I will begin by saying how important it is to stress the understanding of parliamentarians that junior doctors already work incredibly hard across a 7-day period. I think it is hugely unfortunate that this has become phrased in such a way to suggest otherwise as this is such a long way from the view that I hold.
Now we have moved passed that, I would like to address some of the concerns raised to me by constituents about the junior doctor contract.
I think it is perfectly fair to say that the early stages of these negotiations were handled poorly by both the British Medical Association (BMA) and the Department of Health (DoH). However, I do not think that this initial bad beginning should have led to the acrimony that we have seen persist throughout the entirety of these negotiations.
One of the most incendiary concerns circulating early on was to do with the pay of junior doctors. It is important to note that we do not want to see junior doctors take a reduction in take home pay. I heard suggestions that pay could fall by 30% – this is simply not the case. The contract as it stands will see three quarters of junior doctors receive a pay rise and no trainee working within contracted hours will see their pay cut. It is also true that plain time hours will be extended to 7am to 5pm on a Saturday. However, those working 1 in 4 or more Saturdays will receive a pay premium of 30%. Those working anti social hours: nights from 9pm to 7am, Saturday evenings from 5pm and Sundays, will also receive additional pay. Further to this, basic salary will be increased by 13.5%.
Patient safety is another key concern that has been raised. It is accepted that tired doctors risk patient safety and so the new contract will reduce the maximum number of hours that can be worked in 1 week from 91 to 72; the maximum number of consecutive nights will be reduced from 7 to 4; the maximum number of consecutive long days will be reduced from 7 to 5; and no doctor will be rostered on consecutive weekends. A new role of Guardian will be introduced within every trust who will have the ability to impose fines for breaches of agreed working hours based upon excess hours worked. Any fines will be reinvested into educational resources for trainees. Patient safety is key and Dr Mike Durkin, NHS National Director for Patient Safety, has said the new contract will not be unsafe or dangerous for patients. He has in fact stated that the new contract will put right a number of flaws in the current contract.
I believe, as do many, that contractual reform was necessary and that the contract as it stands, 90% of which is agreed by both parties, is fair. This process has been ongoing since 2013 when “heads of terms” were agreed between the BMA and NHS Employers. In 2014, the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) were asked to report on their observations regarding the progress made in negotiations. This was published in 2015 and made clear that updated contract that puts patients first, increases basic pay for junior doctors and rewards those across all clinical specialties was needed. I do feel that to find ourselves in a position where we have had significant disruption in terms of operations as a result of strikes, but also seeing junior doctors feeling undervalued is hugely disappointing.
Moving forward, I do believe that this negotiation has unearthed some clear issues regarding the morale of junior doctors to do with well-being and quality of life and these must be addressed. I understand that Professor Dame Sue Bailey, President of the Academy of Medical Royal Colleges, alongside other senior clinicians, will be leading a review into measures outside of the junior doctors’ contract that can be taken to improve the moral of junior doctors. I will be awaiting further details of this review to see what can be done to address this issue.
The ongoing uncertainty was not helpful and after receiving advice from Sir David Dalton, lead of the negotiating team, that a negotiated solution was not realistically possible, the Government moved to impose the new contract. 90% of the new contract has been agreed between the BMA and the DoH and will see 75% of junior doctors seeing a pay increase, new safeguards and reduce hours.
I hope this information is informative and helps to put across my opinion on these reforms. Constituents should always feel free to call my office to book a surgery appointment, speak to one of my caseworkers, or instead, you can submit a message to me via this website.