Junior doctors contract- please read

[Limpetsmum]

I'm cross posting to raise awareness
In my mid 30s, mother of three and I'm a junior doctor.
I just wanted to raise awareness of why doctors are upset at the moment.
We already work many hours a week unpaid (out of good will because we care about our patients). The new contract in essence wants us to work even more but for less money. It's not 'cost neutral' - it's using the same pool of money to recruit more doctors and pay larger number of doctors within the same pool of money. This is resulting in up to a 30% pay cut for doctors.
Furthermore, finer detaIls of the contracts penalises part time workers and those taking maternity leave further.
A common misconception is that our union is not open to talks/negotiations. This is because the powers above will only talk if certain details such as the ones above are accepted ie only the smaller fine print is yet to be decided. Therefore our union has walked out of talks as the contract is being thrust upon us.
Doctors up and down the country are furious and concerned about patient safety as we're being forced to work unsafe hours. we are all concerned with what is going to come of the Nhs. If this is a step towards privatisation by alienating doctors we are the ones to gain in the long run financially as health care becomes private but we all believe in the Nhs and want to work in a safe, free and fair Nhs.
In addition, my own personal view is that I'm a mum of three. I want to see my kids and not have my normal week extended to include 7am-10pm mon-sat. I want to spend time with my kids and be there for my family as I'm there for my patients. I also have a life to fund and kids to support. I have a mortgage to pay and financial commitments.
Please understand why we are upset, why we are considering striking and if you support us, write to your local Mps to raise the issue.

This is not an official post in anyway but a plea for greater understanding from the wider public as I'm left feeling disheartened about my future and my family's future. Thank you for reading.

Thank you for posting ,

I don't know what to say other than that I'm very grateful for the care I had from the NHS for cancer .

I can't see how the NHS can go on providing more and more care with less and less money and by trying to find "savings " like this .It makes me fear for the future and my blood run cold .

But I have no idea what I can do to help ....tell me if I should write to my MP ( what would I say ? it seems such a big topic .. )

If you write to your mp, raise your concerns as the public - tired doctors, demoralised doctors making life and death decisions. Humanity towards us - we're not machines. We need to be there for our families as well and be able to afford our families. A 30% pay cut for anyone is huge.

I think the government are bagging on the public siding with them and blaming the fall of the Nhs on us 'greedy doctors'. But really this is the start of privatisation. Doctors will leave, parts of health sector will be privatised out. Ironically we as doctors may well end up richer in the long run if this was to happen but we all love working in the Nhs as it's free for all - and that's the way it should be.
Please do write to your Mps. As doctors we all are. But it means so much more if it comes from the public.

I'll just add that I'm on maternity leave currently hence why i have the time to post on here!

20 years ago I was a junior doctor in a hospital in London...my pay including lots of out of hours work was £22000 per annum. It is still roughly that for most juniors doctors. After 5 or 6 years of training. The hours are a little shorter (still long though) and the conditions are slightly better.....but we are about to see the hours and conditions worsen and the pay cut by 30%.

How many juniors will be staying in the UK do we imagine....?
they are valued so little by our MPs and government.

imagine...20 years and back to rubbish....

here is a link to the royal college presidents letter to Jeremy Hunt www.theguardian.com/society/2015/sep/24/letter-from-medical-royal-college-presidents-to-jeremy-hunt-in-full

If you wish to express your support for the junior doctors you could write about your worry about the lack of value placed on so precious a resource .Quote if you like from the letter itself and lend your name in support of fairness.

It would be good to know more about the salaries. £22,000 Is not very much but is that what they are actually paid?
The problem for me is that consultant salaries are extremely high, far higher than any other sector. There is quite simply no other profession where you could earn more than the prime minister, enjoy a final salary pension scheme, be able to reduce your hours after maternity, and never know what it is to be short of work. and be a member of a trade union.
My clients in industry also work unfeasible long hours in combination with ever more extreme travel requirements, defined contribution pension benefits only, and very little job security - in fact none. Women who have children do not complain about their part time contracts -they simply have to leave.
My uncle was a GP in the days when GP Partners worked fewer hours for less and had pensions that were unremarkable. Doctors seemed much happier in the days before the consultant negotiated their extraordinarily high salaries and unique pension rights.
I hope these comments do not offend but I think it is better if doctors know what members of the public feel.

