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Ignoring the new junior doctor contract could backfire on general practice



Advice from the GPC at this year’s LMCs Conference stated practices have no legal obligation to adopt the new trainee contract. Concerns were raised about the work schedules issued by the BMA and NHS Employers.

NHS employers originally suggested all trainees should be on the new contract by the end of October 2017. Given the GPC advice it seems unlikely this will be the case in GP land. Several practices I’ve spoken to don’t know a new contract even exists or where to find it.

There is varying rationale given for sticking with the old. One argument is that the majority of junior doctors did not vote for the new contract, so why should GP adopt it? A very good point. I suspect, however, this has more to do with the financial implications, training time and ball ache of making the required changes. Even when trainees have a lead employer, it is apparently ‘unclear’ who has responsibility for implementing work schedules.

Great.

But has anyone really considered what issues an inconsistent introduction could present?

The new contract has many negative elements which led trainees to vote against its implementation. There are, however, some positives such as safeguards to protect trainees from working excessive hours and plugging practice gaps. The new ‘guardian of safe working’ role provides a means for trainees to exception report when contracted hours are persistently exceeded.

By introducing this for hospital but not GP trainees it reinforces the concept that the overworked, unprotected GP is the norm. GP trainees already work longer ‘normal’ days than hospital doctors despite officially being contracted to the same 40-hour week. This goodwill may quickly diminish when the working hours and pay gap widen.

‘Come to GP, work more hours for free!’

Can’t see that one making it to the next recruitment campaign.

I know, I know. It’s not ‘real life’. How will doctors cope becoming ‘proper’ GPs if they train in such a protected environment? Most current trainees have around 40 years of ‘real life’ to look forward to, so the prospect of a few years of protection sounds pretty nice to be honest. Would it really be so bad for all GPs to have better boundaries in the future and get into the habit of working contracted hours?

The same arguments were had a few years ago when the European Working Time Directive and new training models were introduced. Oddly, the NHS has continued to function and consultants are still being churned out. Are they as well trained? Maybe not. But did they work in a safer, regulated environment? Yes. There is no perfect solution.

Difficulties will also be encountered when trainees move between hospital and practice posts if this inconsistent approach goes ahead. Conflicting rules on front loading and pay protection could potentially mean wildly different salaries depending on where the trainee happens to be working at the time. Not ideal for mortgages or family planning! Oh sorry, I forgot, doctors aren’t human beings are they?

There’s the question of how practice managers will calculate the right salary when trainees are alternating between pay scales? How will the increments work? This could potentially cause chaos for trainees and practice managers. Given Capita’s current record I doubt help from them will be forthcoming.

Strong advice from above is needed here. Junior doctors have been treated poorly in this whole debacle and are more aware of their rights than ever before. Caution needs to be exercised to ensure morale is not depleted further or the future GP cavalry may never arrive.

Dr Sarah Merrifield is a GP leadership fellow in Yorkshire