Changes to junior doctor pay under the contract the government plans to impose this summer will be ‘an absolute disaster’ for GP training, the union fears. Cuts in pay could make it financially unviable for doctors in other specialties to make the switch to general practice, it warns.
NHS Employers has highlighted that terms and conditions of the new junior doctor contract protect pay for doctors switching directly from one training programme to another.
But the BMA says this protection will not help the 'significant proportion' of doctors who do not enter GP training either direct from foundation training or direct from another specialty training programme.
Despite a 'flexible pay premium' for GP trainees worth £8,200 on top of basic pay, the BMA fears up to 50% of doctors who enter GP training will be forced to take pay cuts under the new system.
Junior doctor strikes
Pay erosion under the junior doctor contract could undermine hopes that general practice has begun to ‘turn the tide’ over recruitment. Early figures from the latest GP trainee recruitment round published last week showed that the number of GP trainees recruited was up nearly 150 compared with this time last year.
The warning over GP trainee pay comes as junior doctors take part in strikes from 6-8 April over the imposition of the new contract.
GPC education, training and workforce subcommittee chairman Dr Krishna Kasaraneni told GPonline: ‘We are noticing recently that the number of foundation doctors going directly in to GP training is falling. More doctors are gaining other experience before entering GP training.
‘With the imposed contract, any trainee switching specialties [but not moving directly from one training scheme to another] will be heavily penalised and can face basic pay cuts of £11,000 or more.
'The pay protection that DH has announced until 2019 will mean that trainees who are entering GP training from the non-foundation route will be penalised heavily if they take a career break such as maternity leave and so on.
GP trainee recruitment
‘Despite the headline numbers, the imposed contract is an absolute disaster for GP training and for any doctor who is likely to take parental leave. I certainly would not have been able to switch specialties if this contract was in place when I trained.’
Trainees will be protected against a drop in income until 2019. In a document published earlier this year, NHS Employers said: 'Trainees at ST4 and above will keep their current pay progression until their training is complete or until 2019, while moving to the new arrangements for terms and conditions.'
But from that year, the BMA fears doctors moving to general practice will face significant cuts, and could be put off. Doctors starting now who do not complete training by 2019 because of career breaks, maternity leave or working part time could also lose out, it says.
Foundation doctors going straight into GP training would receive ST1 basic pay of £37,000 a year plus the GP flexible pay premium of £8,200. For these doctors, stepping up from F2 pay of £30,000 under the new deal, pay is likely to be relatively attractive.
Doctors who switch from another specialty training scheme direct to GP training - as long as general practice remains a 'hard-to-fill training programme' - will have their pay protected.
GP pay protection
Terms and conditions of the new junior doctor contract say that to qualify for pay protection, 'the doctor must have completed at least 13 months' continuous service at the level of basic pay paid in the immediately previous appointment on the previous training programme and must take up the first appointment on the new training programme no later than six months after leaving the original training programme'.
But Dr Kasaraneni said as many as 50% of doctors starting GP training do not come direct from foundation training or another specialty training scheme.
Many work in general hospital jobs after foundation training, before deciding what specialty to pursue, or begin GP training after dropping out of another specialty programme and spending a year or more working in different roles, he said.
These doctors could face a reduction in pay under the five-point scale for pay progression that takes effect with the new junior doctor contract.
An ST3 doctor working in a hospital would earn £48,000 in basic pay under the new deal, and this income would be topped up by an additional on call allowance likely to be worth a five-figure sum - although NHS Employers points out the allowance 'depends on the rota being worked, and some do not have an on-call allowance'.
A doctor like Dr Kasaraneni - who completed two years of orthopaedics specialty training, then worked in a variety of hospital jobs before choosing GP training - would now lose a significant sum from this move because he would drop back to ST1 pay and lose on call income on top.
This is in contrast to the current system, which allows doctors to maintain pay increments accrued in other specialties.
An NHS Employers spokeswoman said moving to the five-point pay scale under the junior doctor contract aimed to provide a financial incentive for doctors to stay in training until they completed it.
'Pay under the 2016 contract is linked to progression and level of responsibility. The contract encourages and incentivises people to develop and stay in the training programme and rewards those that do so,' she told GPonline.
'The contract is not designed to protect doctors who choose to opt out of the established training system. However for those doctors who applied to re-enter training from non-training posts in 2016, there are some circumstances where a level of pay protection will apply.'