What is a junior doctor?
The term "junior" is somewhat misleading, as it refers to all doctors in training who are working under the supervision of consultants. That includes everyone from the most junior doctors, who are straight out of medical school, to pre-registration house officers, senior house officers and specialist registrars. It typically takes between 10 and 16 years to become a consultant, although this time period varies between specialties.

How many junior doctors are there?
There are some 39,000 junior doctors across the UK, with more than 30,000 working in the English health service.

Why have they got a new pay deal?
Junior doctors had long complained about their previous overtime system, which saw rates drop as low as 50% of the normal hourly rate for any hours worked over the contracted 40-hour week. Things came to a head during 1999, when junior doctors threatened strike action if improvements were not introduced.

So is it just about money?
No. There are major concerns about patients being treated by extremely tired doctors. Changes were needed to ensure patient safety was not compromised, as well as to treat junior doctors fairly.

Why now?
In fact, a so-called "new deal" was introduced nearly a decade ago, in 1991, to put an end to the ridiculous hours worked by some doctors. But, despite major progress, many junior doctors continue to work unacceptably long hours with inadequate rest periods.

How long are junior doctors expected to work now?
The new contract for junior doctors sets out a maximum 56-hour week, although the ultimate aim is to reduce this to 48 hours, in line with the phasing in of the European working time directive. The directive must be implemented in full for junior doctors by 2009, although there is an interim deadline, in 2004, to ensure no doctor is on duty for more than 58 hours.

How will the new working hours limits be enforced?
The new pay deal, which came into force on December 1 2000, provides hospitals with clear financial and contractual incentives to reduce hours and work intensity.

Explain?
Any junior doctor whose working pattern is "not compliant" with the new deal - ie those working more than 56 hours or with insufficient rest periods - will now be paid a "band 3" supplement worth 62% of their salary. Those who are compliant, but who work between 48 hours and 56 hours will receive a 50% "band 2" supplement. These supplements will rise in December 2001 and again in December 2002, so that a junior doctor who is still working more than 56 hours in two years' time will receive a supplement worth 100% of the basic salary.

The increases sound enormous?
Remember, these supplements are replacing the previous overtime or out-of-hours payments. But there is no doubt junior doctors will be better off. According to the Department of Health, a new junior doctor will typically be £1,700 better off under the new system, earning nearly £26,000, while a senior house officer will see an extra £2,800, earning between £32,305 and £43,140.

How many doctors are currently working more than 56 hours?
Departmental figures from September suggest nearly 25% of the 30,000 junior doctors in England are working over the stipulated maximum. Taking into account the requirements for rest periods, some 38% of junior doctors were thought to be "non-compliant". But managers claim the new questionnaires filled in by junior doctors, on which the new pay system is based, have led to massive increases in the numbers of non-compliant doctors. Some trusts have seen non-compliance levels rise from 20% to more than 80%. The British Medical Association puts this down to "under-reporting" of work levels under the old system.

What is the cost to the NHS?
Hospitals are reporting a 10% increase in their junior doctors' paybill, with the big teaching hospitals being the worst hit. A survey of hospitals in the Northern and Yorkshire region found, on average, that acute trusts face increased costs of £771,031 - or £5,281 per junior doctor. For community and mental health trusts, which employ far fewer junior doctors, the average increased cost is £46,186 - or £3,299 per junior.

What would it take to comply with the 56-hour working week ceiling?
Hospital managers are currently examining this. The survey suggests that, on average, an acute trust would need an extra 17 junior doctors to reach compliance, although teaching hospitals will have to recruit far higher numbers. Also, given that juniors have to be supervised by consultants, an average of four additional consultants would be needed in each trust. In total, reaching compliance in the Northern and Yorkshire region would cost an estimated £17m in new salary costs. This comes on top of the £21m cost of the new pay deal, making a total of some £38m.

If junior doctors' hours are reduced, won't it take longer to train them?
Views are split on this. The BMA claims that junior doctors' time could be used more appropriately, with routine tests performed before a junior doctor is involved and reducing administrative duties. This could lead to reduced working times without impacting on training.