AIBU unreasonable to say everyone should know about the junior doctor's contract the government is trying to impose?

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The government is seeking to impose a new contract on junior doctors. By junior doctors I mean all those in training I.e. Not consultants and GPs. Starting salary for these doctors is £22636 plus a supplement for additional & antisocial hours worked.
The contract seeks to re-classify normal working hours so that 9am on a Tuesday will be the same as 9pm on a Saturday night (so normal hours Include up to 10pm 6 days a week). This will lead to a pay cut of 10-30% for all junior doctors depending on which specialty they work in. They also propose to remove certain safeguards over lack of breaks & working over contracted hours.
They also propose to entirely scrap a pay supplement for junior doctors training to be GPs. This was designed to make pay equivalent to that of a doctor in hospital training who receives the pay banding I mentioned above. There is already a recruitment crisis in general practice. One in ten posts in England are unfilled in a recent survey. Many training posts are unfilled too.
You might think this doesn't matter to you but we are all patients sometimes. I know people who won't be able to afford their mortgage if the contract is imposed and they plan to emigrate. What will happen to the NHS then?

younggirl, "for what is essentially a training role rather baffling."

What I find baffling is that you don't understand what doctors actually do! Ah, if only ours jobs were actually "training" rather than a massive amount of service provision!

YoungGirl the figures are usually quoted as a % of GDP, so yes, it would include the "co-pay", although in practice in France at least top-up insurance is becoming obligatory.

I pay 8% of my salary as my basic insurance premium for state health care (covers approx 70% of my healthcare costs, in most circumstances) and my employer pays a contribution too. Between me and my employer we also pay €300 a month for top-up insurance, though you can get this a lot cheaper

Brioche, I am 31. I will be a "junior doctor" for at least another 4 years. Before working as a doctor I had as much real work experience as any new graduate - summer jobs etc. Are you really suggesting that it is now OK to suddenly cut my pay by 20-30% with no negotiation, and now you want to add in a clause to stop me from leaving the country if I can see a better deal elsewhere?

Can you really see no problems with that, or why people might be a little annoyed?

Although to be accurate the working time directive does not apply at all to managing executives which probably excludes most lawyers for example (no one really knows what that terms means) and also any employee is allowed to agree to exclude it so it isn ot true that the traditional hours are necessarily illegal.

Exactly Grazia. I suspect the reluctance to insist that doctors opt out is political - it doesn't look good for government employees to opt out of EU law. (Possibly another reason why it's bad idea for governments to run health services). But I think if anyone should be expected to opt out, it should be the medical profession given the inescapable 24/7 nature of illness.

Sorry but if you want the big bucks (and let's not be coy, consultants are bloody well paid!) then you have to suck up the antisocial hours, at least in the "training" years. (Using the term in the broadest sense, ie before completion of specialist training at registrar level).

Misti thanks for clarifying. It's off topic but I think some element of co-pay in the UK would improve things a great deal.

If I were a doctor about to have worse pay or terms I would try to do something about that, of course. The interesting EU law point is who is a managing executive (the regulations do not define it) so for employed lawyers the issue would be how senior before someone could say you "manage". Do doctors manage nurses so are not within the directive at all for example?

I am not a fan of lack of sleep for anyone as you make mistakes whether you are a lawyer, doctor, cleaner, parent at home who is exhausted. I know one of my lawyer daughters works some very long hours (no over time) and worse than doctors but will have higher pay earlier on than doctors do. You takes your money and makes your choice, but when the rules are changed later that's when it's tougher which is one reason I (lawyer) chose to be employed by myself not the state or even a private sector employer. Means I don't get my doctor brother's rather large pension from age 55 for life but I am happy to work until I die anyway so it's no problem. In theory consultants accept relatively low pay if they do no private work (compared with banking and law which they might equally have the IQ and exam results to do) for a good pension for 30+ years in retirement

SockQueen- Out in the real world, lots of employees are required to sign restrictive covenants .i think it is entirely reasonable to expect that of employees who have had £250k invested in them!

Agree, Grazia. I also think it is impossible to consider the "fairness" of the situation as a whole without looking at the amounts medics can expect to receive across the whole of their careers. The focus seems to be an a small slice of their career when still junior (albeit with lots of responsibility) when they will be paid not an awful lot - although not un-generously compared to much of the population (who miraculously manage to buy houses and raise families on these meager amounts).

