Junior Doctors Reject Contract Diktat

Junior doctors on a TUC demonstration against cuts to the NHS
Junior doctors on a TUC demonstration against cuts to the NHS

‘IN THE face of proposals from the UK government which amount to imposition in all but name, the UK junior doctors committee has decided not to re-enter contract negotiations,’ British Medical Association (BMA) Council chair Mark Porter announced in a message to members on Friday.

He added: ‘The BMA believes that the changes currently being proposed are unsafe for patients, unfair to doctors and undermine the future of the NHS. This is the time for doctors to stand together as one profession and unite in defence of doctors’ working lives so that we can continue to provide safe, high-quality care for all our patients.’

Dr Kitty Mohan, BMA junior doctor committee co-chair, said: ‘The UK government seems quite oblivious to the fact that junior doctors care for their patients all day, all night, seven days a week. And that, despite the safeguards in place, we still hear examples of junior doctors working days on end or 90 hour weeks.

‘Last October, after more than a year of negotiations, talks with the government stalled after it became clear they were prepared to see these safeguards diluted even further regardless of the consequences for patients and doctors. It has quickly become clear that the so-called negotiations offered by Jeremy Hunt last month in his ultimatum to junior doctors offer nothing to address those concerns.

‘The government has said it wants to negotiate but this “offer” on the table is an imposition in all but name. It would be letting down our members and the patients for whom they care to simply go along with a government hell-bent on getting something signed, sealed and delivered as quickly as possible.

‘This is simply unacceptable. Junior doctors are not prepared to agree contract changes that would risk patient safety and doctors’ well-being. This was our position in October and, in the absence of any attempt by the government to address our concerns, remains our position today.

‘We want a contract that is good for patients, fair for doctors and good for the NHS. That means instead of imposing changes on junior doctors, the government should put aside its artificial deadlines, its imposed recommendations and work with the BMA on genuine negotiations.’

Giving ‘10 reasons why we are not re-entering negotiations’, the BMA junior doctors committee said: ‘Over the last four weeks, the BMA has been gathering the opinions of UK doctors in training. We have been in touch with junior doctors via email, webchat and in person. Having considered this feedback, the BMA junior doctors committee decided on 13 August 2015 not to re-enter negotiations with the UK government.

‘Here’s why: ‘1. Junior doctors told us the recommendations are not acceptable

‘The first and most important reason why we are not re-entering negotiations is because what is on offer now is no better, in fact, it is worse, than when we left the negotiations. If it was bad enough for us to leave in October, it is certainly not good enough to re-enter now. Over 99% of the 4,500 doctors in training who responded to a BMA poll told us that the recommendations are not acceptable and so we cannot accept them as the baseline for any new negotiations.

‘The BMA is clear that what the government is proposing is unacceptable. In order to get the BMA back around the table it is vital that the government reverses its position on the DDRB’s recommendations that would:

‘• Extend routine working hours from 60 per week to 90. It is unacceptable that working 9pm on a Saturday is viewed the same as working 9am on a Tuesday.

”• Remove vital safeguards which discourage employers from making junior doctors work dangerously long hours, and in doing so protect both patient and doctor safety

‘• See pay no longer matching with the experience junior doctors’ gain through their training.

‘2. We cannot allow the contract to be eroded, especially if it puts patients at risk.

”The contract should protect patients and doctors, which it currently does through the banding system, which penalises employers who overwork trainees. The Doctors’ and Dentists’ Review Body (DDRB) recommendations would remove the banding system and simply tell employers to follow the law on working time regulations, which provide weaker protections than the current contract does. Additionally, breaks during shifts would be reduced to just 20 minutes every six hours.

‘3. We agree with the 96% of junior doctors who said that extending plain-time hours to 7am-10pm is not acceptable .

”If we were to re-enter negotiations, we would have to accept that change. We cannot work unsocial hours for the same basic rate as office hours – what about our families, our friends, our personal time? Other professions are paid extra for working evenings and weekends – why are doctors different?

‘4. No pay progression for years

‘The recommendations around pay set out the principle that progression will be based on stage of training and level of responsibility. While this might sound fine in principle, NHS Employers have already put forward their proposal for this, which shows all grades from foundation doctor 1 through to specialty trainee 9 put into six pay grades. This means doctors might be on the same pay grade, and earning the same salary, for three years (or more if you are in less than full-time training), despite the experience gained during this period.

‘5. Reduced pay across the board

‘Using the limited data made available by NHS Employers and making a number of assumptions, modelling suggests that the average doctor, in most specialties, will see a reduction in their pay. To re-enter negotiations would be to accept this.

‘6. Medicine should be a profession for all

‘No one should be put off becoming a doctor because of their gender or their personal circumstances. The DDRB recommends that trainees’ pay should no longer be protected if they choose to have a baby, if they need to train less than full time, or to re-train in a new specialty. In fact, under these recommendations, the only reason someone may receive some pay protection (in the form of a flexible pay premium) would be if their employer determines their experience to be valuable to the service. This would disincentivise people, especially women, from becoming doctors possibly leading to further staff shortages across the NHS.

‘7. Less pay for GPs

‘We know that there are not enough GPs in the UK. The government continues to state that it is going to introduce thousands of GPs to fill the shortfall, but how can that be achieved if GP trainees are paid much less, on average, than hospital trainees? This would be the effect of removing the GP supplement. The suggestion is that this could be remedied by the proposal for ‘flexible pay premiums’, but what happens if we do get more GPs? The premium would stop and GPs’ pay would again reduce to much less, on average, than their hospital colleagues. We don’t think introducing a system that varies depending on the popularity of the specialty is appropriate – there must be a better way.

‘8. Less pay for non-resident on call

‘Doctors currently receive a banding supplement for working non-resident on call. Over three-quarters of junior doctors told us in our poll that replacing this with a single allowance for being available on standby is not acceptable and would not appropriately recompense trainees for the disruption of working long duty periods while on-call.

‘9. Certain specialties affected more than others

‘Some specialties would be hit by a number of different areas of the new contract. For example, trainees working in psychiatry – a shortage specialty – would be hit by the hours based system, the pay progression system and the removal of the entitlement to undertake fee-paid work. Not only would training suffer, but their potential income would be restricted compared to other groups. If trainees were to choose not to undertake this important work, patients may be left without important assessments and reports.

‘10. To maintain the integrity of the profession

‘The government has told us that they want to introduce the new contract for the August 2016 intake, and that they are prepared to impose it if no agreement can be found. The BMA cannot be held to ransom with threats of imposition – if we go back to a pseudo-negotiation we are being defeated. A return to talks under these terms is not compatible with upholding the integrity of the profession or the BMA. These are just some of the reasons why we could not return to negotiations. If we are to oppose the imposition of a contract with which we do not agree, we will need to take unified, resolute action to defend our conditions of service hopefully to achieve a fair, negotiated settlement. We will update you on our plans over the coming weeks.’

The BMA website said: ‘The BMA’s UK junior doctor committee’s decision to not re-enter negotiations does not affect how the UK consultants committee is responding to the DDRB’s observations regarding consultants in England and Northern Ireland and the UK Government’s response. The BMA’s UK consultants committee is weighing up the options of a negotiated settlement and its alternatives.’