101: The Junior Doctors Contract Dispute & What It Means

101: The Junior Doctors Contract Dispute & What It Means

We've seen the news, the anger and the movement of Junior Doctors. But let's be honest, we don't all understand what it's exactly all about. So, medical student Joe Brett breaks. it. down...

Junior doctors strike outside St Thomas’ hospital, London, on 6 April. Photograph: Dan Kitwood/Getty Images

Junior doctors strike outside St Thomas’ hospital, London, on 6 April.
Photograph: Dan Kitwood/Getty Images

The Basics

© Steve Bell 2014 Illustration

© Steve Bell 2014 Illustration

Who? - The junior doctor contract dispute is between the government, headed by Jeremy Hunt, and the British Medical Association (BMA) who's rep is Dr Johann Malawana, heading up around 53,000 junior doctors.

When? - Talks to update the previous contract introduced in the 1990s, started in 2012 and broke down in 2014.

Watch out! - A “junior” doctor is a misleading term as it includes everyone from doctors who have just graduated medical school to
trainees that have spent 10 years in postgraduate training.

Working Hours and Pay

Let's look back. One of the main pledges during the Conservative election campaign was to create a 7-day NHS. However, the NHS currently provides a 7-day emergency service and a 5-day elective service (non-emergency operations and outpatient clinics). In order to increase the number of non-emergency service days to 7, you need more doctors and more funding. This seems obvious - right? Well, this is not what Jeremy Hunt is doing or even has planned. 

Instead, to meet this objective Hunt is stretching out the existing workforce to cover this 7-day service. Stretching efforts like this is not safe for patients, nor the doctors. In order to do this though, Hunt is looking to remove the current financial penalties hospitals have to pay when they are forcing junior doctors to work unsafe hours. It makes no sense. Why remove these penalties if this contract was designed to be safer? It's leaving junior doctors exposed, and vulnerable.

On top of this, currently there are no provisions in place for extra consultant cover, nor for the senior doctors that have the ultimate responsibility for patients, nor any of the allied health professionals (AHPs). This is crucial problem as consultants lead the team and AHPs provide vital services, such as imaging and rehabilitation to name a few...

So… If Junior Doctors are being forced to work longer hours... they will get paid more? Wrong.

1st year junior doctors currently get paid roughly £22k a year, plus supplements for antisocial hours (i.e working weekends and nights). The new contract proposes that an additional 30 hours of the week will be deemed “standard”. This means that 9am on Tuesday morning is viewed the same as 9.30pm on a Saturday. Unfortunately, even the government’s proposed 11% pay increase does not cover these losses. 

The impact will be felt most by specialities that work the most nights and weekend cover, such as Accident and Emergency. In this area, they are already experiencing a recruitment crises - will cutting their pay really help? 

Gender Equality? 

The government is stopping the automatic increase in pay as junior doctors become more experienced year by year. Therefore, women who choose to work part time for a year or so whilst on maternity leave will be explicitly targeted. Moreover, doctors that pursue academic interests will have the same penalties. What kind of message is this sending to young women who want to become doctors? The Department of Health has recognised this disadvantage and states the new contract will “impact disproportionately on women”. WHAT! 

The Strikes

The NHS will last as long as there are folk left with the faith to fight for it
— Aneurin Bevan - Founder of the National Health Service

The junior doctors have undertaken several strikes since the start of this year. Previous strikes have solely affected elective care, with emergency care still being staffed However,  the upcoming strikes on the 26th and 27th of April are different. In these, the junior doctors will no longer provide emergency care. However, consultant cover has been arranged and as such, patients will not come to harm from this.

This upcoming strike is undeniably a drastic measure as a decision by emergency care to strike has not happened before in the entire history of the NHS. This highlights the strength of feeling in the profession. It eptimoses the need for all to stop and speak up against the new contract. It is unsafe and unfair. 

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