Last month I spoke at the junior doctor conference. Such occasions are an opportunity to reflect on the year past but, crucially to look to the future.
The year leading up to the conference had for many of us been dominated by the dispute between junior doctors in England and the Government over the contract imposed on us. The industrial action taken to try and prevent imposition was unprecedented, and while we may have faced criticism from some corners of the profession and the public, it was the only course of action to take.
But now things are different. It is vital to continue an ongoing dialogue with employers so that the many that have made, or are about to make, the transition to the new contract do so with protections hard won both in and outside of the negotiations. This, alongside the opportunity to make further crucial improvements, is why the junior doctor committee exchanged its original mandate for further talks to address our outstanding concerns.
The aim of these talks were to:
The question, now, is since adopting this approach what have we achieved? The reality is that little by little we are progressing on many fronts:
We are working with the Department of Health and NHS Employers to on a gender pay gap review that will explore and make recommendations on changes to pay not only for women working as junior doctors, or indeed all doctors, but for all medical staff in and across the NHS.
We are producing work scheduling guidance to better protect training time and make rostering work better for trainees, looking at specific guidance for those working less than full time. We are reviewing the ARCP process and creating work scheduling guidance so training is further protected, particularly for those trainees working flexibly who are otherwise often left behind. Last week we held our first less-than-full-time forum meeting which was an opportunity for trainees to discuss a range of contractual and non-contractual issues they face and which will serve focus and accelerate our work in this area.
For academics we have ensured the same basic pay uplifts, pay parity and pay protection in university and research posts as in clinical posts. We are working to ensure the Follett principles, apply to ensure they too can have work schedules protecting academic and training time, and the ability to report when this isn’t provided or is missed.
With Health Education England, we have agreed a code of practice that we have been fighting for a decade, an agreement to provide notice of deployment 12 weeks in advance of starting a new job, eight weeks’ notice of the generic rota; six weeks of your specific rota. We worked with NHS England to ensure that NHS Improvement will be looking at this as a quality measure for every trust so we can hold them to account, with HEE bringing this in as a key performance indicator that will be published and assessed.
We have secured preferential applications to specialty training for those with a disability, care needs or for those supporting loved ones with these conditions, and we have improved the inter-deanery transfer process.
We have created a new less-than-full-time pilot, removing restrictions and increasing access to less-than-full-time training in emergency medicine.
In addition, the GMC has announced new flexible standards for postgraduate training, which at least starts to address the demands of our modern workforce. In addition we have agreed that national training surveys will include a focus on rota gaps. For years, we have been saying that rota gaps are a serious threat to patient safety, to the education and training we receive, and to the morale of staff. We have started a huge research project looking to define and quantify what these gaps are and how bad they are so they can no longer be denied.
We also worked with the GMC on a seven-point plan to improve work-life balance, focus on outcomes rather than time spent training, and support doctors with specific needs. This is published and we are in the process of implementing these changes, making it easier to recognise common skills between specialties and hopefully deliver recognition of skills developed outside of training jobs in Locum Appointment for Training posts, Locum Appointment for Service posts and fellowships.
Exception reporting, a key change in the new contract, is simple and powerful. We can and should document every single time that our work or training varies from what was planned. This has been supported by the GMC, HEE and NHSI publically who have made this clear not only to trainees, but seniors. Ultimately this is how we can build up a detailed, evidence-based, incontrovertible picture of a service in crisis. This is how we will find solutions, trust by trust.
On the contract itself there is tangible progress. We have had the contract reissued last month – in this we negotiated with NHS Employers an uplift for unbanded F2 doctors to 1b pay protection. This is new money into the contract. We have created GP trainee work scheduling guidance that protects not only training time, but administrative time and lays out the 40 hour working week.
I know that for many it has felt like it, but the fight is not over. The fight has evolved. We have moved from picket lines to trust board meetings, from public statements to data collection and evidence building so we can make our points clearly now and prepare for the upcoming review of the contract so we can identify the areas where reinvestment is needed and where this contract falls short.
This incremental approach may not make for eye-catching headlines and I recognise there is much more to be done. But it is slowly working. None of us wanted to start from the position we were in late last year - but we have to deal with what we have in front of us. I can’t promise immediate resolution, that would be a fantasy, but I can offer you the reality of a hard road back, mile by mile, to better conditions.
Jeeves Wijesuriya is chair of the junior doctors committee
Negotiation will pay Young (misnomer Junior) doctors more than confrontation with the incoming Elected Government from Friday 9th June 2017 am. In our British democracy, everyone but everyone has a right to be heard before being ignored. Only the majority rules as they win in voting. The Civil Servants make decisions and not Ministers or MPs; akin to"Yes, Prime Minister" which was a true TV series with a sense of British sense of humour. The NHS has a financial crisis due to National financial crisis today and maybe tomorrow. Militancy would be popular in media, it sells their publications and broadcasts, but the punishment would be less Young doctors and less old (now and later old) consultants. Please learn from Miners strike in Rt Hon Mrs Thatcher PM's time. Even Labour Government would have to depend on their Civil servants, to run the country, who have permanent jobs. The majority of public would side with the elected Government as we have seen before. All politicians, civil servants and doctors are patients, therefore, "Patients being used as a shield " will not work. Any one who refuse to learn from history would learn from the future. Please negotiate, negotiate, negotiate and you can lose some and gain some or even win in the British democracy. I am afraid , I mean what I am saying. I am an ardent supporter of the BMA, British Government and British people, since 22 June 1964, who are all patients at one time or the other. They all want the best possible NHS service. Dr Bashir Qureshi; Life Member of the BMA. Life Fellow of the RCGP, RCPCH, FOM, RCP, Hon. FFRSH,RCOG, Hon. FRSPH, Hon MAPHA-USA. and more.
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