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Sarah Hallett (Chair of East Midlands RJDC) thanked everyone for coming, and introduced Kitty Mohan, Chair of the UK Junior Doctors’ Committee.
Kitty delivered a presentation outlining the main recommendations of the DDRB’s report, and what this could mean for junior doctors across the country. A summation of this can be found at www.bma.org.uk/ddrbjuniors
The floor was then opened for comments and questions, with attendees asked particularly to consider how these recommendations will impact on their lives, what their opinions were on the overall package of recommendations, and crucially, what our next steps as junior doctors should be. Below are some of the questions asked, with answers, and some general comments made.
Disclaimer: we have done our best to represent the discussions had, as there were a great number of people who could not attend but wished to be there, and we wish to keep junior doctors locally as informed as possible. The discussions were wide-ranging and quite fast paced, so apologies for any errors made – while these are not minutes in the usual style, we are (as always) happy to make corrections where necessary, and the final report will be accepted at the next East Midlands RJDC meeting.
Please also note that this meeting was held as part of a number of local events in the run up to a meeting of the UK Junior Doctors Committee, and that the information contained herein was correct at the time, but that this is an evolving situation. At the meeting in August, JDC voted overwhelmingly not to return to negotiations. More information on this, and the current situation with contracts, can be found at http://bma.org.uk/working-for-change/in-depth-junior-and-consultant-contract.
What would happen if the BMA walks away?
The government have made their intention to impose the contract next August clear, with or without our agreement.
What will replace the GP supplement?
It isn’t entirely clear, however, it has been suggested that the Flexible Pay Premia mentioned in the DDRB report could be used in this way for GP trainees. We have no idea how much this will be, or indeed, how applying it will work. It is also worth noting that as it has been agreed that the pay envelope is closed (ie, no more or less money on average per trainee) that if we are to pay some trainees more with these RRPs, it goes without saying that somewhere, someone else will be getting less (the phrase used was “robbing Peter to pay Paul”). (See below for more on pay).
If these changes were to come into place, I am not sure that I would be staying in the profession, especially as I have experience outside medicine anyway. Could we all threaten that we will leave or go overseas?
Kitty pointed out the government might not particularly care at present, and/or they might not believe us; currently, many people go abroad already, and the data shows that most of these trainees come back.
I am a GP trainee. My normal working day is 7am – 7pm, despite the fact that it is perceived as a 9 – 5 job. Will I be paid for these extra hours?
Basic pay is up to 48 hours a week, and by law you shouldn’t be working more than this number of hours. In the new system, if you did find yourself working more than this number of hours, you will probably complete an exception reporting form, and maybe a few weeks later, your hours may be adjusted.
My impression is that this is all due to a push towards 7 day working, which clearly isn’t going to work due to not enough people and money. But most of this looks like it is trying to save money.
What Jeremy Hunt is talking about is making consultant-delivered care 7 days a week; junior doctors already provide a 7 day service. It appears that they want to make it cheaper to slot junior doctors wherever you want them during the week. There is indeed the potential to free up money from the junior doctor contract, and to put that money where you want it to be (which may not be back into the junior doctors contract).
This comes back to a principle that was discussed at length during negotiations: with the fixed pay packet, when expensive trainees come off the end of the payscale due to completing training, the money that paid them should come back into the junior doctors pay envelope. But by the end of negotiations, and in the DDRB evidence, it was made clear that this was viewed as an efficiency saving, and that this money should not go back in.
Have the BMA explored the possibility of Industrial Action (IA)?
The words “Industrial Action” come up quite regularly in JDC meetings. The BMA has a specific committee that is looking at IA, particularly given what was perceived as a bit of a lacklustre “day of action” for the pensions dispute. We haven’t been told exactly what their findings and/or recommendations regarding what is felt to be effective IA will be yet. Generally, regarding IA, the aim is to get back in the room to get a better deal. But there are issues with going back into the negotiations too, in that it will probably mean accepting wholesale the recommendations, and any negotiations will just be around the edges. We need to be clear what we’re hoping to achieve if we go for IA.
There are also inherent problems with planning IA. There will always be a group of doctors who are opposed to IA, on principle, and simply will never do it. Next, you have to be a union member, or you will get yourself into trouble taking IA by being in breach of contract. There will be people who on the day of IA wouldn’t have been at work anyway, because they’re on leave or a zero day or post-nights, or they’re on call and therefore dealing with emergencies only and therefore can’t take IA. Some people will really want to join in with IA, and will vote that way when balloted, but for whatever reason, when it comes down to it, simply can’t do it. And then if we go on IA, and 75-80% of junior doctors are in work, this will be thrown back at us, despite there being reasons for it as above – it just doesn’t make for very effective IA. We therefore, for many reasons, need to make sure it really is our final option. But that option will always be there.
The media seems to be very happy to broadcast Jeremy Hunt’s viewpoint. What is the BMA doing about our lack of voice in the media?
