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'Junior doctor contract is a decisive step forward'

Health secretary Jeremy Hunt has said he will impose a contract on junior doctors from August. Read his statement to Parliament in full here

Mr Speaker, nearly 3 years ago to the day the government first sat down with the British Medical Association (BMA) to negotiate on a new contract for junior doctors. Both sides agreed that the current arrangements, drawn up in 1999, were not fit for purpose and that the system of paying for unsocial hours in particular was unfair.

Under the existing contract doctors can receive the same pay for working quite different amounts of unsocial hours; doctors not working nights can be paid the same as those who do; and if 1 doctor works just 1 hour over the maximum shift length it can trigger a 66% pay rise for all doctors on that rota.

Despite the patent unfairness of the contract, progress in reforming it has been slow, with the BMA walking away from discussions without notice before the general election. Following the election, which the government won with a clear manifesto commitment to a 7-day NHS, the BMA Junior Doctors Committee refused point blank to discuss reforms, instead choosing to ballot for industrial action. Talks did finally start with the ACAS process in November but since then we have had 2 damaging strikes with around 6,000 operations cancelled.

In January I asked Sir David Dalton, Chief Executive of Salford Royal, to lead the negotiating team. Under his outstanding leadership, for which the whole House will be immensely grateful, progress has been made on almost 100 different points of discussion, with agreement secured with the BMA on approximately 90% of them. Sadly, despite this progress and willingness from the government to be flexible on the issue of Saturday pay, Sir David wrote to me yesterday advising that a negotiated solution is not realistically possible.

Along with other senior NHS leaders and supported by NHS Employers, NHS England, NHS Improvement, the NHS Confederation and NHS Providers, he has asked me to end the uncertainty for the service by proceeding with the introduction of a new contract that he and his colleagues consider both safer for patients and fair and reasonable for junior doctors. I have therefore today decided to do that.

Tired doctors risk patient safety, so in the new contract the maximum number of hours that can be worked in 1 week will be reduced from 91 to 72; the maximum number of consecutive nights will be reduced from 7 to 4; the maximum number of consecutive long days will be reduced from 7 to 5; and no doctor will ever be rostered on consecutive weekends. Sir David Dalton believes these changes will bring substantial improvements both to patient safety and doctor wellbeing.

We will also introduce a new Guardian role within every Trust, who will have the authority to impose fines for breaches to agreed working hours based on excess hours worked. These fines will be invested in educational resources and facilities for trainees.

The new contract will give additional pay to those working Saturday evenings from 5pm, nights from 9pm to 7am, and all day on Sunday. Plain time hours will now be extended from 7am to 5pm on Saturdays. However, I said the government was willing to be flexible on Saturday premium pay and we have been: those working 1 in 4 or more Saturdays will receive a pay premium of 30%, that is higher on average than that available to nurses, midwives, paramedics and most other clinical staff. It is also a higher premium than that available to fire officers, police officers or those in many other walks of life.

Nonetheless it does represent a reduction compared to current rates, necessary to ensure hospitals can afford additional weekend rostering. So because we do not want take home pay to go down for junior doctors, after updated modelling I can tell the House these changes will allow an increase in basic salary of not 11% as previously thought but 13.5%. Three-quarters of doctors will see a take home pay rise and no trainee working within contracted hours will have their pay cut.

Mr Speaker, our strong preference was for a negotiated solution. Our door remained open for 3 years, and we demonstrated time and again our willingness to negotiate with the BMA on the concerns that they raised. However, the definition of a negotiation is a discussion where both sides demonstrate flexibility and compromise on their original objectives, and the BMA ultimately proved unwilling to do this.

In such a situation any government must do what is right for both patients and doctors. We have now had 8 independent studies in the last 5 years identifying higher mortality rates at weekends as a key challenge to be addressed. Six of those say staffing levels are a factor that needs to be investigated. Professor Sir Bruce Keogh describes the status quo as ‘an avoidable weekend effect which if addressed could save lives’ and has set out the 10 clinical standards necessary to remedy this. Today we are taking one important step necessary to make this possible.

While I understand that this process has generated considerable dismay among junior doctors, I believe that the new contract we are introducing - shaped by Sir David Dalton, and with over 90% of the measures agreed by the BMA through negotiation - is one that in time can command the confidence of both the workforce and their employers.

I do believe, however, that the process of negotiation has uncovered some wider and more deep-seated issues relating to junior doctors’ morale, wellbeing and quality of life which need to be addressed.

