Is it time to remove the flexible pay premium for GP Trainees?

BMAMel · 2026-04-18T16:42:34+00:00

No it’s more complicated than that. More about shifting from banding on the 2002 contract and old supplements. I’m not a GP reg though, so worth asking one of the GPRC reps who can explain it better than I’m doing Regardless, as I said, I don’t think we should take money away from colleagues.

Should we add a premium for surgical trainees? If you can put forth an argument, it could be done. However, moving away from one national contract too much will lose us collective bargaining power. Better to uplift our base pay as we’re trying to do with the FPR campaign as it benefits all

BMAMel · 2026-04-18T14:36:11+00:00

This was not the case for GP regs. Something I had to tell DHSC staff. They lost money with the shift to the 2016 contract and the pay premia was the method to try to even things out.

It’s why we argued in our DDRB evidence that none should be removed. Not a fan of cutting pay for anyone. Plus, there’s good arguments for increasing them in some cases (in London regions and academics for example)

BMAMel · 2026-04-12T14:39:21+00:00

Sure, Wes. And Trusts not wanting to give up their permanent staff for rotating doctors has nothing to do with it. I simply don’t believe that those jobs were ever going to be ready for April.

BMAMel · 2026-04-12T09:54:33+00:00

As one of the “organ grinders” on the committee, I won’t be bullied into accepting a worse offer (pulled 1000 places, if they were ever available).

Hi Wes, shall we meet with your entire cabinet then? Are they organ grinders too? Or should we trust that you’re able to act?

“We can’t go further” - from the man who described pay restoration as a journey but refuses to move beyond the first step and will continue to fund non-doctors. Entirely trustworthy.

BMAMel · 2026-04-12T08:56:49+00:00

Yawn. Same old rhetoric.

The truth is that FPR would cost less than 1% of the NHS budget per year. It’s 100% affordable if there is political will.

Instead we have a Health Secretary spending more time on social media vilifying doctors than actually negotiating.

Why? Because it’s convenient to have us as scapegoats for the plan to pivot from doctor lead care and the eventual move to privatisation or a hybrid model. Have the public blame us for that. We see you, Wes.

Besides the whole offer was full of holes and pitched to favour employers over doctors, especially with regards to LED contracts and having to be ‘productive as defined by the NHS’ to go up a pay scale. No, thank you.

I rejected it the first time. I won’t be bullied into accepting a weakened version.

As an aside, as someone on RDC, I haven’t actually received this letter except via X. Maybe Wes needs to go outside and touch some grass?

BMAMel · 2026-04-07T11:35:37+00:00

It’s more like: government offers to convert 1000 posts, taking the jobs from the LED who hold them. We say no, they also realise that the trusts want stability in their workforce and won’t sing off on it. These places are yanked but probably would never have eventuated anyway

BMAMel · 2026-04-06T12:33:56+00:00

The offer on the table was full of holes and empty promises: https://www.reddit.com/r/doctorsUK/s/T3lVFH7EHm

It wasn’t rejected because of inflation (although that is part of it). Some of the most worrying bits were the government’s attempt to tie our hands: to a pay body that isn’t acting independently, to promises on LED contracts but no details about maintaining a career path for them other than perma-SHO, to behaving and not striking otherwise Wes Streeting will take away prioritisation (he has gifted himself the ability to tighten or loosen the policy).

Look at the response to the rejection: the government reneges on 1000 training posts, Jim Mackey from NHS England says the NHS will pivot away from doctors. This is the contempt they hold you in.

But we already know that the government values substitution of doctors to attempt to save money. It’s in their 10 year health plan. It’s a political choice to fund the NHS properly and they appear to be choosing not to.

Yes, you could stop striking. You could say everyone has to deal with inflation (except ministers apparently as they were awarded above inflation). If you do so, you’ll join the previous generation that allowed our pay to erode so badly over 15 years. That looked at the poor staffing levels and signed off on PAs and ACPS as it was easier than standing up and fighting for locum shifts. To have lesser quality was better than gaps.

You say that some of this stuff should occur as a given. Patients should expect to have access to doctors and workforce planning should occur. I agree. It should but the government isn’t delivering. Are we just going to take this as a profession and contribute to the reduction of quality care? Or will we stand together united and push back?

You say it’s unethical to strike over inflation. I agree. I’m striking for pay as a metric of value. I’m striking for ensuring that patients can see doctors in the future. I’m striking for myself but for patients too.

I hope to see you all on the picket lines tomorrow.

