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In October the BMA decided to stall negotiations with NHS Employers on changes to consultant and junior doctor contracts. This was closely followed by an announcement from the Department of Health in England* instructing the DDRB (Doctors' and Dentists' Review Body) to consider all evidence relating to contract negotiation talks for junior doctors and consultants in England and make recommendations by next July.
I would have preferred the Government to have listened to our concerns and drop their unreasonable demands but the decision to bring in the DDRB at least provides an opportunity to convince a purportedly independent body that we need a deal that is fair for doctors, good for patients and sustainable for the NHS.
I say ‘purportedly’ because our faith in the independence of the DDRB has been severely damaged in recent years as sub inflationary pay awards have become the norm. Despite evidence of falling morale and increased workload, consecutive pay rounds have seen pay go in only one direction.
While we remain sceptical about the process, we are determined to grasp the opportunity to demonstrate what needs to be done to invigorate the profession to meet the challenges that face the NHS. We have repeatedly pressed NHS Employers to provide credible evidence to underpin the significant changes they want to introduce. To date, they have not done so. We are confident of the rigour of our evidence, which is based on information garnered from detailed negotiations, the evidence provided by our own research and engagement with you, at the seven ‘What’s a doctor worth?’ events and through the hundreds of comments on the BMA’s online communities.
The events gave me a great opportunity to listen to doctors talk about the issues they face. It was clear that consultants and SAS doctors accept the need to improve patient outcomes for those admitted to hospital at the evening and weekends. They recognise, as I do, that this will not be achieved by trying to force senior doctors to work antisocial hours. Consultants providing a sevenday service must be able to maximise their impact on patient care.
The junior doctors I speak to just want a fair deal. They want simple things like better working patterns, advance notice of where and when they will be working and a fair system of pay. Fundamentally they want a contract that promotes good training and high quality patient care.
We will submit our written evidence at the end of December 2014. It will published on the BMA website and I would encourage you to read it and more importantly give us your feedback via BMA Communities as I will have an opportunity to give oral evidence in March 2015. This will be our last chance to influence the process before the DDRB makes its recommendations in July 2015. Then we will see if doctors will get a fair hearing and the recognition they deserve.
If you were asked to give oral evidence to the DDRB to make the case for the profession what would you say? It would be great to get the views of members before I have to do it for real.
*The devolved administrations in Northern Ireland and Wales have subsequently asked the DDRB to make recommendations for consultants and junior doctors that work in those countries while the Scottish government has provided a remit to DDRB for junior doctors.
I hope that the DDRB takes into account pension hikes and enormously longer student loan terms when considering JD pay. The landscape of JD finances has changed considerably (for the worst) since I started out in 2008.
The Future depends on efficient delivery of health & social care for patients and the taxpayer in general. With the largest fraction of NHS spending going on labour the NHS leadership needs to ensure it's human resources policy matches its long term strategy. To recruit and retain the most caring clinicians time for reflection and personal develop is needed, for the most innovative clinicians time for research training and development is needed etc etc. I have left to do an MBA, looking back......
.... at the NHS offering I find it increasingly hard to justify my return to my partner, children and myself. I love delivering care to patients & consistently performed well when assessed but the lack of job or lifestyle security due to increasing out of hours pressure on senior clinicians, the significant debt I incurred, the fact my 30 days study leave has never been allocated, the fact my study budget is almost impossible to access and the number of undefilled rotas I have worked on means....
... when I look at my less empathetic, less academic peers, who chose other careers, and now spend more time with their loved ones, have more autonomy at work and have a deposit for a home within commuting distance of work. I don't need the social status that comes with being a doctor my motivations for entering the profession were varied. Pay alone would not bring me back, the package of pay, training time/funding and working patterns as a whole would need to change considering the life of a doctor from.
... school to retirement after 2040.
