24 Sep 2015

‘Real and immediate threat’ to NHS of new junior doctor contracts

Junior doctors aren’t renowned for their revolting. Even if they wanted to, many are simply too knackered.

But they are revolting now. Against a new contract imposed on them after their negotiations with NHS Employers (on behalf of the government) broke down, and the British Medical Association walked away.

The junior doctors (and this means virtually any medic up to consultant, GP or associate specialist) are angry. There is no doubt about it. Mainly, they say, because it will affect patient safety.

Under the new contract, a safeguard is being removed which means employers will be hit by making juniors work longer hours.

A normal working week will be reclassified from 7am-7pm Monday to Friday (60 hours) to 7am-10pm Monday to Saturday (90 hours).

Working a Saturday night will be the same as working a Tuesday morning.

The concern, of course, is not just that patients will be in the hands of juniors who can barely stand, see, think, but that all this will be a disincentive for juniors to go in to acute specialties like A&E. And as we all know, we need more doctors there.

There’s another perverse disincentive in the contract, too.

The GP trainee supplement is to go. It was put there to lure juniors out of hospitals and into general practice and ensure they don’t suffer financially.

I’ve just spoken to a woman junior who says she will lose a third of her salary if she goes ahead with her long-held desire to be a GP.

But that’s not the only whammy.

I specifically said a woman because, under the new contract, incremental pay rates are lost if a junior takes time out for maternity leave or to go part-time. Not to mention if they want to do academic work.

This is 2015, for goodness sake. Employers cannot say we are going to make you work long, antisocial hours, and on top of that don’t go and have babies because we will cut your pay further.

In fact, so astonishing is this hark back to Victorian times that I can’t believe that the men (because surely no women were involved in the drafting) on the doctors’ and dentists’ remuneration review board meant to come up with this.

The Department of Health (DoH) has been passing all media inquiries to NHS Employers, even though it’s ministers who imposed the contract.

But a DoH media release does say “NHS Employers will continue to develop a contract that is good for junior doctors and patients.

They, and we, will talk to all stakeholders, including the BMA, as that work develops.”

The statement continues:

“The proposals actually offered junior doctors a better deal, including:

· enhancing the quality and quantity of training opportunities for junior doctors
· a higher basic rate, with a significant increase in basic salary;
· proportionate payment for additional hours worked (including when on-call);
· unsocial hours paid at a higher rate;
· flexible pay premiums for hard-to-fill specialties.”

In the meantime, a number of juniors I’ve spoken to are saying Australia and New Zealand are seeming increasingly enticing.

Unusually most of the Royal Colleges (surgeons excepted) have issued statements in support of the junior doctors and against the contract.

We have been leaked a letter to Jeremy Hunt from the presidents of nine Royal Colleges in which they warn: “the proposals represent a real and immediate threat to the current stated priorities of the NHS, namely recruitment and retention of front line staff.”

Normally they stand back, but this time they are worried too.

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