Today I attended the BMA Multi-Specialty Working Group meeting chaired my Dr. Johann Malawana chair of the BMAJDC for a update on the contract agreement between the BMA and government parties.

 

After this meeting I am cautiously optimistic this there could be significant gains in both in terms of contractual safeguards against dangerous working patterns and in financially which may alleviate some fears, after all we still have to pay the rent!

 

This report comes with the massive caveat that until the full terms and conditions of service are released all of this is subject to change.

 

This meeting saw representation from psychiatry, paediatricians, neurologists, palliative care, ophthalmology, radiology, anaesthetics, genito-urinary medicine, physicians, ENT, diabetologists, RCSEd, oncologists and myself in addition to Johann a O&G trainee and Ellen McCourt deputy chair and A&E trainee.  This made a well-rounded group for discussion on our hopes and fear for the new contract.

 

From the discussion around the table today there is no doubt that this contract could end up being better for us however, the reason I am cautiously optimistic is that it will require effort from all of us. I am sure we are capable of rising to the challenge. The last 9 months has seen the profession united as never before and has made us a much more proactive group, we simply need to keep the momentum going.

 

The new contract has in essence been born out of this movement with a plan to do away with the infantilisation of junior doctors and to get us involved with our own working conditions, after all a single contract for 46 specialties without some maneuverability is about to have winners and losers.

 

Historically we as junior doctors have been handed a contract and received pay that has covered our rent or mortgage with some extra for training and a decent social life and we have in turn accepted our working conditions without really questioning what our pay is made up of or what we are entitled to. This is about to change an in line with the hit TV show A Game of Thrones if you stand on the sidelines as a passive observer you will lose.

 

The discussion within this meeting took the form of a short update followed by questioning of Johann and Ellen on issues each representative felt pertained to each specialty.

 

During the last round of negotiation the goal was to form simultaneously a statement for press release and also new terms and condition of service, unfortunately there are still amendments being bade to the TCS and hence the press release can be taken out of context. Within the press release from ACAS only major amendment to the TCS were noted however it does not mean that if an issue was not mentioned in the statement it has been removed or negated from the contract merely that it had not changed enough to warrant a formal mention.

 

Negotiation focused on not only the individual TCS but also wider issues affecting junior doctor moral such as work life balance and recruitment & retention issues trying to keep with it the ethos of empowering junior doctors.

 

Discussion around the guardian role was a key point, many of us were concerned that as a senior doctor from the hospital in question there would be a degree of bias however overseeing the guardian will be committees such as the LNC with junior doctor representation on it who will not only have the power of appointing guardians but the power to remove them as well if they are deemed to be performing poorly.

 

The Dalton contract failed its equality assessment largely due to the nodal pay system which would see women with children, less than full time trainees and academics trapped at a specific nodal pay point for much longer than their full time colleagues. Whilst this contract also has a nodal pay system there are plans for accelerated training as part of a whole package of changes spearheaded by Ellen McCourt, further details of which I am trying to obtain. This will shift the emphasis towards flexible working in order to minimize the impact of the scenarios above. Both myself and the RCP representative raised the issue of indicative numbers and that if these trainee groups end up impeding the progress of the regular trainees in order to catch them up this may cause an entirely different equality issue. The exact format of this accelerated programme is yet to be published but I do have significant skepticism about the project.

 

There have been rumors circulating that if we agree to this contract that all trainees would immediately be moved to the new deal. I can confirm today this is not the case and that trainees who will be ST4 as of august 2016 on a full time contract will have transitional pay arrangements until 2021 i.e. completion of training on our current contract banding and all. It is not clear at this stage if trainees taking time out for academics, maternity or less than full time training (LTFT) would have their transitional arrangements continued past then simply because past the general election there is a chance it would be a different government. These arrangements have been signed off by the prime minister and the HM treasury and are out width the protected pay envelope. Discussion was had regarding decisions to apply for higher degrees in light of this limited pay protection however there is a good change that this pay protection would continue as the overall burden of this on the treasury will decrease each year as people come off the top of training rotations.

 

There is likely to be a pay disparity between new ST3’s on the updated contract as this will be the front loaded highest pay point and the new ST4’s on transitional pay arrangements as they will continue incrementally with banding however this should even out with seniority for those on transitional pay arrangements.

 

Payments for additional work done is still projected to run through exception reporting via an app this would include for example staying late to look after an unwell patient or if your list over-ran.

 

Pay protection will be lost unless moving to a different specialty due to disability, caring responsibilities or to a specialty in recruitment crisis. We suspect that this will not affect many people as classically people switch from a hospital specialty to GP in which case pay would be protected. Pay would only be reset to lower nodes if for example a GP wanted to switch to trauma & orthopaedics.

