Many constituents have contacted me with a wide-range of opinions on the latest junior doctor strike action.
I am deeply concerned that the public have been very misled over this by the BMA and some media outlets. In order to go into greater depth, I have chosen to give full details of my views, the views of the Government and what I think the future will hold on my website.
Let me first of all start by stating my own commitment to and belief in the value and need of an NHS – free at the point of use. My priority as an MP is to help drive up standards in our NHS – including reducing waiting times and increasing patient safety. In the Conservative manifesto we pledged to create a 7 day NHS device because it is absolutely disgraceful that if my constituents have accident of a severe health problem on a Sunday their chances of survival are so drastically reduced. I am proud that by next April 1/4 of the country will have A and E facilities on a Sunday that meet our 4 critical standards – this is good progress.
It is important to note that the changes in the Junior Contract are designed to improve standards, work towards a seven day NHS and also improve the situation for Junior Doctors themselves.
The BMA called an all-out strike for 26th and 27th April 2016, with doctors instructed to refuse to provide life-saving care for the first time in NHS history. I believe this is a completely irresponsible course of action and put patient lives at unnecessary risk.
Some suggest that the Secretary of State for Health, Jeremy Hunt, has not negotiated with the BMA Union. This is absolutely not the case.
Over three years, officials had more than 75 meetings with the BMA to negotiate contract reform. Through these negotiations, 90% of the contract had been agreed with the BMA, including agreement on hours and pay. The only outstanding issue was Saturday pay.
Claims have been made that these strikes are to “save the NHS,” yet no one is able to suggest what the NHS is actually at risk from. It seems to me that the dispute has come down to rates of pay on Saturdays.
The Government’s view is that anyone working 1 Saturday out of 4, or more, should get higher premium pay rates. This is a better deal than that awarded to nurses, paramedics or other public sector workers such as police officers and fire-fighters.
I believe that we must move towards an NHS that has services available 7-days a week. That includes access to GPs, operations and appointments at the weekend as well as Monday-Friday and that as new doctors are recruited it is important to ensure that a 7-day NHS does not bankrupt the country.
Here are some facts about the new Junior Doctors contracts under five headings (safety, training, pay, Definition of plain time and unsocial hours and 7 day services) which have been suggested by some of the BMA Union spokespeople as reasons for the disagreement:
On safety, the existing contract provides inadequate safeguards for doctors, too many of whom still work unsafe hours. It allows work of up to 91 hours in any one week and to exceed other working time limits. Would you be happy for your mother or child to be treated by a doctor on their 90th hour of work that week? Surely have been letting down Junior Doctors by having contracts which allowed this.
There are insufficient safeguards against consecutive long shifts. Plus it can be very difficult to speak up when Junior Doctors believe that safety is being compromised as a result.
The new contract proposals will improve patient safety – with safeguards introduced in relation to hours worked, breaks between shifts, and accountability and oversight.
The contract proposals to improve patient safety include:
- Introduction of new strict safeguards on hours worked with an upper limit of:
o 72 hours in a 7-day period (compared to 91 now)
o 4 consecutive night shifts (compared to 7 now)
o 5 consecutive day shifts (compared to 12)
The aim is also to provide greater flexibility on rotas, enabling doctors to better arrange working hours around their needs
- Introduction of break shifts of 48 hours off after 3 or 4 consecutive night shifts or 5 long days, and a maximum of 8 consecutive days worked (also to be followed by a minimum 48-hour break)
- Setting out work schedule contracted hours for Junior Doctors and employers will also identify the learning opportunities that will be provided to meet doctors’ learning needs
- Creation of a new senior leadership role in every hospital, a “Guardian of Safe Working” whose appointment would be agreed with the BMA. Junior Doctors would be able to report exceptions and concerns to this guardian without fear and request a review if they are not treated as promised
- Scrutiny by The Care Quality Commission of junior doctors’ working time as part of their inspection process
In addition, the proposals make clear that financial penalties for employers would be put in place where there are consistent breaches of working time regulations. This money would be held by the Guardian at each Trust and would be spent on improving the working conditions or education of doctors in training in their institution.
