HCSA – the hospital doctors’ union has vowed to closely monitor implementation of the deal to end the latest wave of resident doctor industrial action in England.
HCSA has issued the following statement:
While a resolution to recent rounds of strikes appears to have been found, it should never have taken this long for the government to acknowledge the key concerns of residents and, without proper implementation, we risk further disputes in the future.
While this progress is welcome, HCSA remains concerned that the devil will be in the detail. For instance, given the history of the past few years the government’s pledge that 2027-8 nodal point reform will come on top of an as-yet-unknown annual pay award from the DDRB represents a significant leap of faith.
It is also clear that these reforms do not completely address the pay erosion the profession has faced. Furthermore, those earning a basic ST4 salary will see reduction of take-home pay from this deal as they shift from the 10.7 percent pensions contribution threshold to 12.5 percent.
HCSA is also concerned whether the huge problems caused by core and specialty training bottlenecks will be resolved by repurposing LED roles and if sufficient training capacity exists in a strained system. Increasing training posts earlier on in doctors’ career also risks pushing the bottleneck further towards the end of training, which is not even mentioned in the deal.
Funding to cover exam and college fees has been a longstanding demand of HCSA resident doctors, who face extortionate training costs. But it remains unclear how this will work and how easily and quickly doctors can expect to be reimbursed in practice, especially given many residents already face issues with study budget refunds.
We are also deeply concerned that HCSA resident doctors appear to be excluded from future scrutiny mechanisms – this cannot be right given the impact that these agreed terms could have on our members.
Rest assured: we shall be watching closely and calling out any failure to deliver on the promises. HCSA shall continue to campaign and lobby on the areas which matter most to resident doctors, and we shall show no fear in highlighting issues arising from this deal.
Summary of the deal
Pay
Additional “pay steps” via nodal point reform phased in fully by 2027-8. Progress through pay points will be linked to competencies required for advancement during ARCP. Many residents in between existing nodal points will see rises, although grades such as ST3 will not see a pay increase within this year until formal progression, which mostly affects LTFT colleagues.
2026-7
- F1 and F2 receive full nodal point reform, applied and backdated to April 2026, while residents at 3a, 3b, 4b and 5b will receive a minimum of basic 3.5 percent DDRB recommendation plus 1 per cent
- Residents on nodal points 4a and 5a will receive the 3.5% DDRB recommendation for 2026-7, backdated to April 2026
2027-8
- Full planned nodal point reform implemented for all grades
- The government has made a commitment for the 2027-8 pay round to make clear to the DDRB that the deal should be seen as separate to any core annual pay award the pay review body recommends: “It is not the government’s intention that this is considered as a substitute for a future pay award.”
The government has published full details of nodal point reform under the deal.
Less-than-full-time doctors
The deal commits to enable equal opportunities for pay progression for LTFT doctors in training, supporting them to have ARCPs at 12 months as the standard, should the resident wish this. This will potentially enable faster progression for residents meeting their compentencies.
Fees reimbursement
- Reimbursement of fees for the first two attempts at mandatory royal college exams sat from 1 April 2026
- Fees of royal college and faculty membership and portfolio fees reimbursed by employers from April 2027
Clinical Academic Flexible Pay Premia
An increase to the Clinical Academic Flexible Pay Premia from £5,600 to £10,000 from April 2027
Reform of specialty training places
- A minimum of 4,000 new additional specialty posts over the next three years, starting with 1,000 by August 2027, 250 of these by February 2027
- Trusts will be asked to create roles by repurposing spend on locums, agency staff and “some LED roles”. It states that no LED contract will be terminated early as a result.
Locally employed doctors (LEDs)
- Pledge to “develop and enforce” a standardised national set of terms and conditions for LEDs that mirror all areas of the 2016 resident doctor contract, aside from amendments to reflect their non-training status and appraisal processes
- Move LEDs to substantive employment contracts, except where there is a “legitimate reason” to use a fixed-term one such as maternity cover
- “Expect” trusts to move LEDs onto repurposed 2016 contracts by September 2026 while a new standardised contract is developed. All LEDs to be offered the opportunity to move to the new contract
- LEDs on 2002 contract move either onto 2016 pay points or locally approved scales maintained in line with annual pay uplifts
- Access to the revised nodal points for LEDs via enhanced annual appraisal by October 2026 for all LEDs employed on mirror 2016 contracts
Industrial Relations Committee
A new resident doctor industrial relations committee will be set up to monitor the implementation of the deal.