Why the new junior doctor contract is a slap in the face

NHS Employers have announced that they’ll be forcing an insulting new contract on junior doctors. The BMA Junior Doctor Committee did try to negotiate with them, but talks broke down and last month the BMA decided that it couldn’t come back to the table when what was on offer was so demeaning.

The reaction from medical staff (and the general public) has been visceral. They’ve made it very clear that this new contract would be nothing less than a danger to patients and staff alike and a despicable slap on the face for junior doctors. An unofficial petition calling for strike action has already topped 30,000 signatures.

So why all the anger? Here’s why.

  1. It’s a huge pay cut

From the limited data that NHS Employers have provided about the new rates of pay, most models, including my own, are predicting around a 10-15% pay cut. Although the new deal is supposed to be cost-neutral, we find it hard to trust a Health Secretary who denied nurses their 1% pay rise but then accepted a 10% pay rise himself, and who said that mental health funding had gone up despite mountains of stats that said that it had plummeted. Doctors don’t tend to be greedy people, but almost all of them have massive student loans, many of them have a family to support, and lots of them are trying, somehow, to afford a house. Seeing NHS Employers recently advertise for 200 ‘physician associates’, who only need two years training, for salaries of £50,000 a year, didn’t help our self-esteem.

2. It turns our evenings and weekends into ‘standard working time’

Currently, 7am to 7pm Monday to Friday is seen as standard working hours, and any work done outside of that is seen as worthy of extra pay. This seems reasonable. But the new contract extends these standard hours to 7am to 10pm on weekdays and Saturday, meaning that we’ll be paid the same for an hour of work on 9pm on Saturday compared to an hour of work at 9am on Tuesday. Only Sundays and nights are paid more. This means hospitals can rota us to work far more unsocial hours than we currently do at no extra cost, which is basically theft of our personal lives. Though doctors are frequently needed out of business hours, there’s no reason why we should submit to being paid the same for working at that time. We signed up to help people, not to sacrifice any semblance of a life outside of medicine as a favour.

3. There are no clear safeguards on monitoring our hours

Not so long ago, junior doctors were working over 100 hours a week. It was relentless, traumatic, and frankly dangerous. Then, after years of lobbying, the European Working Time Directive was passed into law and gradually the average number of weekly hours we were allowed to work started to shrink. It’s currently 48. A complex process of ‘banding’ occurs to add on a percentage amount to our basic salary (typically 40%) to recognise how hard we work out-of-hours and another complex process of hours monitoring occurs to make sure we don’t work too many hours. There are big incentives for employers not to overwork their doctors.

But with the new contract, there is no such system of monitoring. Doctors will be expected to go to their employers and ask for a ‘work review’ if they’re worried about their hours, which they won’t do because they’re too busy, which they’ll feel bad about doing, and which they’ll be quietly punished for doing. Back to the 1980s.

4. The reason for change – Cameron’s ‘7 day NHS’ – is deeply flawed

The whole point of this new contract is that David Cameron wants a ‘7 day NHS’. But he refuses to define what that means. He refuses to acknowledge that the NHS already works 7 days a week, and that forcing doctors to work more weekends and nights isn’t necessarily going to help improve services. Though Jeremy Hunt likes to spout about death rates being raised for patients admitted on the weekend, it’s still not clear if those patients just happen to be sicker or if more weekend doctors would save any of them, let alone be value for money.

I am seriously worried that doctors are going to be forced into rotas which schedule them for ever-increasing amounts of weekend and night work, with no clear rationale for what they’re meant to be doing, and no great means of doing it (as many other services are closed at the weekends). Some specialties like psychiatry don’t have a huge call for out-of-hours work, so pulling doctors from their Monday to Friday jobs to man the hospital on weekends would only be counterproductive. And we know that GP patients don’t necessarily love weekend appointments – pilots had to be stopped early as no one booked a slot!

5. Annual pay progression is being scrapped

In the clearest demonstration of how little NHS Emplyers and the DoH know about medical training, they’ve decided that instead of getting an annual pay rise, certain grades of doctor (SHOs, registrars etc.) should all earn the same amount within their grade, no matter how long they’ve been in that grade, as they all have the same responsibility. This is horseshit.

Every doctor knows that a first year SHO is going to be calling their seniors a lot, needing more help, and working slower. But a more senior SHO will be running more of the show for themselves, and helping out their less senior colleagues more, so deserving more money.

Also, pay progression encourages people to stay in their jobs, which at a time when GP recruitment is shockingly low, is a good thing.

6. It mistakes non-residential on call hours for lazing about

The new rate for non-residential on call hours (being at home, but available), is just 5% more than a standard hour’s work. As if doctors who have to rush in from home at 4am to do procedures that only they can do are of no use, when in fact, doing such on calls is often hectic, grueling and vital. And again, specialties who don’t have a huge demand for residential out-of-hours work, like my own, will suffer disproportionately.

7. It discriminates against women and men who want a family life

Currently, if a junior doctor changes specialty part-way through their training, effectively starting again, they stay on the same rung of the pay ladder to recognise their past service to the NHS. But under the new contract, pay will revert back to the lowest rate if the doctor decides to retrain in another specialty, or become an academic. Apart from being a harsh punishment for anyone who simply decides that they want to change their career direction (how dare they?), this is a flagrant swipe at women and men who want family lives, who often retrain in specialties more suited to that end, like GP or psychiatry. As if the fact that stopping annual pay progression will disproportionately hit women who work part time, as pay rises will come every 6 years instead of every 2, wasn’t bad enough.

