Jeremy Hunt’s decision to impose a contract on junior doctors in England from August 2016 goes beyond the issue of their pay. It is yet another piece of evidence revealing the value he places on the NHS.
The demands of austerity have stretched many parts of general practice to breaking point, with most hospitals in England also struggling due to funding shortfalls and a recruitment crisis. It is no wonder that staff report being undervalued and demoralised.
With sickness levels running at record levels, you would expect the government to act more sensitively and with less impudence. But these are simply bullying tactics. How else would you describe a man right at the top of the NHS tree who threatens to impose his will on the most junior of doctors, many of whom will have barely left medical school?
However, the news that Hunt is willing to listen to them might perhaps be a change of heart, and it is of course welcome news for the newly elected chairman of the British Medical Association’s junior doctors’ committee, Dr Johann Malawana.
There is compelling evidence the health secretary might want to consider to work out a decent compromise.
The BMA and other statutory medical bodies have worked with previous governments to ensure that training is protected and that there is work life balance for the juniors. A notable outcome of this has been that medicine is no longer the preserve of male doctors; almost two thirds of qualifying doctors are now female.
Our juniors form the fabric of any hospital in the country. Whether on a ward round, or in an emergency in A&E, a junior doctor is likely to be at hand to give patients the care they need, or work with the team to save a life. The BMA and other statutory medical bodies have worked with previous governments to ensure training is protected and the juniors have work-life balance. A notable outcome of this has been that medicine is no longer the preserve of male doctors; almost two-thirds of qualifying doctors are now female.
So why are the junior doctors so angry? Proposed NHS Employers terms on trainees’ contracts are regarded as being unsafe to patients whose care could be compromised due to long working hours, and unfair due to the level of pay proposed. The BMA says this will not financially benefit any of the juniors who have already seen a pay freeze, a reduction of their pension, an increase in pensionable age, and deprivation of basic amenities such as hospital accommodation and decent meals on site in keeping with their odd hours.
To add insult to injury, junior doctors now face a punitive contract that will slash their earnings by up to 30%. The government is changing what constitutes “out-of-hours working” so that Saturday is now classified as a weekday and evenings won’t incur extra pay.
No surprises then that in the last week the General Medical Council received 2,000 requests for certificates allowing doctors to work overseas. Does Hunt realise that this punitive contract will result in our best juniors being creamed off by lucrative contracts abroad? Furthermore, it will put many bright youngsters off studying medicine. The inevitable effect of this is the much greater risk to healthcare provision and patient safety throughout England, with the daunting prospect that it would take a generation to reverse the damage.
The proposals are particularly unfair to GP trainees, A&E trainees, doctors who take parental leave and clinical academics, all of whom are vital and are likely to face significant pay cuts.
Recent official NHS figures, covering the arrival of the latest round of new junior doctors in August, show that acute medicine was still short of the new recruits it needed, as were renal medicine, elderly medicine, psychiatry and general practice. The irony is that by driving UK trainees abroad or to locum agencies, the Department of Health ends up picking up a far bigger bill than it would have had by simply treating them with fairness.
Many senior medical organisations are concerned about the deal to be imposed. Though the BMA has been negotiating rights for the juniors’ contracts, the concern has already been expressed by Medical Royal Colleges, which are generally not drawn into these matters. And so last week, 11 months after the breakdown of talks and with no sight of the government retracting on the threatened imposition from next August, the junior doctors’ committee of the BMA voted to ballot its junior members in England for industrial action.
More than 80,000 signatures on an e-petition show the strength of support for junior doctors. The BMA is correct that the current proposals are inadequate as a basis for renegotiation, and until they are substantially changed then there is nothing to discuss. The BMA wants to deliver a contract that protects patient safety and is fair to both junior doctors and the health service as a whole. This dispute could still be settled amicably, if the government agrees to very reasonable and just demands of junior doctors, namely:
- Protection of the hours worked, and paid at a standard rate.
- Recognition of unsocial hours as premium time, and paid as such.
- Penalties for employers who routinely have juniors working excessive hours.
- No disadvantage for those working less than full-time and taking parental leave.
- No discrimination of sexes in any pay proposals or hours worked.
- Payment for all work done.
Today’s junior doctors are the consultants and GPs of tomorrow. They have been trained in some of the best institutions in the world. It is time to get behind them or risk them being lost to the NHS.
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