Consultant salaries and pensions already aren't what they used to be. Yes they aren't terrible but they aren't as cushy as you make out. My DH certainly doesn't "earn more than the prime minister" not even close. The pension scheme has also been severely eroded.
But don't get distracted by salaries, even if you don't give a crap about doctors you should be worried about the junior doctor contract changes. The proposals will decimate the workforce which is already suffering a recruitment crisis and will remove safeguards on working hours which means in an understaffed workforce there will be even more pressure leading to overworked drs. The changes will then be filtered through to the rest of the NHS workforce..... The proposals are another way of setting the NHS up to fail so it can be 'saved' by privatisation.
I notice the news today says that JH is going to meet with the new chair of the JDC, it will be interesting to see what comes out of that.

Interesting. I am not in favour of privatisation. But that does not mean I have to accept what the doctors say.
Again I would like to hear more about salaries. I saw a documentary about people who earn more than the prime minister And it was said there NHS consultants earn more than the prime minister. And that is before the private clinics
What is a junior Dr. Salary? Do they still enjoy access to a final salary pension scheme?

Junior Dr salary will vary due to rota commitments and grading but starts at I believe at around £22k. The pension scheme has changed quite a bit and is a bit complex but its changed to a career average rather than final salary scheme.
Whatever documentary you were watching was misleading as most consultants are not on salaries larger than the PM, just as most GPs aren't on the six figure salaries headlined in the press.

OK as requested: Last year's data amalgamated from published sources:

Dr in training F1 (1 year after graduation) £22636, F2 (2 years after grad)£28076

Specialist in training: £30 000 to £47 000 depending on speciality and experience

Speciality doctor (non consultant non training role) £37 176 to £69 325

Consultant £75 249 to £101 451

GP partners are self employed and thus negotiate own contract and own and run the "business" of a general practice

salaried GP £55 000 to £83 000 (on average)

all above are full time posts.

To break down further
Physician Accident and Emergency £48 558
Physician Medicine £37 076
Plastic surgery £50 565
Neurology £76 461
Radiology £50 916
Cardiology £50 865

Plus the above may be eligible for bonuses for additional roles between £7000 and £15000.

These are NHS salaries and don't look at earnings from any private practice, roles in teaching or research, roles ion management eg medical directorships etc.

In these roles obviously salary would go down but additional role would pay as well

hope that helps

The problem is, in the public sector, every profession has a similar sob story (mine included). The public just don't care which is how we ended up with another Tory government.
I think doctors in particular will get very little sympathy as ultimately they are going to be higher earners than most people. I'm not saying it's fair but it's true.

Thank you for that detailed information it's very helpful. Is the government genuinely proposing to reduce the starting salary to 15,000 pounds?

Starting wage for junior docs is about £22k basic (when I started 10years ago it was £20k reflecting the lack of increase in line with inflation). Oncall supplement (which basically means contracted work done outside of hours) brings it up to anything between £27-£30k.
Each year there is an increment which goes up with seniority. With that comes more responsibility (on life/death decisions). I'm in my last year of training. I earn about £48k full time plus oncalls. I can work 48 hours straight over the weekend and still be in on Monday morning seeing patients at 9am (having finished my oncall at 8:59am that morning).
£48k is a decent wage. Out of that comes course fees - approx £1k a year at least. Membership fees and medical protection -another £1k. Exam fees - this year £1k for myself. Then let's not mention all the work we do for free - staying late, starting early, office work we can take home like auditing, presentations, teaching. Time for Revision for exams where pass rates can be as low as 33% so multiple resits are necessary for some. I take 3 months out of my free time to revise for these exams while still going to work. Let's not forget the commutes where we can be posted out 60+ miles from our home as we rotate round different hospitals on a yearly basis - we don't get much of a say in this but just do it because we have to.

And then there's our pension which is no longer final salary. We pay a significant chunk in contributions. Our student loan - 6 years at Uni (I thankfully only had £1k tuition fees a year not the £9k but I've only just paid off my student loan this year.

So out of my £48k a year I take home £2400/month. I pay £2k in childcare/month.
I started earning an income at the age of 24 years. I could have left school at 16 and be a greggs manager in my early 20s with more pay than I take home now. And don't forget we have lost out of 6 years of income and gathered 6 years of Uni debt.