For example, DH expects to retire on over 50k per annum. That is nearly twice as much as the current average salary in the UK. He will receive that amount for life which (inshallah) could be another 30 years. If I survive him, it comes to me. (Not sure I get all of it, but there is certainly some provision for spouses). He currently earns about 100k per annum and entirely deserves this. He is a fantastic doctor not at all biased and rightly valued by his hospital.

If he were to opt out of the NHS pension and take out private provision (which would be nuts anyway because he would lose the employer contribution) the annuity would cost him MORE than his entire net salary. That is a bloody generous pension scheme by anyone's standards.

Now extrapolate that for every senior doctor across the whole NHS. And think about it in the context of massive cutbacks affecting the most vulnerable patients. Sorry, but my sympathy is with them and not with the doctors who are more than adequately compensated already.

It always amuses me about the arguments about being responsible for wards of patients when newly qualified etc,
what happens to the support of the nursing and other staff that support you ? You do nt do it alone you know !

a couple of points to make to counter a few things on this thread:
It isn't like junior doctors (and l Drs in fact) haven't been subjected to the same pay constraints and freezes others in the public sector have over the last few years, they very much have. Drs in their first year used to get free (crappy- mine had rats in!) accommodation for the first year. That was scrapped several years ago with no pay increase to compensate.
The person whose DH is going to retire at 55 - there is no way any current junior will get to do this. There has been two significant cuts to pensions with increases in retirement age imposed since I qualified 10 years ago. I suspect there will be more in the future. Only those closer to retirement still get the original fantastic pension.
People are saying it's ok you get to be a consultant & then get great pay. Well yes that does happen in the long term, but you can be a junior doctor for quite some time. My DH has been a junior Dr for 18 years now! This is also due to the fact he got massively screwed over by government imposed changes to training a few years ago (no one non-medical will remember MTAS but I think that prompted quite a mass exodus) so others shouldn't be that long, but my point is is takes quite a while to get to the top levels.

I am a junior doctor as is my husband. We have spent the last nine years of our lives working tirelessly for the NHS all over the UK as hospital doctors, regularly putting in an additional 2h unpaid work each day (to make sure we chase patients' investigations, deal with emergencies, and take the time to talk to worried patients and their families). We have spent thousands of pounds each year on compulsory exams and membership of GMC and the Royal Colleges. We still have several years to become consultants (because we have taken time out to do medical research) so we would be severely affected by the proposed changes to our contract. At the moment we are struggling to make ends meet, we can't afford a house in our 30s, we can't afford a second car to make commuting easier and we are being forced to squander our income on rental properties in London where we live. We have a baby and can barely afford the childcare we need to work around our on call shifts. Last week my husband worked 75 scheduled hours and this week he is working 83 hours! These figures don't include the 21h he is commuting per week. Lots of people have to work hard and work overtime with no bonuses and lots of people struggle to pay for a child, I get that.

But we are an exhausted and stressed workforce that are administering drugs and making incisions and decisions at all times of day and night that could mean the difference between life and death. So when our quality of life is constantly reduced and our profession undermined by the government, it affects everyone that needs medical care at some point in our lives, which sadly is likely to be all of us.

Very few doctors go into this career for money (most of us could have done finance if we wanted to, but we didn't) but we need money to pay off 5-6yrs worth of debt from university and to support the work we do and the unsociable hours which we work e.g. we need to pay someone to look after our child if you are both working overnight or in the evening. This year I am working Chritsmas Eve my husband is working 25/26/27 Dec and New Years Eve then I am working New Years Day. You also need to live within a certain distance of the hospital in which you work (which in a city like London, can have a big effect on rent and house prices). London needs doctors but living in London off a doctor's salary and having a family is almost impossible.

If you care about your own health and the health service of this country, please support our profession.

I graduated medical school in 2004, I remember being outraged that we had to pay tuition fees of £1000 per year, now I can see how lucky I was. I came out of medical school with £50,000 worth of debt (had to borrow all living costs as my parents aren't well off), which took many years to pay off. This new contract is outrageous, and clearly part of the Government's plan to dismantle the NHS. I really feel for my junior colleagues and think anyone who cares about having a healthcare system should support them.

