Down The LTFT Pay Rabbit Hole…


Guest blogger Helen Jawahar returns following her previous post on indirect discrimination in the new junior doctor contract. Here she examines how LTFT pay is calculated on current terms and conditions and how this varies when the new terms and conditions are applied. An abridged version of this post appears in the junior doctor contract forum to encourage debate.

**UPDATE** Formal modelling verification by The BMA was prompted as several doctors  highlighted concerns on hourly pay equality between LTFT and FT trainees. The BMA JDC met on 03/06/16 and shared information from that meeting on Facebook stating that LTFTs would be paid at the same rate per hour with respect to their FT colleagues.

Firstly let me say I am saddened to be writing a post about equal pay rights for women in 2016. This should be dead by now. I was fairly upbeat about the contract last time I posted, however further modelling and clarification has made me sad again; it looks like we are again looking at a contract that pays LTFT less per hour than their full time counterparts for the same job. Its still not as bad as the imposed one and I don’t believe it is quite as bad as some have made it out to be.

My last post started a war over LTFT pay which isn’t that surprising. The new contract means some very big LTFT pay changes, the question is are these changes fair? What did surprise me from my last post was the amount of replies from people who didn’t know their rights or had had these rights trampled on by their employer. So in an aim to inform and hopefully prompt civil debate on what on earth we should do next lets dive in to answer:

  1. How are LTFTs paid now; and
  2. What’s good and bad about that?
  3. How will LTFTs be paid under the new contract; and
  4. What’s good and bad about that?

As before I am just an ordinary LTFT trainee. I don’t work for the BMA or the government. There are people out their who are much more informed on these issues than me – hopefully some of them will come along and comment. I’m in a way really hoping I have got something wrong on the current pay calculations that someone can pick up that will make this all better – if you spot an error let me know and I’ll correct and send you good vibes.

How are LTFTs paid now?

So before I became an LTFT all of 7 months ago (I’m a newbie at this) I thought it was simple. You work a percentage of full time and get paid that percentage of the full time pay right? –WRONG

To understand what you should be paid as an LTFT you need to know:

Lets say you are just starting ST1. It’s a 1 in 8 rota and the full timers work 48 hours a week. They do 1 in 4 weekends and 7 nights (2200-0800) and 7 long days (0800-2200) in an 8 week cycle which bands them at 1A You did FY1 and FY2 in one year each so you are at the minimum pay point for ST1. You are going to work 60% of what a full time person does which would make you 1 in 13 working 1 in 6.5 weekends .

So 60% of 48 hrs is 28.8 hrs. This means looking at the helpful table in EPFFMT you will be paid at F7 and get 70% of the full time basic salary (what I hear you cry why not 60%? Well as clear as I can make it, this is because banding for FT trainees reflects extra hours over 40/week and intensity a for LTFT it only covers intensity so all hours need to be covered in the base salary

To calculate the basic salary now you look in the PCC and look for the basic pay for an LTFT ST trainee on the minimum pay point at F7 – that’s £21,212 (which should and does work out as 0.7 of the ST1 FTE basic of £30,302)

Now to work out the banding. The key thing here is that the banding is worked out on the intensity of the work the LTFT trainee does independent of the banding the FTEs work. It’s often the same as the FTE banding but it doesn’t have to be. There are three bands (and un-banded):

  • Band FA – 50% – trainees working at high intensity and at the most unsocial times.
  • Band FB – 40%– trainees working at less intensity at less unsocial times.
  • Band FC – 20% – all other trainees with duties outside the period 8am to 7pm Monday to Friday.

There is a really nice flow chart in EPFFMT which I suggest looking at which tells us that out hypothetical 60% ST1 is going to be band FA because they work a more than 1 in 13.5 on pattern and their shifts go past 7pm.

This means they get 50% of their pay again. This can be found in the PCC as £10606 (0.5 x 21212) and then gives the total pay per annum as £31818 (10606 + 21212).

Wasn’t that simple (hah hah). The thing to realise here that this figure is more than 60% of the salary paid to a FTE doing the post above. If the FTE were also ST1 on the minimum pay increment banded 1A they would be earning £45,453 per annum. 60% of this salary is £27271.80 – this is over 4.5k a year less than what the LTFT actually receives.

This leads on to my second point question – what is good and bad about the current arrangements?

If we compare our two ST1s above and work out their hourly rate using a very basic calculation. The FT trainee earns £18.21per hour (45453/(48×52)) and the LTFT earns £21.24 (31818/(28.8×52)). So on cumulative hourly pay the LTFT earns more per hour.

