By Victoria Egerton @VictoriaEgerto2

The Government calls for a 7-day NHS at no extra cost. This is part of Cameron’s pledge of an expansion of weekend emergency care services by 2020. We already have a 7-day NHS. But how do you achieve a 40% increase in productivity, without any extra financial cost?

In 2012 the Department of Health (DH) proposed changes to NHS junior doctors contacts. Consultations between the DH and the British Medical Association (BMA) continued, until they failed in October 2014. On 13 August 2015, the BMA decided not to re-enter into negotiations.

The Health Secretary, Jeremy Hunt, has provided misleading and misinterpreted information in order to present a good cause to limit and regulate junior doctors contracts, in terms of pay and working hours.

Hunt offered an apparent “compromise” of an 11% rise on basic pay. But what does this really mean in comparison with the 25- 30% pay reduction on unsociable hours and weekend rates?

This is not just about the money. The proposed changes will lead to a long hour culture, staff shortages and tired, less focused medics. In turn, this will lead to a risk to patient safety. Would you want an over-worked junior doctor to treat you?

Industrial action is a last resort to failed negotiations and an ultimate strive to protect junior doctors and patients. The new contracts are due to be enforced in August 2016.

Who are junior doctors?

There are over 53,000 junior doctors in England. Their roles and most importantly their significance in the medical profession, is regularly misconstrued. Their title covers a composite of skill, from trainees who have recently qualified from medical school, to those who have practiced for many years.

What are the proposed contract changes?  

The changes include regulations on unsociable hours pay such as rates for different settings, evening and weekend work.

  • Pay reductions of up to 30% on premium rates when working between 7:00 and 20:00 (except on Sundays)
  • Hours extended from 7:00-19:00 Monday- Friday to 7:00-20:00 Monday – Saturday
  • Compromise on overtime rates where Saturday evenings would be paid as unsociable hours
  • Basic pay rise of 11%
  • Pay protected until 2019

An increase of 11% is on basic pay and not on over-time, weekend work or unsociable hours. Many junior doctors work outside basic hours and will lose out significantly. Those that currently work evenings and on Saturdays until 19:00 will no longer receive pay increases for this work. Junior doctors will be paid more for unsociable hours but this would be a lower proportion of their pay.

There has been no guidance on what happens after the three-year pay protection period. The proposals increase basic hours by 25 hours per week accompanied of course, by a pay reduction.

Who made the recommendations for change?

The recommendations were advised by the Review Body on Doctors’ and Dentists’ Remuneration. The DDRB is an advisory, non-departmental public body that is supposed to be independent. Interestingly, it is also sponsored by the Department of Health.

What about misleading information on weekend emergency care?

NHS England dissociated itself with the Health Secretary Jeremy Hunt’s claim, that in only 10% of hospitals in England are patients seen by senior doctors within the first 14 hours of admission at weekends.

Independent statisticians reviewed the same NHS data and astonishingly found that 79% of hospitals actually see patients within this time, throughout the whole week. The NHS records data weekly. There is not a breakdown for weekends.

Who is taking action industrial action?

Of those who voted to take industrial action, 99.4% said that they were prepared to take action short of a strike, and 98% were willing to strike.

76% of junior doctors voted on whether to take industrial action. Comparatively, 66.1% of the public voted in the General Election. For junior doctors, this would be the third strike in 40 years (1975 and 2012).  

Why strike, and what does this mean for the public?  

Jeremy Hunt said that he retains the right to impose the restrictions on junior doctor’s contacts, regardless of whether a compromise is met. The BMA argues that the terms are unfair, harsh and “heavy handed”.

Junior doctors will be paid less and work more. Staff shortages and over worked medics is likely to lead to staff and patient safety concerns. An 11% pay increase is not a compromise. Compared to the amount of income that junior doctors will forfeit from changes to unsociable hour pay and weekend rates, the proposed increase to basic pay is embarrassing.  

What do junior doctors want?

Overall they want “reasonable assurances” that the contacts will be fair and safe.

  • Working hours safeguards that protect doctors and their patients
  • Not to be disadvantaged for working unsociable hours
  • Unsociable hours to be recognised and paid at a premium rate

What about patients during the strike?

There has been a significant amount of scaremongering by Jeremy Hunt, the media and the Department of Health in general, around the proposed industrial action. The medical workforce comprises of around 50% of junior doctors.

There will undoubtedly be a form of disruption. The services affected will include cancellation of planned operations and appointments in order to ensure emergency care is prioritised and patient needs are met by other medical professionals. A strike is the last resort from years of attempted negotiations.

The strike is set to go ahead on 12th Jan.

Fragmentation is great for privatisation

With fragmentation of services in England and the NHS having met the biggest squeeze of funds since the 1940’s, there is a growing concern that the proposed changes to junior doctor contacts will lead to an NHS crisis and a step further towards privatisation.

Concerns also arise that NHS trained junior doctors will practice privately or abroad due to the changes in contracts.

However, Jeremy Hunt has demonstrated that he wishes to muddy and stigmatise junior doctors over the strike with several false accusations over emergency care and also claims that the Health secretary’s staff asked experts to ‘sex up’ the risks of the strike. There have also been claims from reporters who say they have only been allowed to attend NHS England approved hospitals during the strike. Thus, this strike is as much about a battle for understanding the real intentions behind these changes to our NHS, as much as it is for junior doctors’ futures