During the past year junior doctors have learnt a lot. From how to organise a picket and deal with the media, to contract law and equality impact assessments.
On Wednesday 18 May, the Government taught us a lesson in media management.
News of the deal at the government arbitration service ACAS broke, and the Government was able to shape the story. “The war is over”, “the deal is done”, “BMA agrees terms with NHS Employers”.
It left a lot of junior doctors scratching their heads. Was that it? Had we just lost?
Jeremy Hunt appeared on the news, and we thought, how could the BMA have done a deal with this man? How could any deal be any good with the claims Hunt has made?
There are in fact parts of the deal which are good for junior doctors, and directly contradict Hunt’s spin. There are other bits of the contract which are not good enough. The apparent return to accepting that the deal must be “cost-neutral” leaves junior doctors open to more attacks down the line.
The full contract will not be finalised and released until 31 May. However, barring major surprises, I will be arguing for junior doctors to reject this contract.
It will be put to a referendum of BMA junior doctor members (and last-but-one and last-year medical students) from 17 June to 1 July. The ACAS formula names 3 August 2016 as the “effective date” for a new contract, and says that “transition to the new terms and conditions of service” for various groups will be staggered from October 2016 to August 2017.
The BMA Junior Doctors’ Committee will meet on 3 June to discuss our position on the contract.
Strikes, demonstrations, and tough negotiation have won us concessions from the government. I think we could win more. Junior doctors are in a powerful position and have made this a fight about the whole NHS. We should not lose faith in that collective power now.
With the release of the NHS deficit figures, and the evidence of a deliberate running down of the NHS by the government, I don′t think we should give up the political fight for a few industrial gains.
What is in the ACAS formula?
Pay and Weekends: Currently junior doctors receive a pay uplift for unsocial hours (called banding.) The new contract splits this pot of money into sections. It has a pay premium for hours worked at night, retains a banding for Non-Resident on-call (NROC) and introduces a graded banding for weekend work.
This graded banding based on the number of weekends worked is vital for junior doctors. It will deter trusts from rostering more doctors at weekends.
Because it is a banding system it applies to the entire weekend. The risk of a junior doctor being asked to work repeated Saturdays as plain time has gone.
Junior doctors have got what we wanted, a financial disincentive to routine weekend working.
Pay for all work done: Late last year the Junior Doctors’ Committee stated that it wanted pay for all work done. The previous version of the contract honoured this on paper, but not in practice. It stated that if a junior doctor could predict the hours they were going to be overworked, then they could request to be paid for these hours. That would never work in practice.
The ACAS formula states that we will now be able to claim for these hours before, during or after the period of extra work. Doctors will be able to ask for the time to be added to annual leave or claim it back as money.
This will be overseen by the “Guardian”, a newly created role with oversight over a number of areas.
Equality: Here that the ACAS document doesn’t stand up well. The March contract was rightly attacked for its discrimination against women, lone carers and the disabled. The ACAS formula makes some moves in the right direction, but many of these are of speculative benefit.
Loss of annual pay progression means a less equal contract. The new contract is weak on evening working, where safeguards are particularly important for carers.
The Government plans for this contract to be implemented before much of the work around rotas, equality issues or safety has been completed.
Cost Neutrality: Jeremy Hunt argues this contract is “cost neutral”. It doesn′t require the government to give more funds to the NHS.
Compared to October 2015, he says, this new contract will cost no more than our current contract. If we were to transport ourselves back to October 2015 and put all junior doctors on the new contract, the pay envelope would be the same.
But the ACAS formula can’t be cost neutral. An accurate estimate of the extra work done by junior doctors is difficult, but there is a lot of it. If the NHS starts paying for that extra work, then cost neutrality is blown out the window.
Hunt’s “cost-neutral” claim, unless refuted, gives the Secretary of State political leverage for further cuts. In a year’s time, when the pay bill has grown to the NHS actually paying doctors for the work they do, how will the Government respond?
In order to keep the pay bill “cost-neutral”, will it cut doctor numbers? Will it ask hospitals to cut services? Will it try to close whole wards or hospitals?