However the FT will still earn more in total over the year because they work more hours overall. Look at this over a career’s worth of earnings and you have a fairly massive pay gap between the FT and the LTFT. As LTFTs are generally either LTFT because they are female and caring for children/others or in ill health themselves (or like me…both!), this means over a lifetime we have a system that creates a pay gap between men and women/disabled i.e. the average male doctor will earn more in their career than the average female doctor. Also the LTFT trainee will have to pay all the standard costs of training e.g. GMC/defence union/exams/car parking etc and very few of these are reduced pro-rata so they have proportionately higher costs.

The current system attempts to mitigate this further using automatic pay progression (actually I’m not sure if it was designed this way or is a happy accident – maybe someone more educated can let me know). Automatic pay progression means all trainees move up a pay increment per chronological year, meaning that the LTFT still goes up the pay scale even if they don’t move up training grades at the same rate as FT trainees. This reflects the increased experience the LTFT has due to being in the job longer.

All of this means the current set up is generally considered to be very good for LTFT. Its more than equal, it’s a long way towards being equitable even. However the flip result of this is that currently a FT trainee can end up being paid a lot less per hour than their LTFT counterparts. The example we worked out earlier shows this but this can be taken to the extreme due to the way the increments work.

If we use the same rota as before but look at two ST5 trainees one FT all the way through training and one who has been 60% LTFT since F1:

  • The FT trainee has been a doctor for 6 years placing them on increment point three on the PCC.Pay for them is £ 60135, working out at an hourly rate of £60135 / (52×48) = £24.09.
  • The LTFT trainee has been a doctor for around 14 years. Due to annual increments they will now be at the top of the ST pay scale (increment point 9) and earning £50030 works out at an hourly rate of 50030 / (52×28.8) = £33.39

This means the LTFT trainee is earning £33.39 – £24.09 = £9.30 per hour more for the same job at the same grade.

In my opinion this is one hell of a lot of positive discrimination. I’m not sure that this can continue to be justified as more and more people become LTFT including men. At what point do we end up going past equity and just plain discriminating against full time workers? As gender norms change, what if we get to a situation when there are just as many men as women working LTFT? How can we claim that this is equitable then? What about the women working FT? Some of them have children and childcare too, why should they get a lower hourly rate?

In a way that is all moot (though it helps us see where we are coming from and what some current trainees have to lose financially) because the government hate automatic pay progression (not for this reason I must add but because they just hate the idea that anyone gets a rise every year)

So we are now looking at the brave new world of the proposed contract without automatic pay progression and without banding – if you thought LTFT pay was hard to work out before, it gets worse…

How will LTFTs be paid under the new contract?

Well after the pain that was the planned imposed contract I had high hopes for this one. I knew increments were going and so was banding. What I wanted to see was a contract that paid the same rate per hour to both FT and LTFT trainees.

The new contract is more complex than the old for both FT and LTFT.

All the information I have used comes from the “Terms and Conditions of Service for NHS Doctors and Dentists in Training 2016” (new TCS);

And the “Indicative pay summary”(IPS).

Pay is now calculated from a combination of different numbers:

  1. The base pay for 40hrs a week (check ICC)
  2. A variable weekend allowance if applicable (check ICC)
  3. A 37% hourly uplift for all hours between 21.00 and 0700 (plus 37% for any hours up to 1000 for shifts that started no earlier than 2000) (p11 new TCS)
  4. Extra hours at basic rate (p10 new TCS)

So lets go back to our ST1s from the first example. We need to know a bit more about their rota to calculate pay this time so I have assumed that for full time in the 8 weeks they would work an average of 48 hours per week, 2 weekends (1 in 4 weekends, one on nights and one on days), 7 nights (2200-0800) and 7 long shifts (0800-2200). Basic hourly pay £17.31. I have also assumed that the LTFT does the same 60% of both the basic hours and OOH. No flexible pay premia are applicable.

FT trainee is currently band 1A 48hrs/wk earning £45,453 per annum at £18.21per hr

  1. Basic Pay for 40hrs £36,100 (nodal point 3)
  2. 7.5% of full time salary for 1 in 4 weekends 0.075 x 36100 = £2707.5
  3. 37% hourly uplift for nights (11 hours of the night shift. 7 nights per 8 weeks or 45.5 per year which means they will get an uplift for 45.5 x 11 = 500.5 hours (0.37 x 500.5 x 17.31 = £3205.55)
  4. 8hrs per week extra at basic rate (to make up the 48hr week) is 8 x 17.31 = £138.48 (then x 52 for annual figure = £7200.96)

Yearly total = £49214.01 (more than current YAY!)

