Published on 24 Sep 2015

‘Real and immediate threat’ to NHS of new junior doctor contracts

Junior doctors aren’t renowned for their revolting. Even if they wanted to, many are simply too knackered.

But they are revolting now. Against a new contract imposed on them after their negotiations with NHS Employers (on behalf of the government) broke down, and the British Medical Association walked away.

The junior doctors (and this means virtually any medic up to consultant, GP or associate specialist) are angry. There is no doubt about it. Mainly, they say, because it will affect patient safety.

Under the new contract, a safeguard is being removed which means employers will be hit by making juniors work longer hours.

A normal working week will be reclassified from 7am-7pm Monday to Friday (60 hours) to 7am-10pm Monday to Saturday (90 hours).

Working a Saturday night will be the same as working a Tuesday morning.

The concern, of course, is not just that patients will be in the hands of juniors who can barely stand, see, think, but that all this will be a disincentive for juniors to go in to acute specialties like A&E. And as we all know, we need more doctors there.

There’s another perverse disincentive in the contract, too.

The GP trainee supplement is to go. It was put there to lure juniors out of hospitals and into general practice and ensure they don’t suffer financially.

I’ve just spoken to a woman junior who says she will lose a third of her salary if she goes ahead with her long-held desire to be a GP.

But that’s not the only whammy.

I specifically said a woman because, under the new contract, incremental pay rates are lost if a junior takes time out for maternity leave or to go part-time. Not to mention if they want to do academic work.

This is 2015, for goodness sake. Employers cannot say we are going to make you work long, antisocial hours, and on top of that don’t go and have babies because we will cut your pay further.

In fact, so astonishing is this hark back to Victorian times that I can’t believe that the men (because surely no women were involved in the drafting) on the doctors’ and dentists’ remuneration review board meant to come up with this.

The Department of Health (DoH) has been passing all media inquiries to NHS Employers, even though it’s ministers who imposed the contract.

But a DoH media release does say “NHS Employers will continue to develop a contract that is good for junior doctors and patients.

They, and we, will talk to all stakeholders, including the BMA, as that work develops.”

The statement continues:

“The proposals actually offered junior doctors a better deal, including:

· enhancing the quality and quantity of training opportunities for junior doctors
· a higher basic rate, with a significant increase in basic salary;
· proportionate payment for additional hours worked (including when on-call);
· unsocial hours paid at a higher rate;
· flexible pay premiums for hard-to-fill specialties.”

In the meantime, a number of juniors I’ve spoken to are saying Australia and New Zealand are seeming increasingly enticing.

Unusually most of the Royal Colleges (surgeons excepted) have issued statements in support of the junior doctors and against the contract.

We have been leaked a letter to Jeremy Hunt from the presidents of nine Royal Colleges in which they warn: “the proposals represent a real and immediate threat to the current stated priorities of the NHS, namely recruitment and retention of front line staff.”

Normally they stand back, but this time they are worried too.

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24 reader comments

  1. James Alton says:

    The NHS is bloated and wasteful and costs far too much for what it gives.
    All nationalised institutions are wasteful and relatively unaccountable.
    Doctors, in particular, are treated like gods and are paid too much.
    “Our” NHS is rife with fraud of all kinds, and should be de-nationalised into private, more accountable, health organisations.

    1. A Walker says:

      Many thanks for your interest in the issue. In fact the NHS has been independently rated as providing the best healthcare for the second least cost per head of population of the 11 top western nations:

      http://www.independent.co.uk/news/uk/uks-healthcare-ranked-the-best-out-of-11-western-countries-with-us-coming-last-9542833.html

      It is popular misconception that privatised systems, such as the US provide better care, and they are certainly more expensive.

    2. Stuart says:

      How much are you paid? How many hours do you work? And what does your work involve?
      As a junior doctor I get paid 30k for working around 60-70 hours a week (maybe more). I am not treated like a god!! Nor do I want to be treated like one. I would just like to continue working and treating my patients without the risk of being worked so hard I can’t do this properly. I would also like my employer to recognise that if I have 7 years experience as a trainee, I should not be being paid the same amount as a doctor with one years experience just because I want to spend 6 months on paternity leave. Finally, I would like (some of) the public to recognise that doctors (juniors and consultants) work unbelievably hard for patients. The pay cut is a kick in the teeth, but the risk the new contract has for patients will kill off the NHS. Privatise it if you wish- then you’ll definitely find doctors expecting to be treated and paid like gods.

