Bitter dispute leads junior doctors to take unprecedented actionBMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2404 (Published 27 April 2016) Cite this as: BMJ 2016;353:i2404
Three years of negotiation have failed to produce agreement between the BMA and the government on a new contract1 for the 53 000 junior doctors in England. The bitter dispute has led to the first comprehensive strike in the history of the NHS, with juniors refusing to provide even emergency care. Despite the disagreement, Jeremy Hunt, health secretary for England, said that the contract would apply to junior doctors starting new jobs from next August.
Doctors are demoralised and suspicious that the contract will leave them worse off financially and that the new system won’t protect them from having to work unsafe hours, ultimately endangering patients.
The pay structure will change, disadvantaging those who currently work unsocial hours, although basic pay will rise on average by 13.5%. At the moment work done between 7pm and 7am and at weekends is considered out of hours and is paid at a premium rate. Under the new contract, Saturday would be treated as a normal working day for pay purposes, although anyone who works one Saturday a month or more will get premium pay.
Junior doctors contest Hunt’s claim that pay for Saturday working is the only outstanding issue in the dispute, although it is one of the main concerns. Other worries include the removal of pay protection for those who change specialties, whose pay is protected under the current system. Under the new contract, a doctor who moves into a shortage specialty will get a premium, but those who move into other specialties will see their pay reduced.
Annual pay rises will be abolished under the new contract and doctors in training will get pay increases only when they move to a higher level of responsibility. The Department of Health’s own equality assessment said that the new pay structure would disadvantage part time workers, many of whom are mothers. It insisted, however, that “any indirect adverse effect on women is a proportionate means of achieving a legitimate aim.”
Monitoring working hours
Another area of concern is the new Guardian of Safe Working system that will replace the current routine monitoring of working hours which employers undertake at least twice a year. The current monitoring system allows for appeals to an independent panel, but the new guardian will be employed by the trust, which junior doctors say will create a conflict of interest. They say that the details are still to be fleshed out and are not sure if the system is workable. The current system of fining employers for breaches of working hours rules works well, they say, but under the guardian system fines will be smaller and imposed in more limited circumstances.
Changes to the way non-residential on-call rotas are paid for—where doctors will be paid a small percentage of their normal hourly rate when on call at home—amount to “trying to put doctors on a zero hours contract,” one junior doctor has said. Doctors fear that the new system will encourage employers to put more doctors on call “just in case.”
Those who work while on call will be paid for the hours worked, which will be “calculated retrospectively across the rota cycle,” but how this will work is still unclear.
Right to change terms
The new contract also includes a term reserving the right of the employer “in our absolute discretion to review, revise, amend, or replace any term or condition of this contract and to introduce new policies and procedures, in order to reflect and respond to the changing needs or requirements of the organisation or the NHS.”
“It’s inconsistent with the concept of a contract that one party is bound by its terms and the other isn’t,” Robin Allen QC, a leading employment law specialist, told the BMJ. “It can certainly be challenged.”