Contract(Reforms((DDRB(July(2015):(

Modelling(the(eect(on((
Junior(Doctor(Pay(during((
Specialty(Training(
Dr(Steven(Bishop(
smb50@cam.ac.uk(
(

Academic(Clinical(Fellow(in(Anaesthesia(
Specialty(Registrar(in(Intensive(Care(Medicine(
Cambridge(University(Hospitals(NHS(FoundaQon(Trust(
(
Version(0.1((draS)((2nd(August(2015(

Overview(
1. Overview(of(current(contract(and(proposed(changes(
2. My(nancial(model(
3. Eect(of(proposed(changes(to(basic(pay(progression((
((Schemes(A((C)(
4. Eect(of(Scenarios(A[C+:(basic(pay(percentage(upliS(and(
reward(of(OOH(Qme(
5. Eect(on(pensions(
6. Eect(on(student(loans(
7. Comparison(across(acute(specialQes(
8. Modelled(data(from(the(East(of(England(
9. Overall(outcome(for(anaesthesia(
10. Conclusions(
11.(Next(steps(

1.(Current(Trainee(Contract(
Currently(remunerated(from(StR(pay(scale((Points(0[9).(Pay(point(depends(upon(
Qme(in(NHS(service((based(upon(salary(increment(date)(
A(doctor(who(progresses(smoothly(from(FY(to(ST(training(without(Qme(out(of(
training((e.g.(OOPE,(mat(leave)(will(have(a(direct(mapping(from(training(grade(to(
StR(pay(point((e.g.(CT1(=(StR[0;(CT2(=(StR[1(etc)(
Possible((and(not(unusual)(to(have(doctors(at(the(same(training(grade(with(
dierent(base(pay(
Basic&Pay&)&Exisi,ng&
2015%Pay%Circular4%
Point%
Base%Salary%
StR[0(
30,002.00(
StR[1(
31,838.00(
StR[2(
34,402.00(
StR[3(
35,952.00(
StR[4(
37,822.00(
StR[5(
39,693.00(
StR[6(
41,564.00(
StR[7(
43,434.00(
StR[8(
45,304.00(
StR[9(
47,175.00(

Basic&Pay&)&by&grade&
((
((
Anaesthesia%
%
Anaesthesia%post:ACCS%
Grade%
Base%Salary%
Grade%
Base%Salary%
CT1(
30,002.00(
CT1(
30,002.00(
CT2(
31,838.00(
CT2(
31,838.00(
ST3(
34,402.00(
CT2(Anaes(
34,402.00(
ST4(
35,952.00(
ST3(
35,952.00(
ST5(
37,822.00(
ST4(
37,822.00(
ST6(
39,693.00(
ST5(
39,693.00(
ST7(
41,564.00(
ST6(
41,564.00(
(
(
ST7(
43,434.00(

1.(New(Contract(
DDRB(have(recommended(a(number(of(pay(models(
that(are(open(to(discussion.(There(are(three(main(
aspects:(
(a) Changing(the(current(system(of(basic(pay(progression(
(b) Increasing(basic(pay(and(altering(the(way(OOHs(work(is(
remunerated((by(removing(banding(supplements)(
(c) Dening(normal(Qme(as(Mon[Sat(7am[10pm(

Read%the%DDRB%July%2015%document%for%full%details%of%
the%proposals!%

1.(New(Contract(
(a)(Change&to&basic&pay&progression(
DDRB(recommend(just(3[4(increments(in(basic(pay(across(the(whole(of(
specialty(training,(i.e.(the(same(basic(pay(for(longer(periods(of(training(
Three(dierent(schemes(have(been(proposed(by(the(DDRB(to(reect(
increased(basic(pay(with(increased(seniority(
Scheme(B(is(a(good(match((in(principle)(for(training(in(Anaesthesia((cf.(basic,(
intermediate,(higher(and(advanced(training)(
Scheme&A&