Part of the issue is that the media don’t want to hear from the BMA Co-Chair – the voice of the individual doctor who has launched a huge social media campaign (like #iminworkjeremy) is much more interesting to the media. The BMA is trying to come at it from different angles, with not just the same faces, and indeed, if you want to get involved in this please do get in touch with Kitty and Andrew at [email protected]. Sarah H pointed out that not only did Jeremy Hunt specifically attack the BMA in his speech at the King’s Fund (which members of the BMA had been invited to, although they were not in the audience in the end), when the statement around 7 day working was put to the media the night before, they were specifically told not to tell the BMA. This government has made no secret of their anti-union sentiments.
Are there any examples of contract imposition?
Yes, GP contracts a few years ago. However, these are negotiated annually, there was a huge outcry and they renegotiated a better contract in the end. The problem with the junior doctor contract is that we negotiate once a decade. Last time, the contract was rejected when it went to ballot, they went back to negotiation, and a second one was accepted.
What is the likelihood that returning to negotiations will work, ie, that we will have an outcome that is good for junior doctors. It looks like the government is just handing us the same contract again and again.
Kitty answered that she personally had her own opinions regarding whether or not we should return to negotiations, but that she was trying to be as impartial as possible, as she wanted to hear our views. However, she did say that there was a more general question about what we would be able to achieve in the 3 months allocated for these negotiations. 3 months is not a long time; we have already negotiated for 18 months, before stalling in October, partly because of the unrealistic timeframe. Are we likely to get any significant concessions? It seems unlikely.
In the last decade, we have seen a pay freeze, loss of free accommodation, a pension cut, loss of pay in line with inflation – now they are trying to give us a pay cut and make us work more hours – I don’t see any option aside from taking IA. Thoughts?
Specifically regarding pay: it is very difficult, if not impossible, to model the new pay recommendations currently. Kitty made reference to the modelling that has been shared widely on Facebook – this won’t be accurate, as the only thing we know for sure is that basic pay etc has yet to be decided. By the nature of the closed pay envelope, some trainees will have to get a pay rise, while others take a pay cut, ie there are some trainees who will probably benefit from the proposed changes. The problem is that we don’t know which trainees will fit into each group. The BMA is trying to get more information on who is likely to gain or lose from this. It is likely to benefit those who go into specialties with short training programmes, who don’t take time out, and have minimal out-of-hours work, and who work in shortage specialties.
Given that the NHS has the monopoly on being our main employer, and therefore NHS employers can seemingly enforce whatever they want, what is our leverage in negotiating? Why do they want us to go back? Is it simply to get the BMA’s rubber stamp?
The NHS relies on goodwill, and they understand that. We have heard that some local employers are terrified of an enforced contract, with the chaos that would bring and a lot of annoyed junior doctors. That said, it seems that regardless of how low morale falls, junior doctors will always act in the best interest of their patients.
Has the BMA been to them with alternatives, for example, the way that nurses get paid, with higher pay on Saturdays, and even higher on Sundays.
Yes – but their intention is to bring everyone to this system, they are just starting with us. The DDRB report itself recommends that the changes to social / unsocial hours are rolled out to our Agenda for Change colleagues also.
We can’t force the government. As junior doctors, we need to get the public on our side. How about getting high-profile celebrities to speak for us? (Adam Hill and the Last Leg was mentioned).
Unfortunately, the media generally is much more interested in 7 day services. It is very difficult to stir enthusiasm for the junior doctor contracts. We try continually to get/keep the public on our side and will continue to do so.
Not very keen on the idea of the fixed pay envelope. The government needs to have a conversation with the country about the NHS and why it is worth paying for it. We can’t expand services without paying for it. We need to get the public talking about this.
The problem with talking about junior doctor pay to the general public is that the average wage is somewhere in the region of £22,000. And yes, we can make all the usual arguments about how we pretty much could choose any job, and have chosen medicine, and we could still go elsewhere, but this doesn’t have much traction with the public when still that average wage is £22k – our basic wage starts at £22,636 and only increases from there. There is a mentality that we have made this career choice after all, and that all public services are getting cut – why should doctors be any different? This is the difficulty of the opinions we come up against, and it can be an uphill struggle when trying to get across our issues with pay when discussing this with, for example, the Sun.
It is difficult to be able to vote for / against IA until we actually know the figures involved…
Agreed, however, that level of detail just isn’t there yet – and this is acknowledged in the report – 4.81, many aspects of the proposals that require further consideration. We don’t know how many doctors, or how much money we are actually talking about yet.
Regarding the current system of pay progression: I thought your pay already stopped progressing when you took time out of training, eg, to do further study.
The way it works at present, if you have an NHS contract of any sort (eg particularly the case of academic training), your pay increments will continue to increase. If you don’t have an NHS contract, they won’t. They won’t in either case in the new proposals.
Based on what we’ve been hearing, it seems unlikely that going back into negotiations will change anything, and it will still result in an unacceptable outcome. If they impose, can we just work on trying to change public opinion, and then reentering negotiations in a few years time?
The government is currently in a strong position – they have gone from being a coalition to a Conservative-led government. This was certainly the worst possible outcome at the General Election with regards to our contract negotiations. We are at the very start of a 5 year term. That said, we might later be in a better position, but once certain terms are lost, it is very difficult to get them back.
