If you continue without changing your settings, we’ll assume you’re happy to receive all cookies from the BMA website. Find out more about cookies
When you visit any web site, it may store or retrieve information on your browser, mostly in the form of cookies. This information might be about you, your preferences or your device and is mostly used to make the site work as you expect it to. The information does not usually directly identify you, but it can give you a more personalised web experience.
Because we respect your right to privacy, you can choose not to allow some types of cookies. Click on the different category headings to find out more and change our default settings. However, blocking some types of cookies may impact your experience of the site and the services we are able to offer.
These cookies are necessary for the website to function and cannot be switched off in our systems. They are usually only set in response to actions made by you which amount to a request for services, such as setting your privacy preferences, logging in or filling in forms.
You can set your browser to block or alert you about these cookies, but some parts of the site will not then work. These cookies do not store any personally identifiable information.
These cookies are required
These cookies allow us to know which pages are the most and least popular and see how visitors move around the site. All information we collect is anonymous unless you actively provide personal information to us.
If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance.
These cookies allow a website to remember choices you make (such as your user name, language or the region you're in) and tailor the website to provide enhanced features and content for you.
For example, they can be used to remember certain log-in details, changes you've made to text size, font and other parts of pages that you can customise. They may also be used to provide services you've asked for such as watching a video or commenting on a blog. These cookies may be used to ensure that all our services and communications are relevant to you. The information these cookies collect cannot track your browsing activity on other websites.
Without these cookies, a website cannot remember choices you've previously made or personalise your browsing experience meaning you would have to reset these for every visit. In addition, some functionality may not be available if this category is switched off.
Our websites sometimes integrate with other companies’ sites. For example, we integrate with social networking sites such as Twitter and Facebook, to make it easier for you to share what you have read. These sites place their own cookies on your browser as a result of us including their icons and ‘like’ or ‘share’ buttons on our sites.
What seems like a very long time ago we were called to contract talks with the Government and employers.
This was not because the BMA felt that the 2003 contract had run its course but because our negotiating partners felt that changes were needed to facilitate the provision of seven-day services.
My hospital, and I’m sure yours, has had services provided throughout the week in many areas. You will have all noticed however that the number and range of these services has steadily grown and so too has the amount of work that cannot really be deemed ‘emergency’.
You will probably also know that the 2003 contract stipulated that consultants could only be asked to provide ‘routine work’ outside of 7am to 7pm, Monday to Friday (this is in section 3 paragraph 6 of the contract, often shortened to S3P6) by agreement. This last word is of course vitally important.
The Government has made a policy decision to expand further the amount of work done at the weekends, and has published clinical standards.
A major driver of seven-day working is to enable these new clinical standards. They include that consultants should see all admissions within 14 hours, every patient daily unless specifically not needed, and patients on, for example, the surgical assessment unit twice a day.
It is it is worth noting that when the Academy of Medical Royal Colleges proposed standards on seven-day care, which included that hospital inpatients should be seen by an on-site consultant every 24 hours over seven days, it said it was likely to require extra consultants and additional resourcing for community-based services, as well as careful job planning.
There are other drivers of seven-day services. These include waiting list initiatives, Saturday and Sunday convenience clinics, and using spare operating list capacity to foster local service reconfiguration. Clearly it can be argued that not all of this represents emergency.
As a group, consultants have seen their real-terms take-home pay fall by 30 per cent since 2003 and employers are obviously worried that consultants might use this as a lever to regain some of their lost income, exposing NHS trusts to unpredictable wage bills.
The talks were therefore started with the Government’s aim that contract changes would render enhanced seven-day services as ‘affordable’ although this very rapidly became ‘cost-neutral’. Which you may feel is a rather different word.
Why did we agree to talk at all? As I have said, there was not a strong feeling that renegotiation would be in our interest. There were however areas of the contract which it was felt could possibly be improved.
The 2003 contract is based around a consultant’s emergency duty being on call with occasional return to hospital. This is clearly not the pattern experienced by many consultants in 2015/16.