CT1/2(

Scheme&B&

CT1/2(

Scheme&C&

CT1/2(

ST3(
ST3/4(

ST4/5/6(

ST7/8(

ST5/6(

ST7/8(

ST3/4/5/6(

ST7/8(

1.(New(Contract(
(b)&Increased&basic&pay&and&altering&OOH&remunera,on:&
4(dierent(plans(have(been(released,(called(Scenarios(A,(B,(C(
and(C+(
They(all(have(a(dierent(balance(between(increased(basic(pay(
and(increased(OOH(pay(
OOH(work(will(be(based(upon(hours(worked(and(paid(at(normal(
Qme,(1.33x(normal(Qme(or(1.5x(normal(Qme(depending(upon(
the(scenario(chosen(
(
Percentage&Pay&Increase& ((
((
Basic&Pay&UpliD&
Unsocial&Increase&(Sunday)&
Unsocial&Increase&(Night&10pm)7am)&

Scenario%A%
19.10%(
[(
33.00%(

Scenario%B% Scenario%C% Scenario%C+%

17.50%(
15.30%(
14.90%(
33.00%(
33.00%(
33.00%(
33.00%(
50.00%(
50.00%(

1.(New(Contract(
(b)&Increased&basic&pay&and&altering&OOH&remunera,on:&
&There(has(been(substanQal(negaQve(commentary(in(
social(media(regarding(the(DDRB(comparing(medicine(to(
other(industries((including(fast(food,(shop(workers(etc)(
when(selng(the(OOHs(premium(of(33%(and(50%(normal(
Qme(pay.(Personally(I(dont(object(to(these(rates(for(OOHs(
work(and(think(they(are(fair,(provided(our(rate(of(basic(pay(
is(set(at(an(appropriate(level(to(reect(and(respect(our(
training(and(professional(responsibility&
Percentage&Pay&Increase& ((
((
Scenario%A% Scenario%B% Scenario%C% Scenario%C+%
Basic&Pay&UpliD& 19.10%(
17.50%(
15.30%(
14.90%(
Unsocial&Increase&(Sunday)&
[(
33.00%(
33.00%(
33.00%(
Unsocial&Increase&(Night&10pm)7am)& 33.00%(
33.00%(
50.00%(
50.00%(

2.(My(Financial(Model(
I(built(a(large(macro[based(nancial(modeling(system(in(Excel(
It(encodes(the(current(pay(scale(and(the(proposed(new(pay(schemes(and(
scenarios(
It(includes(calculators(for(Income(Tax,(Contracted[out(NaQonal(Insurance,(NHS(
Pension(ContribuQons(and(Student(Loan(DeducQons(
It(is(highly(customizable((opQons(for:(
details(of(actual(or(mean(rota/post(banding(%(
mean(weekly(hours(worked,(mean(weekly(Sunday(hours((7am[10pm)(and(mean(weekly(night(
hours((10pm[7am)(
Availability(allowance(and(RRP(
Tax(personal(allowance(
Student(loan:(choose(whether(to(deduct(from(salary(or(not;(current(loan(interest(rate(
Pension(calculator:(can(select(which(parts(of(new(pay(model(are(pensionable(pay(

It(calculates(the(eect(of(each(new(scheme/scenario(and(compares(it(to(the(
current(pay(banding(system:(
Compares(gross(pay,(net(pay,(pension(and(student(loan(eects(
Looks(at(cumulaQve(eects((gains(or(losses)(over(each(training(year(and(the(whole(of(training(

2.(More(on(modelling(
The(model(requires(as(input(both(current(banding(
and(hours(worked(per(week.(I(have(modeled(this(
in(two(ways:(
1. Extracted(the(mean(banding(and(mean(weekly/
Sunday/night(hours(from(Figure(4.1(of(the(DDRB(July(
2015(report((as(these(appear(to(be(reasonably(
representaQve(of(the(named(specialQes)(
2. Compared(this(to(real(Anaesthesia,(Obs/Gynae,(
Medical(and(A+E(rotas(in(the(East(of(England(

