A second year Specialist Trainee (ST2) in Carlisle earns exactly the same as a ST2 in Cornwall. All Foundation Year 1 (F1) doctors across the country have the same starting salary. The supplementary pay system for doctors who work rotas involving additional or unsociable hours have a banding system that is calculated and applied nationally.
If a doctor is off sick or away on maternity leave or for any other reason, or the Trust has been unable to fill a post, then they have 3 options. First they have the “Bank system”. They can pay their “bank rate” (the hourly rate offered to a “bank” of doctors who already work in the Trust), to do an extra shift, providing it does not interfere with their normal rota. Second is the “Agency system”. The Trust can ask an agency to provide a suitable doctor for the shift and then pay the agency their fee. The third option of course, is the popular “Ostrich system”. They just stick their head in the ground and ignore the fact that they are one doctor down and everyone else working that day tries to cover the hole. If I were to work 3 weekend bank shifts then I would earn slightly less than I earn in 1 month of basic ST2 salary. If I were to work through an agency, I could earn (often considerably) more. The agency also takes a large cut from what they actually charge the Trust. At holiday times, individual doctors can negotiate directly with the Trust or via an agency to increase the hourly rate.
This system is widespread and is being used more and more to plug gaps in under filled rotas and to cover the holes left by doctors on various forms of leave. The bill to individual Trusts often runs into millions of pounds each year.
I wonder if it is time to move to a true market economy in how Trusts employ their Juniors. As student loans increase up to £9000 per year, it is likely that many new doctors will leave medical school with student loans over £50 000 and some who have had to cover all of their own living expenses, will be saddled with an eye watering £80 000 of debt before starting work. If the large teaching hospitals in our cities find it easy to choose from a large pool of applicants due to the allure of their locations (people always want to live and work in London for example), then why shouldn’t Trusts in less popular areas be able to attract more doctors by offering financial perks? Higher salaries, free accommodation or even a US style “Golden hello” to pay off some student loan could be a way of attracting higher calibre candidates to less popular locations.
Whatever the ideological or moral arguments against the idea of competitive payments for attracting Junior Doctors, you should remember that the process is already underway through the locum system. As happens all too frequently in the NHS, when a process starts through the back door, without any debate or discussion, it is run haphazardly, inefficiently, locally and costs far more than it actually needs to. Open competition could save Trusts money, as they would reduce the enormous payments made to locum agencies. The current, nationally set pay scales, could be maintained as a minimum to protect all Junior Doctors.