BMA JDC 23rd September 2017
This will likely be my last trip to the BMA Junior Doctors Committee. I have now been to a number of these meetings and feel I have slowly come to grips with how things run. This particular meeting focused on a number of issues for our trainees;
- JDC Elections
- Transparency within the BMA
- 2018 Junior Doctor Contract review and Pay cap
- Cuts to elective operating in Northern Ireland
- Physicians Associates
- Update from the deputy chairs of Education, Professional Issues and Terms and Conditions sub-committees
JDC elections are held every September. Members of JDC are elected from their regional JDC and are then nominated for the positions of UK JDC chair and the three deputy chair positions; Education and Training, Professional Issues and Terms and Conditions. Three posts were uncontested and returned Dr Jeeves Wijesuriya as UK JDC chair, Dr Hannah Barham-Brown as deputy chair for Professional Issues and Dr Peter Campbell as deputy chair for Terms and Conditions of service. The position of deputy chair for Education and Training was contested between Dr Sarah Hallett and Dr Chukwuemeka Wosu. However, Dr Wosu did not attend and so Dr Hallett was elected following an encouraging speech. These committee members are all familiar faces from JDC and I feel they will provide stable and effective leadership for the year ahead.
The first point for discussion following the election was the JDC chairpersons report. Key to this was the issue of transparency. At present JDC members are asked not to discuss matters from the committee until given clearance by the chair. A number of people feel that this limits transparency and their ability to inform membership of what they are doing on the memberships behalf. However, some of the topics discussed at JDC are sensitive and should not be shared piecemeal prior to an official announcement. To try and find an effective middle ground the JDC chair has agreed that in future meetings there will be a summary at the end of the session to determine which topics can be disseminated. Agendas will also be published further in advance to allow regional committees to make them available to their membership. This was well received by the committee.
2018 Contract Review and Pay Cap
Next year the new junior doctors contract is due to be reviewed. The BMA will be a key player in this review. It should be noted that the BMA remain in opposition to the imposition of the new contract that the government has pushed through. Despite this it is clearly important that the BMA should prepare for next years review. This includes gathering data about how the contract is performing from exception reports and looking at surveys and pay patterns to better ascertain the number of rota gaps currently present. This is a huge body of work and is part of the reason it is so important for all of us to exception report overtime and missed training opportunities.
Also of interest is the recent appeal from healthcare unions to have their pay cap lifted. The BMA were notable in only tacitly supporting this. Both Dr Wijesuriya and the BMA Council Chair agreed that the BMA should have been more vocal in supporting our colleagues in their claim. However, they also noted that the BMA could not have joined them in their appeal. This is for the simple reason that doctors pay is reviewed through a separate organisation to those staff on the ‘Agenda for Change’ contract. Doctors and Dentists have their pay reviewed by the Doctors and Dentists Remuneration board (DDRB). This is an independent organisation set up in 1960 to make recommendations on pay. The BMA feel that the independence of the DDRB has been eroded over time and have previously made statements to this affect. The BMA are currently looking at submitting their own pay appeal to the DDRB in the hopes that they will move from their previous position of maintaining the 1% pay freeze. This appeal will likely take the shape of a percentage increase in line with RPI backdated to 2008, a far larger amount than that asked for by the other unions.
The JDC discussed a motion supporting BMA council in this endeavour. The motion also reaffirmed support for the other unions in their appeal, insisted on better communication of this process with membership and stated that if the DDRB did not meet their expectations then the BMA would seek to bypass them.
The committee discussed the effects of Brexit and the BMAs position on it. Dr Wijesuriya is one of the BMA leads on this subject. As you will be aware there are a number of concerns for Orthopaedic trainees around Brexit. EWTD has largely been secured by the new contract as the maximum hours are built into it, but only for trainees. This is also more subject to change than EU law. Movement, recruitment and retention of colleagues from the EU is also a concern. It is very clear that the BMA will work hard to ensure that we continue to be able to recruit freely from the EU and that those EU nationals already working in the UK are protected in the long run.
The committee received reports from the JDC chairs for the devolved nations. At present there are concerns in Northern Ireland due to the potential cancellation of elective orthopaedic operating at a number of hospitals for cost saving. These issues were raised with the BOTA committee at this weeks BOA Conference and I put this point to the regional chair for Northern Ireland. They have agreed to look into this and reach out to their local members to see if their training is being affected. No relevant issues were raised from Scotland or Wales.
