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So, the Doctors and Dentists Review Body has published its recommendations on the junior doctors' contract and it reads like the wildest fevered dreams of NHS employers up and down the country.
Now I could write for hours about why the recommendations are unfair or damaging to the health service and patients in general, but I think it's important to pick out one of the apparently less innocuous recommendations; that fees earned by junior doctors during NHS time should be given to their employer.
Before I go any further, I should declare an interest, I'm now a consultant in forensic psychiatry and did a lot of fee-paying work during my training (primarily court reports and Mental Health Act assessments). I was also the JDC lead on fee-paying work in the contract negotiations, back in those balmy days when it looked like Her Majesty's Government might actually be interested in negotiating.
Now it may seem reasonable, that if you do something in the time that you are being paid to do work for your employer, which itself attracts a fee, then you should give that fee to your employer. However, that superficial reasonableness falls apart when you look at the possible consequences it brings.Under the current contract, there is an allowance for most employed doctors, including juniors, to complete tasks for which a fee is paid for in their NHS time as long as their employer agrees it does not interfere with their main job. This is category two work – category one being the contracted job of the doctor.It includes all sorts of odds and sods that require a doctor, but is not part of the work undertaken by the NHS, such as signing the paperwork to allow a body to be cremated or writing expert medical reports for court.Some of these tasks are just not things the NHS is set up to deliver, such as certifying passport photos, and some are where a doctor has a legal and professional duty to act independently, such as Mental Health Act assessments.
Whatever the fee-paying work is, it requires the doctor to take a professional stand and make a legally binding statement on which they can be challenged, in court if needs be. As such it carries a significant risk to the doctor concerned and to recognise both the risk and the time involved, a fee is payable.
The DDRB’s recommendation that the fee must be passed on to the employer undermines the independence of the doctor involved and leaves them with all the risk and none of the incentive to do the work.As a consultant, mindful of the cases of doctors who have attracted GMC censure for their medico-legal work, I would have no choice but to advise my juniors that it is not in their interests to do psychiatric reports for the courts, or to nip out during a rare lunch break to do a Mental Health Act assessment on an acutely psychotic teenager who is in a great deal of distress.
The inevitable results will be longer waits by grieving families for their loved ones to be cremated, the acutely mentally ill stuck in police stations rather than being moved to hospital, and huge miscarriages of justice where those involved cannot access the expertise they need.The absolute key to fee-paying work is the principle that NHS work takes priority. I’ve never met a doctor who walked out of a clinic to sign off a body as fit to be cremated, but if that doctor has a spare few minutes it is entirely proper they use it to make a very difficult process for a family proceed more quickly.
It’s a professional judgement in the best interests of patients. We make them all the time. And for that reason we deserve a professional contract that supports us.
Alex Hamilton is a consultant forensic psychiatrist
Visit the BMA website for more information and updates on junior and consultants contract