    3. Simon says:

      The NHS is among the cheapest healthcare in the developed world. UK spends about 9%GDP, France and Germany spend nearly 12%. In return for this we get healthcare that’s above average for Europe. I don’t see how cutting doctors’ salaries is going to improve outcomes further.

    4. Tom says:

      What on earth are you talking about? You are obviously totally uninformed and quite frankly a nasty selfish person.

      Doctors work so hard and are utterly sleep deprived under the current system. The hours they do in a week are probably more than you do in two weeks.

      They are not treated like gods, the starting pay for a junior doctor is 23k. They work 90 hour weeks including night shifts, weekends, Christmas day and new year.

      Get informed you daily mail reading selfish armchair economist.

    5. Kumar Sandirasegaram says:

      We spend far less from our GDP on health care than any other developed country and provide wide ranging health to all our citizens. Our health servisesc is efficient and provides value for money to suggest to the contrary is a lie.

      1. oliver s says:

        You are right Kumar but the politicians are all too stupid to realise that the public IS willing to pay more taxes to keep the system properly funded.
        There are huge inefficiencies and Wigan have proved that 24/7 healthcare is possible . The NHS inefficiencies are probably no worse than other systems but there are stupid anomalies such as free drugs in Wales and Scotland

    6. Helen Oakes says:

      How to ruin the NHS? – Privatisation is the Tory mantra, they hope to make it palatable to the electorate by spoiling it completely, than saying it doesn’t work. Look up how many MPs have interests in private medicine. And ‘private’ is never cheaper for the same service – how can it be? Private firms exist to make money for themselves, of course they do, and if you can’t pay, you’ll have to suffer. Wake up and see this!!

    7. G.Salmon says:

      Agree with James, have witnessed the wastage and incompetence first hand while working for the NHS. Long-term sickness is also rife due to over generous benefits. Junior doctors have no experience of real life in the in the private sector having gone from Uni into the gravy train of the NHS. The strike is putting real people at risk over their greed for a pay rise. Interesting read below, points out the facts.

      http://www.adamsmith.org/blog/healthcare/five-facts-that-undermine-the-junior-doctors-strike/

  2. A Walker says:

    Excellent article. As a Junior Doctor (6 years medical school, 6 years qualified) I can confirm the proposed contract presents a clear and present danger to patients and the NHS as a whole. Despite the comments you quote from the NHS Employers about a higher base rate and higher out of hours rate, the new classification of Saturday as a weekday and evenings as mornings negates these increases leading to a net 10-40% cut in take home pay. See this excellent analysis by Dr Stephen Bishop for details:

    https://drive.google.com/file/d/0B_H7id69DOeYN0FrVlRFekFDZTR4cFRLcWwwVi1MRUljd0Mw/view?pli=1 for details.

    During a recruitment crisis, you are quite correct that it is perverse to cut pay and worsen working conditions. This, along with the ridiculous classification of Addenbrookes, one of the world’s leading hospitals, as, “inadequate” due to staff shortages brought about by government workforce policies demonstrates a pattern of behaviour by this government to undermine the future of the NHS. Whilst no-one wants the deficit to rise, I would bet heavily that the public would be happy to pay an extra few pounds per month to keep healthcare free at the point of use.

  3. Neil says:

    Why are the Tax Payers Allowance allowed on C4 to defend Tory Govt policies again?. If the Tories have a policy they should be defending it. Lat year it was the useful idiots in the Lib
    Dems. If the Tories wont defend then leave an empty chair. This is a political decision so the politicians should be defending it.

  4. Patrick Dunlop says:

    I don’t think that you should have ‘The Taxpayers Alliance’ on your news presentations. They represent nobody as far as I can see but are a right wing pressure group who now seem to have a role in defending Government policy.

