Junior doctors flooded Westminster in their thousands last night (Tuesday) to protest against planned changes to their contracts. The demonstration – to be followed by one in Manchester tonight – came as the British Medical Association (BMA) is balloting its members on industrial action, and junior doctors throughout the NHS are debating their reaction to the news that the government intends to impose a new contract with effect from August 2016.
Under the new contract junior doctors’ normal working day would be increased to include a considerable amount of evening and weekend working. Currently 7 pm to 7 am Monday to Friday and the whole of Saturday and Sunday are considered “antisocial” hours, rewarded by a higher rate of pay. The new proposals would see “standard time” extended to 10 pm in the evening both from Monday to Friday and on Saturday too.
Pay cuts
This would enforce a pay cut of upwards of 15 per cent for many junior doctors – and for some a cut of 30 per cent – especially those in areas like emergency and acute medicine, which depend on out-of-hours working. Exactly how pay would be affected remains unclear, because according to Andrew Collier, the co-chair of the BMA’s junior doctors’ committee, “despite our requests in our evidence submission, NHS Employers have been unable to provide robust data to let us make these sorts of calculations”.
Remember that these junior doctors are those who have finished medical school with high levels of debt – the BMA reckons the average doctor graduates with debts of £90,000.
‘General practice will be even more unattractive.’
Trainees in general practice, where there is already a manpower crisis, could end up earning 31 per cent less than their hospital colleagues, because they are rarely required to work antisocial hours, so general practice will be even more unattractive. In London, 30 per cent of GP vacancies are currently unfilled. So much for moving care out of hospitals to GPs.
The achievement, after many years of struggle, of limits to junior doctors’ working day is threatened by an end to the sanctions NHS trusts can incur if agreements on junior doctors working time are breached. Many who spend time in higher education or research would lose their right to annual increments. Doctors who change speciality, a not-uncommon career path in areas such as surgery, where there are many sub-specialities, would have to start again at the bottom of the pay scales.
Wrecking
The scandal of an NHS staffed by exhausted, demoralised overworked junior doctors, and locums galore, has far greater implications for patient safety than any of the incidents that Hunt and his fans like to cite. Add to this that 20 trusts are now in ‘special measures” and a further 27 are receiving “intensive support”, and Hunt’s wrecking intentions towards the NHS become crystal clear.
The government used a third party to introduce the changes, the Doctors’ and Dentists’ Review Body. While the body is nominally independent, in fact it was given a clear agenda, and Hunt immediately said he would implement its findings, without negotiation. Many of the medical Royal Colleges, which traditionally stand aloof from trade union issues, have voiced concern about the proposals
Those who argue that doctors should run away from the struggle by emigrating should be condemned as cowardly agents of the government. Stand and fight. Whether strike action, or some form of work to rule, is the best strategy requires hard and clear thinking.