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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)

  • @|Anonymous | GP Partner|11 Feb 2016 7:30pm

    I hope you are joking! I thought the whole point was to fight to 'save the NHS'. Do you really want GPs to go down in history as the ones who en masse broke the founding principle 'free to all at the point of service'?

    Expecting patients to pay to register and to maintain private medical insurance or to pay for each consult etc would not work in any but the most wealthy areas.

    It is a deeply divisive concept, which would have few takers. Even those who currently have private insurance still use their NHS GP and, as tax payers, they are entitled to do so.

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  • 'Junior doctor contract is a decisive step forward' doesnt he really mean Divisive?

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  • If you are YOUNG and in the UK you must realise you have ZERO FUTURE.

    YOU will be required to work for less, pay higher taxes and work until your drop dead. Yes the retirement age is mooted for 68 but in a few more years they will raise it past 70 and then even higher......

    And there probably wont be a nice tax free lump sump for you like the cardigans are getting now.

    Sooner or later you will have to face the PAINFUL REALISATION that you are being made scapegoats for the greed of those that came before you. The truth may hurt and shock you but its still the truth. You are turkeys being lined up for the abattoir, and those that run the profession have absolutely ZERO INTEREST in your futures. All they care about is biding their time until they can exit the system and live off the fruits of your efforts on their generous pensions.

    At best if you have another professional spouse you will live a comfortable life. However its unlikely you will be able to purchase in the leafy suburbs like the cardigans were able to.

    If you have children and wish to educate them privately then that will be your lot. And so like a rat on a treadmill they will keep you working in this poisonous despicable system keeping you down with the thought police GMC and CQC as well as you remaining in a constant state of FEAR AND DEFEAT due to the ever present threat of a vexatious complaint.

    Its time to face facts comrades the UK has no future for you....its over...its finished and if you think otherwise you ought to have a liason psychiatrist look at you for your own safety.....


    Its time for you to use the talents and high IQ kind providence blessed you with AND FIGHT BACK!!!

    LEAVE THE CARDIGANS TO ROT IN RETIREMENT AND GIVE THEM A 2 FINGERED SALUTE AS YOU EXIT THESE TOXIC SHORES FOR A LIFE OF RILEY ABROAD.....YES YOU TO CAN FIND YOUR NICHE IN THIS WONDERFUL PLANET FREE FROM THE FILTH YOU ARE CURRENTLY ENDURING!!!!!

    THERE ARE MANY LOCATIONS WORLDWIDE THAT WANT YOU, NEED YOU AND RESPECT YOU. THEY ARE WILLING TO ROLL OUT THE RED CARPET FOR TALENTED INDIVIDUALS AND WILL TAKE CARE OF YOU!! YOU CAN TAKE CONTROL OF YOUR DESTINY AND REMEMBER ONCE AGAIN WHAT IT FEELS TO BE A REAL DOCTOR AND NOT A WHIPPING BOY (OR GIRL--- MUSNT' BE SEXIST NOW)


    IF YOUR READING THIS I KNOW HOW YOU FEEL, I FEEL YOUR PAIN, BUT REMEMBER THERE'S NOTHING WORSE THAN A LIFE HALF LIVED AND DREAMS UNFULFILLED!!!

    DITCH THE COUNTRY COMRADES!!!! ITS NOW OR NEVER!!!

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  • To much 'censoring' in the comments here. Two of my posts have simply been removed. One was a perfectly reasonable critique of the above comment 13th Feb 10:29 taking issue with its overwhelming anti UK negativity. Don't fall into the trap of assuming these comments represent an accurate view of opinion posted here ...it appears there is heavy editing going on. I wonder how long this comment will be left hey PULSE?? How can we judge what people really think when a segment of opinion is edited out?

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