Gender Equality, NHS and Female Junior Doctors

Female junior doctors beware: the Tories are coming to ruin your lives because they hate women, just like everyone else does! At least, that’s what you would believe if you were to follow unexplained pictures on the internet.

Early this morning, prior to my wake up cup of coffee, I saw a delightful post shared by someone whom I can only assume is a junior doctor – yes, she is also female. The post in question (which can be found here [archive here]) highlights how the new junior doctor contract specifically disadvantages women because “reasons”. The argument of the image when taken as is, red lines and all, seems to portray that women are being targeted in this contract to receive lower pay for the same work. The poster of the image, Facebook page The Medical Registrar, fails to offer any real insight or explanation for what is being said in the image, only stating that “the new contract will specifically disadvantage women and single parents”. Le sigh.

The post is a screen-cap of the Equality Analysis on the new contract for doctors and dentists in training in the NHS released by the Department of Health. An 89 page document, the paper “analyses the draft final contract for Doctors in the National Health System” and it covers topics such as biological sex, maternity, race, the new five node pay plan, etc. Note how it says draft and is underlined? No such context is given in the original Facebook post.

Screen Grab of Original Post

What an insightful analysis provided

Yet again we are being hit with the tired, age old argument that women are paid less for the same work because they are women. This is fundamentally false both in the US and here in the UK. They are also trying to argue that single parents will be specifically targeted by this change. This is also false. The current upheaval and change to junior doctor pay will advantage some and disadvantage others, as always happens when pay structures are changed. But do the costs outweigh the benefits?

First, let’s break down the points put forward by this particular section of the paper:

  1. Changes have been made to on-call payments, changes are considered fair.
  2. Changes have been made to plain-time hours and Saturday Intensive Payments.
  3. Said changes may have indirect adverse effect on women but are for legitimate aim.
  4. Such adverse effects will be balanced by a 13.5% average increase in basic pay.
  5. Those working part-time receive same level of pay in later years of training whether full or part-time
  6. Those who work most intense/unsocial hours will receive the most pay.
  7. This may cause women to earn less.
  8. This may disadvantage lone parents (who are disproportionately female).
  9. This may benefit other women, e.g. those who have partners because for them it may be easier to make informal, unpaid childcare arrangements in the evenings and weekends.

The areas that are cause for concern, as noted by the helpful red underlining (good lord without them I wouldn’t know what to react to!), are points three and seven. These two points simply say that women may (!) earn less. The obvious question is why. Why might women earn less, is it because they are women as this post is trying to infer?


The changes being made to on-call staff as referenced in points 1 & 2, which may lead to women earning less, are relatively simple. The current system for additional hours and on-call availability contains “banding payments”, additional payments added to basic pay (which are non-pensionable), which can vary from 20% to 80% depending on the working pattern. Highlighted in Point 25 are some unfair elements of the current system:

  1. Doctors may work anything between 41 and 48 hours, and yet receive the same pay.
  2. Doctors on rotas with no night shifts can be entitled to the same pay as Doctors on rotas with night shifts.
  3. Doctors on rotas with no Sunday working can be entitled to the same pay as Doctors on rotas with Sunday working.
  4. A 100% banding payment applies where there is a breach of the current ‘New Deal’ requirements of 2000. A single breach, by one Doctor, of the shift length or rest requirements puts the entire rota (the group of Doctors on the same working pattern) in breach and triggers a 100% pay supplement to all Doctors working that rota. The pay supplement applies for the duration of that rota, including retrospectively (meaning the payment would apply to each Doctor until the end of the rotation).

Even the BMA agreed as far back as 2008 that the contract needed to be reformed and as such new changes are being introduced, most significant features of the new model are:

  1. Higher basic salary for a ‘basic’ working week.
  2. Proportionate payment for additional hours worked, up to a contractual maximum of 8 hours (or 16 hours if the Doctor has opted out of the Working Time Regulations (“the WTR”).
  3. On-call availability payments (varying according to the frequency of the on-call commitment).
  4. Payment for work undertaken as a result of being on-call (this is included in [1] and [2] above).
  5. Enhanced rates of pay for work done during unsocial hours (‘premium-time’ periods), including a Saturday ‘Intensity’ Payment (SIP).
  6. Flexible pay premia.