Under the current contract training opportunities are too often missed because of service pressures. Insufficient notice of the next training placement results in a requirement for fixed leave and this can make it difficult for doctors to plan their lives. The lack of consultant presence at the weekends may also contribute to a poorer training experience.
The proposals around work scheduling reflect the important of protecting training time within a post which is also delivering patient care.
For the first time, there will be an ‘exception reporting’ system which will identify when there are issues relating to training – including when training opportunities are missed. It will be the Trust Director of Medical Education’s responsibility to address concerns raised through exception reporting.
To improve Junior Doctors’ access to training opportunities further work with Health Education England has been agreed to:
- Define training opportunities, including study leave, as an explicit part of work scheduling
- Develop new arrangements to tackle issues for trainees rotating to different Trusts, for example by defining a lead employer
- Identify and remove educational barriers to access to flexible training, liaising with others including the General Medical Council
- Tackle rising training costs, for example through bulk purchasing of key courses and addressing variation in how these costs are met
- Seek to address the costs both to employers and doctors – including a specific commitment by employers to explore the development of ‘salary sacrifice’ arrangements to offset some of the costs of their training against tax
- A commitment has also been made to give better notice of deployment to posts, against which HEE will monitor performance and publish monitoring data.
To support this, it was agreed that there should be an aim of achieving notice to employers of 12 weeks for at least 90% of trainees by August 2016, with the expectation that this be achieved for everyone by October 2016. This should enable fixed leave to be removed by enabling NHS employers to commit to providing roster information to trainees 8 weeks in advance of starting a post.
Subject to service and training needs, HEE will introduce new measures ensuring that recruitment, selection and deployment processes for doctors in training supports those with partners or spouses who are also doctors in training.
The current contract does not meet the fundamental fairness test of paying doctors equal pay for work of equal value. This was recognised by the BMA as well as employers.
Annual incremental pay progression linked to time served means that pay is not directly linked to increases in responsibility.
Most Junior Doctors are paid banding supplements (which are not pensionable) of 40% or 50% of basic pay for overtime worked, on-call availability and recognition of unsocial hours. Howeverdoctors may work anything between 41 and 48 hours for that payment with significantly different amounts of unsocial hours working. Rotas with no night shifts get paid the same as rotas with night shifts. A rota with no Sunday working gets paid the same as a rota with Sunday working.
The November contract offer proposed a fairer pay system with a pay rise for 75% of junior doctors; and guarantees of income protection for a 3-year period for all Junior Doctors working within the current contract, after which nearly all will have moved to a higher pay grade. The proposals to protect pay have not been challenged by the BMA.
The overall cost of the new contract arrangements is higher than for the current contract. The addition to basic pay is pensionable (unlike current banded payments) so employers will pay more into doctors’ pensions.
The key elements of the package are:
- 11% higher base pay for the 40 hour working week
- additional pension contributions by employers and additional pension for doctors as a result of the increase in basic pay
- pay progression with 6 pay points linked to increase in responsibility rising from £25,500 to a maximum of £55,000
- payment for additional hours worked up to the maximum weekly average of 48 or 56 if doctors opt out of the Working Time Directive
- availability payments for on-call where doctors are required to be available at home
- higher pay rates for unsocial hours worked at nights, on Sundays and on Saturday evenings
- pay premia for trainees in hard to recruit specialties; initially general practice, emergency medicine and psychiatry
- transitional protection for foundation trainees and those in specialty and core trainee (ST/CT) years 1-2 to August 2019 which means that 99% of doctors will receive no less pay than as at October 2015 (with the exception of around 500 doctors on band 3 pay for whom the appropriate action is to reduce hours worked to safe levels)
- for higher trainees from ST3 onwards maintains present pay and banding (with the exception of Band 3 pay) until August 2019.
Junior Doctors can see what the arrangements will mean for them by using NHS Employers’ pay calculator. CLICK HERE. If any constituent, who is a junior doctor, has any concerns about their particular pay rate please do contact me.
As part of the agreement reached with ACAS, all workings have been shared with the BMA so it is clear how the contract offer has been costed and that average pay for junior doctors will not reduce.
