Junior doctors are calling for more concessions from the government over their proposed new contract following the health secretary’s moves to head off industrial action.
Last week, Jeremy Hunt wrote a letter to the chair of the BMA’s juniors committee saying he was prepared to reconsider his plan to reclassify working on Saturdays between 7am and 10pm as part of the normal working week for which doctors would only be paid at the standard rate.
He also promised that existing incentives for qualified young doctors to go into emergency medicine and general practice, where there are shortages, would continue.
Hunt criticised the salary calculator on the BMA website, which suggests some juniors would experience a 30% pay cut, saying “I can give an absolute guarantee that average pay for juniors will not reduce.”
But he re-iterated his desire for a new contract to better support a seven day NHS.
Over the weekend, a response from junior doctors – though not the BMA – questioned the complex data on higher mortality in hospitals at weekends, which is being used to justify contractual change.
It points out that Sir Bruce Keogh, NHS England’s medical director, is co-author of a BMJ article last month which says in a section interpreting the “weekend effect” in hospitals: “It is not possible to ascertain the extent to which these excess deaths may be preventable, to assume that they are avoidable would be rash and misleading.”
While welcoming Hunt’s promises of a new system that made sure juniors were not exploited or overworked, the doctors added that “we remain perplexed, as the government’s proposals will remove vital safeguards that penalise trusts for overworking doctors”.
The letter has been signed by over 2000 junior doctors, consultants and medical students.
It also expressed concern that the “the removal of pay protection and pay progression intended to reflect clinical experience gained from years of NHS service will discourage doctors from carrying out medical research and disproportionately affect women who may work less than full-time”.
The BMA has warned that junior doctors working in parts of the NHS that involve a lot of evening and weekend work, such as emergency medicine, would be left worse off. This, it says, would be disastrous for A&Es, which are already struggling to recruit and retain staff.
In August, the JDC refused to re-enter contract negotiations with the government, saying the deal on offer was unacceptable. The government then said it would impose a contract in August 2016.
In September, the BMA decided it would ballot members over potential industrial action, and the union claims membership is soaring a head of the next stage of the dispute.
Hunt concludes his letter by calling for talks. “The negotiations on the new contract began on the basis of a shared view between the BMA and employers that the current contract had served its purpose and needed reform. The best deal for junior doctors will be achieved by the BMA coming to the table to negotiate on their behalf and I urge you now to do this,” he writes.
The BMA has said in the past it will not re-enter negotiations unless assurances are provided on:
– recognition of antisocial hours as premium time
– no disadvantage for those working antisocial hours compared to the current system
– no disadvantage for those working less than full time and taking parental leave compared to the current system
– pay for all work done
– proper hours safeguards protecting patients and their doctors.
Prof Derek Bell, President of the Royal College of Physicians of Edinburgh, commented: “As always, the devil will be in the detail but it is essential that a contract is achieved that promotes patient safety while delivering fairness and equity for junior doctors. It must ensure that those trainees going out of programme, for example, to undertake academic research or to take parental leave, are not disadvantaged. Furthermore, we must ensure that gender equality in the workforce is achieved.
“It also needs to be recognised that trainees are under increasing pressure, which the proposed changes would have only added to, undermining patient safety in the process.
“We hope that a contract can be agreed that is in the best interests of patients and trainees. Only in doing so, will we begin to address the feeling that the profession is being devalued and the growing recruitment and retention crisis that we face in the NHS.”