New deal for junior doctors: still #notfairnotsafe

Medical student Sophie W explains that the much trumpeted new offer to junior doctors still means a big pay cut and unsafe hours.

Jeremy Hunt’s offer to junior doctors is spin, and doesn’t address the initial concerns about the fairness or safety of the contracts. The new offer includes:

1. An 11 % pay rise on basic salary
2. The offer of renegotiating Saturday afternoons and evenings as antisocial and
3. Instating the Care Quality Commission to monitor Trusts rotor schedules, to prevent juniors form being over worked.

This move by Hunt makes no fundamental changes to the proposed contracts. It does not address the extension of normal working hours, nor reinstate penalties for Trusts if they over-work doctors. It still represents a substantial pay cut overall because of the loss of unsocial hours payments. A strike with this on the table has to be understood as striking against reduced pay and unsafe contracts.

The contract is still unfair. It still considers working 7 pm to 10 pm during the week, Saturday morning and possibly later hours on Saturday as normal working hours. Doctors need time for themselves, for their wellbeing, to share with their partners and family and to focus on preparation for exams they have throughout their training. Without this, it will be hard to keep morale up under an increasingly pressured workload.

The offered pay increase is not an increase. The lower rate of pay for working between 7 and 10 pm during the week, and possibly Saturday morning, would wipe out the pay increase for those working in specialities with longer hours and weekend responsibilities. The 11 % pay rise is also lower than the Dentist and Doctors Review Board’s own recommendations – the committee that proposed the restructuring of contracts, supported NHS Employers. They recommended an increase in basic pay of 14.9 % in light of the changes to antisocial hours, which has not matched by Jeremy Hunt.

The contract is still unsafe for patients. There are still no concerted proposals for holding Trusts to account on over working doctors. At the moment, Trusts ask junior doctors to opt out of the 48-hour week limit in the Working Time Directive, the European law cited by Jeremy Hunt to be the legal framework for protecting junior doctors under the new contracts. Currently, financial penalties ensure that doctors and Trusts agree how long they work, keeping it within national guidelines. Removing this second safeguard leaves junior doctors open to working longer hours, regardless of whether Jeremy Hunts promises to bring down hours. It would take a change in culture to provide adequate safeguards under the proposed system, a change in culture too big to have taken place in time for August, when the contracts are due to be brought in.

Proposals to recognise only hours worked for promotions, and not years of self-development, have not been reconsidered. This still leaves doctors who take time out to look after children, or to take on academic or teaching responsibilities at a disadvantage.

With many doctors looking to work abroad or leave medicine altogether rather than work under the new contract, we aren’t just talking about defending junior doctors’ contracts. We’re talking about saving the NHS from staffing crisis, and preventing new generations of junior doctors from losing the will to support the NHS. If junior doctors lose this fight, other health care workers will be next in line to lose anti-social hours pay.

The NHS is a world class institution, and provides emergency and in-patient care seven days a week for its patients. The block to an entirely seven day service is from the lack of investment in diagnostic tests, scanning facilities and social care support to get people home from hospital. It is not junior doctors, already working long shifts and weekends, that are a block to a seven day service.

With this new deal on the table, we must expose government lies and spin. Ballot papers have been sent out today and the BMA is expecting 80-90 % of votes to be for industrial action.