Decision time on consultants' contract
BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7367.729 (Published 05 October 2002) Cite this as: BMJ 2002;325:729All rapid responses
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According to my dictionary, a ballot is a secret vote. The voting on
the new consultant contract is so secret that many of us have not received
papers. I read that they were supposedly sent out on 25th September and
must be returned by 25th October, yet I and colleagues known to me at
Guy's and other hospitals have yet to receive any communication. Some
other colleagues have received two papers. Who is running this ballot --
the ghost of Spike Milligan?
I contacted the Electoral Reform Society last week, and they assured
me they would contact the BMA and I would receive papers by the next post.
Nothing has happened. I have just phoned the BMA on a helpline number I
have found through the internet, but time is getting short.
I have been a consultant for 22 years, and have rarely encountered
such incompetence. If the ballot matters, it should be re-run properly.
If it doesn't matter, why are we having it?
Competing interests: No competing interests
Editor - The editorial "Decision time on Consultants’ Contract" (1)
was balanced. Its first sentence is a crucial one: “In 1999, the UK
Government promised a Consultant delivered NHS, relying on a new contract
for Consultants to increase commitment to the NHS.” The problem is that
the contract which is now the subject of a ballot appears to have been
designed so as to destroy the goodwill and altruism which remains
absolutely essential if Consultants are to maintain, let alone increase,
their commitment to the NHS. The Department of Health and the British
Medical Association are promoting the new contract, and have set about
formulating and selling the proposals in a most extraordinary manner. It
is almost as if they are acting in concert to defeat the very goal that
they purport to be seeking. I have written an open letter to Dr. Ian
Bogle, the Chairman of the Council of the BMA in order (a) to list and
explain why aspects of this approach give rise to serious concern, and (b)
to suggest how dissatisfied BMA members might stimulate a radical re-
assessment of the BMA’s effectiveness as a Trade Union. I have already
distributed this open letter widely amongst other doctors in order to
provoke discussion and debate. Nevertheless, your readers might welcome
the opportunity to consider the validity of these criticisms, and to
disagree or agree with the suggestion as to a way forwards. I attach the
open letter which was sent to the Council of the BMA yesterday.
AN OPEN LETTER TO DR. BOGLE AND TO THE COUNCIL OF THE BMA
Whatever the outcome of the ballot on the proposed Consultant
Contract there needs to be a radical re-think at the British Medical
Association. Whether a massive no, even-stevens, or a swingeing yes – the
BMA has lost the trust of a large number of Hospital Doctors.
Those who work within the BMA are clearly committed and principled
individuals. They have sought and accepted positions as medical
politicians. No one forced anyone to stand for election. So, when a BMA
Committee, BMA working party, or BMA negotiating group fouls up the
Association needs to take a long hard look at itself. The Consultants’
contract is a foul up. The BMA in general, and the CCSC in particular,
should be shamefaced. Consider the following:
1. The BMA dumped a basic trade union obligation. Professional worth
is not measured simply in terms of remuneration, but the levels of
remuneration need to be set at a professional level. The BMA chose to
lend support to the Department of Health’s shabby judgement of the value
of Consultant work when agreeing that working the proposed core sessions
at any time between 8.00am and 10.00pm on weekdays and between 9.00am and
1.00pm on Saturdays and Sundays should all be paid at the plain time
(basic) rate.
2. The BMA mugged young female Consultants. Working the core four
hour sessions at any time up to 10.00pm at night, or at weekends to
1.00pm, is the antithesis of a family friendly policy. Did the BMA not
seek advice and opinion from a representative group of working Doctor
mothers? This part of the framework is insensitive and short sighted.
Many of the young Consultants now in practice are women. And, in the
future? Presently, 50% of medical students are female.
3.The BMA mugged the Specialist Registrars. The Health Secretary’s
threat to ban newly appointed Consultants from working privately for seven
years was a heaven sent negotiating opportunity. This proposal could have
been accepted pro tem as a negotiating stance under Chatham House rules
whilst insisting on additional and important items as the quid pro quo.
The Department of Health negotiators, and the Health Secretary, would have
blanched at pursuing their lop-sided and stark proposal – not least
because the NHS needs lots of new surgeons, lots of new anaesthetists,
lots of new others. Driving a significant number of these young doctors
into chambers, or making them angry and resentful, would cost the NHS, the
NHS Plan, and the Health Secretary’s political ambitions (spare us his
rhetoric) very dear indeed. Instead, the BMA negotiators kow-towed, and
agreed to a smoke and mirrors stitch-up of the about-to-be Consultants.