Please don't get me wrong - we're not asking for a payrise (although one in line with inflation would be nice as in effect we've taken a pay cut for the last 5 years!) What we are asking for is that the government recognise that we are some of the hardest working people in the country, some of the academically brightest and some of the most devoted to our jobs.

As for consultant wage -£75k starting but take home around £3200 (I think) as increased pension contributions. But also greaTer medical protection costs, responsibilities etc.

Miss triggs hope that answers your question. This isn't a post to say how hard we have it now, it's a post to say the way we are being treated is unacceptable. To be honest, It's the newbies in med school that are going to be affected most, not me but the govt won't stop here. They'll get us all and as 'rich' doctors we're easy targets as they know we have morals and will do what we can to not cause harm.

You can't cut pay by 15-30% and then on top of that ask us to work more hours. Well, you can, but then like many we'll be off. In Qatar they'll have me for £180k/year tax free when I'm a consultant. They'll pay my kids private school fees, accommodation, car, flights. In Australia i'd be looking at over £100k/year and a better quality of life.
We love our work. We love the healthcare system we have. We work bloody hard to keep it going with our good will (there's no way it would survive if we actually charged for all our hours). But at some point my family will come first, and I wont be able to make any more sacrifices in my personal life. Doctors are leaving - better jobs outside of clinical medicine or better clinical jobs outside the uk. And dont forget if medicine isn't an attractive career, the brightest students won't want a career in it.

This is the government's answer to your question as set out by them in their proposals www.nhsemployers.org/your-workforce/pay-and-reward/national-negotiations/q-a-on-the-new-junior-doctor-contract-proposals#1

Shall I let you draw your own conclusions from the "political speak"?

Will average earnings go down?
No, it’s untrue to say that average earnings will go down. The new system is being designed to cost exactly the same, which means that average earnings for junior doctors will stay the same. Our proposals would see basic pay go up whilst average earnings are maintained.

Will individual doctors get a pay cut?
While average earnings will stay the same, redistributing pay from an unfair system to a fairer one does mean that some people who are disadvantaged by the current rules will see their overall earnings go up, while some who are currently advantaged will see their earnings go down.

As the BMA has pointed out, under the current New Deal system a doctor working 47 hours a week can be paid exactly the same as one working 41 hours a week. Under the banding system, a doctor working daytime only can be paid exactly the same as a doctor working night shifts and late shifts, and a doctor progressing to a post with extra responsibility can sometimes actually see their overall earnings go down.

We want a system that rewards doctors for taking on additional responsibility, pays more for extra hours worked, and targets supplementary pay at unsocial hours and shortage specialties.

One of the big tasks ahead is to work out how to move from one system to the other in a sensitive and carefully managed way that doesn't unfairly penalise individual doctors.

Can you guarantee that I won’t receive a pay cut?
Unfortunately we cannot guarantee this. As in our response above, this is one of the consequences of moving from the current pay system to a new, fairer system. We are still designing the pay system and have yet to decide transitional and pay protection arrangements.

Could you provide a worked example/pay calculator showing how pay will be affected under the new contract?
Unfortunately we cannot at this time. We realise this is one of the key issues you would like to find out more about.

We had expected to design pay arrangements with the BMA JDC in negotiations, and as this is not now possible, we are now having to design the different elements of the pay system ourselves. This requires detailed modelling, which cannot be rushed.

In order to provide a worked example of pay, we would need to know the level of basic pay in the new system, the out-of-hours periods, the premium rates paid for these out-of-hours periods, the workings of the flexible pay premia, and any protection or transitional arrangements. As none of this has been finalised yet it is impossible to convert pay in the current system to pay in the new system.

MissTriggs, my understanding is that they aren't looking to reduce take home pay, but rather make doctors work more hours, which in essence is the same as a pay cut (more hours for same $).

No, pay won't go down to £15k. The oncall supplement will go/reduce significantly. So instead of the £27-£30k starting you're looking at going down to £23-25k with that level of pay. But the govt hasn't told us specifics. Different grades will be affected differently but our union has calculated some will expect a 30% decrease.
One of My concerns is that we're not machines. We'd like to have a family and enjoy our family time. With the new contract we're being asked to work even more anti sociable hours for less. With that comes greater and more difficult to organise childcare and inevitably higher childcare costs.

I would point out that the proposals include classing any hours worked from 7am to 10pm are "normal" hours...so of course a pay cut if your salary includes out of hours payments that currently start at 6pm.

