Sir David Dalton and his muddled maths


As most junior doctors know, Sir David Dalton is now heading up Jeremy Hunt’s negotiating team over the junior doctor contracts.  This week, following an apparent stalemate, Sir David took the opportunity to bypass the BMA and write directly to junior doctors.  In his letter, his language and tone was notably more emollient than that of Jeremy Hunt; he acknowledged the “high degree of discontent which has been fermenting for some years and that the proposed new contract has brought this to the surface”.  He also took time to explain the positives that he feels the new contract would offer; limits on consecutive nights, consecutive long days and consecutive weekends; improved notice over rotas and a crackdown on fixed leave; and equal or better rates of pay.

Whilst the language is kinder (and the tone far less bullying that Hunt’s), these are all points that we have heard before.  The greatest sticking point continues to be the re-classification of Saturday as “plain-time”; that is, working time that is no longer recognised as being antisocial, and would no longer attract an increased rate of pay for those hours.

I decided to write back to Sir David.

Dear Sir David,

Thank you for your letter dated 3rd February 2016.  Thank you for taking the time to explain the current state of negotiations, and thank you for all of your hard work during the negotiations of the last few weeks.  It is good to see that you appreciate the widespread sense of disillusionment felt by junior doctors working in the NHS at the moment.

As I’m sure you know, junior doctors are committed to safe, efficient, gold-standard emergency care for patients, whatever day of the week and whatever time of day they fall ill.  Junior doctors throughout the UK, from London to Salford, are already committed to working night and weekend shifts to ensure patient safety.  One of the major sticking points of the negotiations seems to be the Government’s desire to re-define Saturday as “plain-time” working hours.  I appreciate the concessions that have been made by your negotiating team so far, in reducing the Saturday “plain-time” to 10 hours, rather than the 15 hours proposed.  However, I know that many junior doctors feel that this still doesn’t recognise the disruptive effect of Saturday working on their families and personal relationships.

I suspect that junior doctors would be more amenable to increased plain-time working if you were able to explain how the re-classification of Saturday as “plain-time” for junior doctors would lead to a reduction in the “weekend effect” that Mr. Hunt refers to.  Thus far, the evidence for such an improvement has not been presented clearly.  I believe that this evidence must exist, as it would be nonsensical for Mr. Hunt and NHS Employers to have caused a doctors’ strike without it.  I look forward to this evidence being presented in due course.  I think it may be the best chance of averting further disruptive industrial action.

I believe this completely; if Hunt or Dalton demonstrated that patients were getting significantly worse emergency care at the weekend, and that their reforms would solve that problem without being detrimental to the junior doctors, then there would be no disagreement.  Junior doctors would sign up in a heartbeat.  Of course, this isn’t the case; no such evidence exists, and the new contract remains primarily about stretching the NHS thinner for no extra cost, in order to try and implement a poorly-defined and ill-though-out manifesto pledge.
In all honesty, I didn’t expect a reply.  But a reply I got, at 12.30am no less!  Sir David speaks enthusiastically of 7-day services, whilst not explaining how the new contract would help to achieve them.  Most interestingly, he offered an explanation of how the new contract would not affect our pay.
It is categorically not to disadvantage trainees as the current additional costs of Saturday pay will be spread over the rest of the week – to put at its most simplest: if now the cost of a Saturday shift = $150 and a Mon-Fri weekday shift = $100, then the proposed contract allows for each day (Mon-Sat) to be paid at $110.  (forgive the $ sign and the rounding of the arithmetic!)  The total cost and pay remain the same.
Sounds pretty good, eh?  Earning the same as we would under the current contract.  All fears of a pay cut are unfounded, apparently.  Something doesn’t feel quite right though.  I decided, much against my better nature, to do some maths.
Let’s imagine a current rota.  Dr. Hypothetical works a three-week rota, in which she works Monday-Friday, and one Saturday per three weeks, a total of 16 shifts.  Using Sir David’s numbers, she will earn £1650 for this three weeks; 15 x £100, plus 1 x £150.
We can assume that, under the new contract, Dr. Hypothetical will earn the same for each shift.  As we already now, ad nauseam, this will also be “cost neutral”.  From this, we can infer that each Monday-Saturday shift will be paid at £103.13 per shift (£1650 divided by 16 shifts), NOT £110 per shift as Sir David suggests.
This could be fine if the shift pattern remained the same.  However, the alleged point of the new contract is to make it easier to rota more junior doctors at the weekend.  So let’s look at the new contract again, but this time with an extra Saturday shift.  In order to keep the total number of shifts the same, we’ve swapped a Saturday for a Friday.
Again, 16 shifts for £1650.  Dr. Hypothetical isn’t getting a pay-cut, and she isn’t working more hours.  So what are we objecting to?  Compare it, now, to the current contract for the new shift pattern.
Now we can see it; Hunt and Dalton’s attempt to stretch Dr. Hypothetical’s working week to cover more Saturdays SHOULD cost £1700.  And this is before we ask who will be looking after her patients on the Friday.  Dalton’s attempt to portray the new contract as both cost-neutral and hours-neutral is disingenuous; Dr. Hypothetical has suffered a pay-cut compared to what she would have been paid under the current contract for working the new shift pattern.
Hunt and Dalton’s contract fails to recognise that Saturday is NOT the same as a Wednesday.  Our message has been the same throughout the negotiation process:
  • Junior doctors AREN’T asking to work fewer weekends.
  • Junior doctors AREN’T refusing to work more weekends.
  • Junior doctors AREN’T asking for a pay-rise.