Obliged to work an extra 8 hours for the NHS (i.e. not 40 hours, but 48
hours) each week before they can take up private practice activity in what
remains of their free time! This is a contract designed for and agreed to
by middle-aged male Doctors who lack the imagination and vision to address
the needs of those different from themselves.
4. The BMA has wallowed in self deception. The lead Department of
Health negotiator (Mr. Andrew Foster, Director of Human Resources for the
NHS) has made it absolutely clear what he thought of the BMA negotiators
(slide below). It indicates how he thinks that the Consultants must be
treated by their local managers. Re-examine this wonderfully candid
overhead / powerpoint slide. If the BMA Council does not feel both
alarmed and humiliated by its content then it can only be because Council
members have chosen not to look at it. Here is another opportunity for
all of us to relish the exquisite and myriad delights included under Mr.
Foster’s key issues.
_________________________________________________
KEY ISSUES
BMA think managers will not use the contract
Tools that MUST be used
- agreeing new job plans with more clinical care
- only paying extra for work already done to the deserving few who do the most
- using evening and weekend sessions
- using the extra plain time rate sessions
- agreeing important and stretching objectives
- withholding pay progression if not earned
- implementing the private practice rule book
________________________________________________
Subsequently Dr. Peter Hawker (BMA News 10 August 2002) was quoted as
saying that “he believed the (Foster) overhead was no longer in use.” So
that’s all right, then. Well, no it isn’t. It was the subsequent furore
which forced Mr. Foster to indulge in damage limitation by withdrawing his
slide. Withdrawal does not mean, as Dr. Hawker implies, that Mr. Foster
“didn’t really mean it”, or “had his knuckles rapped”. Dr. Hawker might
do well to remember that if it looks like a duck, quacks like a duck, and
it’s father is a duck, then it is – a duck. Just because it flies away
temporarily does not mean that it isn’t a duck.
5. The BMA missed the big opportunity. The number of practising
Doctors in the UK is at a very low level (see OECD international
comparison). In order to get these relatively few Doctors to
enthusiastically produce even more work the BMA negotiators needed to play
this powerful bargaining chip forcefully. The framework document
indicates that the CCSC utterly failed to do so.
___________________________________
Practising Doctors per 1,000 population 2000 Germany 3.6 France 3.3 USA 2.8 Eire 2.3 New Zealand 2.2 Japan 1.9 U.K. 1.8 OECD 2002
________________________________
6. The BMA has denigrated those who have had the effrontery to
question its competence. Take just one example. Any suggestion that the
BMA needs to use professional negotiators has been dismissed out of hand
by CCSC members: “Doctors (i.e. BMA Doctors) know best … no such thing as
a professional negotiator … you don’t understand / you are naïve in these
matters.” The BMA’s incomprehension is startling. If you took 100
Consultants from any Trust, however brilliant, however clinically able, it
would be difficult to find even one who would have the requisite aptitude
and skills to carry out contract negotiations at a National level. Such
skills, joined to a strong backbone, are rare. Why, de jure, should Dr.
Peter Hawker and his negotiating team be expected to have this expertise?
Most of the doctors who have risen within the BMA have done so because of
their medico-political ambitions, perhaps also because they are good
speakers or good organisers. But, good negotiators? Where is the
evidence that an ability to negotiate is also part of their competence? A
more worldly-wise BMA would seek out Doctors with proven negotiating
skills (perhaps one or two of the Junior Doctor negotiators). These
individuals would put together a team of outside professionals with minds
that are sharp and uncluttered by medico-political manoeuvrings. A hard
nosed barrister and a skilled accountant would be essential for a start.
Expensive? It appears that the BMA has money to burn – it has spent over
£400,000 on Roadshows to explain away the present leaky and confusing
construction. Unfortunately, putting together a really professional
outfit requires the wit to ditch our institutional conceits and our
amateur pretensions.
7. The BMA has indulged in unremitting propaganda, spin, and logic-
chopping. Dr. Bogle, how do we reconcile your tough and sweeping
declamation with the various statements made by leading members of the
CCSC? Your approach is certainly robust. “Make no mistake. We will bite
hard and where it hurts if that’s what it takes to make the Government
understand it cannot use the NHS, those who work in it, and those people
who need it, as playthings.” (Dr. Ian Bogle, BMA Council Chairman. BMA
News, 6 July 2002).
Contrast your stance with the numerous sorry statements from members
of the BMA’s CCSC. Statements aimed at browbeating or cowing - not the
Government - but the BMA’s constituency, the Consultant voters.
Threatening. “The framework agreement must therefore
stand or fall as a package – there is no question of re-negotiating the
essential aspects of it.” (Dr. Hawker letter to all UK Consultants.
