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As a junior doctor, I have seen little evidence in the DDRB’s recent report that any of its 23 recommendations will improve either patient care or the working lives of doctors.
My reading of it is that there is a very marked bias towards the NHSE evidence from last year, and much less acknowledgement of our input. In its remit the DDRB looked at; “supporting services and training across the seven day week.” So far, I have seen nothing specifically relating to training and this makes me wonder about how well the DDRB understand the role of a trainee doctor.
Regarding the seven day week, our problem isn’t the idea of working at the weekend, or at nights. As trainees, we all know how much of our job is out of hours, as highlighted by the recent #ImInWorkJeremy campaign.
However, simply shifting doctors from working on weekdays to working at weekends will not fix everything, but runs the risk of reducing weekday services, as well as alienating and exhausting an already stretched workforce. It is BMA policy that patients should not suffer or come to harm due to coming to hospital on different days, but what is necessary for a seven day service isn’t discussed in the report.
Looking at the recommendations in more detail, ‘flexible pay premia’ raises a number of problems in key areas. It appears vague, and open to manipulation and abuse from employers. ‘Flexible pay premia’ seems to be a patch for a problem before the contract is even written, rather than coming up with a system that ensures no one should lose out for doing important out-of-program work.
Other recommendations mean that rotas could become more anti-social whilst falling within the plain hours’ bracket. Plain time would become 7am to 10pm Monday to Saturday, meaning doctors would be paid the same for working at 9pm Saturday night, as when working 9am Monday morning. Trainees could also be paid differing amounts depending how hard it is to fill their particular specialty that year.
There are also recommendations which effectively mean a replacement for pay protection and which remove benefits for trainees that retrain. This is an immediate disincentive to anyone considering retraining, and will promote situations where trainees may end up staying in a specialty they dislike, simply because of the financial loss associated with changing specialties.
This also has the potential to exacerbate problems for general practice given that those undertaking GP training could lose the GP training supplement. Removing this supplement will almost certainly result in a drop in GP trainee numbers, and nationally this is already significantly undersubscribed. Perhaps the idea is that a ‘flexible pay premia’ will solve the problem, should it be decided that general practice is a shortage specialty.
Recommending that fixed leave should be exceptional also raises some concerns. BMA policy is that fixed leave should not be used as it is so detrimental to a trainee’s work-life balance.
There are other issues for trainees within the recommendations which dis-incentivise those wishing to undertake academic or private professional work.Overall, this is not great document for us and it seems to have taken months to get to where NHSE were last October. I have no idea how DDRB feels this report is likely to facilitate constructive, continuing relationships. I suspect underlying it all, is a drive for this to cost as little as possible.
As you can see, the recommendations would affect all of us a little differently, and all comments and queries are encouraged, please let us know what you think.Visit the BMA website for more information and updates on junior and consultants contract
Dr Conan Castles chair, BMA Northern Ireland junior doctors committee