Regarding publicity, is the BMA doing anything with other groups, eg consultants, other healthcare workers?
The consultants are obviously having their own contractual issues, which will also affect us, so we are working with them on that. The BMA does meet regularly with representatives of unions.
Questions asked of the room:
Which parts of the contract are particularly toxic to you?
The extension of plain time and reduction of unsocial hours. 7 until 10 is ridiculous. We need safeguards, to ensure that if we do have to work Saturdays as if they are Tuesdays, our working lives at this time are improved, as currently, weekend shifts can be awful, and currently we know we get higher banding for it. (Kitty: the proposals to change hours certainly is coming across as being a key theme that worries our members, with 70-80% of correspondence received so far around this issue).
Hands up votes:
Who feels that we should re-enter negotiations – majority felt that we should not re-enter, with a few saying we should, and a few more saying they weren’t sure.
Regarding what to do next: Sarah Hallett talked about when GPs faced unfavourable contract changes in the 1960s, a tool they used in negotiating was to collect tens of thousands of undated letters of resignation, and threatened that these would be used should the changes be brought through – she had discussed this with a few trainees and had the gained the impression that this was more risky for trainees who potentially were working in their dream training pathways and wouldn’t want to risk losing these. Someone pointed out that it could work as it directly affected the promise the government has made around numbers of doctors. Another trainee pointed out that the current rules state that if you leave a training programme, you cannot reapply on the same programme, and wondered if we could clarify with the Deaneries if would be enforced? Additionally, it was pointed out that international doctors wouldn’t be able to resign as they would be deported if they were without work. A vote was taken regarding who would be willing to take part in industrial action involving letters of resignation: around a half of those in attendance would be willing.
Who would be willing to take Industrial Action: majority raised their hands yes.
Who would be willing to take IA, if we accepted the premise that to be effective it must be a form that in some way harmed patients: very few yes votes.
Sarah H discussed the idea of a march or demonstration, not just focusing on contracts, but also the wider theme of saving the NHS, inviting other organisations such as other unions and pro-NHS groups to join. Question put to the room: who would be willing to attend a large demonstration on this: vast majority raised their hands yes.
Finally, discussed a large public-facing, probably very expensive campaign (similar to the No More Games campaign around the election, but possibly bigger). Who would be in favour of a large public facing campaign around our contracts: vast majority voted for.
Finally, these were just some of the general comments made by those in the room (a few were unprintable, apologies!):
We should have an 11% pay rise instead, and tell them to go and jump.
If all we can achieve is clippings around these recommendations, we should be entering IA and working to rule once a week for a month.
I’m against IA, and feel instead we need to improve our PR.
I spoke to my (Conservative) MP about these issues. I was told that “as a profession we don’t help ourselves, and our response on social media has been inappropriate". While I might toss and turn in my bed, trying to decide whether I could take IA, I felt what I can’t do is watch our profession be destroyed.
Sarah Hallett reported that she had received dozens of emails, and the opinions in them regarding IA were very much mixed.
Instead of a typical strike, could we not instead do a bureaucratic strike, eg, not coding, not completing CQUIN tasks like VTE assessments – this would only hurt the people we work for. (Kitty responded to this by pointing out that many people even now have issues filling out monitoring truthfully because of the fear of retribution from their bosses – with non-patient IA, we still have the issue of whether people are going to bring themselves to do it in large enough numbers to be effective).
Any form of strike, bureaucratic or not, wouldn’t really affect the government – it would only affect the general public, who are already not on our side. If we do all this, what does the Secretary of State care? It will just create headlines blaming the junior doctor strike for patients’ operations being delayed.
We need to be more creative with actions other than IA, such as the social media campaigns we have seen recently.
We could re-enter negotiations, but be extremely hard-nosed, so that they would end up having to walk away.
Imagine how this looks to those either entering medical school now, or thinking about entering medical school – it isn’t very aspirational. We need to think of this as the whole picture, not necessarily just what it means for individuals.
The government clearly don’t care about negotiating and have harnessed the mainstream media to vilify us. We need the public to be aware of what we are doing, and of why we deserve our pay. We should consider doing a video diary / photo diary to raise awareness of this.
We should buy space in newspapers to put our arguments across.
We shouldn’t settle for less than what we have at the moment.
The BMA have clearly put a lot of effort in to negotiate already. I feel we should walk away – they are clearly not listening.
We should make the arguments against the contractual changes based on patient safety rather than pay – we cannot stretch our current workforce over 7 days and into the evenings without staffing at other times suffering. We need more doctors, and more money invested if they wish to do this.
Many thanks to the >70 junior doctors who attended this event, and to Kitty Mohan for answering our questions. If you have any further thoughts or comments after reading this, please feel free to email them the JDC Co-Chairs (Kitty Mohan and Andrew Collier) at [email protected]
The East Midlands RJDC AGM will be on Tuesday 22nd September 2015 at 19.00. More information can be found here: https://www.facebook.com/events/997848656913486/