Hourly rate for 48hrs per week £19.76 (more than current YAY!)

LTFT 60% is currently F7FA for 28.8hrs/week earning £31,818 per annum and £21.24 per hr

  1. 60% of the full time salary (0.6 x 36100) for 24hrs = £21660
  2. 4% of the full time salary for 1 in 6.6 weekends (0.04 x 36100) = £1444
  3. 37% hourly uplift for all nights – The full time trainees work 500.5 hours per year so 60% is 300.3hrs (300.3 x 0.37 x 17.31) £1923.33
  4. 8 hrs extra per week at basic rate to make 28.8hrs 4.8 x 17.31 x 52 = £4320.58

Yearly total £29345.90 (£2472.1 less than current BOO! AND also less than 60% of the FT total pay (0.6 x 49214.01) = £29528.41 (£182.51)

Hourly rate for 28.8 hrs per week £19.59 (£1.65 less than current BOO!)

Hanging in there everyone? Lets look at the final bit…what’s good (if anything) and bad about that the proposed contract?

 Comparing to the old contract the FT trainee does better under the new system and the LTFT does worse. This will be magnified to the extreme as you move along the training pathway and the removal of the annual increment begins to bite. The front loading of pay to ST3 should help with this somewhat as it helps reach max pay sooner, but to what extent still needs to be modelled (and I don’t feel confident enough in my workings to do it – we need some nice colour coded BMA graphs) but I am sure that the gap between what the average male doctor and the average female doctor earnings will now increase. There are some good posts out their on the forum that delve into this further.

This was somewhat to be expected; we knew that removal of increments was not going to be nice for LTFT, but there was an argument to be made that it was too much positive discrimination at the expense of full time trainees. Personally, I feel on the increment point that I do fewer hours work overall than my full time counterparts and I accept this means over a lifetime I will earn less. However, I have got the time I needed to recover from my illness. I will have the time I want to spend with my baby as she grows up. I have benefited and will benefit from being LTFT in many ways other than pay. I hope that accelerated training and dedicated study funding may help this a bit.

The elephant in the room is of course those LTFT trainees already far into the current system that will not benefit from the front loading, but not in far enough to complete their training on pay protection(which only lasts until 2022). These people are currently forecast to see a large pay cut in their ST8 year. The BMA tried to negotiate a pay protection to the end of all current trainee progression but the government will not commit until after the next election. There is, as I understand it, a review due for 2018 on this issue, but it is a big leap of faith/an unknown for those trainees that this might be sorted.

The most important point for me is does the current contract deliver equal total pay per hour to the LTFT trainee compared to the FT. Well, on my working, not quite. The LTFT ends up earning £0.17 less per hour than the FT trainee;17p you are going to think, that’s not very much, but it’s the principle. The LTFT trainee (doing 60% of the work remember) now earns less than 60% of the FT trainee’s total wage. This doesn’t seem fair at all. If you thought that it was unfair under the current contract that the LTFT earned more than their percentage of the current wage or earned more hourly, remember that was mitigated by them earning less per year and less over a lifetime.

We now have a situation where the LTFT working at a percentage of full time will earn less than that percentage of the total full time pay, meaning they earn less per hour. So they earn less per hour, less per year and less per lifetime. I can cope with earning less per lifetime but not per hour. If I do 60% of the work I deserve 60% of the pay. I am not worth less per hour because I am female or because I have an illness that makes me unable to work full time.

I appreciate the differences I have calculated are very small but do we really want to set out the principle that LTFT trainees are worth less than their FT counterparts? I also fear that the small difference I have calculated will be bigger on less intense rotas (on some very high intensity ones they disappear).

So I will end with a plea to the BMA and to you all;

  1. Please can the BMA do some more modelling/calculating and hopefully prove me wrong. I really want someone that is better at maths than me to show I am wrong and then I can wake up back in this century where we pay men and women equally.
  2. If you are an LTFT trainee, please model your own rota using the information in the TCS and my blog post. Are you going to be paid less than you are now? Can you accept that might be fair? Are you going to be paid less per hour than your full time counterpart? Can you accept this?
  3. And if you are not an LTFT, do you think removal of positive discrimination is tolerable? Do you think less pay per hour for LTFT compared to full time is fair (I hope not)?