21 June 2002).
Threatening. Questioned as to his plans if there is a
“No” vote, Dr. Hawker replied “The deal will be dead. DOH will not allow
renegotiation”. (Hospital Doctor, 12 September 2002).
Be afraid … be very afraid. “Were the contract rejected
the Government could introduce a subconsultant grade …” (Mr. Derek
Machin, lead BMA negotiator. BMA News, 6 July 2002).
Threatening or … exhausted or … irresponsible? “Were
the contract rejected, (the) Consultants have no Plan B”. (Mr. Derek
Machin. BMA News, 6 July 2002).
Arrogant. “Dr. Hawker has refused to rule out the
possibility that even if a majority of doctors vote against the contract,
he will accept it anyway.” (Hospital Doctor, 1 August 2002).
Arrogant. “We have to ask ourselves why practically
every member of the CCSC voted for this contract. They understand
political realities, and that’s what distinguishes members of the CCSC
from the majority of Consultants”. (Dr. Michael Goodman. Hospital Doctor,
15 August 2002).
Washing my hands of it. “My regret is that we could not
secure the same terms (re. private practice) for all Consultants. There
is a difference for newly appointed Consultants … unless they are prepared
to accept a pay penalty they must work 48 hours rather than 44 hours for
the NHS before they can undertake private work.” (Dr. Peter Hawker. BMA
News, 22 June 2002). P.S. The core working week for those not carrying
out private practice is to be 40 hours.
Disingenuous. “We were determined to resist the
politically inspired but non-sensical and unacceptable proposal to ban
newly appointed Consultants from working privately for the first seven
years … we have achieved this objective.” (Dr. Peter Hawker. BMA News, 22
June 2002).
Contradictory and … disingenuous. “… the BMA has also
accepted the Government’s move to impose tighter controls of Consultants
by NHS managers” (BMJ, 22 June 2002, Page 1473) and yet Dr. Peter Hawker
(Hospital Doctor. 18 July 2002) claims that “the new contract does not
give managers any greater powers than they have now”. Dr. Hawker again
“the new contract does not give managers new powers, in fact it will offer
Consultants greater protection than your existing terms and conditions of
service” (CCSC Newsletter, August 2002).
8. The BMA has demonstrated a lack of bottle. Clearly, the CCSC
Chairman and his negotiating team worked extraordinarily hard over several
years. They had a very tough task dealing with Department of Health
negotiators who are understandably frightened of giving any inch that
might possibly perturb the ambitious Health Secretary, Mr. Alan Milburn.
This is not surprising. Their jobs are on the line. But, the BMA
negotiators had alternatives. Either to call the Department of Health’s
bluff on the numerous unpalatable bits in the contract or, exhausted, to
slip into bed with those on the other side of the table. It would have
taken real courage, and an abandonment of amour propre, to have called the
DH’s bluff and returned to the Consultant body and say “these people are
impossible to negotiate with - they want 14% more work out of you for a 4-
7% increase in pay; they want to pay you as little as £1 per hour for
being on call; they want your core working week to be increased from
35/38 to 40 hours; they want these core working times carried out at any
time up to 10.00pm at night and up to 1.00pm on Saturdays and Sundays and
they are insisting that all these sessions be paid at no more than the
basic rate; their proposals are particularly exploitive of working doctor
mothers; they are demanding a 7 year ban on private practice.
Furthermore, the Government has yet again demonstrated its bad faith by
reneging on the earlier assurance that the new contract (once agreed)
would be backdated to 1st April 2002. We cannot agree to their
extraordinary demands. We will advise Council to ballot the Consultant
workforce in order to ask the Consultants if they would wish to avail
themselves of the opportunity of taking some form of industrial action in
order to improve pay and conditions”. Seemingly, this was too courageous
a stance for the BMA’s CCSC and its Chairman. It wasn’t simply that too
many medico-political careers might have gone bung. It was a dreadful and
demeaning collective lack of courage.
------------------------------------------
So, what is the purpose of this letter to the Council? Simply
another harangue at an institution under siege? Just an angry railing
against the medical establishment? An inchoate cry against the CCSC’s
abject acquiescence in the junking of professional autonomy and
flexibility? In part it is all of these but it is also a call for change.
Whatever the outcome of the ballot there needs to be a major overhaul
within the British Medical Association. Is that likely to occur? The
BMA’s mixture of threatening and defeatist statements, the propaganda, the
puff, the pamphleteering, the pusillanimity, none of these provide any
reason to believe that the BMA Council is listening.