2.(The(Model(
Once(I(have(nished(tweaking(the(model(I(will(share(
it(with(the(BMA(and(Royal(Colleges.(
I(will(also(make(it(available(for(general(release(on(the(
www(and(via(social(media(so(that(interested(trainees(
can(understand(the(proposals(in(more(detail.(
I%have%also%produced%an%algebraic%model%of%the%
proposed%pay%reform%that%demonstrates%the%
relaDonship%between%the%new%pay%schemes,%working%
hours%and%rota%design.%I%plan%to%publish%this%in%due%
course.%

3.(Eect(of(changing(pay(progression(
The(DDRB(document(DOES%NOT(indicate(values(for(the(actual%base%salaries%that(
would(be(awarded(for(each(increment(point(in(the(new(pay(schemes.(I(have(
assumed(that(these(will(be(paid(at(the(minimum(exisQng(pay(point(in(each(of(the(
new(bands((based(on(the(StR[x(scale)(before(the(percentage(basic(pay(increase(is(
applied,(e.g.(Scheme(B(before(the(%(increase:(
CT1/2:(30,002((((ST3/4:(34,402(((((ST5/6:(37,822((((((ST7/8:(41,564(

However,(my(model(does(allow(this(to(be(changed.(OpQons(include(minimum%
pay%point,%mean%pay%point%or(maximum%pay%point%or(custom.(E.g.(Scheme(A(
ST4/5/6(could(be(set(to(Mean(current(ST4/5/6(basic(pay),(Max(current(ST4/5/6(
basic(pay)(or(a(custom(dened(value.(

3.(Eect(of(changing(pay(progression(

The(new(basic(pay(increment(schemes(have(a(HUGE(impact(on(gross((and(net(pay)(over(
training.(
Impact(on(total&gross&pay&over&training((CT1([(ST7)(for(Anaesthesia:(

(
(
(
(
((((( (

Minimum&pay&point&
Mean&pay&point&
Maximum&pay&point&

Scheme&A&
[23,628(
[11,742(
144(

Scheme&B&
[20,523(
[11,743(
[2,963(

Scheme&C&
[30,222(
[11,288(
7,647(

((((using(DDRB(Fig(4.1(data(for(Anaesthesia(hours(and(banding(and(picking(the(worst(Scenario(A[C+(in(each(scheme)(

For(specialQes(with(substanQal(OOH(work(the(nal(choice(of(Scheme(is(important.(Scheme(
B(is(the(best(by(far(for(acute(specialQes(like(Anaesthesia((based(upon(all(the(scenarios(I(
have(run(through(the(model)(
It%is%vitally%important%to%know%in%advance%what%the%actual%base%salary%will%be%for%the%new%
increment%points.%If%the%new%bands%are%set%at%the%current%minimum%StRBx%equivalent%for%
the%band%(minimum%pay%point)%then%this%would%result%in%a%very%signicant%pay%cut%over%
training.%I%strongly%believe%that%the%maximum%pay%point%used%above%is%an%unrealisHc%
scenario%and%would%not%be%awarded%by%the%DDRB%within%the%current%overall%pay%envelope%
(but%is%included%here%for%comparison)%

Model(assumpQons(
1. New(pay(increment(schemes:(each(pay(increment(band(is(paid(at(the(
minimum(current(StR[x(equivalent(within(the(band((worst[case(analysis(
or(minimum%pay%point%analysis;%see%previous%two%slides)(
2. Pensionable(pay:(under(the(current(junior(doctor(contract(only(basic(pay(
(not(banding)(is(pensionable.(I(have(assumed(that(only(upliSed(basic(pay(
remains(pensionable( ( ( ( ( ( ( ( ( ( (
((although%my%model%on%changing%one%conguraHon%opHon%will%also%
model%the%eect%of%addiHonal%hours,%Sunday%hours,%night%hours,%
availability%allowance%and/or%RRP%becoming%pensionable%pay)%
3. Student(loan:(by(default(it(assumes(trainees(are(repaying(a(Tier(1(
Student(Loan(via(PAYE(and(the(loan(interest(rate(is(1.5%((although(both(
these(opQons(can(be(changed)(
(

4.(Eect(of(Scenarios(A[C+:(basic(pay(
percentage(upliS(and(reward(of(OOH(Qme(
Modeling(the(eect(of(these(4(scenarios(that(aect(the(rise(in(basic(pay(and(the(
remuneraQon(of(out(of((hours(work:(

