National contract, local effects

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As I’ve said previously, I’m immensely proud of the hospital that I work at.  Throughout the junior doctor contract industrial action, managers and clinicians have worked incredibly hard to maintain patient safety during strike days.  Equally importantly, channels of communication have remained open between junior doctors and the hospital’s managers.  It is a testament to the strength of the relationships within our hospital that they are continuing to serve us well during these times of stress.

During our regular Junior Doctors’ Forum meetings, we have had the opportunity to discuss our worries, fears and frustrations with the interim Chief Executive, with Operations, and with our Chief Medical Officer.  During our last meeting with the CMO, the day after Jeremy Hunt announced that he would impose a new contract, we were told the CMO’s position on the new contract.

“We’ve looked at our data from this hospital, and we know that there aren’t any deaths at the weekend that are attributable to it being the weekend.

 

I know that you’re all worried about some of the sample rotas you’ve seen from NHS Employers; I want to reassure you that, even if we are forced to implement these new contracts, we won’t be changing any of our rotas in this hospital.

This is reassuring; one of the concerns that we have regarding the new contract is that it will lead to us having to work more shifts at antisocial times, and for the same or less pay. It is good to hear that our hours, at least, will remain the same.

However, it does raise other questions.  For example, if the contract ISN’T being used to increase staffing at the weekend, then what effects will it have?  If it doesn’t address Hunt’s “weekend effect“, then what is it for?  And, playing devil’s advocate, if it doesn’t lead to us working more hours, then why are junior doctors still so angry about it?

  • Firstly, doctors are still concerned regarding the safety of the hours safeguarding in the new contract.  Whilst there have been some improvements to the Guardian of Safe Working role since it was initially proposed (through negotiation between NHS Employers and the BMA, I might add!), it remains a flawed and unsafe system.  There remains no good reason to move away from the current system of mandatory hours monitoring by an independent body.  The GoSW role, as an employee of the Trust, can not be sufficiently independent to adjudicate in disputes between employer and junior doctor.  Similarly, the use of fines to boost the Trust’s educational budget creates a clear conflict of interest, and an insufficient deterrent to overworking doctors.  The Trust being fined by the Trust, and paying a fine to the Trust is an obviously ridiculous system.
  • The new nodal system of pay progression shows one band of pay covering all of those between ST3 and ST7.  In our hospital, this covers a large number of the SHOs, right up to the majority of our registrars.  This would mean that doctors with a vastly different level of experience, seniority, and responsibility would all be payed exactly the same.  This is clearly unfair.
  • Our Emergency Department employs trainees from both a paediatric background, and those who are trained via an Emergency Medicine background.  The proposed premium for Emergency Medicine trainees at ST4 and above would lead to registrars in our department receiving significantly different pay for doing exactly the same job, just because they started out as an EM trainee rather than as a paediatrician.  This, again, is patently unfair.
  • The crux of the new contract is about making out-of-hours working cheaper for the NHS.  To maintain cost neutrality, this is being offset by a 13.5% increase in basic pay, for hours worked during “plain time”.  Whilst Hunt’s argument is that this will encourage hospitals to roster more staff at the weekend, what it actually does is disproportionately reward those who do the least out-of-hours work, and penalise those who work the most antisocial hours.  For example, our FY1 doctors don’t do any out-of-hours work; their pay is entirely “plain time” pay, giving them a pay rise on the new contract of 13.5%.  However, we have repeatedly been told that this new contract is “cost neutral”, so that money has to be saved from elsewhere.  Where will it come from?  It will come from those doctors who do lots of work outside of “plain time”, who will lose money on the new contract compared to the current banding system.  This includes our A+E doctors, RMOs, PICU doctors, anaesthetists and surgeons.  Once more, this doesn’t seem fair at all.
  • In paediatrics, over half of our doctors are women.  Women in medicine are far more likely than men to take time out of training for parental leave, and are far more likely to return to work on a less-than-full-time basis.  I’m proud of how paediatrics has embraced flexible working, and how we continue to work to make training as family-friendly as possible.  However, the loss of annual incremental pay increases, and a switch to nodal pay progression, will disproportionately affect our female trainees.  For example, a doctor who works at 0.5 FTE from ST3-ST7 would have an effective pay-freeze for at least 10 years, possibly longer if they have the temerity to take time out to have more children.  This is discriminatory and unfair.  The Department of Health still haven’t performed an Equality Impact Assessment, which is the basis of the BMA’s judicial review.
  • Paediatrics has rota gaps.  12.1% of rota slots are currently unfilled, nearly 1 slot in 8, according the the latest RCPCH report.  On tier 2 (middle-grade) rotas, this rises to 19.5%, nearly 1 in 5.  We are stretched almost to breaking point as it is, and imposition of this new contract may well be the straw that breaks the camel’s back.  Combined with the capping of locum rates, we are on the verge of a staffing catastrophe.  If even a small number of paediatricians leave medicine over this new contract, it will have real implications for the hospital’s ability to provide safe, high-quality services to our patients and families.

We have been told, and I understand, that our Trust doesn’t want to get involved with the junior doctors’ contract dispute.  I understand that the board and the interim Chief Executive want to remain politically-neutral, and feel that it isn’t their fight to get involved with.  However, this is a fight that is happening, and it will affect everybody within our hospital. This is no time to bury our heads in the sand, and it is no time to look the other way.  We have the ability to send a huge, loud message to the Department of Health, either by publicly opposing imposition of a contract that will damage our hospital, or by refusing to introduce it in our Trust.

If we choose to do nothing, we are still making a choice.  This is everybody’s fight, and it’s happening whether we choose to acknowledge it or not.

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