The recent press relating to junior doctors contracts is a worrying time for everyone in the NHS. Thousands of doctors and patients have spoken out about the recent announcements from Jeremy Hunt, stating the new contract won’t pay overtime and includes mandatory weekend working. For an already over worked workforce it seems this will only prove to alienate more doctors into training and for Junior doctors to leave the UK and find employment overseas.
We asked some of our junior doctors Locums what they thought about the impending changes and this is what they had to say:
“The junior doctor’s contract is unfair and unjust.” “This will ultimately put patients safety at risk.” “The public have to recognise that doctor’s exhaustion will impede their care.” “With the threat of a 40% pay cut and increased hours from the government I have decided, like many other doctors, to take my international transferable skills to another country.” “I really want to stay in my country but I will not stay in the UK as the current contract stands.”Below is a great article from the Guardian that simply explains the junior doctor’s contract row.
Q: How has the dispute over junior doctors’ contracts blown up?
A: In 2012 the Department of Health (DH) said that there needed to be changes to the contracts which set the terms and conditions of employment of the NHS’s 53,000 junior doctors in England. They had last been updated in the late 1990s. The British Medical Association (BMA), the doctors’ union, began negotiations. But talks broke down in October 2014 and last month the BMA refused to re-enter negotiations and accused the government of a “heavy-handed” approach. Ministers then said they would impose a new contract on all junior doctors starting in August 2016. It says it is following the advice it has received from the independent Doctors’ and Dentists’ Review Body (DDRB). Ministers’ threat to impose a new contract has sparked widespread anger among junior doctors, several thousand of whom protested in Westminster on Monday evening after NHS Employers cancelled a meeting with them at Central Hall at a few hours’ notice.
Q: What is the dispute about?
A: The standoff involves complex issues. The central ones revolve around the minutiae of how much junior doctors are paid for working in different settings, and at what time of day, during the week, especially in the evenings, overnight and at weekends. But it also involves wider NHS issues such as the long hours culture faced by most hospital medics, patient safety – both the BMA and the DH claim their stance is vital to protect patients’ safety – and the staff shortages that are common in so many parts of the service. The government’s desire to greatly expand the urgent and emergency medical care services the NHS offers at the weekend by 2020 – a key pledge which David Cameron has promised to deliver – is also a key part of the backdrop. It needs more doctors to work on Saturdays and Sundays more often and that not to take up too much of the cash-strapped NHS’s resources.
Q: What does the BMA say?
A: “We urge the government not to impose a contract that is unsafe and unfair. We will resist a contract that is bad for patients, bad for junior doctors and bad for the NHS.” After a huge wave of anger among junior doctors, their representatives last Saturday decided to hold a ballot for possible industrial action over the planned changes.
Q: What does the government say?
A: “We want to improve patient safety in hospitals. We believe the current contract is unfair for doctors and patients, so we want to discuss a way forward with the BMA that maintains average earnings for junior doctors and doesn’t cut the pay bill.”
Q: What will the changes mean for junior doctors’ pay, if they go through?
A: At the moment junior doctors are paid “standard” time for working during normal working hours, which is defined as 7am-7pm Monday to Friday. What most irks junior doctors is that, if Hunt prevails, “standard” time will be extended from 60 hours per week to 90 and stretch up to 10pm every night of the week apart from Sunday. Juniors say that by not being paid extra in future for working at antisocial hours they will lose up to 30% of their salary.
However, the Department of Health says that the proposals that were being discussed bfore talks broken down “actually offered junior doctors a better deal, including: enhancing the quality and quantity of training opportunities for junior doctors; [and] a higher basic rate, with a significant increase in basic salary”, though they will not say by exactly how much juniors’ basic pay – currently around £23,000 – would go up by to compensate for the loss of extra payments for working antisocial hours. They have also tried to allay fears of widespread pay cuts by stressing that they are not trying to reduce the overall cost of junior doctors.
Q: Are the devolved administrations in Edinburgh, Cardiff and Belfast doing the same?
A: No. It is only Jeremy Hunt, the health secretary in England, who has decided to pursue what many junior doctors say is an aggressive and disrespectful approach, given their key role. Junior doctors – all doctors who have not yet become a consultant, which usually happens when a doctor is in their mid to late 30s – are the real workhorses of the NHS. They are supposed to work an average of 48 hours a week spread across six months, but many put in more hours than that. Both Scotland and Wales have said they will not impose a new contract on juniors, while Northern Ireland has yet to make a decision.
Q: Might the imposed new contracts drive UK-trained NHS doctors abroad?
A: Quite a few junior doctors have said they intend to look into this, and, since the decision to force the new contracts through was announced on 15 September, the General Medical Council has had more than 3,000 requests from doctors for the certificate they need to work abroad.
Q: What will happen next?
A: Jeremy Hunt will meet Dr Johann Malawana and other BMA representatives to see if they can defuse the dispute. However, the initial signs are not promising. The DH says the current contract is “unfair for doctors and patients” and needs to change. For its part the BMA says that the DH has to drop a series of pre-condition, including the threat to impose a contract that has not been agreed, before they will resume negotiations.
With the impending changes you might be considering locum work if this is something that you would like to know more about please contact our junior doctors team on 0800 690 6044 or email natasha.brewer@riglocums.com