Today (Saturday 19 May), the BMA junior doctors committee chair told a conference their voices will be heard as equal partners as part of a review and fresh negotiations of the contract imposed on doctors in 2016.
Speaking to the BMA junior doctors conference 2018, Dr Jeeves Wijesuriya announced the Association’s participation in the 2018 review and a formal, collaborative bargaining process to make changes to the contract.
Dr Wijesuriya explained to delegates at the Birmingham Conferences & Exhibition Centre that, after lengthy negotiations with national leaders, the BMA will remain in dispute over the unilateral introduction of the contract while taking this formal opportunity to improve it. The final agreed deal will be put to members in a referendum.1
He said: "In the coming months, our voice will need to be more united and more powerful than ever before, because the difficulties that face the profession continue to grow: our colleagues, our friends and the doctors of the future need us to fight for a better NHS, as well as for staff and for patients."
Read Dr Wijesuriya's full speech to the conference.
**CHECK AGAINST DELIVERY**
Every day, junior doctors across the country make difficult decisions; decisions that directly affect people’s lives, decisions made under incredible pressure. Last year, this conference also made difficult decisions. You set us on a course to engage, to make our hard-fought protections work, to find a way back into concrete talks and to seek the gains we all need to improve our working lives.
It is easy to be angry, frustrated, and criticise from a safe position, away from the realities of the current situation. But as a profession, we do not have that luxury. We have to do more than that. We need to be better than that. Because despite all of the negativity and despair, we have worked to make significant improvements for junior doctors across this country and must continue to do so.
Junior doctors across the country are working under huge pressure, We see ourselves in situations every day where we too are under pressure, working in failing systems or without adequate support. That is why the case of Dr Bawa-Garba has caused such an outcry within our profession. We are all worried about the nature of reflective practice, the possibility of reprisal and legal recourse for honest mistakes made and, more broadly, what this case says about the state of our NHS and the people who regulate it.
The junior doctors committee has had a policy of no confidence in the GMC for the last 18 years and I fully expect that position to be maintained today. But let me be clear, having no confidence alone is not enough.
We are the voice of all junior doctors and it is our responsibility to lobby for and deliver the changes we are seeking, not just to rage against the system. With the GMC, we’ve delivered concrete assurances that they won’t ask for reflections to be handed over in their internal processes, and an assurance that raising concerns will be protective and not punitive. We know this is still not enough, and that we must continue to lobby for the legal changes required to properly give trainees the confidence to reflect and learn from significant events. It is this lobbying that has meant the GMC themselves are now also calling for legal privilege of reflection, as we are, via the reviews of gross negligence manslaughter taking place.
The BMA have reached out to Dr Bawa Garba and I have offered our support on behalf of the entire Association. We have also been granted permission to intervene in the appeal against her erasure from the medical register. We will do whatever we can to support her case and highlight the injustices which have had far-reaching implications. We will continue to fight for doctors, so that they are supported and that their actions are not criminalised by a system we recognise is all too willing to abdicate responsibility for our patients.
We have known since the Acas agreement that in August 2018, a review of the imposed contract would be undertaken - between ourselves and NHS Employers. Last year, this conference gave us a clear steer: to remain in dispute, to continue to push for change via the 2018 review, and to then bring it back to the membership.
This review would give us the opportunity to revisit some of the issues with this contract, to look at what has happened since imposition - but with the dispute ongoing, how this review would take place had been anything but clear.
After months of work however, I am able to announce to you today the most significant progress since the dispute began
Today, I am announcing our participation in a formal, collaborative review and bargaining process to improve the imposed 2016 contract. After lengthy discussions with national leaders, whilst we will remain in dispute over the unilateral introduction of the contract, we will take part in the 2018 review to make changes wherever they are needed – as equal partners. The final agreed deal will then be put to our members in a referendum.
We have been strong, we have been constructive – and now our voices will be heard.
It has not always been easy, but I’m incredibly proud of what we have achieved. In many areas we have forced genuine change, change that will affect thousands of lives for the better – and for which we have to fight on.
This dispute has shone a light onto the working lives of junior doctors, and we have used that attention to drive for change, including in areas outside the contract itself
We have worked collaboratively with NHS Employers to produce comprehensive and positive guidance on good rostering as we committed to do at our talks with Acas back in 2016. This will ensure employers honour both the spirit and the letter of the safeguards in the 2016 contract that we fought for. This guidance requires them to take steps to minimise fatigue, value LTFT (less-than-full-time) and NROC (non-residential on-call) doctors, and make use of new, more effective rostering technology.