But … Doctors, both Hospital Doctors and General Practitioners, need
a strong union. They need the BMA; a radically altered BMA in terms of
its attitude and its approach to Trade Union matters. It is time that the
membership, both General Practitioners and Consultants, grasped the reins
in order to stimulate change. How can we do this? We should write to our
Banks with an instruction to stop the monthly direct debit (subscription)
as from 1 January 2003. We should write resignation letters to the
Chairman of Council explaining that we have set this process in motion.
We should start setting up these January cancellations as soon as
possible. A rock fall – or even better an avalanche - of cancelled Direct
Debits would cause the officers of the Association to move very fast
indeed and radical change would be proposed. When those changes are
detailed in writing and time tabled for action, then we should all rejoin
a BMA which belatedly has understood its primary function and seeks to
regain our trust. A professional negotiating team with explicit
objectives and adhering to clearly defined principles could then be
mandated to meet with our employer so as to set about devising a proper
professional contract.
Dr. Bogle, as Chairman of Council you have talked tough … “make no
mistake we will bite hard, and where it hurts, if that’s what it takes to
make the Government understand …”. You at least will recognise that
puncturing the anachronisms and pretensions of the BMA lies in the hands
of a membership which really does have teeth. We should use those teeth.
We should stop the January Direct Debits tonight. We should not wait
until tomorrow. It is up to us, the membership, to stimulate change.
Whatever the outcome of the ballot.
End
-----------------------------------------------------------
Yours faithfully,
Dr. Gerald de Lacey
Consultant Radiologist
Northwick Park Hospital, HA1 3UJ
Email address: gerald.de-lacey@nwlh.nhs.uk
1. Gray D. Decision time on consultants’ contract. BMJ 2002; 367: 729
-30 (5 October).
Competing interests: Practising Doctors per 1,000 population 2000Germany 3.6France 3.3USA 2.8Eire 2.3New Zealand 2.2Japan 1.9U.K. 1.8OECD 2002
EDITOR- The editorial “Decision time on consultants’ contract” (1) is
fair but makes one vital error; consultants are not voting on a contract.
The ballot paper asks “Do you wish to have the opportunity to take up a
new contract based on the framework agreement and subsequent
clarification, from April 2003?”
For most consultants, accepting or rejecting a new contract will be
the most important decision that they make; it will have far reaching
consequences for their financial wellbeing and personal lives. Voting yes
to the above question is like buying a house on the strength of the estate
agent’s particulars. Your present accommodation which you have occupied
for years is dreadful and you are desperate to move, you receive details
of an exciting sounding house (usual caveats included: measurements are
approximate and the agent is not responsible for any inaccuracies) and you
go to view. From the outside the house looks wonderful but some of the
rooms are locked and cannot be inspected and it becomes clear that there
are potential problems with a disputed boundary and rights of way. You
ask the agent for clarification but despite further correspondence you are
none the wiser and not reassured. The vendor presses hard for an early
exchange of contracts and with the agent tells you that you will never
find another bargain like this one; such chances come once a lifetime!
Your solicitor adds a further note of uncertainty by telling you that the
vendor has a long track record of shady dealing. I doubt many consultants
would buy a house under these circumstances; there is always another day
and another house.
The position of the government and the BMA that there will be no
renegotiations and any negotiations on a different contract will be
delayed for several years is both offensive and unsustainable. The
government has a large agenda for the NHS; it will not meet its objectives
without the commitment of the consultants. If the result of the ballot is
no as it may well be, the government would be sensible to start a further
dialogue and the BMA wise to employ professional negotiators. The likely
response, however, will be an orchestrated campaign to denigrate the
consultant body yet again. Is the BMA’s public relations department ready
and waiting?
Gray Smith-Laing
consultant physician and gastroenterologist
Medway Maritime Trust, Windmill Road, Gillingham, Kent ME7 5NY
Gray.smith-laing@medway-tr.sthames.nhs.u
1 Gray D. Decision time on consultants’ contract. BMJ 2002; 367:729
-30. (5 October.)
Competing interests: No competing interests
Female medical students
Gerald de Lacey draws attention to the British Medical Association's
lamentable failure to negotiate a family friendly contract. He states:
'presently 50 % of medical students are female'; in fact, the proportion
is 59%(1)and rising steadily as young men become less and less interested
in pursuing a medical career. From McManus's charts one can infer that the
number of male applications to medical school is falling at c. 200 per
annum and is now less than 60 % of what it was in the mid-seventies: if
the young women also get the idea that medicine is not for them we really
shall be in a mess.
1. McManus IC. Medical school applications - a critical situation.
BMJ 2002;325:786-787 (12 October).
No competing interests
Competing interests: No competing interests