#JuniorContract – Foundations for Progress

It’s been two weeks now since junior doctors felt like their world imploded. Television, radio and social media have been awash with strong feelings, stern warnings and cries of disbelief. Ballot for industrial action is looming and the BMA have stuck to their guns and continue to demand that their five core demands are guaranteed in writing before they return to the negotiating table. This is a stance which is supported by most junior doctors. There can not be any doubt that the strength of feeling doctors would have on the issue of their new contract was underestimated. As a cohort we have shown ourselves to be highly motivated and for the most part, united. Quite frankly, junior doctors tend not to ‘pipe up’ that often. But over the past few years, as professionals we find ourselves more and more burdened by debt and struggling to balance the demands of our work with the ever increasing demands of a formalised training process. The fact is that this really is a case of it being the last straw that broke the camel’s back.

All well as that may be, I think that as a cohort of professionals we have a very strong case for our initial demands. Exploring the wider issues facing junior doctors in today’s NHS is of course important, never again should we leave it this late to stand together, but what is of vital importance with a view to progress is making an argument which allows everyone to focus in on and see our demands for the reasonable requests that they are.

  • Proper recognition of unsocial hours: Each time this argument is ventured on an official platform, it is lost in the clamour of the department of health saying they want a seven day service and junior doctors crying ‘we already work seven days’. Both of these things are true but neither is the argument at hand. The relevant point here for discussion is of course that if you are going to request a body of professionals work unsocial hours you need to provide appropriate remuneration. If a father works three Saturdays, giving him two Mondays and a Wednesday off in return is not of comparable value to his family. It is not of comparable weight in his work-life balance. Similarly, working until 10pm is not social. No amount of diversion tactics will change that.

I am a junior doctor, I will continue to demonstrate commitment to a safe NHS, seven days a week, if you commit to remunerate me appropriately.

  • No disadvantage for those working antisocial hours:  Taking into account the speciality short falls, this point should of course be a given. Junior doctors have read the DDRB report. They view the idea of ‘flexible pay premia’ with suspicion. They feel the proposals systematically disadvantage those working antisocial hours. The government I will presume would also not want to disadvantage those working antisocial hours already, not given their stated goals of a ‘seven day service’. So the point for discussion right here and now is not whether or not the DDRB report adequately provides for this section of doctors, but whether or not the government can agree not to disadvantage them. Agree to this and negotiation is within sight.

I am a junior doctor, I will support the BMA returning to the negotiation table if you commit not to disadvantage those working antisocial hours.

  • No disadvantage for those working less than full time: This is a difficult point. The section of doctors affected by such change would be broad and includes parents, doctors with disability and those participating in research. The government have a seemingly reasonable plan to link pay to actual responsibility. The fact remains that they have no real evidence based and reproducible way to make this happen. The section of ‘less then full time trainees’ might include doctors who actually work up to forty hours a week; full time by an other industry standards. They simply cannot link grade of training to responsibility to a way that it is reliable enough to dictate a doctor’s pay. The meer fact that they have created a situation where such broad swathes of the medical profession could be so adversely affected is illustrative that these plans have not been thought through to a point that would make imposition anything but grossly unfair and misguided.

I am a junior doctor I will continue to devout my working life to the NHS if you remove the threat of disadvantage to those working less full time.

  • Pay for all work done: I would venture that doctors will always work in excess of what they are contractually required to. It is the nature of our profession; we know that and the department of health knows that too. NHS employers openly saying that they did not want to create a situation where junior doctors could claim for ‘every extra minute spent carrying out their duties’ was a horrendously ill advised statement. It has whipped up the mistrust junior doctors have in their plans to a whole new level. The BMA ask that we are paid for all work done. I do not know a single doctor who would ever take their good-will work away from the patient on front of them but NHS employers created a situation where the principle has become very important.

I am a junior doctor, I will invest some trust back in this process if a principle that supports expectation of pay for work done is respected.

  • Proper hours safeguards protecting patients and their doctors: What history has taught us is that the introduction of proper safeguards to prevent the exploitation of junior doctors made our work environment safer. Mr Hunt told the independent that the constraints are punitive to trusts when it comes to staffing a seven day service. This is true of course, but for very good reason. Tired and overworked doctors make mistakes. Perhaps the department of health actually feel that by removing the safeguards and leaving this issue to local relationships between doctors and their hospital, they are giving everyone an opportunity to work closely together. If that is the intention, I think doctors would say thank you for it, but it is still wrong. Junior doctors are the vulnerable members of the hospital work force that are shunted from hospital to hospital. They have no on-going relationship with their local employers and often feel like those contractual safeguards are all that they can depend on.

I am junior doctor, I will feel protected by my new contract if proper safeguards are kept.

This situation has awakened junior doctors to the responsibility they have to engage with healthcare policy; as WB Yeats put it ‘All’s changed, changed utterly: A terrible beauty is born’. On a personal level, I am thankful for that. I think in the end those responsible for healthcare policy could be too. We are of infinite more use when engaged in reasoned discussion.

So there you have it, five reasonable requests which will bring the BMA back to the table. Yes its a ‘simplification of the issues. Yes there are many more complicated discussions to come. But if the department of health truly wish to achieve their goals for the NHS with junior doctors on their side, this has to be the start.


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