Patients need time with doctors. This should be the number one quality of care issue. Doctors need an employment structure that allows more time to be spent with individual patients and encourages a positive attitude to this work. NHS management should be required to minimise opposing pressures, especially production-line concepts of "efficiency" and administrative work which could be done by someone else or avoided altogether. If future job definition truly reflected this priority, morale of doctors at every level (and patient satisfaction) would be improved dramatically and there would be less pressure for increased salaries.
The main problem with doctors lives is not the salary, not the patients but the almost complete withdrawal of a supportive working environment in the modern NHS which is still being incompetently "managed" in 1980s Thatcherite style.
There is a misconception about consultants underworking. I work unpaid up to 40% over my paid hours and effectively get no SPA time.
Doctors work very hard under ever-increasing pressure and scrutiny but are demoralised by constant criticism, lack of trust in their professionalism, onerous revalidation which serves no useful purpose, reducing pay and the forced alteration in pension for those 52 and under. The oldest doctors in this group have given and still give their all to the NHS and have worked very unfair rotas as young doctors. We are willing to work weekends for emergency care, of course, but please do not take away our pay progression as well as all the other changes- or many of us will not feel motivated to continue in the NHS.
Using recruitment and retention as a measure of what pay rise should be given is irrelevant where there is a monoploy employer and particularly in the period during the most serious economic recession for 70 years. This measure should be scrapped now. Real and substantial cuts in take home pay after pension increases should be taken into account.
After 40 years of full time NHS practice, out the door at before 7 and home usually in time for the late evening news, in the hospital largely unpaid for most of many weekends, and being called frequently at night. I know what isn't healthy both for doctors and for patients. The new consultant's contract and the effect of a defined hours contract was just a wakener for what is to come. When threatened with a revue of contractual commitments by aggressive managers, many consultants would say "bring it on" and lets see how what I do compares with what you pay me for. It seems to me that we are heading for a re-run of the original Milburn game, where the dogma said that the consultants were on the golf course, and yet reality, confirmed by numerous independent surveys, is always that consultants work many extra hours unpaid.
We are now back there again. This time however the maths are much harder to ignore. In 2010 the first year of Baby Boomers started hitting the NHS fan. A greater number of survivors over 65 because of a truly wonderful period of improving public health. However this naturally only postpones their morbidity, and now the wards, ITUs, ERs, HDU's, are full to bursting with desperately ill oldies, who don't need just a bit of diuresis and then discharge, but major bowel surgery, interventional radiology, midnight scans etc etc. Even those who do manage to die get shocked, cooled and kept on IPPV for 2 days. Its a whole new world since 2003. All of it has been predictable from the pop statistics which every government holds, and all of it ignored.
I have read in today's BMA e-mail that 7 day working has been hit on as a solution, and that it would be within existing budgets. It might work, if all the existing posts were staffed 24/7, however we have established a safe limit to the working week, and by a clever ploy of removing the personal tax allowance for those earning over £100K to do an extra session in ER the boys would effectively be working for nothing. I don't think so. Even if we used both carrot and stick, we come nowhere near the number of doctors needed.
Had successive governments, planned for all this? Well there has been a lot of crowing about more doctors and nurses, but one click on Google, and from the WHO figures they haven't begun to make a dent on the massive shortfall of Doctors per Capita as compared with nearly anywhere else with a half decent health system. When I was teaching for a big London institution, most of the medical students seemed to be Chinese, and very nice people they were too, preparing to go home to Singapore and Shanghai, and extol the qualities of a UK education.
As it stands many of our juniors are considering Oz (3,3 doctors per 1000) and better pay. Looking at the WHO figures the proportion of Doctors in Eastern Europe seems to be falling, maybe they are coming here to fill the gaps, I don't know, but it is significant that the USA has a similar problem of staffing.
Believe me I've tried my best. I did my stint on Negotiating Committees, Council and other worthy establishments, and have observed the cycle of events several times. However, whatever government gets in this year will get its bum badly bitten by this one.