ON Monday night, following five days of conciliation talks with the government, it was announced that strikes would be suspended until mid-January. This followed assurances from health secretary Jeremy Hunt that he would remove his threat of simply imposing, without agreement, a new contract on junior doctors. Talks will restart between both sides and we hope that in the coming weeks we can agree a contract that is good for patients, junior doctors and the NHS.
We understand that many patients still faced disruption this week, which junior doctors sincerely regret. We had hoped to reach agreement sooner, to avoid any disruption for patients, but the government refusal to enter talks until the last minute left us with very little time to negotiate. But it is because junior doctors believe that the government’s proposals would be bad for patient care, that they took such a firm stand.
The government has been planning to impose a new contract on doctors - from junior to consultant level - from next summer, including reclassifying “normal” working weeks to include Saturdays.
It would also mean the working day would be considered to last up to 10pm every day, except Sunday. The health secretary has accused junior doctors of misleading the public, yet at the same time he continues to conflate junior doctors’ concerns and the government’s rhetoric on seven-day services. He disingenuously omitted to mention the concurrent, and larger, pay cut for junior doctors through loss of the pay banding system. He didn’t begin to address doctors’ concerns about patient safety. The junior doctor contract is in no way a barrier to seven-day services, with the vast majority of junior doctors routinely providing care to patients 24/7.
The outpouring of anger and frustration we have seen from thousands of junior doctors across the UK must be a wake-up call for the health secretary. If he and his team thought that junior doctors would simply accept their threats to impose a new contract, they have been proven very wrong.
We are already seeing reports of thousands of doctors, including a large number of junior doctors, looking for opportunities to move and work abroad, which at a time when the NHS is facing a recruitment and retention crisis is cause for serious alarm. The government’s proposals will impact those specialities such as general practice and emergency services that are facing particular workforce shortages, whether it is through reducing the pay to those doctors involved in the greater amount of evening and weekend work, or reducing pay for those in training. Worse still, by making it easier for hospital trusts to return to the days where junior doctors worked dangerously long hours, they risk compromising patient care as well as junior doctors’ health and wellbeing.
The British Medical Association has been clear that it wants to deliver a safe and fair contract for junior doctors and patients. Instead of genuine negotiations, the government has insisted that junior doctors agree without question. This would not have allowed the BMA to negotiate over proposals we believe are unsafe for patients, unfair for doctors and undermine the future of the NHS.
There are more than 50,000 junior doctors in England alone. They form the backbone of our NHS, working around the clock, seven days a week, and with a starting salary of less than £23,000, earning less than you might expect. Despite improvements in working hours in recent years, more than four in five junior doctors continue to struggle with long hours. Working 12 days in a row and clocking up 90-plus hours in a week are still common. Almost one in three have considered leaving the profession.
The contract determines obvious things like pay and working hours, but also affects the quality of doctors’ working lives and the quality of their training. It also plays an important role in ensuring medicine remains an attractive profession for the brightest school leavers, especially at a time when students undertaking a medical degree face debts of up to £70,000. Junior doctors work long hours and take high-risk clinical decisions, but in return they need a contract that protects them and the patients they care for, delivers a fair system of pay and ensures they have the opportunity and flexibility to learn as they progress. These things are vital to delivering high quality care for patients and to ensure doctors are trained to the best possible standards.
Instead of working with the BMA to deliver this, the government want to force though changes that will be bad for patients, bad for junior doctors and, ultimately, bad for the NHS.I am glad that the health secretary has finally acquiesced to negotiations, but I doubt he will understand that the BMA is part of the solution, not a problem for safe and quality care the patients deserve.
The strikes may be postponed, but a settlement is still a long way off. The date of January has been set by both sides as ending the temporary suspension of the threat to impose a contract and the counter threat to reinstate strikes.
The coming weeks will be challenging, but it is vital that we do all we can to come to a negotiated agreement
Dr Chand is deputy chair of the British Medical Association (BMA) and has worked as a GP since 1983. He is ex-chair of Tameside and Glossop NHS