Contract latest: Junior doctor members in England are being sent ballot papers on 5 November 2015 and should expect to receive them one or two days after this date. The postal ballot will close by 5pm on 18 November 2015. Find out more
Over a year ago, we began negotiating with the government represented by NHS Employers on a new junior doctor contract. We know that money is tight in the health service right now, but through the negotiations, we sought to make genuine improvements to doctors' working lives and to patient safety.
We tried to develop safeguards which would improve safety and prevent doctors regularly working exhausting 90-hour weeks.
We had tentatively agreed:
• No junior doctor should work more than 72 hours in any seven consecutive days
• No junior doctor should work more than four consecutive night shifts of up to 13 hours
• Rest days before and after night shifts
The BMA proposed additional safeguards, including:
• Facilities for doctors during night shifts (for example, rest facilities and guaranteed access to hot food)
• Facilities to support doctors whose night shift over-runs and are not safe to travel home (for example, transport home, or a room to rest in before travelling)
The government was not prepared to include these important safety measures in a future contract.
The government also insisted on a reduction in the breaks that junior doctors are allowed to take during shifts, arguing that it would be safe for doctors to take just one 30-minute break in a ten-hour shift.
The current contract's system of banding and monitoring recognised the effect of long and antisocial hours. Paid as a percentage of basic salary, the banding supplement succeeded in driving down hours from the unsafe levels seen in the 1990s.
We proposed an alternative that was based on two complementary and inter-related strands.
The first strand involved regular reporting and review of unscheduled hours that a doctor works. Regular reporting would give employers the opportunity to quickly identify and deal with problematic rotas.
The second strand involved payment for any unscheduled hours that a junior doctor has to work. Payment for unscheduled hours is crucial, without financial penalties, increasing hours are inevitable.
We explained that, as well as providing fair reward to the doctors who work those hours, this would provide the financial incentive necessary for employers to not overwork their doctors.
The government was not prepared to agree a replacement for the system of banding that we considered safe for patients and doctors.
We explained that over time, if implemented properly, we did not believe our proposals would increase employers’ costs.
We explained that junior doctors regularly have to take clinical decisions about how best to care for patients. When stretched NHS resources mean that other cover is not available, junior doctors are often not able to pass care to another doctor. Instead, they have to take the decision to stay late themselves to care for a patient.
The government told us that it only prepared to pay for unscheduled hours worked if they had been authorised in advance and that it was not prepared to pay for unscheduled hours incurred when junior doctors exercised their clinical judgement.
Instead, the government told us that it expects junior doctors to demonstrate their professionalism by working additional hours without pay.
The government proposed that plain-time hours should be from 7am to 10pm every day of the week (including weekends). They argued that this would free up money to increase junior doctors’ basic salary, and allow them to pay a higher premium for unsocial hours (those between 10pm and 7am) – whilst ensuring that the overall pay bill did not go up or down.
This is a dramatic shift away from current plain-time hours. It would open the door for employers to shift more work to evenings and weekends without proper consideration of safe and sustainable working patterns.
Restructuring hours in this way would disincentivise junior doctors from working rotas with intensive out-of-hours commitments, such as emergency medicine. This risks further exacerbating recruitment difficulties in those specialties.
We could not sign up to proposals which destabilise emergency medicine recruitment and impinge upon junior doctors’ right to a life outside of medicine.
One of our key goals was to ensure that junior doctors get the training they need. This is vitally important to ensure that the next generation of doctors are highly skilled and equipped to deal with the rising pressures on the NHS. High quality training will deliver a better and safer NHS in the long run, but it is too often sacrificed to meet short-term demand.
To ensure that time for training and development was protected and enhanced, we proposed a system called work scheduling. Junior doctors would be provided with details of their training opportunities in advance. This would enable them to hold employers who do not provide sufficient training to account. It would also enable employers and deaneries to identify gaps in training that need to be addressed.
However, the government was not prepared to incorporate the robust, independent review mechanism needed to make work scheduling anything more than a paper exercise.
At the start of the negotiations, we agreed with the government that the 'average gross pay across the junior doctor workforce' (total pay bill divided by number of junior doctors) would not change from at the end of 2012/13.
However, late in the negotiations, the government changed its position, wanting to base our calculations on 2013/14 data. This would have led to a reduction of around 1 per cent in the average gross pay of junior doctors.
Many of the changes we were discussing would have led to cost savings. We insisted that any money saved should be recycled back into the contract, to maintain overall funding at current levels.
