Adam Mallis
Mar 29, 20237 min
Updated: Nov 1, 2023
You will need to provide some examples of hot topics you can apply during your medical school interviews. Here you will learn everything you need to know about the junior doctor contract. These ethical implications and some example medicine interview questions and model answers for you to look at. Combine your reading here with medicine interview tutoring and information on the junior doctor's strikes to boost your answers and delivery.
A junior doctor is any doctor in training who is not yet a consultant or GP - they could have been out of university for 1-10 years (or, rarely, even more)
The junior doctor contract details terms and conditions for junior doctors’ employment in the UK
In 2016, proposed changes to the contract were widely opposed by doctors and led to four periods of strike action before an agreement was reached with the government to adopt a contract seen as a compromise
The contract was again updated in 2018 to make some minor changes
The ongoing 2023 junior doctors’ strikes may lead to more changes to the contract, particularly regarding pay
👉🏻 Read more: MMI Medicine Interview Tips Guide
The progression pathway of a doctor is complex and non-linear. The BMA has a simple guide here that can help you to understand it.
A ‘junior doctor’ is any doctor in a training pathway who is not yet a consultant or a GP. A consultant is a fully qualified doctor who specialises in a particular area of medicine and usually works in a hospital, whereas a general practitioner sees patients in primary care facilities such as GP practices and manages patients with a broad range of different conditions.
There are many types of junior doctors:
Foundation Year 1/2: Foundation year 1 and foundation year 2, or FY1/FY2, doctors are those who are in their first and second year out of medical school respectively. They rotate around 3 specialities per year for four months each.
GP Specialist Trainee: GPSTs have completed their foundation years, and are in a 3-year training program where they rotate around relevant specialities before qualifying fully as a general practitioner
Core Medical/Surgical Trainee: These are trainees in ‘uncoupled training’, where their post-foundation year training is split in two: first, they train broadly in medicine or surgery; second, they train more specifically in their chosen area.
Specialist Trainee: These may be trainees in the second phase of ‘uncoupled training’, or in ‘run-through training’ where doctors enter a single, unbroken, training program between FY2 and consultancy.
Other: Various other more complex pathways exist, where doctors can work as FY3/4/5/etc, clinical fellows, and more.
Importantly, all junior doctors are fully qualified doctors with medical degrees and responsibilities in looking after patients. They may have been qualified as a doctor for many years. Medical students are not junior doctors.
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The junior doctor contract is different in each of the four devolved nations: England, Scotland, Wales, and Northern Ireland. All doctors are encouraged to read it at least two months before starting work.
The contract outlines all of the workers’ rights to which doctors are entitled, encompassing a wide variety of key issues. The BMA has a guide to all of these issues. Some key ones to know about include:
Overtime: The contract specifies what counts as overtime, during which doctors are paid more. Currently, overtime applies between 8 pm-6 am (or 9 pm-7 am, depending on region) Monday-Friday and all day Saturday, with rates increased further on Sundays or bank holidays.
Working limits: Doctors should work no more than 72 hours work in a consecutive 168-hour period, with a maximum of seven shifts of any length worked on seven consecutive days or four long shifts on consecutive days
Pay protection: If a doctor is switching specialities to one that is hard to fill (eg emergency medicine, psychiatry, GP), or for reasons related to disability/caring responsibilities, then their pay shall be protected at the rate that it was had they not switched for the duration of their training. They will therefore be paid more than a new trainee, to reflect their increased experience.
Pay progression: Pay progression based on experience shall continue when a doctor is on academic or maternity leave.
In 2015, Jeremy Hunt (then-Health Secretary and current Chancellor of the Exchequer) proposed changes to the contract that included:
Pay changes: Doctors would be paid more at a base rate, but less for overtime work and therefore be up to 30% worse off overall
Pay protection removal: Doctors’ pay would not be protected when switching to a hard-to-fill speciality, reducing interest in these specialities and contributing further to understaffing.
Pay progression pausing: Doctors on academic and maternity leave would have their pay progression paused.
The contract was part of plans for a “7-day-NHS”, where similar services would be provided on weekends and weekdays.
These suggestions were highly controversial and led to a series of strikes in 2016 across four sets of dates for 24-48 hours each after 98% of junior doctors voted to oppose the proposed contract. Eventually, an agreement was reached between the BMA (the doctors’ union) and the government and the strikes stopped.
