Dr Shree Datta addressed the BMA’s annual junior doctors conference on 8 May:
There is no doubt that this year has been another busy and productive year for the JDC, with our three largest areas of activity focussing on the EWTD, recruitment and specialty training and the junior doctors’ contract.
The EWTD has been a key challenge for UK junior doctors, with full implementation for us in August 2009. The EWTD is important health and safety legislation but despite almost 11 years for preparation, there have been tremendous concerns across the NHS about its poor implementation. We know that the greatest concerns junior doctors have about the EWTD centre around the continuity of care and quality of our training as a direct result of the haphazard approach hospitals have to dealing with the requirements of the law.
In response to these concerns, last year, we published key recommendations exploring mechanisms to maintain the quality of training. These recommendations have been taken forward in a report focussing on the impact of EWTD on training for the Secretary of State.
Next, we conducted a survey which provided a useful insight into the impact of the EWTD six months in. With over 1,500 responses, our survey was one of the most extensive and robust analyses of junior doctor working arrangements so far under the full WTD.
Those in surgical specialties in particular reported in our survey that they were more likely to have to provide emergency cover and cover for long term rota gaps. We have also heard their concerns over the quality of training promised by a 48-hour working week. In response to these concerns, we have set up a short life working party to help address the concerns specific to these trainees, with the deans and GMC and royal college input.
We found that substantial changes have been made to many rotas to make them at least appear EWTD compliant. The emphasis on training has been lost and many rotas have gained a greater anti-social component. Our survey found that four in ten junior doctors are now working on understaffed rotas. Our earlier survey back in 2008 found just three in ten respondents reported rota gaps. Things are getting worse.
In response to these concerns, we organised a conference to address the issues put forward by the EWTD on training, with solutions such as training lists and clinics, dedicated time and resources for trainers and better use of rotas put forward and informing the work of deans, NHS:MEE and others.
Shoddy and thoughtless attempts at compliance and anti-social rotas have caused many frustrations. It is clear that whilst the natural reaction may be to criticise the regulations themselves, the crux of the matter is the implementation. We have taken forward these concerns to the employers. It is essential that they engage with us to ensure not only that their rotas are New Deal and EWTD compliant but that training opportunities are maintained within that time.
One of the key issues for junior doctors relates to the information we are provided during the process of recruitment, be it for foundation or specialty training. The existing arrangements often leave junior doctors without vital information regarding our future employment. For example, where we will work and our rota. In response to our concerns, negotiations are progressing with the health departments on a Code of Practice which recruiters must follow when making appointments.
Turning to the third area of particular focus this year, it’s important to remember that the majority of queries the BMA receives are related to contractual issues which doctors encounter on a daily basis. We have heard calls for a new junior doctors contract. But, as every pundit out there predicts arctic temperatures for public sector spending, it may be some time before any negotiation on a new juniors contract would be of benefit to us.
This makes our current contract even more important, which is why we launched the successful ‘Know your contract, know your rights’ campaign. This highlighted a range of areas within our contract and aimed to make sure that juniors were fully aware of their generally underclaimed contractual rights. We brought out a huge number of resources ranging from template letters to presentations and point by point guidance on key issues such as banding and monitoring, and we want all juniors to get everything that is owed to them under our existing contract.
The election has coincided with a general consensus in the political classes that the years of generous spending on health have come to an end. The NHS is going to have to change the way it works, and that impacts on all of us, directly.
At the same time, we are seeing ongoing problems from the poor workforce planning of past decades, which will haunt us for years to come. Doctors are becoming stranded in specialties where they were tempted in at the bottom by SHO or core training posts, but where those in charge knew there were no higher training posts for them, and even after that, probably not enough consultant posts either.
So, how do you deliver tomorrow’s profession in today’s working environment?
The JDC’s priorities remain, firstly, to foster and maintain sound working conditions for junior doctors. As a trade union the BMA must first and foremost represent the interest of its members and we remain firmly committed to providing the necessary support to junior doctors experiencing problems in the work place.
Secondly, to improve the quality of post-graduate education and training.
The NHS prides itself on its highly trained staff, but the quality of doctors it produces depends on the quality of training provided. Alarmingly, our training is now under threat on many fronts. Funding cuts. Rota staffing gaps. A review of training funding that is lurching out of control. And 48 hour weeks that can feel like 40 hours have been spent on nights.
The Mid Staffs inquiry emphasised the important role of education and training in the hospital workplace and it is clear that the training of junior doctors is not an optional extra. A cavalier attitude towards our training cannot and will not be tolerated. We remain the future of the NHS and it is imperative that our concerns are addressed if we are to provide care of the highest quality to patients in the future.
Finally, the BMA looks to promote flexibility and support for junior doctors by issuing guidance and lobbying the relevant body on issues relevant to junior doctors - for example, the recent changes announced by the GMC to who will qualify for a CCT. That problem led to lobbying at the highest levels within the GMC and the royal colleges in an attempt to find a legal solution that negates the impact on junior doctors. With heavy pushing from the JDC, we are inching towards a solution that does not disadvantage us as juniors.
This year the JDC has strengthened its foundations both regionally, with more support for new regional representatives, and nationally, with better and more regular communication with the devolved nations. We have secured our foundations as the representative body for UK junior doctors by liaising and networking with all other major trainee organisations. We have strengthened our working relationship with the health departments, employers and deans. Our success and strong reputation has been built on by engaging in honest and constructive dialogue, and we will continue to hold true to what we stand for. Any new government must recognise and value the contributions of juniors to the NHS.
The year ahead promises to hold new challenges for UK junior doctors, both for training and for conditions of service. The JDC will continue to stand up for junior doctors. We will continue to take forward your concerns, and we will continue to build upon the relationships we have developed to strengthen the voice of juniors, but we need your active involvement too. Our policy must reflect the areas that doctors at the frontline wish to see the BMA campaign for - which will evolve with the needs of the profession - and the views of junior doctors remain central to the work of the JDC. We’ve heard them today and we want you to keep telling us all year what you would like to see us do next.
Because regardless of the challenges the future may hold for the NHS, it is clear that junior doctors will remain a key ingredient in a recipe for its success.