The government was only prepared to recycle savings for a short, undefined period. This would have led to a gradual erosion of the amount of money available to pay junior doctors’ salaries.
Abolishing time-based pay progression in the public sector is a political priority for the government.
The government proposed an alternative model based on what they called 'rate for the job', but it was unable to explain to us how this would work in detail. Their proposal would have lead to a cut of tens of thousands of pounds across the duration of their training for junior doctors who took maternity or extended paternity leave. The same would apply to many junior doctors who take time out to pursue academic training.
We argued that, as well as being unfair to many groups of doctors, it would make being a doctor a less attractive career. If implemented the government’s proposals would disincentivise academic training.
It is vital that junior doctors are given the details of their place and hours of work as far in advance as possible - they need this in order to plan their personal and family lives. But sometimes employers don’t provide this information to junior doctors until the day before they start a new post.
We wanted the contract to contain minimum standards for the provision of advance information about rotas.
The government refused to put this into the contract and wanted to consider this problem only after negotiations had concluded.
Some junior doctors are contracted to take fixed periods of annual leave. This means that their employer can decide when they are allowed to take time off.
This practice is restrictive, unfair and seriously impinges on junior doctors’ lives outside the hospital. It has no place in the 21st century NHS.
The government was not prepared to take steps to restrict this practice.
The ‘period of grace’ is a six month extension to the contract of junior doctors who have received a CCT (certificate of completion of training).
Maintaining the existence of the period of grace allows a smooth transition from training to consultancy, allowing trainees to remain in the region in which they have been trained and bridges the gap when there is a mismatched between a trainee’s CCT date and consultant recruitment rounds.
The government wanted to significantly limit the period of grace available to trainees. In many cases, this would mean potential unemployment for senior trainees and would result in the underutilisation of the skills of this crucial part of the medical workforce.
Again, we urge the government to reconsider its stance and work with us to find solutions that are good for patients, fair for doctors and sustainable for the NHS.
Kitty Mohan and Andrew Collier are co-chairs of the BMA junior doctors committee.
Use the comments section below if you are on a desktop computer, or if on mobile, go to BMA Communities
Well done on the update, and on standing firm with regards to safe working hours and protecting training.
What is the next step going to be?
Thanks for taking a stand with this - the changes they propose would be a disaster for junior docs. There is no way the medical unions in Australia or New Zealand would accept these kind of working conditions. We shouldn't give an inch. If they are happy to waste millions on an ineffective and unwanted reorganisation then they should at least pay us fairly. At the moment they are deliberately taking advantage of our collective good will. While Im prepared to stay late occasionally in unforeseen emergency situations this has become an every day occurrence due to inadequately staffed rotas. Personally I think we should 'clock in and clock out' with a swipe card that accurately records the amount of overtime we do. Ive spent too many evenings away from my friends and family and it is only fair that this is compensated through my pay.
I am a final year medical student, due to start work as a foundation year doctor next September.
Personally, while I understand that patient safety is paramount, there is absolutely no way I will stand for inadequate staffing leading to necessary overtime. Nor will I be willing to accept fixed leave.
Frankly, these sorts of working conditions would be completely unacceptable by other most professionals and non-professionals.
I feel as though doctors' willingness to pander to the inadequacies of the system, accepting that it is "the way it has to be" and "that the consultants used to work 100+ hour weeks" rather than being firm and standing ground with regards to working conditions needs to end to see real change.
It is not just unions in Australia and New Zealand. Our dental collegues seem to manage to fend off pretty much all the rediculous things by the government/NHS/GMC we have to deal with on a daily basis with ease.
By the way, Anon, It's actually currently legal to have fixed leave and it's unfortunatley very convenient for the employer when they organize the rota so there isn't much you can do about it apart from turning down your work contract. That leaves you jobless annd unless you have some good contacts in the EU you will be stuck with your provisional registration forever.
I'm a very late entrant to the profession. I've already willingly accepted the fact that training in my mid fifties means that I will be working long beyond my retirement age to pay back the investment that the system has put in to training me, and under the pervious settlement I was quite prepared for this. What I am not prepared to do however is practice medicine which could be unsafe.
I have to say that if the government's current proposals were brought forward I might even feel unable to take up an FY1 post at all because I recognise that in my late 50's I may simply lack the stamina required to safely work these ridiculously long hours with so minimal a break.