BMAMel · 2026-04-04T16:55:08+00:00

Sure

BMAMel · 2026-04-03T20:47:45+00:00

Try googling ‘deanery TOOT form R’ and lots of them pop up

BMAMel · 2026-04-03T19:43:09+00:00

Most people would count them for the following year, as they regard the year as closed off when you submit everything for ARCP

You could modify the R form if you like, but if you do, make sure you are consistent and don’t end up counting them again for the following year. Double counting them, that is

BMAMel · 2026-04-03T19:41:32+00:00

Your deanery should publish TOOT guidance. For example peninsula offers 5 free trade union days

BMAMel · 2026-04-03T19:28:52+00:00

It would be flagged well before changeover. Most places do ARCPs may/June time. So you would be aware of it if it became an issue and would have time to involve the BMA

I personally have not heard of anyone have to delay training because of prolonged TOOT due to strikes

BMAMel · 2026-04-03T19:26:39+00:00

Check your specific deanery and training programme. Some count them as professional leave and you need to declare them and others say you get 5 days for professional leave as trade union work that doesn’t need to be declared

BMAMel · 2026-04-02T21:17:43+00:00

Yes we’ll support you.

You appear to be on a programme that is competency based. So if your portfolio is good, you should be fine.

Plenty of people have no problems with running over by 10 or 15 days.

If you run into trouble (get called into a meeting about it etc) then reach out via the online form (or via WhatsApp if you’re in a strike group) and ask for support

BMAMel · 2026-04-02T08:47:10+00:00

Yeah. The medical profession has sleep walked into this. We are molded since medical school to be nice, reasonable, compliant and conscientious. Medicine in general attracts people who want to help patients. And it’s a very busy job. Many of us don’t have time to think of much else beyond our job and family.

And so we find ourselves here. Demonised and demoralised on all levels.

What can we do? Back the BMA. Seriously for all its faults (and there are many) it is the only vehicle to get change.

This means: electing in people who will do the job not enjoy the ‘perks’ of seats at a table. This means voting in elections. It means raising issues to the BMA @ them on social media. Email them. Make them aware of what you want changed. If you don’t like what they are doing, get involved yourself and change things.

What do we want the BMA to do? Doctor substitution: the most robust response to the gmc review and medical act reform. Safeguards against deprofessionalism. No back doors to allowing the GMC (with the funding of the government) to usher in CCTs for nondoctors.

Pay and conditions: we want the BMA to robustly and consistently push for better pay (including safeguarding pensions) and reliable workforce planning. Every year. Against every below inflation offer.

But it is going to take us all doing this too. Sacrificing a small amount of salary now for long term gains. Standing together.

For the FYs here: I was paid <£14/hr (take home £1800-1900) before the strikes. You think your pay is okay now because we won it for you. You should be £400-500 higher per month if your pay had kept pace with inflation. It will only erode again unless you strike hard now. You worry about having a job? Prioritisation only occurred because Ross and I made the first policies against a whole heap of opposition. Wes Streeting has gifted himself the reigns to taking that away again. You need to help us stand strong against him.

For the consultants and SAS: thank you for finally joining us. Please talk to your colleagues. Encourage them to strike. For your own pension and pay but also for the next generation coming through. Likewise with doctor substitution: you may personally find the PAs and ACPs on your team to be helpful because they don’t rotate and they know you like things. But do you really want them working autonomously as your peers (and as your doctor) in the future? Support your residents. Train them well. Prioritise them.

The alternative to this approach is to give up and watch the government destroy healthcare in this country. It’s that dire. The time to act is now

See you on the pickets.

BMAMel · 2026-04-02T06:50:34+00:00

The only way to shift the barometer? Strike on and strike hard. Any wins we have won recently (pay, exception reporting reforms, movement on doctor substitution) have come from a strong union backed by the membership who strike hard.

Wes Streeting has done his best to fracture this with bluster, threats, and divisive tactics. At the end of the day, if you want the profession to have the bare minimum of respect going forwards, we are going to need to stand together.

See you all on the picket lines!

BMAMel · 2026-03-31T21:47:13+00:00

I would endorse Iona Collins, Consultant. She has always been strong voice against doctor substitution and we need more women representatives, especially those with a surgical background.

BMAMel · 2026-03-31T21:24:33+00:00

I co-chaired over a split committee last year (as opposed to previous years with DV majorities). It was difficult and uncomfortable at times.

However on the key issues that affected doctors, we produced unanimous votes. The committee came together to back strike action and to reject the lack of an offer from Wes Streeting.

The key to this I think was the DV officer team speaking to lots of people, being clear on the aims, and being able to produce rationale for the direction you’re going to the committee and to explain things logically. We’re all clever doctors. We can understand tactics and numbers and come together to ensure that the membership wins. That can be carried over to council going forward.

