Guest post: The government on junior doctors - "We're committed to the values of the NHS"

[MumsnetGuestPosts]

Junior doctors working in the NHS are among the best in the world. They are the leaders of tomorrow and with over 50,000 across the country, the backbone of medical care in our hospitals.

The debate around proposed reforms to their contracts has highlighted their passion and dedication. That's why this week's firm contract offer from the Government and NHS Employers is important.

The Government has been clear that our proposed reforms are about delivering a fairer, safer deal for doctors and patients. This proposal builds on the cast-iron guarantees that the Government has already set out on better basic pay, a shorter working week and improving patient safety.

In order to deliver safe patient care around the clock, seven days a week to patients, we need a culture of safe working hours for NHS staff. The current junior doctors' contract incentivises long hours by rewarding those that work above and beyond the legal limit. Our proposal will change that.

Contrary to suggestions of a return to the long hours of the past, our proposals will reduce hours. The new contract will be based on no junior being required to work more than an average of 48 hours per week, with tougher limits on unsafe hours - including a new maximum working week of 72 hours, down from 91. Employers will be banned from scheduling any shifts over 13 hours too. This will all help to reduce burnout and improve patient safety, so junior doctors can deliver the very best care.

We are proposing an end to the 'week of nights' experienced by many junior doctors, with a new limit of four night shifts in a row and are introducing a new limit of five consecutive long days.

No junior doctor will receive a pay cut compared to their current contract either. Around three quarters of junior doctors moving to the new contract will see an increase in pay, with the remainder getting pay protection. There are a very small minority - around one per cent of junior doctors - who are forced to work excessive hours under the current contract and who will be better protected under the new contract against breaching hours limits. Junior doctors will get better basic pay based on progression through training instead of time served, a shorter working week and improved patient safety.

As the British Medical Association (the union for junior doctors) has now begun balloting its members for strike action, it's important to be clear about how we're making pay fairer.

We will remove the current situation where two doctors working very different hours can be paid the same. We will remove the complex banding payments system and replace it by paying doctors for hours worked. As opposed to misleading statements by the BMA, there will be around an 11% increase to junior doctors' basic pay - with proportionately higher pay for unsocial hours.

To support this offer, junior doctors can now log on to a pay calculator where they can work out projected pay. This can be found at here.

Everyone working in the NHS wants to give patients the same high quality care every day of the week and we know that junior doctors already work at weekends, providing good, safe care to patients.

But the current pay structures result in some hospitals rostering three times more senior cover during the week compared to the weekend. Junior doctors that do work weekends already often don't have the right level of support to deliver the safest care we all want.

Over the next few weeks, junior doctors will be invited to briefing sessions with Medical Directors and HR Directors at their NHS Trusts over the next few weeks to elaborate on the offer I have laid out here.

We're completely committed to the values of the NHS - the same values that encourage aspiring doctors to take up a career in medicine. That is why we have stated that a new contract will be in place from August 2016. The Government is very clear that it will not remove this timetable for putting in place a new contract. I hope this firm offer will allow junior doctors to make decision based on fact. Once again, we invite the BMA to come back to the table and negotiate on the detail of this offer to secure a deal that rewards doctors fairly and has safe care at its heart.

[Floraclare]

I've studied the pay calculator in depth and as I'm a woman with children, I will see my pay frozen for years. I'm set to lose around £18,000 over the next 3-years, mainly due to having caring responsibilities

I've never seen doctors so demoralised and devalued - and you will cause huge harm to patient care if you force through this contract.

Doctors are not asking for a pay rise - we already work 24- hours a day, 7-days a week - and in my last job I was working 2 out of 3 weekends. Are you really aiming to remove doctors from already overstretched weekday services, in order to make them work even more weekends?

The new contract is an attack on the NHS, an attack in doctors, but most of all an attack on WOMEN doctors. This contract will make it so much harder for women doctors to consider having a family and will significantly limit their choice of career

[Kbob]

"To support this offer, junior doctors can now log onto a pay calculator where they can work out projected pay"

You may not be surprised to discover that this is not all it seems! An IT savy junior doctor has pulled it apart and discovered a few fairly major flaws, not least that you would never want to be seen by a doctor working on the rota it used to make they pay work!
www.bishley.com/junior-contract/wp-content/uploads/2015/11/Problems-with-NHSE-Pay-Calculator-v1.0.pdf

[NoTechnologicalBreakdown]

Oh thank goodness more and more people seem to be seeing the spin and lies the tories have spun and / or are increasingly speaking out. I too think they are simply preparing the nhs for privatization for their rich friend's benefit. Along with the rest of the public sector.

It is a myth that the public sector is always wasteful and inefficient compared to the private sector. In terms of total society resources of course public sector run against need will always trump a private sector run for profit. That's why our privately-owned government doesn't like it. There needs to be a re-balancing between the needs of individuals and the needs of the state, which lest we forget again actually means the needs of all. Tony Benn once said that if the NHS was privatized revolution would follow, even in Britain. Be warned.

