Are you about to start as a preregistration house officer?

Ian Urmston from the BMA tells you everything you need to know about conditions and contracts

It's late July 2001 - most newspaper columnists have warned their readers to avoid hospital for the next six weeks - but you have finally made it! A new house of brand new doctors is waiting to cram as many text and reference books into their white coat pockets, sling a new stethoscope around their necks, and, most visibly, pin their "Dr" name badge on a lapel. On your first day as a preregistration house officer you will be given a final defining accessory - a bleep. The only practical advice, as a lay person, I can pass on about bleeps is this. Contain your excitement. It will, I am assured, be shortlived. Your understandable enthusiasm about starting out on your career will wane as the bleep begins to take control of your life.

It will not be news to you that house officers work hard. You will have plenty on your mind in respect of caring for your patients and impressing them and your senior colleagues with your ability and knowledge. To add to this burden you will also be an employee and this status brings with it responsibilities and rights far removed from your role as a clinician and something, perhaps, you are even less prepared for.

Preregistration house officer (PRHO) jobs

PRHO jobs are meant to be primarily educational. You will, however, be providing services to your employer. House physicians or surgeons are salaried and contracted to an NHS trust and, as such, a contract with terms and conditions of service will apply to you. The BMA has negotiated a national contract for junior doctors and your post should reflect this. Details are available on the BMA website (www.bma.org.uk) under the junior doctors link. Trusts are obliged by law to issue you with the contract and a job description and a contract is normally sent with the formal offer of the post

Contracts

Before finals the majority of students will know which job they will start with but many will not have seen the contract. If you have not received any paperwork by the time you have passed your exams, you should write to medical staffing at the trust requesting the contract and job description. You should not sign the contract before you have graduated. Nor should you be pressurised into signing a contract or letter of acceptance presented on your first day at the trust. Do not sign until you have had time to read the papers and check that the information, particularly on the job description, about salary and job band, hours of work, and rota or shift arrangements matches your expectation when you accepted the job. Trusts may add clauses to the nationally agreed contract. These are not always in your best interest (see authorisations for deduction from salary below). It is possible for you to be put on the payroll without having signed a contract despite anything you are told to the contrary.

Study the contract and job description carefully before signing and if they do not match the model agreements, or if you have any other concerns, take advice from the local BMA office.

The importance of contracts and job descriptions

Employment contracts determine what a worker does and what they get paid for doing it. Any confusion surrounding a contract can work against you. Misunderstandings or misinterpretations could cost you literally many hundreds of pounds or even your job. As the doctors' trade union and professional organisation the BMA has negotiated a standard model contract and full job description for junior doctors (see box).

Together with the job description you should have an accurate picture of the working conditions and duties of the post and the training available.

Once signed the contract is binding not only on the trust but on you. Problems become difficult to resolve if you have signed a non-standard contract. Take advice from the local BMA office.

Elements of the contract and job description

Hours of duty - your contractual commitment should be spelt out clearly in terms of set hours.

Pattern of work - it should be clear whether you are on a rota or shift arrangement and how many doctors you share this pattern with.

Cover arrangements - house officers normally cover each other's annual leave. If you are expected to provide prospective cover this should be explained clearly in the contract.

Salary and band - the junior doctor contract has changed recently and full time junior doctors' pay is based on a standard working week plus a supplement for out of hours work. Each job is in a band (1,2, or 3), which reflects the level and intensity of the work done outside the basic 40 hour week. The band determines which level of supplement is paid.

Leave entitlement - you are entitled to five weeks' paid leave a year. This is strictly divided for each six months period. Make sure that you arrange your leave with colleagues as early as possible. Commonsense dictates that you cannot all be off at the same time. Paid sick leave entitlement is not generous in the early years of your career. It increases with length of service.

Start and finish dates - these should be explicitly clear.

Deductions from salary - employers are allowed to deduct only national insurance, income tax, and superannuation from your salary. This should be stated in the contract (see authorisations for deduction from salary below).

Authorisations for deduction from salary

The standard contract (paragraph 14) ensures that your trust cannot make deductions from or variations to your salary, other than those required by law (tax and national insurance) without your consent. Ensure that it is part of your contract. Occasionally trusts try to leave it out or ask you to sign a piece of paper authorising deductions for phone calls, wear and tear on room furnishings, and accommodation, etc. Any deduction from your salary should be authorised individually. Make sure that you read everything you are asked to sign. Do not agree to strike out references to paragraph 14 from the model contract and do not sign a blanket authority for multiple deductions.

Frequently asked questions

Can the trust amend my contract?

Once a contract has been entered into, subsequent alteration of its terms cannot be made without written mutual agreement. This includes any unilateral alteration of your banding assessment during the term of your contract which can be construed as a breach of contract.

Can the trust make my hours longer?