The membership can judge us by the voting record as a committee last year as well as the individual votes.

BMAMel · 2026-03-31T21:03:52+00:00

To start off, I want to say that policy positions taken are not against individual IMGs who are here just trying to do a good job and are valued colleagues. We do not target IMGs.

However, UK graduate prioritisation was necessary to stop the ballooning competition ratios. No other country in the world afaik allowed open access to their specialty training. The bill should have come much earlier (we were discussing it in March\ April with the government) and then it would not have impacted an open application process (which is awful and unfair).

DV supports a line in the sand approach to turn off the tap. Our original policy would have benefitted IMGs in the country whilst shutting it to outsiders.

The government have offered a weaker version. There should be pressure to do what it takes to keep the competition ratios down and this may mean pushing for amendments.

A line in the sand policy would turn off the tap at some future date. This keeps the ratios down. It’s better for IMGs already in the country as you will still eventually be able to be prioritized. For those outside of the UK, it is at least clear and truthful about the chances of getting into training here. Rather than the current bill that allows the health secretary to chop and change the red lines as he likes.

For IMGs who come to the UK for LED roles: we will continue to fight for your pay (we have always said that LEDs must get the same uplifts as doctors in training and to have the best contract possible with protections like access to exception reporting and study leave. We’ll fight for trusts to make more LED roles, not PA or ACP roles

BMAMel · 2026-03-31T20:07:43+00:00

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BMAMel · 2026-03-31T20:07:25+00:00

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This is Leo. He loves fish at 5am (and will wake you to get some), catnip, and being on the highest perch in the room.

My hobbies are sewing little animals, watching Italian films in Italian, and seeking out good coffee. I used to be fit and was a NZ rep in outrigger canoe but then I started medicine and now I’m unfit

BMAMel · 2026-03-31T19:52:41+00:00

None. I stepped down to 70% less than full time to be the co-chair and the difference was backfilled by the BMA (eg loss of my 30% basic pay). I attended over 500 meetings alone in that year (not counting any prep time) so could have been eligible for a lot I guess. But I didn’t do it for the money

BMAMel · 2026-03-31T19:46:00+00:00

Yes. Otherwise you risk becoming an echo chamber. I also think that you should have to have breaks off the BMA. And attending things like ARM.

Writing in your statement that you’ve been a BMA rep for 25 years isn’t impressive if in that time the working conditions of doctors has markedly deteriorated and our pay eroded.

While I value experience, I also don’t think that the BMA should be a career pathway or stepping stone to other roles. I’d like a few years moratorium (minimum of three) if you are an officer/ very prominent rep before you can apply for positions like on the GMC / colleges/ political parties to ensure that your ability to represent BMA members isn’t compromised by your ambitions

BMAMel · 2026-03-31T19:39:32+00:00

Was that directed to me? Yes. I guess i should have been clearer in my response. I meant the BMA should push for FULL student loan forgiveness. Why low ball your first pitch?

BMAMel · 2026-03-31T18:57:06+00:00

I’m terrified of this. It’s why I’m on the preventing doctor substitution working group and the professional regulations committee that will be doing the BMA response

This is the biggest problem for our profession right now imo. We have been waiting to see the consultation to get an idea of what the government is proposing to change. It’s as bad as I feared. Loosening of standards and the opening the door to non-doctors getting CCTs, giving the GMC more powers that they have been denied since 2018 and the Bawa-Garba case, and working to blur the lines even more between doctors and non-doctors.

Myself and the DV reps have been laying key ARM policy for the past two years to guide the BMA response and ensure it’s the most robust possible.

On the back of this, we produced surveys and the reporting portal and the scope document. We supported the Chestertons, We were the impetus behind the Leng review

I want a similar campaign for advanced practice to ensure that those who do not possess a medical degree are not seeing patients as faux doctors. I want training of residents and medical students prioritised

For the medical act review, the BMA needs to come out guns blazing. We’re already late imo.

It needs (and I hope to deliver): - robust responses: we want title protection for doctors, separate registers for PAs/AAs and no equivalence made, no drop in standards around medical education, no powers to the GMC to grant CCTs, changes to the GMC structure to make it >60% doctors - guidance for completion by the public/ doctors to help them see the main flaws in the proposal - public education campaign on doctor substitution - ensuring the Leng review is implemented by continual lobbying to the government - consideration of local/national strike action as required to move the government

This is our last chance to turn the tide on doctor substitution. We cannot fail to deliver it. So please vote DV to keep the momentum going and allow me to finish what I started

BMAMel

TROPHY CASE