Many are planning to leave in droves. I got this news bulletin on my doctors.net.uk email this morning:

"Hundreds of doctors have registered to work overseas following the government decision to impose a new contract on juniors, it was revealed today.

The General Medical Council confirmed it received more than 1,600 requests to apply for certificates of current professional status between Wednesday and Friday last week.

It says it normally receives about 25 inquiries a day - a total of about 5,000 a year."

I am sure most of us do support doctors. They work very hard (mind you so do we lawyers too). As Angel describes it it hardly seems worth it although when I was a juinor lawyer (children's father a teacher) I had a long commute and our childcare cost more than half our net salary each so I am not sure it was that much easier 30 years ago and their father worked school holidays for extra pay. Was it a mistake taking several years out to do medical research? I took no years out from law so earned more younger and bought a (very small and long commute) house younger than those who took years off, didn't read law first, did other things.

I can certainly compare the then and now. My brother has a silver merit award which I think are as rare as hen's teeth these days. He is very very good and most doctors won't be in his category although of course he is not as good as I am as a lawyer- sibling rivalry rules. His pension will be £50k at 55. So will be the lady's husband above who is a consultant. My father was an NHS consultant who did not choose to retire until 63 and even then he was very cross he was not allowed to work in his NHS role beyond that. He wanted to but the rules then prohibited him - what an utter waste. He had to do private work only full time until 77.

Younger doctors have a different deal. My sons' friends are sitting there now in the sixth form choosing between things like law and medicine. We want the best people in both and it does fluctuate. Lawyers don't always have an easy time or high pay either. It is a compettive situation for the best 18 year olds. At the moment I see nothing to put them off doing medicine as if they qualify in medicine they can get high paid jobs abroad if needs be.

I agree with both comments above. Grazia 1984: with regards to your question re. medical research, we often question whether this was a bad decision as we are now going to pay a very high financial cost for that choice. However it's worth bearing in mind that a proportion of doctors need to do medical research as medicine simply would not advance without it. My research involves studies in patients that only a doctor could do and I like to think that by doing this research I have contributed something useful to the patients who suffer from this disease. Of course I also did it because I enjoy it so I'm not pretending its just altruism but my point is that doctors need to have varied careers that interest them and, whats more, the more you do as a doctor e.g. research/ exposure to different specialties etc.. the wider your breadth of knowledge and experience and (generally speaking) the better you are at your job. The doctor that Jeremy Hunt wants to create is one who graduates with a huge amount of debt aged 23/24 (I graduated in 2006 with £30 000 debt despite parental help) and then, due to severe financial limitations, is unable to do any medical research, work in any different areas from the one s/he ultimately specialises in and works full time till the age of 68 (currently the retirement age). So if you have a family and need to work part time in order to manage child care you will face a pay cut which is clear discrimination and will lead to burn out.

Well said ANGELISL. Unfortunately yours is a very common story, particularly where both partners are medics.

We're in a similar situation, albeit I am not a doctor. We had to move over 400 miles, to a place where we have no friends and no support, because that is what DH needed to do in order to have a job. In order for me to carry on doing my job (the job I spent 6 years studying for plus several years of training so don't particularly want to "give up") I have to commute over 4 hours a day (on top of the 12-16 I will typically have to work). This is because I can only do it in a number of main cities in the UK and DH is obliged to live within a certain distance of his hospital. There was no assistance or anything with his big move and there is no consideration given to his "family life" at all. All applications for a transfer to be in a hospital in the same COUNTY that I work in have been rejected.

This whole process has been challenging enough, but we are scraping by to pay the mortgage and pay off the extensive student debts while he has to pay for insurances, exams, conferences, seminars, travel and parking (as they won't even let him have a car park space at the hospital!) and I have to spend 1/4 of my salary on train fares. If these cuts go through, either we will not be able to pay the mortgage or one of us may have to give up our career.

It is all very well people saying "Yes but one day he'll be a consultant and will earn lots". Firstly, that's in no way guaranteed. Secondly,
I genuinely worry that DH will die from complete exhaustion before he gets to that point.

The problem here is the monopsonistic nature of the provision of healthcare in this country.

It is ironic that those who seek to protect the NHS are also those who grumble about the poor levels of pay (esp for nurses).

Either introduce competition into the provision of healthcare, or accept the poor pay. The option of maintaining the monopsony and increasing pay levels just isn't on the table to be chosen.

