Enough is enough

by Dr Jeeves Wijesuriya

The Government's pay announcement for doctors in England is completely contradictory to its claimed wider vision of ensuring safe and effective NHS care in the future.

Location: England
Last reviewed: 27 July 2018
Jeeves Rajiv Wijesuriya

This week, public sector workers across England have voiced their frustration and anger at yet another round of disingenuous and derisory pay announcements from the UK Government. While we are still awaiting news on the pay awards from the devolved nation governments, after years of broken promises and disappointments, the pay announcement for doctors in England is even worse than many predicted.

Since taking up his new role, the Secretary of State for Health and Social Care, Matt Hancock, has emphasised that the NHS workforce is an early priority, tweeting “I value you. I admire you. I will fight for you and I will champion you. #LoveNHS”.

Fine words perhaps, and a definite change in tone from the Government, but following Tuesday’s announcement, many will feel that these words were yet more empty promises. Actions speak louder than words, and in the face of years of pay freezes and below-inflation increases which have amounted to an almost 22% real terms pay cut for junior doctors, these apparent commitments to value the workforce will be seen as meaningless.

Tuesday’s announcement just serves to confirm that the DDRB (Review Body on Doctors’ and Dentists’ Remuneration) process is broken. In recent years, we have raised concerns regarding the independence of the review body, with government interference in the process putting undue pressure on the DDRB to accept government policies on pay caps in the public sector, not to mention the debacle over the DDRB’s risible recommendations for the junior doctor contract in 2015.

The recommendations made by the DDRB are yet again inadequate, but even these were in turn ignored by the government, with even more derisory proposals announced. We must be clear: a 2% increase on basic pay for junior doctors from October 2018 simply matches inflation. This is no pay ‘increase’.

The impacts of these ‘increases’ are widespread; as women on average undertake a greater amount of childcare, the below inflation pay rise, coupled with the rising costs of childcare (which conversely are well above inflation rates), may force many to reduce their hours to accommodate unpaid childcare. This is particularly galling at a time when the government has commissioned a review of the Gender Pay Gap in medicine. This could well exacerbate that gap.

In our evidence to the DDRB, we stressed that in light of the ongoing real terms pay cut, combined with significant increases in costs of living (including tuition fees, costs associated with training, examination costs and indemnity), living standards for junior doctors are deteriorating, and the attractiveness of medicine as a career choice is likewise decreasing.

Increasing numbers of junior doctors are needing to take time out of their training due to concerns about their own wellbeing, with this year’s GMC National Training Survey showing that nearly 1 in 3 junior doctors report signs of burnout. A fair pay deal is part of a range of measures that must be taken to recruit and retain an adequate number of doctors into the workforce, not just when they finish medical school, but beyond in specialty training.

This Government announcement is completely contradictory to its claimed wider vision of ensuring safe and effective NHS care in the future. The junior doctor workforce is a fundamental part of ensuring that the right clinician is in the right place, at the right time, with the right skills. Junior doctors are also the senior medical practitioners of the future; if the Government ignore this group then patient care that will inevitably be impacted.

The Government’s claim that “this is a pay rise that recognises the value and dedication of hardworking Doctors and Dentists “shows a complete misunderstanding of the issue. Doctors spend their careers making the care of their patients their top priority, in what are increasingly overstretched difficult conditions; it is time that this Government made public sector workers, those dedicated to caring for others, their priority.

At the beginning of this round of the pay review process, the former Chair of BMA Council, Dr Mark Porter, wrote to the DDRB calling for them to exhibit the independence they were originally formed to provide.

Last month at our Annual Representatives Meeting, the Representative Body called on the BMA to “identify actions to reflect the feeling of the profession and support achieving a fair settlement for medical staff.” It is increasingly clear that the DDRB are unfit for purpose in identifying fair settlements for the health service. Originally created to offer independence, the fact, that their recommendations are also now ignored by government suggests that this intermediary is no longer fit for purpose and that direct negotiation with government is required to ensure that the profession is not ignored.

We are keen to discuss next steps with other unions whose members are equally frustrated by recent pay announcements and take stock of this dialogue when planning our response. Ultimately any final decisions on actions from the BMA will need to be taken by BMA Council.

Junior doctors, along with their colleagues across the profession and the public sector, have had enough of real terms pay cuts, spun to give the appearance of a positive step forwards. There will be an Association wide consultation and response to this, to demonstrate to Government the strength of feeling among members. However, it’s clearly time for the profession in England to withdraw completely from the DDRB process, and for the Secretary of State to commit meaningfully to addressing pay, recruitment and retention issues directly.

Jeeves Wijesuriya is chair of the BMA junior doctors committee.