 

With regard to the basic salary reduction from 13.5% increase to 10-11% increase this was a conscious decision by the BMA in order to reduce the pensionable portion of our pay and hence increase the take-home at the end of the month. It is likely that we will all over the course of our career enter more then the £1 million cap on pensions anyway so I think this could be a sensible decision.

 

On to the tricky question of non-resident on-calls, this is where the whole thing get complicated. The first part of payment of NROC is formed by the availability allowance. This is a lump sum added to your pay every month of 8% so if you earn £2500 per month it would be topped up to £2700. Next is your weekend uplift again as a lump sum so you work 1 in 8 weekends you get a 3% uplift which makes it £2775. Next you get an amount for projected work done and here is where the projections become unknown without the full TCS. Essentially each time you get a phone call you ping the app to say you have been disturbed. Each time you have to go in you claim for transit time and for time in hospital. It all adds up and the BMA are confident that on a reasonably busy on call you should break even compared to the current system if not find yourself a little better off. This will require accurate documentation of exception reports but once we assimilate this into every day practice i.e play the game this could work out well for us.  These payments for exception reports are out width the ‘pay envelope’ and do not form part of the department of health’s payroll projections.

 

Many of you will have noted that the last nodal pay point has been removed and the funds from this are to be allocated to the “senior decision maker” this will be a departmental decision as to who holds this position. In many specialties such as anaesthetics or O&G there is a two tier registrar system in which the senior registrar on call would be the senior decision maker. The definition becomes less clear in single tier specialties such as ours and I will have to await the full TCS which will hopefully have an improved definition for this.

 

Post on call rest sessions can be difficult to manage whilst also achieving adequate training with this in mind I have specifically asked if there is any wiggle room to take them at a later date. Any post on call rest must be taken within 24 hours of the on call or you can request to take it as time in lieu or receive payment for it. A record of this must be taken by the rota coordinator and every 3 months the balance shall be cleared with monitory payment.  This should allow us to have the flexibility to arrange our rest sessions around our training.

 

The clause regarding fidelity to the NHS has been amended so that the NHS has first refusal not just the trust you are working in. It also will be quite specific and prospective. For example you could request a locum for next Saturday for ST7 in trauma & orthopaedics. If they have not got such a locum on that day you will be free to do your own thing. You will not be asked to cover out width your specialty for example they would not make you be an A&E SHO for the day. With regard to the pay it will be 22% above the prevailing rate. With the clause now not limited to your own trust this provides a market to breed competition and hence if trainees refuse to do locums for under £x amount per hour foundation trust will have the power to offer more. In addition you will get an extra 22% this will be 10% that would have gone to the locum agency and 12% that would have gone to the agency doctors annual leave etc. allowance. This could end up with trusts that would have paid £50ph paying £61ph. The intention of this is to destroy the use of locum agencies to fill rota gaps.

 

I am pleased to report that the clause allowing NHSE to alter our contracts with no consultation has been removed from this contract and that in addition to monitoring by the BMA there will be a formal review of the new contract in 2018/19 to iron out any flaws in the system.

 

Other issues included discussion on the cessation of the BMA judicial review, this was to assess the SOS power to impose a contract however if the contract is not to be imposed then there is little point in proceeding with a legal challenge to it. We also discussed the abandonment of the review of junior doctor morale, the outcome of which was that we would need to pilot the new contract prior to assessing its impact on the profession.

 

Who is going to loose our? It is likely that NROC specialties who rarely if ever get called e.g. dermatology, people who change specialty out-width the ways described above and potentially LTFT, mothers or academics depending on how long they stay at their pay node.

 

So what happens next? The full TCS should be released prior to 31/05/16 and I shall spend another day going through them as I did last time to try and make them more manageable and give an assessment of their impact on T&O. On 03/06/16 I shall attend the JDC meeting where the full TCS will be discussed and if found to be acceptable the membership may be balloted, it is worth noting that the JDC has the power to accept the TCS without a ballot or overturn the result of a ballot. During this period the BMA are going to run a series of roadshows to help explain the new contract. I highly recommend going to one, I entered the meeting today feeling the BMA had sailed T&O up a certain creak without a paddle but after talking through the issues as previously mentioned I feel cautiously optimistic.

 

What happens if we are balloted and the answer is no? I understand from Johann that the Dalton contract that was imposed was significantly worse than where the negotiations had got to at that point, it is therefore likely that in the event of the No vote the government would impose a contract again but row back on some of the key negotiated issues and for this reason I strongly advise that we await full terms and conditions of service and that you analyse them yourself in addition to the summary I will provide.

 

I shall be appraising the new full Terms & Conditions of Service upon their release but this will take time. I shall be attending the BMA JDC meeting on the 3rd of June to participate in the decision making process for moving forwards.

 

James Shelton

BMA Specialty Observer

British Orthopaedic Trainees Association

@bota_bma