[MrsConsultant]

My DH has just retired from the NHS.
I am so relieved, because I was beginning to worry that he would have a heart attack from the stress and work load.

He has never worked less than 80 hours a week throughout his whole career in the NHS. All this nonsense about nights and weekends is misleading and manipulative. Of course consultants work nights and weekends.

Successive governments have always undervalued and exploited NHS staff, especially junior doctors who are over a barrel, if they want to pass all their exams and progress in their careers.

DH was 37 when he became a consultant - after 2 degrees and 2 further membership exams. He qualified at 25 - so spent 12 years working roughly 100 hours a week as a junior doctor. Only 2 weeks off sick in his entire career. Things were actually starting to improve a little bit for the juniors, now this government wants to put the clock back.

The amount of money wasted on pointless re-organisations of the NHS is a national scandal.

Not only are we going to lose junior doctors, the consultants we have are retiring in disgust. I really worry about the future of the NHS, because the people in control don't respect or listen to the people actually doing the work.

[Poppyred85]

Yawn. Haven't you got anything new to say? Do you really think if you all keep saying the same thing we will start to believe you? I'm a GP. 8 months ago I was a junior doctor. Your lies and spin really do take things to a new level- bit like Jeremy Hunt's expenses claims.
To those who are worried about patient safety if juniors strike- consultants and GPs are behind our juniors and will ensure that patient safety is not compromised if they strike. This is a fight for the survival of the NHS.

[Floraclare]

And Medical Women UK are very concerned that the new contract will widen the gender pay gap

www.medicalwomensfederation.org.uk/about-us/news-blogs-competitions/404-medical-women-s-federation-s-response-to-proposed-changes-to-junior-doctor-contracts

[Mouthfulofquiz]

I know that this isn't a race to the bottom, but lots of staff have already had increment freezes for the last few years. As a family, who both work in healthcare but aren't doctors, we are about 15k per year down on where we should be according for agenda for change.
Everyone that works for the NHS is important, let's not forget that there are lots of people making financial sacrifices, and doing on calls for free.

[Carriemac]

We can see through the spin and lies. No NHS worker will ever vote for the conservatives again. My DH is a consultant, 80 hour weeks and every third weekend .

[MargoReadbetter]

Nobody should be doing on calls for free. MPs can claim dinner expenses if they have to work unsocial hours, which they define for themselves as being after 7.30 pm. But healthcare workers should work for free? (And the vending machine food isn't too hit either.)

[katieks]

Fortunately doctors have seen through the government spin. Overall the deal offered is WORSE for junior doctors despite the misleading headline grabbing '11% pay rise'. The guarantees about pay only apply to current doctors - those starting next year will be worse off than those doing the exact same job this year.

The proposed rota changes are worse, the incremental pay progression are worse, overall the deal is a lot worse!

The 'patient safety' card that the government is playing is misleading too. The juniors working on the front line know what is needed for patient safety - more NHS staff all round and more NHS funding. The NHS relies on so much goodwill from all it's staff it'll collapse without it.

Doctors are not going to let this slide - the government are going to lose this battle.

[Kacie123]

Glad to see (justified) criticism of this here. Why do people keep thinking Mumsnet is a place they can write any old rubbish and get support?

Over on Twitter people seem surprised that Mumsnet posters have seen through this nonsense, but on these boards we have academics, business leaders, entrepreneurs, economists, writers and more, including a sizeable number of NHS doctors and nurses.

The attitude that people here aren't capable of reading between the lines or seeing through self-justifying nonsense never ceases to surprise me - this weird view that "mums" are somehow the soft touch of the political world...

[MargoReadbetter]

Kacie123 - maybe we're supposed to be so overwhelmed in baby stuff and work we just let the man in our lives to do our thinking and if we could be relied on to do that little gentle nudging in the right direction...

[GruntledOne]

This is utter insanity. You are proposing to rota junior doctors to work unsociable hours even when they work in areas of specialisation that do not require them, and that will therefore leave hospitals short during the hours that they are needed. And it is utterly pointless to rota them to work those hours unless you are also going to ensure that the necessary support staff are also available and working those hours - or are you going to make the doctors do all their own portering, lab testing, secretarial work and nursing?

And pay protection is a nonsense unless you are going to make it (a) indefinite and (b) index linked. And you're not, are you?

[elio]

Has it not occurred to you to listen to the thousands of doctors that are telling you this is unfair and dangerous for patients? Instead you are hoping they will sell out on all their future colleagues? The same medical students that are going to have extra debt from fee rises? That's nice... Then you try and smear the British medical association saying they won't negotiate when it is YOU that won't negotiate on anything but relocation expenses? That doesn't address patient safety unless you want a masive amount of drs to relocate themselves to a country that respects their profession. I didn't realise quite how much politicians lied until this started and I gave to say I am shocked, doctors on the other hand have taken an oath go act in the best interest of their patients which is what they are doing. If they are forced to strike it will be the government's fault. Get back to the table without impositions.

