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Whilst gains have been made by Junior Doctors over the last 8 months it is clear that we do not yet have a contract offer as good as the one we are presently working under.
Voting No is therefore a positive decision on our part. We know that the medical profession deserves better than the offer currently on the table.
We arrived at this decision after much deliberation, recognising that we have an obligation to reject a contract which will be harmful to the future of our profession as well as the NHS.
By voting No we affirm that there is room for significant improvement to the present offer. We are absolutely confident that the BMA, backed by its members, will be able to extract those improvements from Government over the coming months.
The BMA’s demands prior to the ballot for industrial action were:
Proper recognition of unsocial hours as premium time and no disadvantage to those working unsocial hours compared to the current system.
While the new “weekend banding” has received much attention, it is the loss of our evenings as premium time that will cause the most disadvantage to trainees. Particularly in Accident and Emergency and other specialities with high intensities of evening work.
As evenings are now plain time, this puts trainees that work these shifts at significant disadvantage. Flexible Pay Premia, initially designed to attract trainees into hard to fill specialities are now simply being used to fix structural flaws in the new contract.
The weekend banding compromise is a partial solution to the problems of the government's “plain vs premium” time rhetoric with regards to Saturdays. But the problem is still only insufficiently addressed. Those who work the most weekends actually end up being paid less per hour for that work compared to those who work fewer weekends. The ostensible disincentive for Trusts to roster routine weekend working does not appear strong enough and does not reward those who do the most unsocial work.
No disadvantage to those working less than full time and taking parental leave compared to the current system.
Less than full time trainees lose out significantly under this new contract, due to the loss of annual pay progression. Those who move to less than full time earliest in training are affected even more severely.
This will impact hardest on those with caring responsibilities (the majority of whom are women) and those who practice with a disability.
It is unacceptable for us to leave this group behind. At a time of increasing rota gaps we cannot afford to allow this group of doctors to be portrayed as a burden. We must view our Less Than Full Time Colleagues as a strength, to be encouraged and nurtured and treated with equity. A diverse, inclusive workforce should be the minimum standard.
Pay for all work done.
The contract has moved forward significantly in this regard, but concerns remain around the practicality and implementation of the concept of pay for all work done. The role of the Educational Supervisor and fines at the Departmental level raise the possibility of conflicts of interest. Many trainees have little faith in the Guardian role. This role needs to be strengthened further if trainees are to have any faith that “pay for all work done" becomes a reality rather simply a slogan.
Proper hours safeguards protecting patients and their doctors.
Safeguards around the number of shifts and appropriate rest time are to be welcomed. However, individual fines do not penalise Trusts who overwork their doctors as robustly as the current monitoring rules. We must work to strengthen this area further in order to properly disincentivise Trusts from overworking their doctors. This should include Trusts who routinely run with rota gaps, putting increased strain on the existing workforce.
All the above areas were not designed to be high water marks for negotiations. They were to be the minimum standards we were willing to accept. Junior Doctors have taken 8 days of industrial action, including an unprecedented full walkout. This has clearly moved the government, and this contract is an improvement on the March offer. But it is not an equitable contract, it is not a contract that rewards those who do the hardest work, and we do not yet have faith in the mechanisms to protect against overworking.
We encourage Junior Doctors to reject this contract offer, and empower the Junior Doctors Committee to fight for the contract you deserve.
Yannis Gourtsoyannis and Pete Campbell