This is a post for both my colleagues in the health service, doctors included, and the public, so I thank you for taking the time to listen and let me explain what’s going on with this junior doctor contract dispute.

First of all, what actually IS a junior doctor?

The simple answer is, any doctor who is not a consultant. That means, in some specialties such neurology, ITU, or haematology, a doctor leaving medical school can take over FIFTEEN YEARS as a junior doctor. The first four years sees us progressing through the ranks of the two Foundation Years – that is, years to rotate around medical and surgical jobs, followed by two years as what we call a Core Trainee, in basically either a medical or surgical field. By this time we are what used to be called “Senior House Officers”. After this, we choose a specialty that we want to stay in – we’re called Registrars at that point, until we qualify at the other end, sometimes more than ten years later, as a Consultant. Only then are we no longer junior doctors. So you can see why there’s about 54,000 of us in the UK!

So what’s the latest news about the industrial dispute?

You may have heard that today the government announced its intentions to forcibly impose a new contract on junior doctors, despite months of negotiations by NHS England, and the BMA, the British Medical Association. On the face of it this seems like a final blow to doctors, a nail in the coffin. However it is really only another step in the government’s plan to chip away at the resolve and morale of doctors across the country. This fight is by no means over yet!! We doctors are 100% resolved to fight tooth and nail to ensure the safety of our patients, the future of our profession and ultimately, the future of the NHS. One little word from the government at this juncture may be enough to dampen our spirits temporarily, but it is not going to stop us from fighting for what we believe is right, safe and fair – it is not going to take the wind out of our sails. To my fellow colleagues, don’t despair, they haven’t heard the end of it yet. To people viewing this who aren’t doctors, we’re not doing this lightly, there’s a lot more to this than meets the eye.

If you have the time, please bear with me as I try to explain as best I can, what is truly going on in this crazy dispute.

So what is all this nonsense about anyway?

This dispute dates back to well into the last government. A panel was commissioned, the Doctors and Dentists Review Body, the DDRB, to look into the working hours and pay of junior doctors and consultants within the health service. As long ago as July 2013 the BMA’s Junior Doctors Council, the JDC, entered negotiations to hammer out key agreements for a new contract to include topics such as: 

• What is defined by “normal” working hours?
• What safeguards and financial could be put in place to prevent doctors working well beyond their rostered hours?
• What model of pay could be used to recognise progression through the career of a junior doctor?

Unfortunately, by the end of October 2014, the government via the DDRB failed to come up with an agreement with the BMA around safeguarding and welfare measures. At this point the government refused to “negotiate” the details of the contract it wanted to be imposed, but instead invited the BMA to sit around the table to discuss the method of actually imposing the contract itself. Of course that was ludicrous, as doctors at the time had voted unanimously that the contract as it stood was totally unsafe and unfair.

Before I continue with what’s happened, it is necessary to explain how a doctor’s current contract is made up. It’s a complicated system and the press have never quite got the hang of it, so I shall do my best!

Like any permanent job, we have our basic rate of pay. This is currently decided upon by both rank (i.e. Foundation Year, Core Trainee, Specialist Registrar), and year of service at that rank. For a first year junior doctor, this is currently twenty-two thousand, six hundred and thirty six pounds. Added to the basic pay is what is called a banding. This is a percentage of our basic wage added on, normally between 10 and 50 percent, which depends on how many hours, how many evening, weekend and night shifts that we are allocated to work over a three-month period. Those who rarely work outside of normal working hours, and work only thirty seven and a half hours a week, will find themselves “unbanded”, that is to say, basic rate only. Those on something like an A&E rotation, requiring many weekends and night shifts at work, will find themselves on a 1A banding, receiving an extra 50% on top of their basic pay.

Seems fair so far?

It might be interesting to note, though, that we cannot claim overtime. Our rostered hours are merely a portion of the hours we actually put in. Only a few lucky specialties can say they finish every day on time – some doctors working on the busier, shall we say, more hectic and under-staffed, specialties, such as gastrointestinal surgery, or geriatrics, can find themselves regularly working two to three hours extra to each shift, and can claim no overtime for these. The safeguard in the current system to prevent this happening too much is called “monitoring”, where one’s true hours can be entered into a spreadsheet over a one month period throughout the year, and if they are found to be far over and above those which were rostered to you, the banding that I mentioned earlier will be changed for that particular job for you and any successors on the same job.

As I said – it’s a very complicated system!

So, why is all of that important?

The recommendations by the DDRB in its July 2015 contract proposals document saw the end of banding, the end of annual pay increments and the end of the monitoring system as we knew it; they even went as far as to redefine “normal” working hours to include Saturdays and evenings up to 10pm – previously this was until 7pm. The end of banding alone saw a potential reduction in pay for some doctors of up to 50% of their wages – imagine trying to explain that to your mortgage company!

These proposals, and the fact that the government was refusing to negotiate anything other than how to actually impose the contract, brought the BMA to balloting its members for industrial action: there really was no more negotiating possible at this point. Out of thirty seven thousand, one hundred and fifty five BMA junior doctors balloted, 76% of junior doctors responded – ninety-nine point four said they would partake in any action short of striking, and an overwhelming ninety-eight percent voted that they would be prepared to take part in strike action. The action was always to force the government to re-enter negotiations about the contents of the proposed contract.

The first strikes were set for December, the first two were to be for junior doctors not covering emergencies, and one full withdrawal of service, including junior doctors in emergency areas. You may remember that at the very last minute, before the first strike was due to take place, the government finally accepted the BMA’s offer to re-enter negotiations, with the help of the industrial conciliatory service ACAS. We called off the strikes as a result – they had done their job without even being needed! So we thought.

