Negotiations between the British Medical Association (BMA) and National Health Service (NHS) employers to construct a new contract for NHS junior doctors in England began in 2013. Simplistically, the remit was to replace the existing contract, which had stood the test of time for the previous 13 years, with one that was deemed fairer by honoring all work done. It was agreed that the junior doctors’ pay would remain the same and that the existing pot would be redistributed among training grades according to their differing rotas.
Early in negotiations, it transpired that the new contract was being drawn up to significantly devalue weekend pay to support the potential rollout of 7-day elective services. There were also major concerns regarding the removal of existing safeguards that penalized trusts for excessive hours and dangerous rotas and the loss of automatic pay protection, which disproportionately hit doctors in academics and those with young children.
Talks broke down in 2015, and the BMA balloted its members, who voted for industrial action. The past 6 months have seen fierce campaigning between the two sides that reached an acrimonious nadir when the Secretary of State for Health Jeremy Hunt announced in February that, following failed negotiations, he would impose his new contract against the will of the BMA. The BMA reacted by ramping up industrial action to include a full walkout, the first time doctors in the United Kingdom have withdrawn emergency care. As a tense deadlock ensued, various key stakeholders, notably the Academy of Medical Royal Colleges, helped to broker a last-ditch return to the negotiating table. In May, the two sides reached a joint agreement, and a new contract was announced.
The BMA held a new referendum at the end of June. Fifty-eight percent of members voted to oppose the new terms and conditions. The Secretary of State has since announced his intentions to impose this new contract from this summer regardless of the referendum, and, at the time of writing, the BMA is currently considering its position.
THE NEW CONTRACT
The newly revised contract makes key concessions, including better remuneration for unsocial hours, a more independent safeguarding structure, and the potential of “accelerated training” to allow those who take time out of training to catch up once they return.
It is unlikely that this contract will be as compelling as the previous contract, which was simplistically ingenious—a low rate of basic pay with a significant “banding” supplement that covered additional duties over and above the standard working week. This fixed supplement incorporated goodwill, allowing doctors to “get the job done” by working the necessary additional hours.
This new model puts us in unchartered territory. While it is an honorable ambition to reward all working hours, this is not traditionally how NHS doctors have been paid and adds a devilish complexity to human resources logistic planning. Unlike other nonmedical professionals who are used to billing a client for their hours, we are employees of the State. Our hours are long and often unpredictable. It is not in our natural psyche to charge for our time in this fashion, but it seems that we will need to adjust to this new horizon.
Medicine remains an attractive career in the United Kingdom, yet the path of the junior doctor and beyond is becoming tougher. As many potential recruits and current trainees ponder their fate, we hope that the terms and conditions of this fantastic job will be enough to continue to retain and recruit some of the brightest minds, sustaining a viable medical workforce for the future, capable of maintaining an enviable publicly funded health care system that remains free at the point of delivery.