We have committed our adult lives to becoming doctors.  Our student years were spent in libraries, wards and lectures whilst our friends were enjoying extended reading weeks and Christmas holidays.  We watched our peers start earning money, buying cars and saving for houses whilst we continued to study.  We have incurred thousands in student debt, with our successors set to suffer even more.  We have been tossed around the country, like leaves in the breeze, following wherever our training jobs may take us.  We have spent so many of our evenings, nights and weekends to looking after strangers in their darkest hours, and more time still on portfolios, courses and journals in an effort to keep up and continue to progress.  We have missed Christmases, birthdays, weddings, funerals, Nativity plays, parents’ evenings, families and friends.  And we’ve done it all through choice, in the hope that we will enjoy the most rewarding of careers, and be treated fairly by those who employ us.

Is that too much to ask?


One thought on “Sir David Dalton and his muddled maths

  1. This shouldn’t be calculated within cost-neutral parameters as Dalton’s example does not encompass all the other elements of the pay package outside of plain time. Antisocial supplements for nights and Sundays will be adjusted accordingly after basic pay to meet the government’s cost-neutral criteria.

    Therefore, Dalton’s figures are correct. He has taken the £50 from saturday and divided it by 6 = £8.33. (Rounded up to £10 as he states.) This means each day Mon-Sat will cost £108.33

    Now a rota on the new contract with 16 shifts in total = £1,733

    That is almost the same (£33 MORE) as you would be paid on the old contract plus an extra Saturday.

    HOWEVER, in the real current contract, working any number of weekends up to but not including 1:4 attracts no extra pay whatsoever. Therefore, in reality the pay remains the same on the old rota, signifying a 5% pay rise from £1650 to £1,733.

    In addition, Dalton now proposes that a trainee rostered to work 1:3 Saturdays or more should be paid an extra 33% supplement for all Sat hours worked. This compares to the current 25% increase in banding from 40% to 50% should a doctor work 1:4 weekends or more.

    Which means that trainees working between 13-17 Saturdays a year would have rotas that may be relatively disadvantaged. And even this would be difficult to immediately determine, seeing as current banding incorporates at once weekend frequency, on-call frequency and OOH frequency (see my initial paragraph).

    In short, without viewing the proposals in full, it is impossible to determine the ‘cost-neutral’ nature of NHSE’s offer without further information beyond Dalton’s purely illustrative example.

    These are my own views. I have no affiliations with either NHSE or the Department of Health.

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