02.06.2016

Reject the new contract

We need to develop a realistic strategy for victory, writes Richard Galen

Last weekend saw the public release of the terms and conditions for the renegotiated junior doctor contracts after the conclusion of talks between the department of health and the British Medical Association in May. The contract offer is set to be balloted to BMA members (both junior doctors and senior medical students) on June 17, with the BMA itself pushing hard for a ‘yes’ vote. This has come following unprecedented industrial action by medics, including the first strikes encompassing emergency care in the history of the national health service.

The latest talks came after health secretary Jeremy Hunt, in what he called a “show of good faith”, said the government was willing to “hold off the threat of imposition” of the new contract, while negotiations took place - a bizarre sentiment, given that he did not intend to change the date when the new contract would take effect (however, during the latest round of negotiations he conceded that implementation would now be put back to October).

Despite the lack of any real substance to the rhetoric used, however, this marked a significant U-turn from the man who insisted back in April that “the matter is closed” and refused to entertain the idea of reopening negotiations. It is, of course, impossible to identify exactly what caused this retreat by the department of health, with some newspapers speculating that a plea from the Academy of Medical Royal Colleges to both sides was the trigger, but it is clear that many doctors who reluctantly manned the picket lines during the all-out strikes last month will now feel a degree of vindication for their actions.

Although dire warnings from the government that the strikes would cause an “unacceptable” risk of patient deaths filled the headlines, stories of harm and calamity resulting from industrial action were conspicuous only by their absence. Neither did the predicted drop in public support occur, with a post-strike poll conducted by The Independent showing that 58% supported the action, with only 31% opposed.

The solidarity shown to striking doctors by the teachers’ unions and other public-sector workers, despite its token nature, did also not go unnoticed, with the BMA’s junior doctors conference in April voting to develop links with other unions, and to lobby the union itself to do likewise. This was a much-needed step by the BMA, which all too often in the past has remained aloof from organisations such as the Trades Union Congress.

In a further blow to Hunt’s imposition plan, his stated motivation for the contract change - reduced numbers of doctors causing the so-called ‘weekend effect’ of higher mortality, following hospital admissions at the weekend - was also called into question by the publication of two papers in the medical journal The Lancet. One found no association between numbers of senior doctors rostered at the weekend and mortality rates, while the second, looking at stroke patients, showed no difference in 30-day mortality between patients admitted during the week and at the weekend.

This, then, was the backdrop to the reopened contract negotiations, which was hosted by the Advisory, Conciliation and Arbitration Service, with many doctors feeling the BMA simply needed to consolidate its position of strength in the form of a contract registering real gains in working conditions, remuneration and patient safety. The main areas of concern amongst junior doctors were: the existing draft contract’s inherent discrimination against women and single parents; the penalties for taking time out of careers to carry out research; the lack of safeguards against unsafe working patterns; and unacceptable levels of remuneration for the impact of out-of-hours working on family and social life, as well as the medics’ own general well-being.

Ultimately the admission of discrimination in the government’s pre-negotiation contract was down to the loss of automatic pay progression, as well as the disparity in pay for so-called ‘less than full-time’ (LTFT) trainees, of which the vast majority are women (often due to childcare commitments). Single parents would also lose as a result of increased rostering during unsocial hours.

Terms and conditions

Although there have been some gains for the BMA (including better relocation expenses for families; and pay protection if disability, caring or family issues mean a doctor has to change specialty), these issues have not been adequately addressed in the renegotiated terms and conditions, with the government having achieved one of its major aims - making it cheaper to roster doctors at the weekend (as part of the misguided “seven-day NHS” pledge).

Weekend hours during the daytime will effectively count as ‘plain time’ - doctors instead getting a percentage uplift to salary (from 3% to 10%) only if they work more than one weekend in eight. The calculation is to be based on the number of weekends worked rather than the percentage, meaning that many LTFT trainees will lose out despite doing the same proportion of weekend work - an issue compounded by the fact that childcare is often far more expensive at the weekend.

Importantly, this also establishes a precedent for the government to renegotiate other NHS workers’ weekend pay and conditions for the worse - an issue that drew many fellow health workers to side with the junior doctors during the strikes.

For those taking time out for teaching or higher degrees, there remains a ‘pay premium’ onto any basic salary of £4,000 per annum - but with the increase in university fees this may not be enough to cover even the tuition, thus discouraging those who wish to get involved in research and training future doctors.

Some of the biggest negotiated changes have come in regard to the new role allocated to the so-called ‘guardian of safe working’, who will supposedly prevent unsafe working hours. The guardian will be appointed by a panel which includes junior doctor representatives and will be advised by a junior doctors’ forum scrutinising the use of any fine payments made by the hospital for overworking their medics. Also, panels for reviewing work schedules deemed unsafe and excessive will now have to include a representative from the BMA or another recognised trade union.

However, such safeguards will mean nothing if they do not tackle the root cause of the problem - simply not having enough junior doctors - an issue that has been conspicuously absent from both sides in the negotiations. With no rota examples published for the proposed contract, it remains impossible to see how increased rostering at weekends will not affect weekday care, with medics being forced to remain beyond their hours to ensure the safety of their patients (it is, of course, already routine practice for doctors to remain at work unpaid for as long as an hour after the end of their shift to ensure a smooth and safe handover).

Finally, for many doctors, a fair salary is a key issue that needs to be encompassed in an agreed new contract. Although the so-called ‘front-loading’ of pay (ie, higher salary at earlier levels, with less incremental pay rises to compensate) was welcomed due to increased access to loans and mortgages, the fact remains that over the last six years doctors (along with most other NHS employees) have had their pay frozen, and the new contract simply does not make up for this. Future rises will again, in effect, be ‘pay cuts by stealth’ as a result of inflation - these are to be fixed at 1%, 0.9% and 0.8% over the next three years. There is also a reduction in the original offer of a 13% pay rise (now 10%) and 150% basic pay (now 137%) for night shifts - a totally unacceptable concession by BMA negotiators.

On social media, doctors have given differing interpretations of the new contract, and it is difficult to tell currently which way the vote will go. Given what has been achieved so far, however, it is hard to imagine that we will now abandon fighting for our cause. But it is important to remember that the ballot result is not completely binding and the BMA can still choose to accept the contract on our behalf - there is a danger it will do just that if the vote is particularly close.

We now need to confirm and re-establish the unity that has marked this dispute - the original ballot for action garnered a 76% turnout, with an unprecedented 98% voting in favour, while every strike has been fully supported by the vast majority of BMA junior doctors, as well as some who are (or were previously) non-members.

Up to now the government line has been that we naive junior doctors have been misled by BMA officials with a ‘political agenda’. Let us now expose this for the nonsense it is by voting overwhelmingly to reject the latest package. We must also develop a realistic strategy for resisting any imposition and continue working for the necessary concrete solidarity from our fellow workers.