Percentage&Pay&Increase& ((
((
Scenario%A% Scenario%B% Scenario%C% Scenario%C+%
Basic&Pay&UpliD& 19.10%(
17.50%(
15.30%(
14.90%(
Unsocial&Increase&(Sunday)&
[(
33.00%(
33.00%(
33.00%(
Unsocial&Increase&(Night&10pm)7am)& 33.00%(
33.00%(
50.00%(
50.00%(

4.(Eect(of(Scenarios(A[C+:(basic(pay(
percentage(upliS(and(reward(of(OOH(Qme(

(
(
(
(
(
(
(
(
(

Eect(on(Anaesthesia:%%cumulaDve%gross%and%net%pay%over(CT1[ST7(training(using(data(from(
DDRB(Fig(4.1(compared(to(current(banded(pay(scheme((assumpQons:(new(pay(scheme(set(to(
minimum%pay%point,(only(upliSed(basic(pay(is(pensionable(and(Tier(1(student(loan(deducted)(
Gross&Pay&
Net&Pay&
Dierence& Dierence&
Scheme&A&

Scheme&B&

Scheme&C&

Scenario%A%
Scenario%B%
Scenario%C%
Scenario%C+%
Scenario%A%
Scenario%B%
Scenario%C%
Scenario%C+%
Scenario%A%
Scenario%B%
Scenario%C%
Scenario%C+%

[23,472(
[23,628(
[22,336(
[23,540(
[20,366(
[20,523(
[19,219(
[20,433(
[30,069(
[30,222(
[28,954(
[30,135(

[15,075(
[14,923(
[13,933(
[13,612(
[13,694(
[13,540(
[12,542(
[12,226(
[18,009(
[17,859(
[16,887(
[16,556(

A(big(loss(of(income(during(training!(
The(relaQve(dierences(between(Scenarios(A[C+(are(also(demonstrated(when(modeling(other(
acute(specialQes(with(OOHs(commitment((although(the(absolute(gures(vary).(Scenarios(C+(
(and(C)(are(the(best(opQons(and(demonstrate(the(smallest(pay(cut(to(specialQes(with(a(
substanQal(OOH(commitment((although(there(are(caveats((see(SecQon(11(of(this(slide(set)(

5.(Eect(on(pensions(
An(upliS(in(basic(pay(increases(pensionable(pay(and(places(the(trainee(in(a(higher(
pension(contribuQon(Qer(at(an(earlier(stage(of(training((without(a(headline(change(in(
the(published(pension(contribuQon(rates).(Thus(trainees(will(make(more(pension(
contribuQons(over(training.(
Eects(for(Anaesthesia(over(training(CT1[ST7((assumpQons(as(previously):(
Increase&in&
%
Pension&
Contribu,ons&
%
%
Scheme&A&
Scenario%A%
5,222.60(
Scenario%B%
4,838.50(
%
Scenario%C%
4,310.37(
%
Scenario%C+%
2,686.13(
Scheme&B&
Scenario%A%
5,465.17(
%
Scenario%B%
5,077.82(
%
Scenario%C%
4,545.21(
Scenario%C+%
2,920.14(
%
Scheme&C&
Scenario%A%
4,707.55(
%
Scenario%B%
4,330.37(
Scenario%C%
3,811.76(
%
Scenario%C+%
2,189.24(
%
(note%the%wide%variability:%this%is%due%to%increased%basic%pay%pushing%some%scenarios%into%a%higher%
pension%band%earlier%in%training,%with%contribuHons%rising%immediately%from%9.3%%to%12.5%!)%

5.(Eects(on(pensions(
Despite(pension(contribuQons(increasing(this(does&not(result(in(increased(
deferred(pension(benets((i.e.(a(larger(pension)(at(reQrement(
Current(pension(scheme(is(career[averaged(and(thus(benets(at(reQrement(are(
related(to(career[average(pensionable(pay.(The(proposed(changes(in(basic[pay(
progression((Schemes(A[C)(cause(the(mean(basic((pensionable)(pay(over(training(
to(decrease((again(modeled(on(Anaesthesia(as(previously):(
Change&in&
Mean&
Pensionable&Pay&
over&Training&
Scheme&A&