No one is arguing that the Drs have it the hardest of all...loads of people have been and are being treated shoddily...but here is one place where we can support fairness and transparency.

The thing is I think Nurses, teachers, local govt employees and so many others have also been treated badly. BUT I don't want to let that stop us fighting for our NHS.

The argument that others have it the same or worse so often is a call to do nothing rather than a call to start here....

there is already a mass exodus of drs to places where they are valued and paid well....it will only increase.

As a Mum of 4 and single parent it is unlikey that I would be a ble to work the new contract. Who will look after my little ones at 10pm for standard rate...and the part time proposals are even less attractive than the full time one.

Thanks for all these excellent answers -much more useful than the newspapers
As a trainee Lawyer I also used to work all weekend and all evening on a regular basis. There was never any suggestion that I should be paid for this
I am not sure if doctors realise what conditions other people are working under. When I was a child my uncle the Dr. Would sometimes have to leave home to attend a patient at the weekend. But nowadays people in any profession may spend the weekend in the office, on the telephone or an aeroplane.

I have been a doctor for 8 years and currently work part time as I have a toddler and my DH is also a registrar and the only childcare that would have allowed us to both work full time would have been a full time nanny and some additional nursery time which we wouldn't have been anywhere near able to afford. I work 50% of my previous rota as I wasn't allowed any other combination so I now work 24 hours a week paid and probably 4-6 unpaid on average. I get paid £28,000 a year and with this new contract I would be paid £20,500. Around 1/4 of my hours currently are outside 7am-7pm Monday to Friday. I am an obstetric registrar and so work in a high risk, high pressure speciality and I honestly think it would be unsafe for our patients to be working longer shifts with less break between, as it has been proven was unsafe in the past. It is a huge step backwards for the NHS to be putting both doctors and patients under this additional pressure and risk at a time where resources are already stretched.

sorry out of hours currently starts at 7pm.
also includes Sat and Sunday but new proposals are that 7am-10pm sat would be ordinary hours.

the oft quoted 30% reduction would be for GP trainees who have a GP training supplement that is removed under the new proposals ....although this could be replaced by a training and recruitment package to attract trainees to the speciality.

it is difficult to predict exactly what pay would be because really the restructuring is so bizarre and includes so many unknowns...they want to "redistribute pay" without increasing the total pay bill, they want to increase "core" hours without increasing the total pay bill, they want to increase out of hours cover without increasing the pay bill...

basically getting more for the same price....a pay cut.

And i agree with PP, where is the humanity? What happens to mothers and fathers who want to see thier children, what if you are single and need to see friends and family, what if you are a single parent without support? it's a vast unmanageable mess and so complicated that it is hard to enlist support from the public.

Do you think that the BMA is making a strong enough case about patient safety? I can't help wondering if their previous advocacy of very high salaries is reducing their effectiveness now.

It is very Interesting

To be honest the BMA is focusing on patient safety. This is a real issue but I think other main issues are;

1. is this the start of privatisation? -Because doctors will leave and then what are we left with? (I am seriously considering going abroad depending on what changes are made to the consultant contract so it is a real issue)
2. and my personal opinion and bug bear that I feel strongly about- our right to a family, family time and being able to afford that family. There's only so much I'm willing to compromise on. If pay is reduced then I'm better of doing something else and seeing my kids more. Yes, job satisfaction is less (which keeps us in the job) but there is a line.

there are a few lucid people helping out:

blogs.channel4.com/victoria-macdonald-on-health-and-social-care/junior-doctors-contracts-affect-patient-safety/3141

I think the BMA is trying, the Royal Colleges are trying...is it being heard? I don't know

What I really dislike about this whole debate is the 'I would have earned more as a manager in Greggs' etc etc. it's just making people who also work hard, and long hours, also with responsibilities, feel devalued. doctors do have a great responsibility that's of a higher importance at the end of the day, than my figures I have to achieve in my role, but I'm not enjoying the feeling that no-one else should earn a decent wage for what they do. I also know this is just my opinion, and the way I feel about the way this is playing out in the press, on here, on Facebook etc.
I support all people in getting a fair wage for whatever role they undertake.

I agree....
everyone wants to feel valued and appreciated .
We should never set ourselves up against other workers in the fair pay debate...
unfortunately the nitty gritty is harder work to put across than inaccurate, unhelpful tag lines...