Trusts should not increase the hours of junior doctors to the maximum permitted in each band. Any changes to the working arrangements, which might lead to an increase in hours worked, can be introduced only with your agreement and the approval of a junior doctors' regional action team (implementation support group in Scotland and Northern Ireland and SAFER in Wales).

Can the trust change the working pattern?

Under certain circumstances the trust may alter rota or shift patterns. If this is proposed you should take advice from the local BMA office at the earliest possible opportunity. Pay protection will apply if the changes happen while you are in post. Pay protection applies to all posts. If your trust tries to bring in changes while you are in post please contact your local BMA office for advice about the process which must be followed and any protections that apply to you individually.

Does the trust have to provide accommodation?

All house officers are required to be resident as a condition of their appointment. This means that you must live in the hospital when on call. Where you live in your own time is up to you. However, house officers are provided with a free room exclusively for their own use. Some trusts offer on call rooms only which would be used by each person on the rota in turn. If this is not suitable for you the trust is obliged to provide you with a room for your exclusive use. These arrangements apply only to house officers. Hospital accommodation for junior doctors must reach minimum standards. Details are available on the BMA website.

Do I have to pay council tax at the hospital address?

House officers will not normally be liable to pay council tax. Information about council tax for doctors resident in hospital is available from local BMA offices.

I have started work but haven't got a contract. What should I do?

You must have a written agreement. Some trusts are slow at providing documentation even though there is a legal requirement obliging them to supply this. If you have not received a contract or statement of job particulars when you start, you should have one within two months of taking up the post. If you still have no written contract after this period and you have raised this with medical staffing notify the local BMA office.

Should I be given a copy of the national terms?

The national terms and conditions of service is a very long document. You would normally be shown relevant extracts and job specific details. A copy of the full documentation should, however, be available in the junior doctors' mess or at the medical staffing office. The BMA produces a free Junior Doctors Handbook for all members-a new edition is due to be published very soon. It covers all relevant terms of service for junior doctors.

Should I join the NHS pension scheme?

Although you are entitled to opt out of the NHS pension scheme the BMA recommends all doctors to join and remain in the scheme as it has been shown to make good financial sense.

What can I do if I have a problem?

The first thing that you should do if you come across a serious problem, either affecting you or others on your rota, is talk to your local BMA rep or your medical staffing officer. If you wish to discuss the situation with someone outside the hospital and you are a BMA member contact your local BMA office.

What information is available from BMA?

The BMA publishes lots of information about contracts and work-related issues. Many of these resources are on the BMA website (www.bma.org.uk). Publications include the Junior Doctors Handbook and guidance notes or fact sheets on subjects such as: NHS indemnity, the NHS pension scheme, first house job, council tax, tax and national insurance. Look these up on the BMA website or request a copy from the local BMA office.

After passing finals

Once you have qualified there are two important things to do.

Register with the General Medical Council

You must have provisional registration with the GMC. Trusts cannot allow you to work unless you have a current registration. It makes for an inauspicious start to turn up on your first day and be told you cannot work. Popularity with colleagues, consultants, and managers will not follow. The medical school will supply a GMC application form called PR1. Complete and send this to the Registration Directorate, General Medical Council, 178-202 Great Portland Street, London W1N 6JE. Tel (020) 7580 7642; fax: (020) 7915 3558. There is a fee (currently £100).

The GMC will issue you with a certificate of provisional registration as soon as it has heard from your university or examining body that your qualification has been conferred. If there is a delay, chase up the GMC. Do not assume registration until you have the certificate in front of you.

Choose an address for registration where you can be sure of receiving mail. Your name could be removed from the Register if correspondence fails to reach you and is returned to the GMC. Let the council know promptly of any change of address by letter.

Join a medical defence or protection organisation

The BMA, the health departments, and GMC all advise doctors to have defence body membership or to take out other personal indemnity insurance. There is a NHS indemnity scheme that covers your work on NHS business. It does not cover work outside the NHS or any "Good Samaritan" acts. Doctors should ensure personal access to indemnity advice and cover by joining a defence or protection body. You should ensure that the cover you opt for is adequate for the activities you will undertake.

Induction courses

Trusts provide induction courses and standardised starting days for PRHOs. Important local information is provided at these meetings. This can include explanations about local policies on prescribing, test ordering or reporting, and other bureaucracy, the hospital facilities and layout, work timetables, and level of responsibility expected from the appointee and how the bleep system works.

I hope that this has been of some help to you. Remember that as an employee you need to be aware of your rights. The BMA is the doctors' trade union and professional organisation. It provides members with support, guidance, and representation where necessary to resolve contractual problems. Like any form of insurance you need to have paid if you want cover. Local offices will check contracts only for members and the association cannot help doctors with problems that predate membership. Good luck.

Ian Urmston, senior marketing executive, BMA
Email: iurmston@bma.org


studentBMJ 2001;09:171-216 June ISSN 0966-6494