If you continue without changing your settings, we’ll assume you’re happy to receive all cookies from the BMA website. Find out more about cookies
When you visit any web site, it may store or retrieve information on your browser, mostly in the form of cookies. This information might be about you, your preferences or your device and is mostly used to make the site work as you expect it to. The information does not usually directly identify you, but it can give you a more personalised web experience.
Because we respect your right to privacy, you can choose not to allow some types of cookies. Click on the different category headings to find out more and change our default settings. However, blocking some types of cookies may impact your experience of the site and the services we are able to offer.
These cookies are necessary for the website to function and cannot be switched off in our systems. They are usually only set in response to actions made by you which amount to a request for services, such as setting your privacy preferences, logging in or filling in forms.
You can set your browser to block or alert you about these cookies, but some parts of the site will not then work. These cookies do not store any personally identifiable information.
These cookies are required
These cookies allow us to know which pages are the most and least popular and see how visitors move around the site. All information we collect is anonymous unless you actively provide personal information to us.
If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance.
These cookies allow a website to remember choices you make (such as your user name, language or the region you're in) and tailor the website to provide enhanced features and content for you.
For example, they can be used to remember certain log-in details, changes you've made to text size, font and other parts of pages that you can customise. They may also be used to provide services you've asked for such as watching a video or commenting on a blog. These cookies may be used to ensure that all our services and communications are relevant to you. The information these cookies collect cannot track your browsing activity on other websites.
Without these cookies, a website cannot remember choices you've previously made or personalise your browsing experience meaning you would have to reset these for every visit. In addition, some functionality may not be available if this category is switched off.
Our websites sometimes integrate with other companies’ sites. For example, we integrate with social networking sites such as Twitter and Facebook, to make it easier for you to share what you have read. These sites place their own cookies on your browser as a result of us including their icons and ‘like’ or ‘share’ buttons on our sites.
Twas the night before changeover when all through the house…If accepted by the Government, the DDRB recommendations will ring changes to the NHS that will echo across the UK. They will affect junior doctors’ professional and personal lives, and they will affect patients.
One of the big protections of the New Deal contract we currently work under is that of our shift patterns. We’re restricted to maximum shift lengths, to minimum gaps between shifts, to sensible definitions of ‘on call’ (where you can actually achieve some rest) and we’re entitled to regular breaks to eat, drink and recharge. Looking back at the last year that I’ve spent as a new junior doctor, I’ve been quite lucky with my rota: I’ve only had the odd 12-day run here and there, and I think the most hours I’ve worked in a week is 90.
Even when I was doing those run-throughs, I was entitled to protected breaks, had sensible gaps between shifts with opportunity to rest, and, while I felt exhausted at the end, I was still safe to work because of that protected rest.
I’m about to start a job involving 24-hour on calls. I have rest days after my on calls, and I am confident that I will, for the most part, get a sensible amount of sleep during the on calls — and they won’t turn out to be 24 hours of straight working. This confidence comes from knowing that the job has been monitored as part of my employer’s contractual obligations, and that if the rota had turned out to be dangerous, they would have faced a financial penalty (and had to fairly remunerate the doctors who’d been overworked).
But looking beyond that, to a world in which the DDRB’s recommendation to dispense with banding and monitoring, I feel no such reassurance. It proposes a system by which doctors report ‘exceptions’, time worked out with the theoretical rota hours. The DDRB will then consider these exceptions in its next pay advice. This recommendation will provide precisely no safeguards for the doctor working that rota.
The UK Government routinely ignores the DDRB’s advice to increase doctors’ pay, even in line with inflation. Even if the individual hospital or department is somehow incentivised to reduce the number of exceptions reported by their trainees, there will be no direct link between hours worked by a doctor and cost to the department, and as such there will be no real incentive to design safe rotas.
Finally, the removal of contractually obligated monitoring processes will lead to a huge reduction in the detection rate of unsafe rotas, which will lead to more doctors putting patients and themselves at risk by working unsafe rotas.
Looking back over the last year is a profoundly positive and relatively pleasant experience. Looking forward to the possibility of a new contract inspired by the DDRB’s recommendations is very much a terrifying and negative one.
Adam Collins is an F2 in South East ScotlandVisit the BMA website for more information and updates on junior and consultant contracts