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Everyone is a negotiator, all the time. We negotiate with colleagues, with our partners or kids, with friends, with strangers. But few of us have been part of a formal negotiating team. As doctors in the NHS, we rarely have to individually negotiate our own terms and conditions. Instead there are national contracts, negotiated by the BMA. The usual pattern is a major, set-piece negotiation of a whole contract every now and then – the last one for juniors came about in the late 1990s - with later tweaks and amendments.
Last September we started full negotiations for a new junior doctors’ contract, and have been meeting employer representatives about every fortnight since.
The BMA team has a number of members elected from the juniors doctors committee, and is informed by a broader steering group which includes public health trainees and academics. We use staff expertise in areas like pensions, economic analysis, contract law and public affairs.
The negotiations themselves are probably not how you imagine. We don’t sit in two long rows facing each other, workers lined up against top-hatted mill owners. That tends to create confrontation by default. We deliberately opt for a horseshoe-shaped table, intermingling the two teams.
Another important principle is that we don’t demonise the other side. We focus on the issue, not the person. The employer representatives are professional, courteous and smart, as we try to be.
What we don’t want to do is end up in positional bargaining – ‘we want 80, you want 20, so we’ll go for 50’ – because it tends to lead to outcomes that are not satisfactory for either side. We are using 'principled negotiation' - looking to see what the underlying needs are behind a demand and meeting as many of both sides’ needs as possible to ensure that any negotiated agreement is long-lived.
These contacts are just a fraction of the work involved. Our own team meets at least weekly for a whole day to prepare for the next meeting.
As the whole contract is being rewritten, we have broken it down into a large number of topics of various sizes and difficulty, for example annual leave, working hours or pay progression.
Contract negotiations proceed between meetings mainly by each side taking a topic and writing a paper about it, aiming to take what the current contract says or does and update it or completely re-write it. The aim is to find a solution that suits both sides; sometimes that can take several goes.
Many of the negotiators, including me, work less than full time. It can still be difficult to fit in all the training requirements of the job, but my own employer has been very helpful and supportive.
After our meetings with employer representatives, we produce an agreed statement. Now, I know they can look bland and superficial. We do try to give a flavour of how the day has gone and where we are making progress. But because we have set the principle that ‘nothing is agreed until everything is agreed’, we don't have formal agreements to announce after each meeting.
It can look like we’re not making progress when in fact we are producing a pile of ‘provisionally agreed’ schedules, ready for the whole lot – hopefully – to be put together for final approval by junior doctors and ministers.
Overall, the experience has been even more detailed, arduous and frustrating than I expected. I have realised that an important part of what we do is harm reduction. That sounds gloomy, but at a time of financial contraction in the NHS and huge political pressures on public sector workers, we have an important role in staving off worse outcomes that might follow from not negotiating.
But despite the work (and I’m writing this at 2am having just finished going through some urgent papers), I’m glad to have the opportunity to improve parts of the contract that are not working well. It’s about trying to help junior doctors do a better job in treating our patients.
Tom Dolphin is a member of the BMA junior doctors committee and a negotiator on the juniors and consultants contracts
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