We’ve also produced a fatigue and facilities charter which increasing numbers of trusts are signing up to – giving doctors proper rest in a career where being fatigued all too often seems like normality
In England, the soon-to-be-published Enhancing Junior Doctors’ Working Lives report will detail the tangible progress that has been made through projects overseen by this group, of which we were a founder member. Through it, we have secured real improvements to the educational experience of junior doctors.
We have helped to improve flexibility in our application systems, supported trainees when those systems have failed them as they did with medical ST3s and reviewed the inadequate ARCP (annual review of competence progression) process. We ensured better enforced notice periods for new jobs and rosters, and our lobbying has led to £10m of investment into projects to support trainees returning to the clinical environment after time away for any reason.
We have helped to improve access to study budgets which will remove thousands of pounds of personal costs to trainees, protected the simplicity of the current system and access to aspirational courses. These changes mean more money goes into your training, and less into trusts' bottom lines.
We all know that this is a profession and an NHS worth fighting for. But, the BMA’s junior doctors careers survey earlier this year revealed that more and more doctors are taking time out of training – or even considering their long-term future. Burn-out, wellbeing, and taking non-training posts in other countries are the main reasons, and we need to take action to tackle all of these.
The NHS simply cannot survive if it continues to haemorrhage the talented, hard-working and innovative staff it is currently losing.
Too often we feel like a cog in the machine – like we are not valued for the work we do and the humanity we provide every day on the frontline in hospitals and GP practices that sometimes seem more like battlefields than places of care.
During the coming year we will continue to do everything we can to encourage the prioritisation of training, pastoral care and the wellbeing of doctors. It is often demanded that doctors provide the best, bespoke care but we are seldom given the same treatment. We are trying to reintroduce humanity back into the system via the huge amounts of ongoing work around bullying and harassment, widening participation and ensuring that time and resources are available for the senior doctors who are responsible for our training.
Working less-than-full-time can bring its own unique set of challenges– and this has been one area, in particular, where we’ve begun to make real progress. Having established a forum for less-than-full-time colleagues, we’ve now managed to remove unneccesary limitations on less-than-full-time doctors undertaking locum work in line with both their needs and those of the modern workforce.
Ahead of our participation in the gender pay gap review, we have also changed our membership rate for doctors working flexibly, because we are committed to being an organisation that values and works for all doctors.
In several areas of the country, thanks to our union and the hard work and diligence of BMA staff and representatives, junior doctors have won back pay that they were owed in banding appeals.
Through the role of the guardian of safe working and the system of exception reporting, a crucial safeguard for every single one of us, we can see change happening. Trainees are finding they now have a serious and supportive system which not only allows them to raise concerns but, crucially, to have those concerns addressed in real time. As a result of this new process we have started to see attitudes soften, extra staff hired and rota patterns changed. This is a system which can work when it is properly supported and implemented – and in a stretched, struggling NHS it could not be more crucial that we continue to work with local representatives as well as NHS Improvement and other organisations to improve this system.
When members tell us there’s a problem, we take action. But that progress is impossible without engagement, co-operation and being a forceful, constructive and critical voice at the table.
In the coming months, our voice will need to be more united and more powerful than ever before, because the difficulties that face the profession continue to grow: our colleagues, our friends and the doctors of the future need us to fight for a better NHS, as well as for staff and for patients.
These challenges could not have been revealed more starkly than they were this winter.
Nationally, political decisions and chronic underfunding must be opposed; contractual arrangements must be improved and serious action on workforce recruitment and retention taken. These are huge issues to address. The truth is that we cannot do any of this in factions. We must face our challenges together, not alone.
Sometimes, change is gradual, incremental, and even frustrating. But it always matters: It is always worth fighting for a better workplace, it is always worth fighting for a better NHS, it is always worth fighting for a better future.
We are not finished. Now is the time to press forward – to push for progress on each and every issue so crucial to our futures – and we need to do so together.
Notes to Editors
The BMA is a trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.
1 - The BMA and NHS Employers have agreed the following joint statement:
The BMA and NHS Employers have reached agreement in principle for the delivery of the 2018 review of the 2016 Terms and Conditions of Service for Doctors and Dentists in Training. The BMA remains in dispute over the introduction without agreement of the 2016 contract. All parties however agree to enter into a formal collaborative bargaining process as equal partners via which they will jointly review the efficacy of the contract and negotiate changes to address the areas for improvement identified. Following the conclusion of this process the package of negotiated changes will be put to consultation by BMA members, and if accepted the dispute will be ended and the contract collectively agreed.
- You can follow the conference on Twitter using the hashtag #JDConf2018
- Read the BMA and NHS Employer’s new joint rostering guidance for junior doctors in England here.