Junior doctor contract: How the two sides moved
After months of deadlock and strikes, the government and the British Medical Association finally reached a deal on a new contract in England in May.
The deal has since been rejected in a vote of junior doctors, although it is well on its way to being introduced.
Significant changes were made to the contract that ministers had said previously they would impose. So how far did the two sides shift?
The basic pay rise is not as generous
The deal ministers had said they were imposing included an average hike in basic pay of 13.5%.
Under the terms published in May that will be reduced to between 10% and 11%.
Night shift pay is also being reduced from 50% extra to 37%.
Clearly both of these represent a saving for the government but it has left more money to be distributed elsewhere.
The most frequent weekend workers get more
Those working one in two weekends will get an extra 10% on top of their salary. The supplement then reduces as the frequency of weekends drops, down to 3% for one in seven.
Those doing one in eight or fewer get nothing for working Saturday or Sunday.
That compares to Saturday evening work and all-day Sunday attracting a premium payment under the terms which were to have been imposed.
Add to that the 8% extra doctors will now get if they do on-call duties - most of them - and the BMA are happy that unsocial hours are being properly rewarded.
Those taking time out will get extra help to catch up
One of the major criticisms of the original contract was that it unfairly penalised women. The guaranteed pay rises doctors currently get was to be replaced by a system whereby pay is linked to achieving certain levels of training.
But if doctors take time out, such as women on maternity leave, or move to part-time work, such grades take longer to reach.
To mitigate against this, the government has agreed to pay for extra support to help people in this position to catch up.
There are a host of other tweaks too
Doctors wanting to work extra hours as a locum (a lucrative sideline) will have to give first refusal to the NHS. Rates of pay for that are being improved to 22% above their normal rate, but that should still represent a saving to the health service as private agencies charge much more.
Some doctors may be unhappy with this restriction. But most will be pleased with other changes. When doctors work extra hours beyond their shift (as many do) there will be a formal mechanism to make sure they are appropriately rewarded or able to take time off in lieu.
Junior doctor oversight and involvement in the work of the independent guardian have also been strengthened.
And the winner is…
Neither side, of course. The art of any Acas mediation is to ensure both sides get some of what they want. It is why Sir David Dalton, the boss of Salford Royal Hospital brought in to negotiate with the BMA, has called it a "score-draw".
Another telling sign is that the deal agreed remains cost-neutral. Ministers are not putting extra money in beyond that which they had already planned to.
The BMA feels it has got a better system for rewarding those who work weekends frequently, while the government believes increasing weekend cover will now be more affordable.