I can’t emphasize enough how harmful this new contract will be for junior doctors and patients alike. Masses of my friends have already left for Australia, and they aren’t coming back. Why would they? The powers that be treat our NHS staff like dirt and unless we stop it soon, there won’t be anything left to protect.

I’m still undecided about strike action. If you could guarantee me that it would have a positive effect, then I’d be the first on the picket lines to fight for patient safety in the long-term. But the ignorance and deafness that NHS Employers and the DoH have shown is becoming legendary, so we may need another option. I’m open to suggestions. Help.

About Alex Langford
I am a psychiatrist (now an SpR) based in Oxford after 3 years working in South East London. Before I went into psychiatry, I used to be a general medical doctor, and I also have a BSc in psychology. I'm particularly interested in improving the public face of psychiatry, evidence based medicine, teaching and patient rights. Don't mention cricket unless you've got the next fortnight free to discuss it.

14 Responses to Why the new junior doctor contract is a slap in the face

  1. BecB says:

    I have a great GP and a great psychiatrist. When I was looking for new doctors, one of the things that I looked for were their hours, if the clinic had a lunch break etc. I’ve found the doctors that don’t work stupid hours and have at least a little bit of time to eat their lunch are more empathic, patient and supportive than the doctors that work in those super clinics that pump patients out. I also assume their clinical practice would be better for similar reasons.
    I can’t imagine what it would be like for junior doctors who are still learning.

    I just wish these politicians would impose the same rules on themselves as they do on the health systems they ‘manage’.

    • Polemicist says:

      I think this debate needs some perspective. I am going to be affected by this new contract. I am ENT trainee, have a big family and mortgage. I cant afford not having a pay rise let alone a pay cut of 15%. I dont like it one bit. But as intelligent people we must understand the greater issues at hand.

      Since 1948 doctors have been on a steady downward spiral to becoming truly working class with salaires to match. Many here wouldnt believe it but most doctors (some reports indicate 95%) opposed the NHS because it would make them state employees with the result that pay would become a political football, they were right. I dare say had we stayed self employed practitioners we would be seeing earnings similar to those in finance and big business. But we as a profession were swallowed into the state sector.

      The state is becoming poorer in contrast to its rising public service liabilities. All public services are taking a hit and so must NHS staff. As the wage bill for the NHS accounts for 70% of its budget, it doesnt take an economists to work out where the fat needs cutting. There is a historical and global re-alignment of economies. The UK has been becoming poorer for the last 200 years. The small blip in the post war years and astronomical governement borrowing is what allowed the state to be extravagant enough to create bloated public services like the NHS (see greece for an illustration). Looking at this new contract in isolation seems like oppression and i personally dont like it, but in a more wider and historical context it only seems inevitable.

      We will have to accept that as doctors we will be living and earning more like our working class comrades and less like our friends who chose easier but more financially rewarding porfessions such as banking. The world is changing. Western economies are no longer as rich as they use to be and thier public services will need to reflect that change. The junior doctor is an unfotunate but inevitable victim.

  2. Fenella says:

    THanks Alex for explaining it so well. Sadly this govt has a real issue with doctors. If not GPs then junior doctors, then others. I am shocked that the unsocial hours has changed in such a rough way. Working after 9pm on a Friday used to be unsocial until MOnday morning. It is a financial move but unacceptable as the rest of the NHS workforce don’t get such a raw deal in terms of the working week.
    Finally your blogs are very informative and I value them tremendously. I hope your patients value your good skills as an SpR!

  3. Pingback: Imposing unsafe junior doctor contracts harms all of us | learn4kicks

  4. Pingback: Why the new junior doctor contract is a slap in the face

  5. Karina says:

    Thank you Alex for such a good explanation. It is very sad news and almost made me cry. Just bought a home and had a child. What news could be worse for a junior doctor?

  6. C Pattison says:

    This Conservative government continues on its course of enrichment of the rich to the detriment of everyone else. Undermining the NHS will enable increasing privatisation and mega profits for those private health companies, whose hands are already deep in government pockets. This treatment of junior doctors is disgusting, as are many actions this government has taken.

  7. Hubert Page says:

    ‘I’m still undecided about strike action. If you could guarantee me that it would have a positive effect’ – that is the lamest thing i’ve heard in a while!!!
    If you really believe in something you stand up for what you believe in, walk the walk so to speak regardless of whether you’ll get your way or not. Moaning on the sidelines on the basis that you don’t like the conversation is equally lame, What did the BMA achieve for us or for anybody buy walking out of the negotiations?

    • Dan says:

      Is it not that Dr Langford would rather not put patient safety at risk in the short term unless he knew it would ensure patient safety in the long term?
      He, (I may be assuming here) like myself, would rather not be in the position of jeopardising patient safety in a strike if these changes are going to be railroaded through anyway.
      But I admire your passion, and I agree we need to persevere with negotiations, which is unfortunately extremely frustrating when dealing with the likes of *shudders* hunt.
      Also thank you Alex.

  8. Wajid Iqbal says:

    I am a trainee doctor in psychiatry. I do the so called non-resident on call shifts. The shifts are normally 13 hours long. I provide cover for 7 different sites located many miles apart in 4 different towns. I spend my nights juggling competing demands from these sites. The time that I have when I am not on a site is spent driving my car on long roads. Contrary to the popular belief I am not in bed or watching TV.

  9. mili68 says:

    Reblogged this on disabledsingleparent.

  10. mili68 says:

    Tweeted @melissacade68

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