Views And Reviews

Junior doctors plan further hours' survey

BMJ 1994; 309 doi: (Published 01 October 1994) Cite this as: BMJ 1994;309:882
  1. L Beecham

    Under the new deal on junior doctors' hours of work no doctor should be contracted to work more than 72 hours on an on call rota in hard pressed posts after 31 December 1994. The Junior Doctors Committee does not believe that this target will be achieved universally and plans to survey junior doctors before the end of the year to highlight those places where the targets are not met.

    In the anonymous questionnaire doctors will be asked to provide details of their working patterns, contracted hours, whether these include cover for colleagues' annual and study leave, and the maximum number of hours on duty without a period off duty. There are questions on standards of accommodation, personal security, and catering. The JDC also wants to know if doctors regret taking up a career in medicine.

    The progress reports from task forces for the period 30 September 1993 to 31 March 1994 show that if the rate of reduction of hard pressed on call posts remained the same until the end of the year there would still be 5500 posts (21% of all posts) outside the contracted hours' targets. Since the reports were completed, however, several steps have been taken. Task forces have been given a greater role in approving further staff grade posts and, with postgraduate deans, to vary the number of senior house officer posts. A further £11.6m was made available for 125 extra consultant posts. Authorities and trusts were asked to conduct an urgent review of skill mix and reassess working arrangements.

    The medical director of the NHS Executive, Dr Graham Wingard, has emphasised that the new deal remains “a high ministerial priority.” He says that the small number (13) of posts reported to be contracted for over 83 hours in March should have been eliminated.

    A working group has been set up to examine ways of monitoring hours of work and of involving junior doctors and purchasers in the process. This has recommended that all units should introduce a system for assessing hours of work, which is agreed by task forces and juniors' representatives, and that reports on hours of work should not be accepted by task forces unless they have been validated by juniors' representatives.

    In the reports to 30 September 1994 Dr Wingard has asked task forces to assess the percentage of posts where doctors are working more than 56 hours - the December target for doctors on full shifts.

    Juniors oppose performance related pay

    The JDC is strongly opposed to performance related pay in the medical profession, but at its meeting last week the committee defeated by one vote a motion from the Northern Ireland JDC that the executive committee should “formulate a rolling programme of industrial action, not excluding strike action, to be put to junior doctors in the event of the government persisting in this ridiculous pursuit.”

    There was sympathy for the sentiment of the motion but several speakers pointed out the constraints of taking industrial action. This had to be against an employer when a dispute arose; but it was the government and not health authorities or trusts which wanted to impose performance related pay. Dr Keith Reid, a research fellow in physiology in Sheffield and a JDC deputy chairman, said that the motion was premature and the committee should see what the review body recommended in its 1995 report. The former chairman, Dr Edwin Borman, said that he was not opposed to industrial action but that the BMA was in the middle of an effective campaign to oppose performance related pay. He urged members to write to their members of parliament, and he reported that representatives of the BMA would be meeting the Royal College of Nursing to discuss performance related pay.

    New regional directors of public health appointed

    The number of regional health authorities (RHAs) in England was reduced from 14 to eight in April, and seven regional directors of public health were appointed last week.

    North West: Professor John Ashton, at present professor of public health policy and strategy at the University of Liverpool.

    West Midlands: Professor Rod Griffiths, at present professor of public and environmental health at the University of Birmingham.

    Trent: Dr Lindsey Davies, at present head of the public health division at the NHS Executive.

    Anglia and Oxford: Dr Pat Troop, formerly director of public health for the former East Anglian RHA.

    North Thames: Dr Sheila Adam, formerly director of public health for North West Thames RHA and at present visiting professor at the London School of Hygiene and Tropical Medicine.

    South Thames: Dr Sue Atkinson, at present acting regional director of public health and clinical development at the South and West RHA.

    South and West: Dr Gabriel Scally, formerly director of public health for South East Thames RHA.

    It had previously been agreed that Professor Liam Donaldson, regional director, would also be regional director of public health for the Northern and Yorkshire RHA.

    The regional directors will become regional medical directors of the NHS Executive when regional health authorities are abolished, subject to parliamentary legislation, in April 1996.

    Government maintains position on public sector pay

    The government has emphasised that a tight regime on pay will continue to play an important part in overall expenditure control. In its economic evidence to the pay review bodies, which include the doctors' and dentists' review body and cover 25% of the public sector, the government points out that any increases in pay should be at least offset by improvements in efficiency or productivity. Pay increases, it says, have to be earned and annual, across the board increases should not be regarded as a right.

    The government's intention is that pay should be set at levels to recruit, retain, and motivate staff within available cash levels. There will be no access to the reserves to fund pay settlements in the coming year. It will be up to employers and employees to negotiate settlements to reflect local circumstances and performances. The government says that there will be no set limit laid down centrally and no need for agreed procedures for pay bargaining and pay setting to be abandoned.

    In its evidence to the doctors' and dentists' review body the National Association of Health Authorities and Trusts (NAHAT) says that it supports the retention of the review bodies but hopes that they will not tie the hands of NHS trusts by making awards that are not appropriately linked to central funding. It wants the review bodies to facilitate the move to devolved local pay determination. NAHAT supports the government's view that the review bodies should determine a small, nationally based pay award and that the trusts should be able to decide on a local reward, which reflects local circumstances and performance.

    Nurses call for 8.3% increase

    The unions representing the 600 000 nurses, midwives, and health visitors have asked for an increase of 8.3% in their evidence to the nurses' pay review body, maintaining that their members' pay has slipped relative to other professions.

    The health minister Mr Gerald Malone said that the nurses' claim was unrealistic, and the Labour party's health spokesman, Mr David Blunkett, said that if the Labour party was in power it would offer a pay rise in line with inflation, which at present is 2.4%.

    BMA seeks information on advanced directives

    In its report earlier this year the House of Lords committee on medical ethics recommended that the health professions should develop a code of practice on advance directives or living wills. The BMA will coordinate the drafting of a code and has set up a working party chaired by Mr Derek Morgan of the Institute of Law and Ethics in Medicine in Glasgow.

    The working party wants to gather information on present practices of drafting and implementing advance directives from doctors and other health care professionals, lawyers, hospital managers, and administrators. It would welcome evidence of good practice from any of these sources or from others with experience of operating advance directives.

    Information should be sent to the secretary of the working party on advance directives, BMA, BMA House, Tavistock Square, London WC1H 9JP by 31 October.

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