Definition of plain time and unsocial hours
The proposals in the new contract will protect pay and protect doctors from working unsafe hours as has been set out above.
The government has consistently set out the fundamentally important role that junior doctors play in providing clinical cover at weekends. But it has also been clear that the objective is to achieve the same consistency of standards throughout the week, and that this will involve all parts of the workforce being rostered to provide care through weekends as well as during the week.
The November contract offer designated plain time for pay purposes as 7am to 10pm Monday to Friday, and 7am to 7pm Saturday. The offer made clear all other time was to be paid at an enhanced rate. This would be time plus 50% for nights and time plus 33% for Saturday evenings and Sundays.
The DDRB (the Review Body on Doctors’ and Dentists’ Remuneration) report set out clearly that current plain time definitions are out of line with the wider economy and that comparator groups to doctors generally do not receive unsocial hours enhancements. In ACAS, however, NHS Employers confirmed as part of an overall agreement their preparedness to discuss their proposals. They also offered to discuss protections relating to the frequency of weekend working. Employers also take the view that night working is onerous and should receive a higher premium.
7 Day Services
The ambition to deliver more consistent standards of urgent and emergency care across 7 days will require change across every area of healthcare delivery, not just doctors’ contracts.
The 7-day services programme which started in 2009 is designed to improve the whole range of weekend services, from making diagnostic tests like MRI scans available, to providing better support services like pharmacy and physiotherapy so that patients can get the treatments they need in good time. There are also plans to integrate health and social care to make it easier for doctors to discharge patients at the weekend and improve flow across the hospital.
Employers are clear that they need to be able to roster staff when they are needed. However doctors in training can be assured that they will not be expected to work longer than an average 48 hours and average pay will not reduce.
Below is a time line of the stages in this long-running dispute.
Again, I have tried to make the information as factual as possiblebecause I believe that there has been far too much miss-information on this important issue.
During the negotiations the BMA union walked out of talks twice, circulated a grossly misleading pay calculator to their members when no proposals were on the table, broke a written promise to compromise on Saturday pay by refusing to discuss the issue in negotiations and rejected a final offer from the Government that independent NHS leaders judged a fair and reasonable compromise.
The government wants to modernise the Junior Doctors Contract to make it fairer for doctors and safer for patients.
In 2012 the British Medical Association and NHS Employers began discussions on the new contract. The negotiations broke down in October 2014. An independent review body, the Doctors’ and Dentists’ Review Body (DDRB), was invited to review the contract and to make recommendations, which were published in July 2015. The BMA declined to re-enter negotiations at that point.
The new contract offer, which takes account of the DDRB recommendations, was published in November 2015 by NHS Employers. CLICK HERE to read that contract offer.
The Health Secretary made a written statement to Parliament on 4 November on the proposed contract and invited the BMA to return to the negotiations without preconditions. CLICK HERE to read that Written Statement.
The Secretary of State gave a speech to Parliament on 30 November 2015, outlining that agreement had been reached to continue negotiations and avert the previously planned strike action. CLICK HERE for more details.
ACAS, the company who mediates these sort of negotiations published a memorandum of understanding which set out the terms under which the negotiations would proceed. CLICK HERE for more details
Following weeks of talks, NHS Employers’ Chief Executive Danny Mortimer wrote to Jeremy Hunt on 4 January 2016 outlining the position the contract negotiations had reached as the BMA announced its intention to take industrial action. CLICK HERE to read that letter.
In response to the BMA’s announcement the Health Secretary wrote to Chair of the BMA Mark Porter expressing his disappointment at the decision. CLICK HERE to read that letter.
Sir David Dalton, Chief Executive of Salford Royal NHS Foundation Trust has been appointed by the Health Secretary to lead negotiations on behalf of government and the NHS in new talks with the BMA.
Sir David wrote to chief executives, human resource and medical directors in the NHS on 5 January to explain his new role in the negotiations.