These issues include inflexibility around leave, lack of notice about placements that can be a long way away from home, separation from spouses and families, and sometimes inadequate support from employers, professional bodies and senior clinicians. I have therefore asked Professor Dame Sue Bailey, President of the Academy of Medical Royal Colleges, alongside other senior clinicians to lead a review into measures outside the contract that can be taken to improve the morale of the junior doctor workforce. Further details of this review will be set out soon.

Mr Speaker, no government or health secretary could responsibly ignore the evidence that hospital mortality rates are higher at the weekend, or the overwhelming consensus that the standard of weekend services is too low, with insufficient senior clinical decision-makers. The lessons of Mid Staffs, Morecambe Bay, and Basildon in the last decade is that patients suffer when governments drag their feet on high hospital mortality rates – and this government is determined our NHS should offer the safest, highest quality care in the world.

We have committed an extra £10billion to the NHS this Parliament, but with that extra funding must come reform to deliver safer services across all 7 days. That is not just about changing doctors’ contracts: we will also need better weekend support services such as physiotherapy, pharmacy and diagnostic scans; better 7-day social care services to facilitate weekend discharging; and better primary care access to help tackle avoidable weekend admissions. Today we are taking a decisive step forward to help deliver our manifesto commitment, and I commend this statement to the House.

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Readers' comments (14)

  • One step forward, two steps back - Lenin would have said.

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  • Watch what medics can do now Mr Hunt. Thank you for galvanizing us.

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  • We are not your average public servant Mr Hunt.

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  • @1:51. Indeed so, bags packed and off to sunnier climes. Who will replace us, the next generation of consultants; did you forget about that knock-on effect? Blame a civil servant later? Perfect.

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  • Interesting that a guardian role is going to be needed and that they have even thought about how they are going to invest the money from the fines for breaches in contractual hours.
    Should we assume this contract has once again been based upon the doctors dedication to their patients and the goodwill of everyone involved to pick up the pieces due to sickness and annual leave. I think it may have run out.

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  • Doctors will be too tired to work the extra hours that we all know will be required. Many of the JDs are already becoming burnt out. It will not be tenable. Us old docs all did excessive hours when younger, but not having to rigidly follow protocols as JDs do now. The system will collapse.

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  • This is a decisive step forward over a cliff edge.

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  • Next steps please... before a contract is imposed on GPs:

    1. BMA should work up a costed insurance-based plan for fully private general practice prior to our complete withdrawal from the NHS.

    At £200 registration fee per patient per year a list size of 1500 would give gross practice income of £300,000. Deduct 60% (as this is what average business expenses seem to be for most practices). Left with £120,000 per annum gross income per practitioner based on registered list. Any consultations or interactions should be charged an item of service fee.

    A separate charge would be needed for actual consultations as well as home visits.

    2. GP partners, salaried and locums consider coming together to form chambers to provide the above medical care.

    3. Private chambers should provide subsidised medical cover for other doctors or current NHS staff +/- their 1st degree relatives. Everyone else should pay full whack.

    4. Subsidised cover should include retired doctors (I'm looking at you John Glasspool).

    5. BMA should negotiate with the DOH (or simply impose) a charge for providing NHS-backed prescriptions or negotiate a system whereby patients claim back costs of private prescriptions from the DOH.

    6. BMA should negotiate a service price at scale for GP clinical systems e.g. EMIS.

    7. BMA should negotiate an agreed service price for reports to the DWP and social services etc

    The above plan is simply a rough outline. Hopefully the really business-minded ones out there could develop this further. It would provide some benefit for being a doctor in the UK- i.e we provide reciprocal cover for each and our families as well as those unfortunate enough to remain in what will be left of the NHS.
    If the rest of the Great British public thinks they were better off before they should hold Jeremy Hunt to account.

    I hope the BMA is seriously looking at working up an alternative to NHS general practice. This is not an impossible task as the dentists have shown. If we have pre-prepared our own "nuclear" option then sending mass undated resignations would hold real power. If Jeremy Hunt persists with contract impositions and his destruction of the NHS we would be in a position to walk away. The public would then deal with Hunt and Cameron as reality bites.

    as wiser GP than me has already said it... Ditch the contract comrades!

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  • Professor Sir Bruce Keogh describes the status quo as ‘an avoidable weekend effect which if addressed could save lives’

    evidence please - anyone?

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  • This is the man wants to buy healthcare on the cheap - a five star service with 3 star prices. Now A 7 day service with a 5 day funding. The doctors are better to support privatisation and let market forces speak for it self.

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