service to the NHS. The new contract package provides improvements in all these areas and represents a clear step forward for junior doctors in Wales.

To underpin the new deal, the Welsh minister for health and social services is providing an investment into contract reform that equates to 3% of the current junior doctor workforce cost. This additional funding covers the costs of moving over to the new contract as well as providing ongoing investment in the junior doctor workforce that would not otherwise have been achieved.

The contract deal is based on the contract in place in England – the ‘2016 contract’ as amended following a review in 2018. However, it is not the same contract. We have won a wide range of improvements and changes above and beyond the English contract – not least a significant, permanent pay uplift on that contract – that address some of its shortcomings and make it a better deal for Wales. This is a new contract that WJDC is endorsing to you all.

Dr Makwana

First and foremost, the new contract delivers comprehensive working-hours safeguards, the same as the ones seen in England. These ensure rotas are designed in ways that are safe, less fatiguing and provide a better work-life balance. It means no more 12-day stretches, no more 14-hour days, and mandatory rest after night work. When you are too tired to drive home after an exhausting shift, you will be able to rest on site free of charge, or your employer will pay for public transport or a taxi home.

There will be a new system for pay, which increases the amount of basic, pensionable pay you receive and frontloads it earlier in the pay scale. There will be five nodal pay points, which will be based on progress through training, rather than on your years in service to the NHS.

However, we know the effect this competency-based pay system can have on pay, and on the choices trainees want to make about their training – be it by training less-than full time, training in two specialties, or taking time out. To mitigate some of these issues, we negotiated a new flexible training pay premium unique to Wales, which will provide additional pay to core and early specialty trainees to recognise out-of-training experience after completion of the foundation programme and the experience gained by training in one specialty before switching to another.

Exception reporting will be introduced like in England, ending the problem of rota monitoring exercises failing through incomplete participation, meaning bandings very often don’t reflect the work you’re really doing. Instead, pay will be for the hours you work, and when you work over those hours – or you miss a training opportunity owing to service pressures – you will get that time back in lieu, or be paid, or your working arrangements reviewed to ensure you don’t miss your training.

At the top of many people’s minds will be how pay will be affected by the new contract. The contract fundamentally changes the way hours are valued. There are positives and negatives to this, as well as winners and losers. This is always the case with contract reform. Through improvements we have won over and above the English contract, however, we have done our best to ensure the effect of changes is softened, and the ways doctors choose to work and train in Wales isn’t artificially shifted by the pay system. Included in our web resources is a ready reckoner for pay and representative trainee pay journeys to help you better understand the effects of the new pay arrangements.

For existing trainees in Wales at the point of implementation, there will be cash-floor pay protection. This will ensure your total pay never drops below the level it is at the day before you move to the new contract, providing certainty regarding pre-existing financial commitments and allowing you to make a decision based on what you think is best for all junior doctors in Wales, not just based on your own circumstances.

The UK Government’s decision to not provide additional uplifts to the multi-year pay deal that was agreed as part of the English contract reform has had the effect of further suppressing pay in England in the face of spiralling inflation.

As part of the new contract in Wales, we were able to ensure we did not carry over this pay suppression into the pay scales proposed here. Instead, the new pay scale will reflect the pay awards recommended by the Review Body on Doctors' and Dentists' Remuneration in the last three years rather than those from the multi-year pay deal. This has resulted in a proposed pay scale for Wales that is on average 4.8% higher than the English pay scale.

Clearly, there is still work to be done on pay and, whilst we were able to agree as part of contract reform that the new pay scale should be set at a higher level to that in England, we are nonetheless clear that contract reform and pay awards are distinct issues. There will be no multi-year pay agreement as part of this contract deal, and there will be a further pay award as usual next summer before implementation of the new contract could begin in August 2023.

This means we are able to remain dynamic to issues of pay. WJDC is clear about the need for restoration of pay to address historic pay erosion and will continue to fight for this alongside other branches of practice in Wales and across the association. However, the committee also recognises the value of the proposed contract reforms and the positive impact they would have on improving the working lives of junior doctors in Wales.  

Please read the guidance and materials provided on our website. If you have any questions not answered in these materials, please contact [email protected] and we will be happy to provide more information. A dynamic FAQ document will provide further information in response to common questions and will be updated over the next few weeks.

BMA Cymru Wales staff and WJDC representatives will be visiting workplaces across Wales to explain the contract package and the choice you now face, as well as providing an opportunity for questions. These events will typically take place in the middle of the day and often during grand rounds or existing training slots. Please make every effort to attend these events where you can – your consultant should recognise the importance of this decision and allow you the time away. For those who are unable to attend the roadshows, or work in places we will be unable to visit, a webinar will be held at 6.30pm on Thursday 29 September with the same information.

The referendum will open on 3 October and will ask you if you wish to approve the introduction of the new junior doctor contract. Doctors in training, final-year medical students, and locally employed doctors in Wales who are BMA members will all receive a vote.

WJDC believes this is the best deal that could reasonably be reached via negotiation. It provides solutions to many of the longstanding concerns we have heard from members regarding their working lives and is a vital reform and modernisation of our terms and conditions of service. We urge members to accept this deal.

We look forward to seeing many of you as we begin roadshows in the coming weeks. Keep an eye out for more information, including dates and locations of the roadshows, via email, on our website and via our social media channels as the referendum process begins.

Evan Sun (pictured, top) is chair of BMA Welsh junior doctors committee and Milan Makwana is deputy chair