Over the Christmas period, the two parties battled out the finer details of the proposed contract, and we all waited with bated breath for an announcement that they’d sorted it all out. Unfortunately, such an announcement never came. Talks broke down. On the 4^th of January doctors were disappointed to learn that the government had barely budged on its position.

They had, though, started a campaign of spin against us by this point. By using the ridiculous complexities of our current contracts against us, they’d started to convince the public that we were simply rejecting a pay RISE! (HAH!). They had chosen to ignore the fact they were cutting out banding – that 30 to 50% of our pay that I mentioned earlier – and instead focussed on giving us an 11% rise to our basic salaries. Also they (and by They I mean their figurehead, Jeremy Hunt) had decided to mis-quote an article by Nick Freemantle in the British Medical Journal and push the message that patients were more likely to die on a weekend. He also decided to push out that stroke patients had a 20% more chance of dying if admitted on a weekend.

Doctors were furious!

We knew that the statistics had been totally misinterpreted for the benefit of arguing their point. It’s like me doing a survey about sunburn and ice-creams – we know that in hot weather, people eat more ice-cream, and some people get sunburnt – the government would see this statistic and conclude that ice-creams cause sunburn! 

Of course, that’s blatantly wrong. 

The same applies to the weekend argument. Yes, there is evidence that worse patient outcomes occur on weekend admissions, and yes there is evidence that you are more likely to die of a stroke if you are admitted on a weekend. However, the key point here is that there is nowhere, and I mean no evidence at all, that the cause of these deaths are in any way related to the staffing levels in a hospital on the weekend. The most likely probably explanation, is that people don’t tend to seek healthcare on a weekend, the only days they have off in a week, and so the ones who do really fall ill are the ones more likely to attend – the same ones, therefore, more likely to not do so well out of their hospital stay. 

Anyway, I digress.

The first strike of British doctors since 1975 happened on the 8^th of January 2016. Tens of thousands of junior doctors throughout hundreds of hospitals in England took up positions on picket lines and hosted impromptu “meet the doctors” campaigns in their local town centres to spread the message of the ridiculous, unsafe and unfair contract offering by the government. Consultants and our non-training colleagues remained in the hospitals to cover for us as we fought our corner. Emergency services still ran, the wards were still manned, A&Es stayed open and patients were still treated throughout the day. We made front page news across the country, and possibly around the world. Our colleagues in hospital, in the community, and members of the public were overwhelmingly supportive of us in our strikes. “Support the Doctors” stickers and lanyards were seen all over the place! 

A few people stopped us to express their disgust at what we were doing, but the vast majority of these, on actually hearing what we had to say about the situation as opposed to believing what they read in the press, actually walked away touting a sticker and signing our petitions themselves.

Yes, operations were cancelled, yes, outpatient appointments were postponed. 

I know I speak for all doctors when I say we thoroughly regret any inconvenience caused to our patients as a result of having to take industrial action. But let it be a fact that we did not do it lightly. If we had any other way to stop a dangerous, unsafe and unfair contract being imposed, we would do it in a heartbeat. But without taking a stand and causing disruption now, we would be doing the whole service an injustice by letting changes happen which will cause far greater disruption, far worse service, and far more dangerous working environments in the future.

We thought that the government had actually started to listen to us in what we were asking for by the next strike, scheduled for the following fortnight at the end of January. It was called off with plenty of time to spare, to the relief of us all, and we were told that the parties had returned to the negotiation table. Unfortunately history repeated itself, and by the beginning of February we were told that the action was back on. However, in what was considered a good move by the BMA, this action on February 10^th was downgraded from what was initially intended to be a FULL withdrawal of service, including junior doctors in emergency departments and on emergency cover roles, to one identical to that which took place a month beforehand.

Why did this get changed to allow emergency cover? The simple answer is, we listened. We listened to the concerns of the public, our patients, our hospital managers, our fellow juniors and our consultants – a full withdrawal of service would put tremendous strain on the hospitals, and whilst as much as possible would be done by the hospitals the reduce the impact on patients and their safety, there is obviously a greater danger in a full walk-out than one that still provides basic Christmas Day level cover.

So where are we now?

The government today released a plan to forcibly impose a new contract on Junior Doctors in England, commencing November this year. It is different than the one that was proposed back in October 2015, but it is still a long way off being safe, being fair, being respectful, to doctors and their patients in future. A lot of progress was made behind the scenes at ACAS, between the BMA and NHS England – some great ideas came about regarding working hours, regarding being paid for what hours doctors actually work, for provisions to prevent doctors being abused and forced to work every weekend under the sun. However, there is still a long way to go by both parties, before an acceptable proposition is created. The government’s decision to forcibly impose this contract at this juncture, despite the ongoing good work of the negotiating parties, is a blow to us in the medical profession, it sends the message that they really don’t care about our concerns – it’s not just about getting Saturday off to socialise, or getting paid more – I hope you can see there’s a lot more to it than meets the eye.

What’s next?

This is not the end of the road. The news of the forced imposition of the contract has riled up even the more passive of our workforce. Talk about waving a red rag to a bull! I expect, regretfully, that this is not the end of the story, it’s not the end of industrial action by doctors. To my colleagues I say for goodness sake don’t give up yet – keep those energy levels high, because we’re going to need them if we are to continue engaging in this fight against what we know will result in an unsafe, nay dangerous, and unfair contract. 

To members of the public I say thank you so much for continuing to support us, it’s not easy to know who to believe in the tide of media releases for and against us. 

But rest assured we didn’t enter into this profession to be rich, for fame, to cause trouble. 

We entered into this profession because we care – we give a damn – we want the best for all of our patients today, tomorrow, and for the foreseeable future. Please stand with us as we fight for what we know is right. 

Together we can do this.