Scheme&B&

Scheme&C&

Scenario%A%
Scenario%B%
Scenario%C%
Scenario%C+%
Scenario%A%
Scenario%B%
Scenario%C%
Scenario%C+%
Scenario%A%
Scenario%B%
Scenario%C%
Scenario%C+%

[3,353.21(
[3,375.50(
[3,190.82(
[3,362.81(
[2,909.38(
[2,931.87(
[2,745.53(
[2,919.06(
[4,295.58(
[4,317.45(
[4,136.29(
[4,305.00(

Thus,&greater&pension&contribu,ons&for(a&smaller&pension&at&re,rement(

6.(Eect(on(Student(Loans(
Reduced(gross(pay(results(in(smaller(student(loan(repayments.(Over(specialty(
training(less(student(loan(is(paid(down(with(accumulated(compound(interest(as(a(
result.(
Modeling(Anaesthesia(with(the(same(assumpQons(as(previously((plus(using(
current((and(very(conservaQve)(student(loan(interest(rate(of(1.5%(over(7(year(
model(period):(
Underpaid&
student&loan&
(with&
compound&
interest)&
Scheme&A&

Scheme&B&

Scheme&C&

Scenario%A%
Scenario%B%
Scenario%C%
Scenario%C+%
Scenario%A%
Scenario%B%
Scenario%C%
Scenario%C+%
Scenario%A%
Scenario%B%
Scenario%C%
Scenario%C+%

[2,174.43(
[2,188.91(
[2,068.89(
[2,180.66(
[1,891.55(
[1,906.16(
[1,785.08(
[1,897.84(
[2,782.79(
[2,797.00(
[2,679.26(
[2,788.91(

7.(Comparison(across(acute(specialQes(
Using(the(model(assumpQons(as(stated(earlier,(
Scheme(B(and(Scenario(C+(are(the(most(favourable(
for(the(acute(specialQes(that(partake(in(substanQal(
OOH(work((subject(to(some(caveats;(see(SecQon(11(of(
this(slide(set)(
(this(is(in(broad(agreement(with(the(DDRB(proposals(
which(state(that(Scheme(B(and(Scenario(C/C+(are(
their(preferred(opQons)(
I(have(used(Scheme(B/Scenario(C+(to(compare(the(
eects(between(specialty(groups.((

7.(Comparison(across(acute(specialQes(

AssumpDons:%Scheme%B,%Scenario%C+.%%Specialty%banding,%weekly%hours,%availability%supplement%and%RRP%are%extracted%from%
DDRB%Fig%4.1.%%Basic%pay%for%Scheme%B%pay%bands%is%set%at%current%StRBx%equivalent%minimum%(worstBcase%analysis%/%minimum%
pay%point).%%Pensionable%pay%is%upliYed%basic%pay%only.%%Tier%1%Student%loan%deducHons%are%deducted%

7.(Comparison(across(acute(specialQes(

AssumpDons:%Scheme%B,%Scenario%C+.%%Specialty%banding,%weekly%hours,%availability%supplement%and%RRP%are%extracted%from%
DDRB%Fig%4.1.%%Basic%pay%for%Scheme%B%pay%bands%is%set%at%current%StRBx%equivalent%minimum%(worstBcase%analysis%/%minimum%
pay%point).%%Pensionable%pay%is%upliYed%basic%pay%only.%%Tier%1%Student%loan%deducHons%are%deducted%

7.(Comparison(across(acute(specialQes(
Why(does(Anaesthesia(fair(so(badly?(
It(doesnt(receive(any(of(the(availability(supplement((as(
we(are(never(on(call(from(home(as(trainees)(or(RRP(like(
the(other(specialQes(
If(A+E(didnt(receive(these(they(would(receive(an(
equivalently(sized(pay(cut(

QuesQon(to(the(reader:(does(the(new(contract(
fairly(reward(high[intensity(out(of(hours(work?(

