On 13 August 2015, the BMA junior doctors committee decided not to re-enter negotiations with NHS Employers over a new contract for trainees.
1. Junior doctors told the BMA that the recommendations are not acceptable
The first and most important reason why the JDC is not re-entering negotiations is because what is on offer now is no better – in fact, it is worse, the BMA says – than when they left the negotiations. If it was bad enough 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 said the recommendations are not acceptable.
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 pay review body’s (DDRB) 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. The BMA 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 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. The BMA agrees with the 96% of junior doctors who said that extending plain-time hours to 7am-10pm is not acceptable
To re-enter negotiations, the BMA would have to accept that change. Doctors cannot work unsocial hours for the same basic rate as office hours – what about doctors’ families, friends, 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 be 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
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.
The BMA disagrees with 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 said in the BMA 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 said 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.