Also, in reply to MrsTriggs - the monitoring/banding thing is complicated and I think you haven't got it quite right. There is no "bonus" for working longer hours, the banding supplement is altered to reflect the hours actually worked where these do not match the expected hours according to the rota. The fine is for breaching the EWTD.
Junior Dr's get base pay + a banding supplement depending on number weekends/nights worked and intensity of that work. This supplement can range from unbanded (0% supplement) to Band 3 (100% supplement). Reality is most posts at FY2 and above attract a supplement of 40-50%.
Junior Dr pay comes from 2 sources- part funded by NHS education (from the relevant organisation for England, Scotland, Wales or NI) as junior doctors are (to a greater or lesser extent) still in training. The NHS Trust pays a proportion- usually equivalent to the "out of hours" supplement. This arrangement was made to reflect the fact the NHS Trusts are providing "on the job training". As part of this agreement, the trusts must provide appropriate learning opportunities (i.e. the junior dr's in the trust are not simply there for "service provision"- although clearly this is a large proportion of their duties) and appropriate rota's.
Junior Dr's are "monitored" at least twice per year. During this "monitoring" period the doctors on each different rota are asked to record their working hours (and whether they achieved breaks) during a 2 week period. The data is collated- to "fail" the monitoring more than 75% of the Dr's on the rota have to have breached the maximum hours for that particular banding (these numbers will include those Dr's on annual or study leave, those on post-night "zero hours" days and so on).
If this happens, then the post must be rebanded to reflect the actual hours worked- so it could go from a 40 to a 50% banding. Pay would be backdated to the time each Dr started on the rota which had breached and would continue to be paid at the higher rate until the cause for the breach has been addressed (could be change of rota, filling a vacancy and so on). Once the trust feels it has addressed this, the rota will be re-monitored and if it is compliant (i.e. 75% or more of the dr's on the rota work the hours expected and get their breaks) then the rota will be down-banded. In no way is that a "bonus" or "danger money"- it is acchange to pay to reflect the actual working hours.
The "fine" is a separate matter. If the EWTD is breached, then the trust must pay a fine (not to the Junior Dr's). I think it is £5000 per trainee on the rota that has breached EWTD, but I could be wrong.
These rules were brought in because the relatively high cost to the Trusts for not ensuring the rota's they asked junior doctors to work were fair/paid appropriately seemed to be the one thing that ensured they played fair. Before this the rules were frequently flouted, as there was no significant disincentive to do so- in fact the financial incentive was to do the opposite.
As it is, the monitoring process is often manipulated. But at least it is something. The proposed guardian sounds even more watered down and ineffectual.
I have worked in departments where in the run up to monitoring all sorts of things are put in place to ensure there are more doctors around (so more likely to get achieve breaks and finish on time) or someone is sent round to try and make sure we are leaving on time. As soon as monitoring is over, everything goes back to normal. Monitoring forms are frequently lost/ allegedly not returned (a minimum of 75% of doctors on the rota must return forms for the process to be deemed valid)- so the process has to be repeated at a later date. Although, if the rota is compliant these problems never seem to occur. We got round this by collecting all the forms together, photocopying them all and then handing them in together, asking for note of receipt. When the forms were "lost" we were able to supply a copy. Strangely enough, the number of "lost" or "not returned" forms dropped dramatically and a few more rota's breached.
One post where we did 24 hour resident on-call (only supposed to be called out during the night for emergencies, but available and on-site for the full 24 hours, plus doing a normal 8 hour shift the next day), the nurses were all told that we were being monitored and only to call us in an emergency and had to record why they had phoned us. They were told the reasons we were called would be scrutinised. Out with the monitoring period this was never done. At this time, there were 2 vacant posts on the rota so lots of cross-covering was going on. We failed that monitoring period anyway, so management changed the on-call process- overnight calls were filtered through a senior charge nurse who decided whether the Dr could be called. They also employed a temporary locum to fill one of the vacant posts. We (only just) passed the second monitoring process, but within a week the new process for filtered calls was abandoned as being "impractical" and the locum's short-term contract was not renewed after their initial three weeks.