On Hunt’s latest letter

Anyone who follows me on Twitter probably knows that I have some opinions of the current negotiations (or lack thereof!) between the Department of Health and the BMA.  The relationship between Jeremy Hunt and the UK’s 50,000 junior doctors seems to be at an all-time low.

However, Jeremy Hunt has now written another letter to Johann Malawana of the BMA, offering further concessions and assurances.  The full letter can be found here, but I’d like to examine some aspects of it in more detail.

“I am giving a firm guarantee on behalf of the Government that no junior doctor will see their pay cut compared to their current contract.”

A good start.  Doctors not having their pay cut is certainly welcome, but really should be a bare minimum expectation.  At the moment, an individual doctor would expect to see their pay INCREASE incrementally, so this guarantee of “not a cut” starts to look less and less like a good deal.  Also, this doesn’t mention what doctors will be expected to do to earn their money; more work for the same pay is the same as a pay-cut in practical terms.

“It is deeply regrettable that so many of your members still believe that pay-cuts in the order of 30-40 per cent are on the table… there has been no attempt to correct the misinformation and fear… [caused by a pay-calculator on BMA website]”

The vast majority of doctors that I’ve spoken to have never seen the pay-calculator in question.  Junior doctors have been trained for years to analyse literature for themselves, spot inconsistencies and inaccuracies, and to approach things in a sceptical manner.  The safety of our patients depends on this.  We have read the evidence; reports from the DDRB, publications from NHS Employers, and carefully-worded statements from the Department of Health, and we have made up our own minds.  To suggest that 50,000 of us could be misled by the BMA is an insult to doctors and their intelligence.

“I want the new contract to improve patient safety… by better supporting a seven day NHS… Nights and Sundays will continue to attract unsocial hours payments, and I would be pleased to discuss in negotiations how far plain-time working extends on a Saturday.”

“Plain-time working” currently includes 7am-7pm from Monday to Friday.  Hunt’s new definition of plain-time currently includes 7am-10pm from Monday to Saturday; an extra 15 hours between Monday and Friday, and a further 15 hours on a Saturday.  His willingness to negotiate on Saturday working is welcome, but makes no concession on the extra 15 hours during the week. Plain-time working currently covers 60 hours per week; current proposals would extend that by another 50% to 90 hours per week.

“The new contract will mean that no junior is required to work more than an average of 48 hours per week… including a new maximum of working week of 72 hours… compared with the current contract which permits more than 90 hours a week.”

Firstly, the European Working Time Directive already limits a doctor to an average of 48 hours per week.  This is no concession or improvement.  A maximum working week of 72 hours is welcome; I have first-hand experience of working a 90-hour week, and certainly agree that these weeks are not good for either doctors or patients.  However, what Hunt doesn’t mention in this letter is that the proposed new contract removes financial penalties and safeguards against Trusts who exceed this new limit.  Without a financial penalty, there is no incentive for Trusts to comply.  Without compulsory hours monitoring, there is no way of knowing if the limit is being exceeded.  The “speed limit” metaphor is apt here; Jeremy Hunt wants to reduce the speed limit from 90mph to 72mph.  However, whilst doing this, he is also scrapping speed cameras, the police, and removing any penalties for speeding offences.

“The current contract provides a perverse incentive for juniors to work unsafe hours by paying those who breach safe hours up to 100% of their basic pay.”

This is so clueless as to be insulting.  No doctor chooses to work on an illegal rota in order to increase their banding.  These rotas are made by their employers, who force doctors to work these hours.  It is not a choice made by doctors.  I have had the (dis)pleasure of working on a 100% banded rota, and I had no choice in the matter.  100% banding is a deterrent against employers exploiting their staff in an unsafe manner.

“I invite you once again to come back to the table to negotiate a contract that rewards doctors fairly and that has safe care at its heart.  My door is always open.”

Jeremy’s doors aside, this is what we all want.  The BMA, 50,000 junior doctors and 64 million citizens of the UK all want a junior doctor contract that is fair and safe for all.  A contract that doesn’t punish doctors who do the most out-of-hours work.  A contract that doesn’t punish those who take maternity leave or undertake academic work.  A contract that protects doctors and patients from exhausted doctors.  A contract that encourages doctors to stay in the NHS, rather than leaving the UK or leaving medicine altogether.

Jeremy Hunt knows what he needs to do to negotiate this contract.  Drop the threat of imposition, drop the pre-conditions and the non-negotiable points, and let’s talk.  Swallow your pride, and let’s come up with a #juniorcontract that works for everyone.

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