Junior Doctor Contract explained

In the UK, there are different contracts for each region: Northern Ireland, Scotland, England & Wales. For England, the latest update is in 2018 & it is worth making sure you’re aware of the changes from the 2016 version.

Before you start work, you should receive an adapted personal version of this with the additional policies where you’ll be working. This outlines your specific rights as a junior doctor & knowing these well can make sure you’re looking after yourself.

Why is it important?

The contract outlines your rights and entitlements to pay, hours, leave, safety, expenses, facilities and everything else. If you don’t know your rights, how can you know if they’re not being considered?

If you’d prefer a video guide to Employment topics, check out our free “Employment Essentials” course. You can also find relevant articles covering leave, well-being, ensuring work-life balance & other employment topics here.

What should I do?

Step 1: Read the national Terms & Conditions

Reading the T&Cs that exist across your region will help you understand which hours are unsocial thus attracting more pay, limits on working hours (in case your rota is unsafe), the breaks you’re entitled and what policies must be in place if you do end up doing more hours or are unable to take breaks. These are key things that protect your well-being!

These form the bulk of the rules and there will be some adaptations for where you’ll be working.

For a summary of the rota rules to make sure you’re taking the breaks you need & not breaching with the locums you do you can read this.

Step 2: Ensure you receive your personal contract at least 2 months before you start

If you don’t receive it, you should let the Human Resources department know that you’ve not yet received it (you can contact them by email or switchboard). Most people don’t end up checking it nor do they sign the document, but by starting work you implicitly agree to it. Worse than this is that many receive it after they’ve started work!

Step 3: Look for issues

The terms should be broadly similar or refer back to the national T&Cs with amendments reflecting your role & grade. The issue is if they deviate significantly with something you shouldn’t be agreeing to & that’s why you should check it. In 2021, the BMA (the largest trade union for junior doctors) states over 25% of over 6000 contracts checked deviated from the national model.

If you can’t be bothered or find it too confusing to check for changes, you can join the BMA who can check it for you if you become a paying member. But by doing this & not learning it for yourself, you run the risk of never fully understanding your rights.

Check every line & refer back to the T&Cs above making sure there are no significant differences. If there are and you’re not sure what this means then you should ask HR, your colleagues or the BMA to clarify.

European Working Time Directive

As part of signing your contract, you may be asked if you’d like to opt out of the EWTD. This opt-out is asking if you’re happy to opt out of the safety limits for maximum hours per week under the EWTD – in almost all cases the answer is going to be no as this is a legal protection designed to keep you safe.

Our maximum average hours are limited by two things – the junior doctor contract & the EWTD. The former limits our hours to 56h whereas the latter to 48h. However, as rotas can’t be designed assuming everyone will opt out, the default rota has you working less than 48h. In fact, even the busiest of rotas tends not to exceed an average of 44h per week.

What does opting out allow then?

It allows the possibility of the trust introducing a contract for you that exceeds 48h per week. This is really unlikely to happen on a case-by-case basis but may occur if you’re not a trainee (e.g. you’ve applied for a direct post rather than through Oriel).

It allows you to locum a lot more. However, given the average hours tend to be several short of 48h per week, there is usually plenty of room to locum assuming you remain compliant with the general rota rules of the contract. With tiredness & exhaustion, it is unlikely you’re going to work well beyond this, but you also are more likely to make a mistake and your indemnity provider may not protect you or charge you a premium for doing all those extra shifts.

Finally, by opting out, you raise the possibility of medicolegal issues. There is written documentation that you knowingly opted out of safe working hours designed to protect you.

With all this in mind, it makes sense to opt out later (as you can do so at any time), when you feel it is appropriate.

Resources & References

Written by Dr Akash Doshi (ST4 Endocrinology & Diabetes)

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