Advances made in cutting junior doctors' hours are under threat from government proposals for a new "professional" contract, the doctors fear.
Negotiations, which will continue at a meeting between the two sides today, are proving difficult after the Department of Health put forward a plan effectively severing the link between hours worked and pay, the Independent has learned.
At present, doctors have to be available for 32 hours overtime at half pay. Health trusts should not require more work than this but have to pay the full hourly rate if they do.
This acts as a disincentive against breaking limits which were agreed only after a very bitter and public dispute between the two sides.
Junior doctors believe the proposed new contract ignores huge variations in workloads. And they fear that, although the negotiations are for a newly-created specialist registrar grade, any change could eventually affect staff at all levels.
One said: "We see it as a very worrying step. The thing which is most likely to maintain pressure on controlling hours of work at reasonable levels is salary."
Peter Bennie, chairman of the junior doctors' negotiators, said: "I wouldn't want to give detailed comments while we're in the process of negotiations. We hope to have a good outcome, but the negotiations are difficult."
The move will be seen as a major step backwards after the Government's "New Deal" promised no junior doctors in hard-pressed posts should be contracted to be on call for more than 72 hours a week by the beginning of this year. They should not have to work more than 56 hours.
It is already clear these targets are not being met. Evan Harris, a junior doctors' representative on the British Medical Association's national council, said it appeared that nearly a third of junior doctors had not had their hours cut to the 56 hours limit.
Not being able to claim additional payments would encourage trusts to put pressure on doctors to work longer and longer hours, he said. "Seeking to exploit junior doctors is not a professional way to behave. This latest plan appears to be Treasury driven."
Another junior doctor said the changes ignored the fact that "junior doctors in different settings do quite radically different types of work".
The new specialist registrar grade was devised to speed up training and bring Britain in line with other European countries. It will be introduced in radiology and general surgery next week. Existing terms and conditions will apply until next April.Reuse content