7 thoughts on “Down The LTFT Pay Rabbit Hole…

  1. Hi,

    Than you for the wonderful explanation. You have taken a lot of time and effort to work this out. However I feel that you have made a basic mistake.
    you cannot combine weekends, nights and days and get an average hourly rate.
    Weekends and nights are special and will be paid at a premium rate and will be equal for both.
    Daytime rates will be the same for LTFT as FT.

    What is concerning is people who do 1 in 2 wekends get a lower weekend hourly rate, compared to people who do 1 in 3, who in turn gets a lower hourly rate compared to people who do 1 in 5.

    This incentivises Trusts to make us work more weekends as our hourly rate goes down.

    Tomorrow at the JDC I am hoing to ge validation of my calculations, after which I will be free to share it with you.


  2. I am a part-time ‘junior’ A+E doctor. I am not in a training job. I am sure I am not representative of part-time doctors or training doctors – most have children, ill health or caring responsibilities – I do not. I choose this, I am privileged. But what might happen to me might happen to other LTFT trainees (especially after pay protection ends)…

    Current Contract
    I am paid at ST2 level. The full-time rota is 46 hours/week and is 6 weeks long. It involves 1 week of nights in these 6 weeks and 1 in 2 weekends. I work 50% of this, but slightly less weekends as I work only 1 out of the 6 weekends (I make up for it in other unsocial hours).

    Currently I am contracted to work 22.33 hours/week (I also do extra shifts ad hoc via the internal bank to fill in the HUGE amount of rota gaps). This means I am paid at ‘F5’ for LTFT which = 50% of the fulltime salary. As I work greater than 1:6.5 weekends and 44% of my hours in the current contract are classed as ‘unsocial hours’ (after 7pm weekdays and all weekends) I receive a banding supplement of 50% extra of my salary.
    ST2 = Pay Scale 1 of Specialty Registrar Pay Scale = £32156
    Paid at F5 rate for 50% of the hours (£32,156 x 0.5) = £16,078
    PLUS FA BANDING for unsocial hours (£16,078 x 0.5) = £8039
    Salary £16,078 + Banding £8039 = TOTAL £24,117

    New Contract
    ST 2 Pay scale = Nodal Point 3 = £36,100
    Paid at 50% rate = £18,050
    PLUS 4% extra (of fulltime salary) for weekend of 1 in 6 weekends (36,100 x 0.04) = £1444
    PLUS New antisocial hours uplift of hours after 9pm = £1665 (22% of my hours are after 9pm)
    PLUS 2 hours per week, every week to make upto 22 hours/week (17.31 x 2 x 52) = £1800
    Salary £18,050 + Weekend Banding £1444 + Night uplift* £1665 + 2hrs per week every week £1800 = TOTAL £22,959

    Old Contract Total £24,117 – New Contract Total £22,959 = £1158 Less per year

    *Night uplift based on (£17.31 x 0.37) added per hour for every hour worked after 9pm over the 6 week rota x (52 weeks/6weeks)

    —> £1100 LESS per year???!! I MUST HAVE made a mistake somewhere?

    Some thoughts:
    – If I swap out of 2 weekday shifts to do a weekend instead (to make it 1 in 3 and get 10% extra weekend banding instead) = TOTAL £25125 = £1000 MORE per year? So, does the contract encourage me to work an extra weekend? Yes. Is an ST2 less on two weekdays what our A&Es need or what LTFT trainees want? No. Does it encourage the NHS Trust to maintain the status quo and just pay me less?…

    – “Pay protection” – is it available to those not training? Does it even matter? As when it runs out new batches of LTFT doctors will be paid far less…I MUST be wrong? I realise I choose this work pattern, but others do not…


  3. Update:

    I asked the BMA – the new contract does not cover non-trainee posts, nothing new there as the old contract doesn’t. However, currently non-trainee posts will just be ‘as per national terms and conditions’ = equitable pay.

    Trouble is that with a new contract ‘as per national terms and conditions’ now involves pay protection and pay premia – these are now not guaranteed as it will be up to Local Trusts and would be difficult to define outside a defined training structure. Thus, this could potentially lead to disparity in pay, including a pay cut for some acute specialties? Genuinely concerned for non-trainees, and must have this wrong somehow?


    1. Hi Paul. Foundation trusts can employ people on whatever T&Cs they wish to offer. NHS trusts have less room to manoeuvre. Often national T&Cs are used for ease. So it would probably be best to ask your specific employer what they plan to do contractually with ‘non-trainees’ – I’d be surprised if they change things if they don’t have to.


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