8.(Modeled(data(from(the(East(of(England(

This%is%work%in%progress%and%will%be%released%soon;(
although(iniQal(results(are(in[line(with(the(data(
modeled(using(DDRB(Fig(4.1(extracted(values(
already(shown(

9.(Overall(outcome(for(anaesthesia(

AssumpDons:%Scheme%B,%Scenario%C+.%%Specialty%banding,%weekly%hours,%availability%supplement%and%RRP%are%extracted%from%
DDRB%Fig%4.1.%%Basic%pay%for%Scheme%B%pay%bands%is%set%at%current%StRBx%equivalent%minimum%(worstBcase%analysis%/%minimum%
pay%piint)%and%compared%with%bands%set%at%StRBx%maximum%(bestBcase%analysis%/%maximum%pay%point).%Pensionable%pay%is%
upliYed%basic%pay%only.%%Tier%1%Student%loan%deducHons%are%deducted%
Note:%I%believe%the%bestBcase%analysis%is%unachievable%BB%increasing%the%pay%bands%to%maximum%StRBx%equivalent%(best%case%
analysis)%would%increase%the%overall%gross%pay%envelope,%which%is%something%the%DDRB%is%not%allowed%to%do%in%its%remit.%%
%

10.(Conclusions(

The(contract(reforms(have(the(potenQal(to(be%nancially%disastrous%for(doctors(in(training.(The(DDRB(Contract(Reform(document(is(decepQve;(its(
illustraQons((parQcularly(Fig(4.1)(are(designed(to(hide(the(true(negaQve(nancial(impact(over(a(doctors(Qme(in(specialty(training.(The(DDRB(report(
only(demonstrates(the(eect(of(the(contract(changes(over(a(one(year(period((where(per(their(remit(the(overall(gross(pay(envelope(should(remain(
the(same)((they(fail(to(take(into(account(the(changes(in(the(pay(progression(structure(which(has(a(much(greater(negaQve(impact(over(the(course(of(
training(than(the(mechanics(of(how(OOH(work(is(rewarded.(

(The(degree(of(disaster(depends(upon(a(few(variables:(

The(pay(progression(scheme(and(upliS/OOH(scenario(used(
The(basic(pay(award(assigned(to(each(increment(in(the(new(pay(schemes((This(alone(can(negaQvely(inuence(cumulaQve(gross(pay(over(training(to(the(
tune(of(30,0000.(In(addiQon,(the(basic(pay(award(and(increment(structure(inuences(when(in((training(you(move(up(to(the(next(pension(contribuQon(Qer,(
paying(more(in(pension(contribuQons((for(less(deferred(benet)(with(a(reducQon(in(net(pay).((Overall(Scheme(B(and(Scenarios(C/C+(are(the(most(benecial(
to(the(acute(specialQes,(HOWEVER(the(situaQon(changes(if(the(basic(pay(awards(are(markedly(higher(than(the(minimum(assumed(values(used(in(my(
analysis([see(next(slide](

Anaesthesia(fairs(poorly(compared(to(other(acute(specialQes(

Using(DDRB(data(on(banding(and(hours,(cumulaQve(net((take[home)(pay(for(anaesthesia(over(7(years(of(training((CT1(to(ST7)(would(reduce(by(12,200(
[equivalent%to%a%reducHon%in%net%(takeBhome)%pay%of%95/month%at%earlier%stages%of%training%and%220/month%at%higher%stages!](
Once(the(reduced(student(loan(payments((and(resultant(cumulaQve(interest)(are(accounted(for(this(results(in(an(overall(net(loss(of(up(to(19,500(over(7(
years.(
Other(acute(specialQes(all(see(cuts(in(gross(and(net(pay(but(to(a(lesser(extent;(equivalent(specialQes(such(as(A+E(and(Obs/Gynae(are(largely(protected(by(
their(availability/RRP(supplements(

The(proposed(reforms(result(in(increased(pension(contribuQons(over(training(for(less(deferred(benet(at(pensionable(age(