[elio]

m.westernmorningnews.co.uk/Comment-Junior-doctors-8217-insulting-new/story-28026099-detail/story.html

[Mouthfulofquiz]

Yes, I'm too busy making cupcakes and doings arts and crafts to smell a massive load of bullshit... Erm. I think Mumsnet is probably one of the least likely places I would come on and tell a load of porkie pies.

As an aside - when our conservative MP knocked on the door prior to the election for a chat and I said I voted labour, he peered over my shoulder and said to my husband that he ought to have a word with me about my politics. I think he was joking. But even so - I was so that I didn't even say anything. Much to my shame.

I'd really like the conservatives to stop treating ALL NHS staff badly with regards to pay.

[FoggyMorn]

What a pile of shite.

DS, a Medical student, is already looking into emigrating (and looks set to take exams along with his finals that will allow him to practice elsewhere). Many of his year group are too.

People of his age have fewer ties to the UK, so it's not surprising that many of them want to leave for better conditions and pay.

What is more surprising, I think, is the number of senior Doctors I know who have emigrated recently in late 40s to mid 50s. We are considering this ourselves. DH has had a drop in take home income (in real terms) of almost 25% over the past 8 years or so, due to a masive hike in pension contributions, tax changes etc. He's had enough!

[Mouthfulofquiz]

Yes, I'd forgotten the enormous pension contribution hike...

[mamadoc]

I'm a consultant. I was a junior until I was 38.

The government wants a truly 24-7 NHS but apparently Drs hours will be reduced. How does that compute if you have the same number of Drs? You would need to employ many more to make that equation work (and many more other staff too).

Long hours over the legal limit are not incentivised by the current pay structure. Junior Drs do not strive to work very long, unsafe hours. Their employers are penalised for breaching the legal limit by having to pay the Drs they have exploited a much higher wage if it is proved that limits were breached. The government wants to take away this penalty so that employers can do whatever they like. And believe me they will because they did in the 1980s before these safeguards were introduced.

Basic pay will increase OK. However the unsocial hours pay will reduce leaving those who are doing the hardest job worse off. Saturdays until 10pm are not unsocial hours according to this proposal. You could be made to work every Saturday and be paid the exact same as someone working 9am -5pm weekdays. This will drive Drs away from acute specialties like A&E, paeds, O&G which already have trouble recruiting. I don't want this to happen as a parent as much as anything else.

There will be protection for current Drs for 3 years. That's pretty much the least they could do really. All the new starters will be doing the same jobs for far less pay.

Pay progression will be based on progress through training not on time served. Sounds attractive but will disadvantage anyone who is part time due to childcare or ill health. In this unequal world the people working part time to care care for children are still overwhelmingly women. This will certainly increase the gender pay gap.

It is true that most NHS staff have experienced a pay freeze for 5 years. This includes Drs. This is on top of the pay freeze which we never complained about.

Once he has redefined antisocial hours for Drs do you not think that he will come after Agenda For Change next? If Saturday evening is normal working hours for Dr stands to reason it should be the same for a nurse.

I realise that does not look attractive for Drs to gripe about pay but this really is not just a bunch of well paid people moaning about having to take some pain. It is about safety, equality and fair reward for the most difficult jobs.

[AyeAmarok]

I do particularly like the 11% payrise figure.

Wasn't there another group of public servants who recently were awarded an 11% payrise?

Although I don't think they had to work a higher proportion of unsociable hours to get it...

[wonkylegs]

I also don't think that group of individuals had to take a massive pay cut that outstripped the rise at the same time

[mamadoc]

If people are interested in understanding this issue I do recommend Kbob's link

This shows some hard facts and figures and an example rota so you can see what people are really doing for what money.

Starting salary out of med school 25,000 under the new terms (currently 22, 000) and this can now include working until 10pm weekdays and Saturdays until 10pm. My DH pays his new graduate recruits roughly comparable money for a desk job Mon-Fri 9-5 after a 3 year degree course.

It also clearly shows how they are hoping people are selfish enough not to strike if they get 3 years protection and will sell their colleagues down the river.
Apparently the calculator won't even produce a calculation for registrar level Drs it just says 'you'll be alright mate you'll have finished training by the time pay protection stops'
If you look at the figures in the link reproduced from the governments actual proposal you can see that future registrars will in fact be many thousands of pounds worse off.

[TelephoneIgnoringMachine]

You are planning to privatise the NHS. This is very clearly one of the many steps the government intend to take in order to force the NHS to fail so they can justify doing so. You know it, we know it. Stop treating the populace like we're morons.

[BoreOfWhabylon]

What on earth was the point of posting this here? Do you think we are all stupid?

You are hell-bent on dismantlng the NHS; we know this, you know this.

Bullshit and spin. With an extra helping of bullshit.