After months and years of arguments, claims, counter-claims, protests, rhetoric, and anger, the BMA leadership and the Government have finally come to a compromise deal on the proposed new junior doctors’ contract. It’s not over yet. The precise wording of the contract has to be worked out, and the junior doctors have to vote to approve it in a referendum from 17th June to 1st July (having a referendum any time other than late June is inconceivable.)
Key issues in the debate included the hours doctors can be required to work, changes in the way pay progression operates through doctors’ careers, and weekend pay.
Under the agreement, the new contract will formalise rest patterns and breaks, limit the amount of weekend working doctors can be required to do and compensate doctors for working beyond scheduled hours.
The Government wants to move pay progression from a system based on how long a doctor has been qualified to a system based on skills. The BMA considered this penalised those who took career breaks, especially to have children. Under the agreement, ”accelerated training” will be available to ensure that people who do take time out can “catch up”, and after a career break, doctors will not have their pay reduced on coming back.
The new contract will increase basic pay by 10-11%, while pay during night shifts will be 37% above basic rate and pay for being on call will be 8% above basic rate. These fixed "bonuses" are a move away from the previous system, which had a far greater range of possible percentages, from 20% to 100%.
On the big issue of weekend pay, the general principle will, unlike previously, be that weekends are paid at basic rate. However, if a doctor works more than 6 weekends a year, they will receive increased pay depending on how many weekends they work.
Debate will continue to rage as to whether it was justified for the Government to even try to increase working and reduce pay for doctors on weekends. Under the agreed plan, the Government can claim victory on this key principle: weekend working is now seen as “normal”, at least up to a certain number of weekends. The weekend “bonus” is also lower than it was before, and lower than the BMA and the Government originally proposed. This helps to explain why the plan does not increase costs for the Government.
We will soon be able to see whether this policy will reduce weekend deaths and increase patient satisfaction to be worth the disruption it has caused. We will also have to see whether “accelerated training” offsets the potentially discriminatory effects of removing guaranteed pay increases.
The BMA undoubtedly hopes that the Government’s commitments on rights to rest and compensation, and greater involvement for doctors in shift allocation, will ease their worries about patient safety, something which was key to their arguments.
What may be more important, however, are parts of the agreement that won’t make the headlines: a whole range of measures to improve the voice of junior doctors in their organisations, to increase pay during periods of training, and to improve recruitment processes.
If the NHS is to avoid intensifying a staffing crisis, among all the other challenges it faces, it needs to do better at communicating with and listening to its staff. The test of this agreement will be if junior doctors stay in the NHS rather than fleeing to Australia or the private sector. The past few months have been unnecessarily painful for doctors, patients, and the Government. In a whole range of policy issues, this Government, and indeed all Governments, would do well to speak to the professionals before fighting them, not after.