Student(loan(repayments(are(reduced;(loans(will(take(longer(to(pay(down(and((will(accumulate(more(interest.(For(current(trainees(with(Tier(1(loans(
this(is(less(of(a(problem(whilst(interest(rates(are(low((1.5%(for(Tier(1(loans(at(the(Qme(of(wriQng).( (
(
(
(
(
(
(In%the%future,%trainees%with%large%Tier%2%loans%(that%include%tuiHon%fees%of%9000pa)%and%are%esHmated%to%total%around%55,000,%may%fair%worse.%
Interest%rates%for%these%loans%are%much%higher%(currently%5.5%)%%and%they%will%be%in%repayment%for%longer.%

The(contract(reforms(also(recommend(a(reducQon(in(annual(leave(enQtlement:(this(results(in(more(work(for(the(same(pay.(The(eects(of(this(have(
not(been(factored(into(my(model((although(this(would(be(simple(to(do).(

11.(Next(steps(
What&we&need&to&know&to&provide&an&informed&reply&to&the&reforms&(and&the&DDRB&must&clarify&these&ASAP):&
1.
The(actual(basic(salary(awarded(at(each(increment(point(in(the(new(pay(schemes(A(to(C:(

2.

The(choice(of(new(pay(progression(scheme((and(the(actual(basic(pay(award(for(each(increment(point(in(the(new(scheme)(
greatly(inuence(the(benet/loss(trade[o(between(the(dierent(upliS/OOH(scenarios.(Scheme(B/Scenario(C+(appears(to(
have(the(least(negaQve(impact(for(the(acute(specialQes((which(is(in(line(with(the(DDRBs(preferred(opQon),(although(if(this(
were(chosen(without(a(pre[published(and(agreed(salary(scale(the(DDRB(would(be(free(to(choose(a(salary(scale(that(had(a(
greater(than(predicted(negaQve(impact(on(gross/net(pay(over(training((and(hence(a(dierent(scheme/scenario(might(have(
been(more(benecial(with(the(pay(award).(Thus(it(is(impossible(to(state(with(any(certainty(which(scheme/scenario(combinaQon(
has(the(least(impact(on(a(given(specialty(unQl(the(full(pay(scale(informaQon(is(published.(

Which(components(of(the(new(pay(scheme(are(pensionable(

3.

My(model(assumes(that(only(the(upliSed(basic(pay(is(pensionable(
However(if(any(of(the(other(components(of(gross(pay(are(pensionable((addiQonal(hours(above(40(hours,(Sunday(hours,(night(
hours,(availability(allowance,(RRP)(then(the(conclusions(of(this(modeling(exercise(are(very(dierent:(pension(contribuQons(
massively(increase((with(a(much(earlier(jump(from(9.3%(to(12.5%(pension(contribuQons(during(training)(and(reduced(
cumulaQve(net(pay.(The(trade[o(between(the(dierent(Schemes(and(Scenarios(is(also(aected(and(would(change(the(
benet/loss(trade[o(of(each.(

How(alternaQve(training(routes((e.g.(ACCS(or(dual[training(in(ICM)(will(t(into(the(new(pay(schemes(and(hence(
when(basic(pay(increments(will(occur,(e.g.(
Will(the(CT2A(year(in(ACCS(Anaesthesia(be(paid(at(the(CT1/CT2((core[training(basic(pay(rate(or(the(equivalent(ST3/4(junior(
SpR(rate(

For(ST3+(trainees(dual(training(in(ICM,(when(will(registrar(pay(progress(up(the(increment(scale?(
(((These(factors(have(a(large(impact(in(cumulaQve(net(pay(for(trainees(who(are(on(longer(training(programmes(that(dont(t(neatly(
into(the(ST1[ST8(brackets(proposed,(but(their(addiQonal(training,(skills(and(knowledge(should(be(recognized(through(pay(progression.(
(

I%strongly%believe%that%at%the%very%minimum%QuesDons%1%and%2%above%are%claried%by%the%DDRB%before%
further%negoDaDons%conDnue.%Without%this%informaDon%it%is%impossible%to%reach%any%rm%conclusions%
about%the%proposed%changes%and%how%they%impact%dierent%specialDes.%