  5. Alan Manklow says:

    Tax Payer Alliance bloke should really get some lessons on media appearances, I gave up counting after hearing x14 “actually” during in less than two minutes of him talking….

  6. Jill Whewell says:

    Thank God this has at last made it into the news.
    Perhaps you could further investigate why Wales and Scotland are not following the same pay and conditions structure and why many new doctors who will qualify next year are aiming to apply for their first jobs in either of these places which traditionally are usually considerably understaffed. Finally you could report on the incredibly large number of applications to the medical authorities by doctors planning to move abroad where they feel their hypocritical oath is not in jeopardy.

  7. Laura O'Neill says:

    Absolutely fantastic interview with Dr R, who liberally wiped the floor with the nerk from the Taxpayers Alliance. Clear, concise and incontrovertible information about the likely effects of the renegotions on junior doctors’ contracts. More please!

  8. Alex says:

    Thank you channel 4. We are all absolutely exhausted and incredibly concerned and worried regarding this contract. Sleep lost and tears shed.
    We all want the best for our patients and the right to a family life. we just want to carry on doing the job we love without the threat of this horrific contract over hanging our heads.
    If this contract goes through I will not stay in this country. I will not be subjected to criminally long hours, I will not make life and death decisions when I am absolutely exhausted. I will go somewhere else where my work and skills are appreciated and looked after, and where I can actually provide a service we can all be proud of. Thank you for your coverage.

  9. Emily mccullagh says:

    I work as a GP in an affluent Southern market town. There are 4 town centre practices, we are all seeking a full time GP to fill empty positions, facing imminent retirements which have been delayed out of courtesy to their colleagues knowing what their retirement will mean. After 12 months of advertisements, no applicants other than the same 72 year old doctor who has spent little of his career in the UK. When we approach the GPs coming out of the local VTS scheme directly they were ALL intending to leave for Australia or if they had UK ties would only accept locum posts. Hospitals in the same dire crisis. Good will is keeping the system just afloat but lashed by government contracts, negative press from certain quarters, CQC etc it will not survive for much longer. The doctors, nurses and paramedics have all protested. It has to be the voting public now.

  10. Roy says:

    Why are we asking the Taxpayers Alliance to argue the Government’s case? This organisation is a distraction that merely gets in the way of serious discussion.

  11. oliver s says:

    Where are the brave politicians who admit that the funding model for the NHS is completely bust? With new genetic cancer / Alzheimer and other drugs round the corner in the Star Trek era of medicine a new model is needed.

    My suggestion is that National Insurance would be hypothecated purely for NHS and home care. Furthermore it would be payable ( subject to income or maybe better – asset limits – for life. Care and NHS costs are explosive in the elderly. They need to pay when they can afford to do so.

  12. June Young says:

    This is ridiculous in every way, Dr’s have to work long hours already and work unpaid overtime as a matter of course , the contract system is ridiculous, making impossible demands on doctors …who are people, not machines and have families, relationships and commitments outside of the demanding work.The friend of mine who is a doctor has opened my eyes re: the awful work conditions, and he himself won’t strike due to his refusal to put patients lives at risk….just like many others, as your article stated, this is 2015 and these conditions will drive doctors away , and who could blame them.SAD, very sad treatment of dedicated people :-(

  13. Fenwick Kirton-Darling says:

    Who are the “TaxpayersAlliance” and why did they provide the spokesman for NHS management?

  14. Patrick Black says:

    This nasty right wing neo liberal Tory government is hell bent on undermining the Nhs at evey level in order to privatise it in the name of corporate greed it but it’s latest insane and inhumane wheeze is this appalling new contract for Junior Doctors which deserves to be tossed into the dustbin of history like this vile Government itself.

    If and when Junior doctors have to resort to industrial action or even strike action to defeat this monstrous contract they will have the resounding support of the General Public and millions of Health and Public sector workers behind them.

    Enough is Enough !