The flexible training chair gave an update on LTFT working negotiations. They are making good progress with the GMC on making LTFT easier to go into. This is mainly through reversing the current mentality with regards to how these placements work. At present most LTFT posts rely on the trainee to slot into their consultants work plan and take their time off when convenient to the trust. The GMC are looking to give guidance on reversing this so that LTFT posts are designed to be convenient for the trainee.
One of the key discussions was around physician associates. The BMA are clear that PAs should be used to enhance training opportunities and should not detract from them. Jeannie Watkins (President Faculty of Physician Associates) gave the JDC an overview of what PAs do and how they are trained. She emphasised that, as yet, they do not have compulsory regulation but run a voluntary system. They are pushing for formal recognition by an act of parliament to allow for formal regulation, likely through the GMC. They are hoping that once regulated they will be able to move towards prescribing rights. This will essentially allow them to work alongside junior doctors to carry out service provision. Concerns were raised from the committee about the current position of non-prescribing PAs who are better placed to fill training opportunities whilst junior doctors fill out discharges etc. There were also concerns about the funding for the training of new PAs both in terms of how much they pay for their training and where any funding may be coming from. Finally concerns were raised about career progression with some worried that PAs would become increasingly senior to the level of being responsible for patient care. We were reassured that PAs are ‘dependant’ practitioners meaning they have to be supervised and work under a consultant.
Whilst Mrs Watkins tried to assuage concerns, and I was convinced that her intentions are good, the committee continues to have concerns. These are shared by the BOTA committee. We have heard mixed reports of PAs including some performing simple procedures such as carpal tunnel release. We feel that with good regulation and clearly defined job roles they can be used to enhance training by removing service provision tasks from junior doctors. We are very clear that no junior doctor should have a training opportunity removed from them in favour of a PA. We ran out of time for further discussion in the committee but I have explained the BOTA line to Dr Wijesuriya who has agreed to put this forward in the JDC list server.
Deputy Chair Reports
Professional Issues – The professional issues subcommittee continues its work on rota gaps and how these are affecting training. This is a large body of work and will be feeding into the 2018 contract review as mentioned above. They are also involved in the BMAs anti-bullying work. This is a three year project and they are keen to engage with groups such as BOTA who have set up their own sub-specialty campaigns (#HammerItOut).
The other large issue being worked on by the professional issues sub committee is that of whistleblowing protection. This has had a lot of media attention. The BMA have worked hard to ensure that all doctors are safe to meet their GMC requirement to speak out about patient safety issues. This is due to be picked up at the next JDC meeting when two independent legal advisors will be able to available, suffice to say for now that they are happy we are covered. The BMA council have also given JDC freedom to pursue this further if they feel necessary.
Education and Training – The main body of work produced by the education and training subcommittee was the Enhancing Junior Doctors Working Lives project. This looked at how employers could try and improve life for their junior doctors. This sprung out of the contract discussions but is separate from them. A Code of conduct was agreed which includes recommendations for trainees to get their placement information 12 weeks in advance, generic rota 8 week and personal rota 6 weeks in advance.
They have also been working with the GMC to try and make training more flexible. This is to allow for a more adaptable work force with generic competencies being ported from one specialty to another if a trainee changes practice.
Finally they have been looking at study budgets and cost of training. The government have recently being looking at the cost of training and produced a document that both the BMA and BOTA felt was a ludicrous underestimate. The BMA are working with specialty organisation to try and produce a more accurate document.
Terms and Conditions – The terms and conditions subcommittee had a busy year with the new contract. However, as well as this they have been working on a few other projects. These have included reviewing leave allowance which is normally worked out on a 40 hour week. Most of us work a 48 hour average week due to mandatory overtime which should also be included in this calculation. The BMA are currently taking legal counsel on this issue.
They will also be working with the subspecialty organisation to look at how Non resident on calls are being implements under the new contract. This is obviously of interest to us and we will be feeding into this work.
This was by far the most productive JDC meeting I have been to. The new group of committee members seem very cohesive and were able to make good progress through a large number of discussion topics. This is not to say that everything was supported unanimously and I feel this is important. As I have previously said, this is likely to be my last JDC but I feel that whoever replaces me as BOTA BMA representative will have a good year.