Junior doctors are striking again in 2023 over pay, as you can read about in our article on that topic.
In 2018, more changes to the contract were suggested, and in 2019, these were finalised with the BMA’s agreement.
👉🏻 Read more: Common NHS Hot Topics in 2023
Some specialities are particularly hard to fill in the NHS - for instance, A&E medicine, general practice, psychiatry, maxillofacial surgery, and anything in very rural areas such as the Scottish highlands and islands.
This may be for a variety of reasons such as lower pay, less sociable working hours, harder working conditions, behaviourally challenging patients, or simply the fact that doctors find them less interesting. Various schemes are being introduced to help to remedy this, as you can read about in our article on the GP shortage in the NHS.
Some key factors to consider are making these specialities more appealing inherently by resolving issues such as poorer working conditions as best as possible, as well as offering additional benefits to doctors in these specialities.
Pay protection for doctors moving to these specialities later in their career is an important factor, as many doctors who eventually fill these positions come from other specialities previously.
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Doctors may take leave for various reasons - perhaps to undertake important research projects, or for personal reasons such as having a family. The contract outlines that doctors should not have their pay progression (the usual increase in pay as a doctor gains experience) paused during these periods.
This is important for multiple reasons. For one, it ensures that doctors can pursue other ventures in their lives that are important to them. Additionally, it is a core part of gender equality in the NHS, which has a significant gender pay gap.
You could get questions about any of the above topics in your medical school interviews. Some top tips to consider are:
Remember that the contract, and the disputes surrounding it, are not just about money! Show off your understanding of more complex issues as well.
Bear in mind that ‘junior doctor’ is a very general term that can describe a variety of types of doctors at all stages of their training.
Consider the 2016 strikes in relation to the 2023 strikes - comparing and contrasting them can be extremely helpful in making nuanced and intelligent arguments.
👉🏻 Read more: MMI Medicine Interview Tips Guide
A: Junior doctors went on strike four times in 2016, in opposition to a proposed new contract by Jeremy Hunt, who was the UK’s Health Secretary at the time.
The contract was opposed for a variety of reasons. First, it changed provisions for what counted as overtime. This meant that whilst doctors’ base rate of pay was increased, their actual earnings would likely decrease by up to 30% for those most affected. Many doctors saw this as not just an unacceptable pay cut, but an insulting and somewhat sneaky way of trying to implement it.
Second, other terms of the proposed contract would have made working conditions worse for junior doctors. These included details about night shifts and for how long doctors can work on a shift. In particular, there were concerns that these changes could have led to extreme fatigue that may have endangered patients - a common analogy used by protestors was that you wouldn’t let an exhausted pilot fly your plane, so shouldn’t let an exhausted doctor practice medicine.
Third, pay provisions aside from rates also would have worsened. This includes scrapping pay protection and pausing pay progression for doctors on maternity leave, changes that would have exacerbated understaffing in hard-to-fill specialities and worsened the already-significant gender pay gap in the NHS.
Given these proposed changes to the contract, and even more, it’s no surprise to me that junior doctors went on strike in 2016. Thankfully, the strikes ended when a compromise was reached between the BMA and the government on a mutually beneficial contract.
👉🏼 Read More: Medicine Interview Questions Guide 2023
What are some key similarities between the 2016 and 2023 junior doctors' strikes?
What is a junior doctor?
What are some key differences between the 2016 and 2023 junior doctors' strikes?
What does the junior doctor contract say about how long doctors can work in a week?
How can we ensure that doctors don’t become dangerously fatigued to the point of endangering patients?
Do you support pay protection for doctors switching to hard-to-fill specialities? What about doctors switching specialities in general?
Should pay progression continue for doctors on maternity leave and academic leave?
What do you think that NHS doctors think about Jeremy Hunt and why?
What is the junior doctor contract and what does it outline?
What changes to the junior doctor contract were proposed in 2016?
👉🏻 Read more: 280 Common Medicine Interview Questions 2023
Overall, junior doctor contract questions can provide a valuable opportunity to reflect on the ethical challenges that can arise in medicine and to demonstrate your ability to think critically about these issues.
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