Where women may be affected is raised in Point 30 where it is stated that “childcare is more expensive at times (when) Doctors are likely to be on-call and that the position under the new contract would adversely affect single parents (a disproportionate number of whom are women)”. The proposed solution to this was an on-call payment rate equating up to 3.3 times that received by other NHS doctors and that a carer’s allowance should be exclusively available to single parents. However, following discussion with NHS Employers the BMA withdrew the carer’s specific allowance because giving special treatment to single parents (alone) in relation to on-call alone would not be fair or justifiable. Even so, this is still balanced out with a 13.5% average increase in basic pay.

Also, to tie in with this are the changes to plain-time and Saturday Intensive Payments. Plain-time (or core hours) are hours where basic rate of pay apply and are currently defined as 7am to 7pm, Monday to Friday, with a Doctor working 40 hours or fewer. Point 34 states “the new contract: (a) extends the definition of plain time to cover 7am to 9pm, Monday to Friday and 7am to 5pm, Saturday, and (b) provides for enhanced payment rates during premium time at: (i) time plus 50% for work undertaken on nights (9pm to 7am, every day), and (ii) time plus 30% for work undertaken on Saturdays between 5pm and 9pm and on Sunday between 7am and 9pm.” True, for weekdays that is 2 hours a day more plain time but this is rewarded with time & a half for night work and time & three tenths for Saturday evening and all of Sunday.

The addition of Saturday Intensity Payments (SIPs), as said in Point 35 says that “doctors will be paid time plus 30% for all work undertaken between 7am to 5pm where they work shifts beginning on Saturday at a frequency of 1 in 4, or more frequently”. This is here to reward staff who put in the extra effort regularly working the unsocial Saturday hours. The reason this may affect women is because single parents (disproportionately female) will have to pay for childcare costs as they may not have familial care available, be it in the form of relatives or partners.

However, these changes do also affect single male parents yet these are a minority. Also, to assume that these changes blanket effect all women is false. A single woman (or a single man) going through the NHS doing her/his training will not be negatively affected in the ways argued by the Facebook post as they do not have children to care for. Also, the post does not highlight how the new contract specifically says how women will be isolated and disadvantaged.

Where the post tries to argue that the new contract targets single parents (notably women because they comprise the majority of single parent junior doctors) it ignores that this is a decision all parents have to make: briefcase or baby? To manage both a career and a child is difficult as both require lots of time and energy, this will also stand true for working in the NHS. Do not be surprised that single parent junior doctors will have a hard time completing their studies because raising a child (as a single parent or not) is a very difficult task to complete. The naivety displayed in the original post is astounding.

In short, the post says that under the new contract single parent junior doctors (who are mainly women) will have a difficult time working and raising a child and the contract openly admits that. The contract openly admits that these new hours will be tough but they will be financially compensated for their work. This is misogynistic because women (even though female junior doctors who aren’t single parents won’t be disadvantaged but that is still misogynistic because women).

[Update 15-05-16: Corrected some grammar issues and how some text is displayed. Also added below image and text.]

I wasn’t going to add this but it’s been sitting on my hard drive and in the back of my mind for ages so just like an itch I’ve got to scratch, I uploaded.

I counted how many times it reference men and women in the document and compared how they were referenced. The numbers may be off a tad because this task was really boring and I hated doing it.

But note how often women are referred to negatively, this shows how bad and how sexist this contract is for women, am I right!?!? Also see how it doesn’t reference men negatively so that must mean that the contract is really good!?!?

Oh and yes, the contract does actually cite being a woman as a protected characteristic. Because “muh, womyn!

What really drives this home is the female single parents argument. The NHS doesn’t know how many of its single parents staff are male or female, so they assumed they are primarily female. Hence why we kept hearing that the new contract is sexist against women because it disadvantages single mums.

It also disadvantages women because they choose the easier hours for easier pay and this is wrong because it is the current time signature and you are not allowed to do that because we said so, so stop doing it.

Updated image for blog.png


One comment

  1. […] even more jobs for the girls”. Also, by way of topical flavour, you will be aware that the current conflict over junior doctors’ contracts is essentially a gender issue. The EHRC is weighing into the bout on the doctors side taking […]


Leave a Reply

Please log in using one of these methods to post your comment: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.