Health secretary addresses concerns by saying he wants to cut junior doctors’ hours, maintain their pay and increase safety in the NHS

Jeremy Hunt has moved to head off the potential strike by NHS junior doctors by seeking to reassure them that their pay will not be cut and they will not have to work longer hours under the proposed new contract that has sparked so much anger.

In a letter on Thursday to Dr Johann Malawana, the chair of the British Medical Association’s junior doctors committee (JDC), the health secretary sought to defuse the increasingly heated row over the unpopular new contract he has threatened to impose on them.

In the letter, Hunt offered the JDC, which represents most of the 53,000 junior doctors in the NHS in England, “absolute guarantees” on their pay and working hours, and a major concession which would not extend trainee doctors’ normal working week to include up to 10pm on Saturday.

Jeremy Hunt letter to junior doctors makes big concessions on contracts Read more

On the overall cost of junior doctors to the NHS, Hunt writes: “Firstly, this is not a cost-cutting exercise. I can give you a categorical assurance that I am not seeking to save any money from the junior doctors’ paybill. Whilst I want to see an end to automatic annual increments [with pay rises instead based on moving through the stages of training and taking on more responsibility], these changes would be cost-neutral, rather than cost-saving.

“This will mean that junior doctors would still benefit from four or five progression pay rises as they move through training.”

On the crucial issue of working hours, junior doctors have been particularly incensed by Hunt’s proposal to extend the hours classed as normal working time – and paid at the “standard” rate – from 7am-7pm Monday-Friday to 7am-10pm Monday-Saturday.

Hunt has told the JDC: “I can give an absolute guarantee to junior doctors that this contract will not impose longer hours. No junior doctor working full time will be expected to work on average more than 48 hours a week. I want to see a work review system with teeth that ensures that juniors are not exploited and that addresses issues of overworking if they arise.”

And on junior doctors’ pay – another big issue, as they were estimated to be set to lose between 15% and 40% of their income under the new contract – Hunt writes: “I have asked NHS Employers to develop the details of the new contract to ensure that the great majority of junior doctors are at least as well paid as they would be now. In addition, although the current proposal does not provide protection for those whose pay reduces when they change jobs, under an agreed move to a new contract we would be willing to consider such protection for individual doctors who would otherwise lose out.”

Addressing the widely feared loss of overtime for junior doctors working antisocial shifts – overnight and at weekends – Hunt adds: “In any scenario, I can give an absolute guarantee that average pay for juniors will not reduce. I have already given my assurances that GP trainees will not be disadvantaged compared with the current system. I can also say that it is our intention that flexible pay premia would be used to support recruitment into shortage specialties such as accident and emergency medicine and general practice. We would also include pay protection for doctors who change to shortage specialities and to support agreed academic work.”

Facebook Twitter Pinterest Junior doctors protest in London against new contracts. Photograph: Thabo Jaiyesimi/Demotix/Corbis

The BMA did not confirm whether the letter would do enough to convince doctors not to strike when given the opportunity, adding that it still needed more information on key points of contention . Dr Johann Malawana, the chair of its junior doctor committee, said: “It is encouraging that the health secretary has finally recognised the vital role that junior doctors play as tomorrow’s leaders across the NHS. However, questions still remain and we are urgently seeking clarification on the points raised in the letter.”

Hunt sparked a wave of anger among junior doctors by announcing on 15 September that he intended to impose a new contract on them about a year after the JDC walked out of negotiations about it with the Department of Health.

Junior doctors contract row: an explainer Read more

The doctors’ union denounced the new contract as “unsafe and unfair ... [and] bad for patients, bad for junior doctors and bad for the NHS”. Itclaimed it would extend by 50% the working hours a junior doctor is paid at the basic rate and would see working at 9pm on a Saturday paid at the same rate as 9am on a Tuesday.

It also claimed the contract could see trainee medics losing up to 30% of their pay as a result of receiving far fewer overtime payments for antisocial shifts and would also deepen the crisis in GP recruitment by removing a supplement paid to newly qualified doctors to help persuade them to go into general practice.

Amid a rising tide of unrest, the JDC voted on 26 September to hold a ballot about taking industrial action, including a possible strike, in protest at Hunt’s plans. No timetable for the ballot has been announced but junior doctors have staged well-attended protests against the plans in London, Manchester and Glasgow in the last 10 days. Up to 14,000 have also already pledged to attend a major rally in central London on 17 October.

The Academy of Medical Royal Colleges, which represents the UK’s 250,000 doctors professionally, welcomed Hunt’s letter as an attempt to break the deadlock. “We are pleased to see the initiative from the secretary of state to seek to unblock the impasse on the junior doctors’ contract,” said Prof Sue Bailey, the organisation’s chair.

“The current concerns around the [proposed] contract reflect a strong feeling from our trainees that they are not valued in the NHS. Aside from the specific outcome on the contract, the academy believes this underlying issue has to be addressed and [medical royal] colleges are keen to play their part.”

Bailey also echoed Hunt’s renewed call in his letter for the BMA to resume negotiations over the new contract with NHS Employers, which represents hospitals and other major NHS bosses.

“The view of [the] colleges is that the current difficulties will only be addressed through a return to negotiation and this must be the priority for the BMA and NHS Employers,” said Bailey.



“Whilst colleges have no responsibility for the detail of terms and conditions, we are clear that the highest standards of patient care are delivered by energetic, motivated and properly rested doctors with a positive work/life balance. This also results in the most effective learning. We hope this is reflected in the outcome of contract discussions.”



Hunt wants to see both junior doctors of all types and senior, experienced hospital doctors, such as consultants, working much more routinely at weekends in order to help realise the government’s pledge of creating a seven-day NHS by 2020, without it costing the cash-strapped NHS any more money.