It is in a sense. My relative earns many times the NHS pay from non NHS work. I don't know what the proportions were for my father in his day (he gave up some of his salary to do some private work) So that does operate in some sectors particularly in cities where people are rich enough to pay for private treatment. Also the pull of working in Australia is there - a third category of buyer after the NHS and private work, although I agree that on the whole there is one buyer - the NHS.

In the 1950s my mother kept my father for 10 years from her teaching salary whilst he qualified as a consultant and they put off children for 10 years after marriage for financial reasons. He had to live in the hospital at one stage so their sexual assignations as a married couple were difficult to arrange.

So NHS consultant retirement for 20 something junior doctors now who will become consultants in due course is 68? If it's any comfort I basically have no pension (as a self employed lawyer) and will work until I die.

Grazia, private medicine just isn't a reality for many doctors now. I know when DH graduated we used to speak of his ability to do private medicine but the reality is that (1) it's too expensive to set up. He has senior colleagues who are giving up because it just isn't cost-effective anymore (disclaimer, we live outside of London). Another of his colleagues has just declared private income of £20k to his medical indemnity company and immediately had to pay increased fees of £16k , (2) DH has 2 weeks a month where he works 120 hours, the other 2 weeks he work approx 60 hours. He doesn't have the energy for private work.

DH has 2 weeks a month where he works 120 hours

I think this is a large part of the problem with the public sector. I very much doubt your DH actually 'works' 120 hours per week. by work, I mean actually treating patients/doing paperwork etc? That works out as 17 hours a day, 7 days a week. What I think is more likely is that he's on call over a weekend and is counting those hours as 'work'

The thing is, everybody else (on a decent salary) works like this all the time. DH (C level exec in large multinational) is 'on call' 24 hours of the day, 7 days a week, 365 days a year. If there is a serious problem, at his level of seniority, he is expected just to get it fixed, irrespective of the time of day/night. This is a huge pain, but he is well paid for it and on balance, he would rather take this inconvenience and have the nice perks.

He would never view his job in terms of 'no of hours worked per week', once you get past a certain level of seniority in any field you just can't look at it that way.

The public sector really needs to grow up a bit and realise that times have moved on from the heavily unionised past; people in senior posts need to work flexibly and drop their petty 'work to rule' style attitudes.

Yes, but ManorGreyhound 1) your husband would not accept a 30-40% pay cut; and 2) I'm willing to bet that people don't DIE if he makes a mistake.

You're absolutely right DH wouldn't accept a pay cut - the difference is, he works in a functioning market environment with an inelastic supply (of labour) curve, so he will never have to. If his company started talking about paycuts, he would quite simply leave and go and work for somebody else.

...which brings me back to my earlier point about the monopsonistic nature of the NHS. It is the very fact that there is no competition (except from overseas) that creates a system in which paycuts like this can be forced upon individuals.

I do wonder how people fail to see this. It is a fundamental flaw in the system, yet the NHS is still seen as some sort of sacred cow.

I'm willing to bet that people don't DIE if he makes a mistake.

It would be great if we could get some perspective about doctors and what they actually do. I agree that they fill a vital role in society, but all the hysteria about how they SAVE LIVES is not helpful.

Unless they have discovered the secret of immortality, no doctor actually saves a life - at best, they might manage to postpone the date of a person's death by a few years.

As a society, we do like to skirt the fact that we can actually do a lot to extend our own lives, but fail to do so.

Manor, yes he is on call for this 120 hour week. But for many of these on- calls he actually works. It isn't just a paper exercise. This month this has included one weekend where he has been in work at 7.45 on the Friday morning, had 2 hours at home Friday evening, I saw him again for approx 5 hours on Saturday and then he made it home about 11 pm on the Sunday. He then took several phone calls before he finally handed over at 8 am on Monday. Fortunately one of his colleagues did his Monday afternoon clinic because he was wrecked.
Obviously the solution is to recruit more consultants but there are few willing to specialise in his particular field. There are a few juniors but they tend to go overseas to do a fellowship and don't come back! Unfortunately at the moment the UK does not compete with conditions offered overseas.

Whole point is the recategorising of 'normal' hours to include evenings and Saturdays. Once they have done this then they can push this for nurses, porters, everybody! The reason to go for doctors first is because there is very little public support for them. Private medicine is being forced through.