  15. Tanya says:

    Very soon there will be a huge crisis in this country as there won’t be any doctors. The NHS already is having to plug the gaps by filling posts using very expensive locum doctors – very short sighted. They should be cherishing the doctors they have by implementing fair working conditions, reasonable hours and pay which takes into account the effort and responsibility required (90 hours per week is ridiculous and puts patients, and doctors lives at risk). The NHS needs to realise how dedicated and hard working most doctors are, often going way above and beyond what they are contracted to, often, I’m sure, very frustrated that they can’t give the care that they’d like to because of restricted time and resources. They NHS is only still functioning because of the goodwill and massive amount of unpaid hours that many of its staff work – they genuinely care about their patients. This goodwill is in very great danger of running out – there will be a recruitment crisis and doctors will go abroad where they enjoy better pay, conditions and working hours and are respected and valued by the public. There is a misconception that doctors earn loads. I remember a junior doctor opening her first pay packet – she was really excited – until she worked out that she had earnt more per hour doing a paper round when she was 14!). If you really want to know – Google doctors pay in the NHS – you will be surprised how poor the pay is to comparable professions (You can earn more in McDonalds and have no student loan). Also, the general public and the government are not in the loop regarding the extremely hard work required to become a doctor. Starting from the age of 14, prospective doctors have to work very hard to gain the GCSE A* and A grades required, then typically 2A* and 1A grade is needed in chemistry and biology and often maths at A level (only achieved through extremely hard work at an age when many kids are enjoying being young) they have to secure work experience and most universities require additional IQ type test to even get an interview. The financial burden is huge (student loan of at least £50k by the time they finish medical school), and then the real hard work starts once they get to medical school. There is a mountain of knowledge which has to be absorbed, understood and tested in very tough exams and unlike many university courses, the week is almost fully timetabled, with studying done at weekends and evenings, leaving little opportunity for part time work to help fund their courses and holidays are typically much shorter than most courses. The student loan almost always isn’t even enough to pay their rents, let alone food and clothing or to pay for the transport to the many placements, which is for almost all, is not funded and can be considerable. There is a problem with male recruitment into the profession. Reason – blokes no longer see it as a credible career. It is sheer hard work, doctors are no longer respected by the public and those clever enough to consider medicine as a career can earn much more money, have a family life and not live in fear of being sued by often ignorant members of the general public. Doctors must be fed up with the public who fill up their clinics with ailments that could be treated at home with a couple of paracetamol and a day of rest, who know more than doctors (who have years of studying and experience behind them) – they’ve ‘Googled’ it and know what’s wrong with them and what treatment and medicine they need, they must be irritated by patients who ignore the plethora of advice regarding lifestyle choices in order to avoid ill health and then expect doctors to wave their magic wands and cure them in 10 minutes with absolutely no effort on their part. Why do it? I can only assume that most doctors are in fact angels sent from heaven. I urge the government and the general public to start valuing and appreciating the amazing job that NHS staff do – against the very heavily stacked odds and to start taking responsibility for their own health. If we don’t, I foresee a future which is dependent upon ‘Google’ to cure us.

  16. Michael Dunkerley says:

    I have experience and knowledge of the private, insurance based health care in the USA and our NHS. The NHS is a better system. The for profit system in the USA is in greater danger of collapse through the greed of the providers and drug companies than is the NHS.
    In the USA hospitals charge $20,000 a day before doctors, drugs and medical costs. An aspirin can be charged at $30. A friend was admitted with a broken ankle. Total costs billed were nearly $250,000 fortunately mostly covered by insurance which cost them $9,000 pa as a single person. A family of 4 would have to find $16,000 for basic cover. Then there are hidden extras, co-payments and deductibles paid by the patient, which can amount to thousands of dollars. People have to go without drugs because they can’t afford to fill prescriptions. The Affordable Care Act has only made things slightly better by subsidising insurance costs for some people.
    Traditionally USA basic health insurance cover has been paid by employers as part of remuneration but only for those in work. Even this cover is in decline now as employers withdraw this benefit.
    Never think that private health care can offer a better system. Private health care is only for rich people. It leaves the majority of the population high and dry!
    Making the NHS work is a management challenge, but behaving like an exploitative Victorian employer is not the answer. Why should doctors be paid less than politicians – politicians who try to reduce their own workload by side-stepping responsibility for doing things properly by handing chunks of the service to private companies. In 10 years time the politicians will be long gone leaving the mess they created behind.

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