Consultants are not well protected from enormous amounts of work performed out of hours. A set of protections against this was felt to be useful. Similarly the present clinical excellence award scheme is not supported by all consultants and at the outset of negotiations it seemed we might have the opportunity to work on enhancements to the scheme.
The current pay scale is not a good match to the CARE pension that new consultants will have most of their lifetime pension entitlement based upon.
As one would expect, some of things that we might hope to achieve during a negotiation may not come to pass and likewise some of the things that we would not wish to give away are sought by the other side!
We have had a very able group of negotiators with the support of a professional negotiator so whatever has been achieved is not through lack of expertise, intelligence or trying. There has been a strict timescale imposed by the Government and talks were guillotined prior to Christmas.
The current situation is that the negotiation document has gone to the Government for comment, approval and costing. We hope that Government will bear in mind that an agreement which is acceptable to the vast majority of doctors is the only one that will see the kind of contractual change it seeks.
Usually that will need to be via some sort of benefit to most clinicians. In a cost-neutral environment it will clearly have a very difficult task on its hands. We are getting a better idea of the carrots as well as the sticks.
We are touring England and Northern Ireland in our blue satin BMA tour jackets to let you know all about it and, vitally, hear your views. Until that time consultants up and down the country will of course continue to provide seven-day services where they realistically expect them to make a difference to their patients, all on their currently unaltered 2003 contract.
Mike Henley is a deputy chair of the BMA consultants committee. Follow him on Twitter @trentconsultant
What will you do when Jeremy Hunt, who will veto any ersatz negotiation that you have fooled yourself into thinking you have been having, imposes a contract of his own choosing?
Why are we putting up with this tosh at all?
Successive attempts to "negotiate" have landed our so-called "profession" (for that's not really what it is any more) in the ignominious predicatment in which we now find ourselves: demoralised, over-worked, under-paid, exploited, judged by the general public to be greedy and over-paid and judged by Jeremy Hunt to be work-shy layabouts who spend their weekends having a life, like he is entitled to enjoy.
I've seen my retirement age rise by over 25%, the cost of my pension rise by over 100%, my salary has remained frozen for years, yet my mortgage and weekly shop are not getting any cheaper; meanwhile, the BMA has upped the price of membership each year since I can't remember when, and my Royal College just added a 10% hike in fees, all on account of "rising costs".
Is everyone blind to what's going on, or just so pusillanimous, that they're prepared to bend over and take whatever Hunt and his predecessors have elected to dish out.
We are allegedly a profession, not a charity. Pushing costs onto doctors and treating people poorly while simultaneously demanding excellence and imposing contracts on people is not my vision for any form of medicine, let alone modern medicine.
Isn't it about time that we stopped deluding ourselves and just pulled the rug out from under this political prat?
I salute the junior doctors - and Mark Porter's - stance and the affirmative action they have taken. If they give in, the profession will be broken forever. I only hope consultants have the same resolve when it's our turn next, as it inevitably will be...
Good to read both the pros and cons spelt out in an honest, unvarnished way. Clearly we might not have wanted negotiations to even start, but if they had to, it's better to work for improvements. Bit like the debate whether to stay in the EU!
I am ready to strike.
Just tell me when!
Please be aware that the suggested contractual "variation" about to be forced upon us will bribe the younger Consultants to sign up, as their progress to the higher wage bracket will be faster.
See comments below, we have been watching (no sleeping) while our wages have been slashed.
The government needs to know what good medical care is worth!
We can influence them by working to rule, stopping WLIs and proving to the public how much work is going on!
Let's all stand up to this!
If you need a consultation about academic paper writing? You can navigate here college-homework-help.org/.../case-study and communicate to a manager.
Do you want to work as doctor but have no experience? this service resumecvwriter.com/.../one-page-resume would help you to create a great and catchy resume.
Thanks a lot for the post. It has helped me get some nice ideas. I hope I will see some really good result soon.