Image: Flickr/Garry Knight
Over the past year doctors have shown themselves to be a strong, united voice for the protection of our NHS. We are a powerful force in driving positive change in this struggle for a safe and fair contract, fit to meet training requirements whilst maintaining world-class NHS healthcare.
We recognise the proposed contract is an improvement to the February (Dalton) imposition, however we feel that it does not address key workforce or long-term service needs of a public NHS. We therefore call on colleagues to reject this contract: Our NHS deserves better.
In April we took industrial action. The government stated there was nothing that would bring them back to the table - there would be no more negotiations. The concept of imposition appeared a reality.
Following three separate sets of Industrial Action, judicial reviews and numerous individuals (all of us) making a difference in every arena, doctors forced the government back to the table. Significant concessions were made. Another offer was tabled.
We have carefully appraised the contract on offer and it does not meet the stated aims that led each of us to undertaking industrial action. The contract we need should be equal and equitable for all, value the contribution of staff and have patient safety and the future of the public NHS at its core.
We are in the midst of a staffing and funding crisis in the NHS. Recruitment and retention of doctors is essential for the survival of the NHS and to the quality care received by the British public. We are concerned that the way doctors are paid under this contract offer may in future penalise other staff, exacerbating recruitment and retention problems of our allied healthcare professional colleagues.
We urge you to consider the contract carefully, and ask yourselves, does this contract meet the challenges that the NHS and we as a profession face? We believe it does not and therefore propose that this contract is rejected in its current form.
The NHS faces many challenges and the Junior Doctor contract will not be a panacea to those. We will not right all the wrongs. However this contract is a gateway to the erosion of our health service and the terms and conditions of our allied healthcare colleagues. It does not offer equality. It does not offer practical solutions to safe working or champion patient safety.
We see four possible outcomes of a majority ‘No’ vote:
1) A return to negotiations
2) 'Imposition’ of the current offer
3) 'Imposition’ of a worse contract
4) Stay on the current contract
Which of the above we get, is down to us. We have moved the government and through a strong, united voice we can move them again. We have campaigned tirelessly on key points: equality, an un-modelled 7-day NHS, stretching 5 days of doctors over 7 days, patient safety, and the future of the NHS.
The ongoing ‘talks’ between the Department of Health and JDC Executive show that both sides feel the current contract needs continued work. It shows there is still room for negotiation and improvement of this deal. We do not accept the argument that doctors must vote ‘Yes’ for this to be enabled. A‘Yes’ will make some points impossible to negotiate.
An NHS contract must be costed, analysed and fit for public consumption. With this in mind we propose a reset on negotiations and a moratorium on plans to introduce a new contract.
This is a bold move, however the current contract is based on a premise which has no basis in improving patient care, nor retaining and improving Junior Doctors working conditions. It was premised on achieving a more affordable workforce and stretching staff thinner, on an unproven ‘weekend effect’. In November 2015, united, we told the government our opinion and as a united voice we can do so again.
We are creating a firmly resolute junior doctor campaign which will ensure our deep beliefs about the future of the NHS will not be sold off.
Recruitment and Retention
At the heart of the problems of the NHS is a staffing crisis. We need a contract that attracts the best doctors to stay and train within the NHS. Flexible Pay Premia is not a means to this end; we call for a contract that adequately remunerates areas of the NHS hardest hit by both service and training pressures, allows flexible training, and is backed up with commitments to train enough doctors to meet the needs of the communities we serve.
Less than Full Time Training
We recognise that a diverse workforce is the minimum standard. It is not an aspirational goal to be rejected as unworkable at the end of the day. By driving LTFT trainees out of medical and surgical specialities we will worsen rota gaps and drive down working conditions across the board.
59% of Junior Doctors and 70% of medical students are women, who form the bulk of LTFT trainees. By agreeing to a contract that at its core remains discriminatory against the female workforce, we are setting a precedent for the wider NHS and UK workforce. We fight for flexible, rewarding training that sees all trainees as an asset not a burden and the potential way out of our current staffing crisis. We need more, well supported LTFT employees, and will help come to creative solutions to achieve this.
Weekends and Evenings
Weekends are valuable, we live in a society that values its weekends, especially for family. We recognise the gains industrial action has won us some concessions in protecting our weekends but the current offer does not go far enough. Evenings and weekends are premium time for a reason. We believe that our contract must remunerate those who work the longest, the hardest and most anti-social shifts appropriately.
The new contract would see evening work become plain time, disproportionately affecting those who work the most intensive shift patterns and creates a banding system for weekends which does not appropriately recognise the importance of weekends working.
We want a contract that safeguards our patients as well as the importance of weekends in our family life. We need a contract that recognises work life balance is good for doctors, will aid recruitment and ultimately lead to better patient care. The contract as it currently stands rewards least those who work the most weekends by paying them one of the lowest daytime weekend hourly rates.
Guardians and Safeguarding
The role of the Guardian has significantly improved since the February offer, however remains of concern. The new system of exception reporting transfers the burden of responsibility for safe working practice from the employer to the employee.
We must build a system with safety at its heart and not one which relies upon individual Junior Doctors to hold their trusts to account by reporting understaffing of wards and unsafe hospitals. We propose a national reporting system for rota gaps.
Pay for Work Done & Time Off In Lieu
Pay for all work done exists outside the pay envelope. Without an appropriate increase in funding put aside for doctors there is a real chance that individual doctors would be claiming money from cash-strapped trusts, pitting the doctor against the hospital. As fines will be made at department level, doctors may be pitted against their own service, giving the junior doctor an ethical dilemma. The alternative of time off in lieu will not be a reality for doctors in understaffed hospitals and with underfilled training posts.
Over the past year the Junior Doctors, as a united force have fought hard for something better, that addresses the issues in our contract but also safeguards our NHS. We understand that people want to see a resolution to this conflict. But ask yourself:
Does this contract meet the demands of the NHS? Does it justify why you took industrial action? Is this contract what you hoped to have achieved with said action? Just because the contract is better does not mean that the contract is what it should be.
This contract is an improvement on the Dalton ‘Imposition’. Compared to the August 2015 position it is unrecognisable. Undoubtedly our leaders have achieved this and galvanised a profession to fight for the NHS in the process. Our actions to prevent those proposals seeing the light of day has potentially saved lives.
However, when we vote on this contract we can’t focus on where we have come from, or what we owe to whom for their successful commitment, but on where it takes us.
The contract on offer will not fix the recruitment and retention crisis. It is not going to help trainees on rotas with less than 50% fill rates such as GP and Core Medical Training. It is not going to help with the cost of living crisis as inflation continues to outstrip pay. It is not going to attract trainees back from abroad and encourage people to stay as a doctor in the NHS.
It will drive LTFT out of medical and surgical specialties and possibly out of medicine as a career, despite the best efforts of our negotiators to prevent that. It will require a constant fight with management in order to be paid for the work we do, with no independent oversight, without concrete safeguards that a hospital has any legal duty to honour.
Despite what some may say, an acceptance of this contract would be acceptance that our concerns have been addressed. It would send the message that there is no more work to do.
In order to fight for a contract that retains and values staff, encourages flexibility and is fit to cope with the modern demands of a junior doctor, to create a world class future for the medical profession, for doctors to have the time, energy and resources to deliver the world class healthcare we know we can, we must reject this contract and continue the fight for a better one.
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