Leaders of the British Medical Association's junior doctors committee, who agreed to the deal on Thursday, were ordered to return to the negotiating table after an emotional all-day meeting of the full committee yesterday.
The BMA said the deal could be worth up to pounds 300m over three years to the 35,000 junior doctors. But its complexity meant that it was impossible to calculate what it would be worth to individual doctors and the juniors' committee wanted more detail of how it would work.
The health department said it was "delighted" that the committee had accepted the "principle" of a new pay structure and was now ready to negotiate on the detail. A spokesman said: "They haven't thrown it out and they haven't agreed it, but they have accepted the principle of a new pay structure."
The BMA was due to agree to a ballot of all junior doctors on industrial action yesterday if negotiations with the government broke down. Mass meetings have been held around the country over the summer to rally support. While that threat has now been temporarily averted, industrial action remains a possibility if final agreement cannot be reached.
A BMA spokesman said: "A lot of juniors are still very upset and although the negotiators have secured what they believe is a very good deal, many are not satisfied."
Under the proposed new deal, overtime, which is paid at half the normal rate, would be abolished and consolidated into basic pay. The new pay structure would have four bands reflecting increasing intensities of work which would attract increasing rates of pay.
NHS trusts with the most doctors working long hours would face the heaviest salary bills if they failed to reduce their hours. Currently one in four juniors is contracted to work beyond the official maximum of 56 hours a week agreed in 1991. The health department says that by the end of the three-year period of the agreement, no junior doctor would be working beyond 56 hours.
A health department spokesman said: "The whole point of the deal is to get away from the situation where it is cheaper to make a junior doctor work overtime [because it is paid at half the normal rate]. It provides a strong incentive for trusts to reduce their hours."
However, the BMA said not knowing how trusts would react made it impossible to calculate the effect of the deal. The BMA juniors committee yesterday voted to call a special conference followed by a referendum of all juniors on the deal, after further negotiations, before accepting it.
Meanwhile, Britain's 500,000 nurses, midwives and health visitors need pay rises of up to 13.5 per cent if recruitment and retention problems are finally to be conquered, according to their leaders.
Launching their submission to the pay review body, union officials yesterday said there would always be problems as long as trainee managers at sandwich chain Pret a Manger were being offered pounds 15,000 a year while the starting salary for a staff nurse was pounds 14,400.
The Royal College of Nursing, the public service union Unison and other employees' organisations said more than 85 per cent of health trusts were suffering recruitment problems and 44 per cent reported difficulty in retaining employees.Reuse content