On 7 January, 3 senior NHS leaders wrote to every Junior Doctors at the request of Sir David Dalton regarding the proposed new contract for Junior Doctors . This included key areas such as pay and safety and non-contractual matters around training, to ensure every Junior Doctors was in full possession of as much relevant information as possible in advance of industrial action. CLICK HERE to read the letter in full.
The conciliation service, ACAS, facilitated talks on Friday 8 January in which it was agreed that talks would continue in the week beginning 11 January.
ACAS announced that all parties had agreed to recommence talks on Thursday 14 January to try and reach a negotiated settlement.
NHS England has published a statement on the action taken on 12 January. CLICK HERE to read more.
On 1 February the BMA announced its intention to strike on 10 February as planned but modified the level of service it asked Junior Doctors to withdraw. Rather than an all out strike, emergency services were still provided and the strike lasted for 24 hours from 8am.
Jeremy Hunt wrote to the Chair of the BMA Council, Mark Porter, in response to the latest decision to strike. CLICK HERE for that letter.
The BMA announced its intention to suspend the previously announced 48-hour strike as talks continue.
A Department for Health spokesperson said:
The strike that took place last week was unnecessary while talks are ongoing, so it’s extremely welcome news that the BMA has suspended next week’s action, though as it stands emergency care will still be withdrawn in February. In the end, the government and junior doctors want to do the same thing by improving patient care at weekends – and we look forward to further constructive discussions.
On 3 February Sir David Dalton wrote to all doctors in training, updating on the progress with negotiations with the BMA Junior Doctors Committee.
On 10 February Sir David Dalton wrote to Jeremy Hunt to update him on the negotiations and to advise that government should do whatever it deems necessary to end uncertainty for the NHS.
The Health Secretary gave a statement to Parliament on the introduction of the new junior doctors’ contract on 11 February. CLICK HERE for that statement. An independent review into junior doctors’ experience of their training and support while working for the NHS and looking at the long-standing issue of low morale was also announced.CLICK HERE to read more information.
On 23 February the BMA announced 3 further dates of industrial action in March and April.
Dr Mike Durkin, NHS National Director for Patient Safety, wrote an open letter to junior doctors on 4 March in which he described the contract changes as ‘good for doctors and patients’. CLICK HERE for more information.
On 8 March the Government Legal Department set out the Health Secretary’s response to the proposed claim for judicial review by the BMA regarding the introduction of the new contract. CLICK HERE to read that response.
On 23 March the BMA announced its intention to escalate industrial action to a full withdrawal of labour, including emergency cover, for 48 hours on 26 to 27 April.
A Department of Health spokesperson said:
This escalation of industrial action by the BMA is both desperate and irresponsible – and will inevitably put patients in harm’s way. If the BMA had agreed to negotiate on Saturday pay, as they promised to do through ACAS in November, we’d have a negotiated agreement by now – instead, we had no choice but to proceed with proposals recommended and supported by NHS leaders.
On 31 March, the equality analysis of the new junior doctors’ contract was published. CLICK HERE to read that analysis.
The new terms and conditions were also published by NHS Employers HERE.
On 19 April the Health Secretary wrote a response to a letterfrom the BMA’s Chair of Junior Doctors’ Committee, Dr Johann Malawana, about the forthcoming industrial action on 26 and 27 April. CLICK HERE to read the Health Secretary’s letter.
On 24 April, Jeremy Hunt wrote to Mark Porter, Chair of the BMA, to invite him to a meeting on Monday 25 April and to appeal to him to avert the strike planned for later that week, when junior doctors will withdraw potentially life-saving care for the first time. CLICK HERE to read that letter.
On 25 April, Jeremy Hunt gave a statement to Parliament on NHS 7 day services and the impact of industrial action by junior doctors. CLICK HERE to read that statement and the following questions.
Mr Hunt also wrote a second letter to Mark Porter and reiterated that his offer to meet to find a way forward was still open. CLICK HERE to read that letter.
I hope that this very sad situation can come to an end soon. It is not right that the Government should be held to ransom by a trade union and I hope that a contract can be agreed as soon as possible. It also deeply concerning that strike action has affected the health of my constituents and people up and down the country. We must together work to improve our NHS for both NHS staff and also the British public who fund it.