Now people who know me on my course will be aware that I am far from a normal 55 year old. Mostly I compete on reasonably equal terms with my younger colleagues, but sadly it is a physiological fact that beyond 30 years old stamina does start to drop. So I have reason to suspect that I will not be the only one who would struggle with this.
I think the government needs to understand that the nature of the junior doctor workforce has changed a lot from the days, often fondly remembered by our seniors, when all graduates were all 22 or 23 and enjoyed the machismo of pulling off a 36 hour shift! Many misty eyed consultants who probably advise the government on the safety of this forget that around 30% of today's juniors are a good 10 to 15 years older than they were when they started (25 years in my case) and like it or not that does make a difference.
The rise of the GEP student population means that a substantial percentage of new doctors are in their 30's and 40's and this system which might be workable for a 23 year old, is in my opinion unlikely to be safe for 30 or 40 year old. So what are they going to do? Have a two tier system? Accept that some patients may be harmed? Scrap all older medical students?
This clearly needs to be thought through more carefully.
If nothing else, the startlingly unfair position taken by the government and subsequent deadlock only demonstrates how toothless the BMA really is. The govt know very well our union won't rock the boat and that changes will go ahead regardless.
I stumbled across this site and I am sorry I did!
I am sorry guys but to listen to the new tranche of juniors banging on about unsafe hours, unsociable activities; citing a clocking on and off mentality only then to complain that they are not getting enough training and or spoon fed teaching makes me glad I am shortly to retire.
I fully appreciate that working 128hr weeks was ridiculous, falling asleep holding back a retractor was equally bad but and its a big but you cannot come out of the system at the end trained unless you put the time in one way or the other ie shorter hours / longer training or longer hours / shorter training and please don't cite better teaching methods because I don't have the time (with 32 day 62 day and 18 week targets to meet myself as well as organising junior rotas with teaching time off accommodating rest period before weekend on call) to be able physically to give you that better teaching you also demand.
I accept that the government proposals are bad and I no way sanction them but equally you cannot honestly cite work / life balance issues (Matthew Jones) as being bad. As intelligent motivated individuals you should all have appreciated what being a member of the profession demanded (note not requested). So you are a GEP (Jenny Day) you knew what this involved when you applied or at least you should have. Incidentally I was one too once - before GEPs were invented!
As I say I am sorry I stumbled on the site just my 2p which is worth less than it was, now that like you I haven't had a pay rise in 6 yrs which incidentally the BMA seems to have done nothing significant about.
@ Experienced (ie old) H&N surgeon
Oh yes I knew - and I'm certainly not arguing about the terms that have been in place up until now. As you correctly say "that's what I signed up for."
However some of this appears to represent a deliberate rolling back of some of the safeguards that were introduced, and that is what I am questioning. Sure we have to work flexibly, that's simply in the nature of doing a job which has to be responsive to urgent patient needs, but that is different for deliberately removing the right to take a break when it is feasible.
While ultimately I, like everyone else, will go along with whatever comes out the end of the negotiation, I think it is important to bear in mind that we are not machines. Short breaks are important. They can save lives if they maintain our concentration at peak performance.
I suspect even the government really knows this, otherwise why would they plaster motorways with signs urging drivers to take a short break?
"Instead, the government told us that it expects junior doctors to demonstrate their professionalism by working additional hours without pay."
Quite right too.
Many other professionals give their time (sometimes hours and hours long into the night) for the benefit of their clients as well as their career.
Why should doctors gain the privilege of paid overtime when others will never have access to this?
Decent way of presenting the blog. I like it!
Fascinating and thank you for sharing. It's absolutely vital that this is publicized.
Is there any way it could be converted into a more digestible 'infographic' etc.
Is the 22 October 2014 date correct. Was the document produced a year ago or is this a recent update ie 2015.
Courage, mes braves !
I didn't realise the grace period is under threat. This would have a huge impact on our service. At present juniors will negotiate with their employers to move jobs at a time that is convenient for both doctor and the service. Limiting grace will result in gaps in the rota, particularly around August time when most CCTs will now be due, lack of possibility to gain the necessary competencies to work as a consultant, no opportunity to act up as well as unemployment and major financial penalties for doctors. Generally an all round bad thing for the service.
Who are theses clowns in government that are ruining our country and our NHS!!! I think their names should be made public so that they can be held to account. They should be doing what the people of England want and what we want is a working and fair NHS not a government that is trying to destroy it.