Applicants for senior medical positions in New ZealandBMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.6996.61e (Published 01 July 1995) Cite this as: BMJ 1995;311:61
- Alec J Ekeroma
- Lecturer in obstetrics and gynaecology Department of Obstetrics and Gynaecology, University of Bristol, St Michael's Hospital, Bristol BS2 8EG
EDITOR,--Ian Powell raises several sad points about the employment situation for salaried medical specialists in New Zealand,1 which should serve as a warning to specialists in the NHS. The recent health reforms in New Zealand are similar to those in the NHS, with the creation of an internal market (a split of purchaser and provider functions) and devolution of decisions on staffing to the local level. Crown health enterprises (similar to NHS trusts) contract for services and negotiate pay and conditions with their workers.
Local pay bargaining, which is currently being debated in Britain, began to operate in the early stages of New Zealand's health reforms despite protestations by the nurses' and junior doctors' unions. Industrial action by the junior doctors' union in 1991 was not successful in the main because of two factors. Firstly, new industrial legislation effectively weakened influence of unions, and, secondly, there was minimal support from the New Zealand Medical Association (whose members are mostly general practitioners) and the Association of Salaried Medical Specialists. The recent campaign by the BMA (whose membership includes more than 80% of British doctors) against the introduction of local pay bargaining was successful mainly because of solidarity among medical staff and the active participation of senior consultants.
What happened next in New Zealand might happen to doctors' pay and conditions of employment in the NHS if local pay bargaining was introduced. In the first year of local pay bargaining one of the crown health enterprises in the South Island of New Zealand offered junior doctors 20% less pay than was offered to doctors in other parts of the country. The junior doctors took strike action, whereupon the crown health enterprise employed doctors from overseas. The same scenario was apparently repeated by another crown health enterprise in the North Island some two years later. Powell's letter confirms that consultants are now being given similar treatment. Local pay bargaining may control wage costs, but this has been to the detriment of the morale of staff and perhaps to the quality of service. The BMA has had the courage to resist local pay bargaining on behalf of its members, but resistance will be harder should the nurses and midwives lose their current industrial action against it.
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