The threat of imposition

Politicians’ continual demands for doctors to do more, faster, and for less were unlikely to pave the way for easy negotiations over changes to doctors’ pay and conditions. In fact, the BMA has acknowledged that it knew from the start that discussions over changes to the contracts for consultants and junior doctors were likely to be “challenging.” NHS Employers, which negotiates on behalf of the government, has spoken of the “18 months of serious discussions” underpinning the negotiations. Nonetheless, the news that discussions between the two organisations had broken down was still disappointing.

This week Abi Rimmer looks at what doctors can expect to happen in the wake of the collapse of the talks (http://careers.bmj.com/careers/advice/view-article.html?id=20019802). Most strikingly, her article points to the possibility that, rather than being agreed, changes to the pay and conditions of consultants and junior doctors could be imposed on the profession.

The imposition of changes to contracts could occur in several ways that do not require every current consultant and junior doctor to sign a new contract immediately. For instance, the existing contract arrangements could be closed to those taking up new positions, or agreements could be reached at a local level. Another possibility is that the benefits of the current arrangements could be gradually eroded to such a point that doctors are forced either to move to a new contract or lose out.

The government certainly has form in this area. After the collapse of talks over changes to the 2013-14 contract, ministers imposed the changes it sought before GPs returned to a negotiated settlement for the changes to their contract in 2014-15. Given that consultants and junior doctors last agreed new contracts over a decade ago, the effects of an imposed contract might be much more long lasting for them.