As you are no doubt aware the Secretary of State Jeremy Hunt announced to parliament that he will be unilaterally imposing the new contract on doctors as of August 2016. It was an option few believed would be taken and as such I have been feeling the BMA has been somewhat on the back foot. The JDC met on the 20th of Feb having toured the length and breadth of the country canvassing for your opinions of how your trade union should proceed.
For our part BOTA surveyed the Linkman for each region via Google forms and encouraged linkmen to open it up to their region’s trainees. We had a reasonable response for a 24-hour pol with 131 respondents. This poll was framed around the BMA regional surveys but with some additional comments and free text boxes available. Respondents were free to check as many options as they liked.
The majority of those surveyed would be most keen for a continuous and sustained full withdrawal of labour (n = 44), the next most popular options were continuous sustained emergency care model, refusal of certain administrative duties e.g. death certificates and notice of refusal to sign august contracts (n = 24. Continuous weekly walkout e.g. every Tuesday and Thursday indefinitely (n = 23) closely followed by full walk out 2+ days (n = 22). 56 respondents also opted for the variety of alternative full withdrawal of labour models e.g. 8am – 5pm full walk out but on call cover still provided out of hours.
With the results of our survey fresh in my mind I asked the following questions pertaining to the orthopaedic viewpoint at the specialty update:
How has the situation fundamentally changed given that after 2 days of emergency cover that lead to the imposition of this contract trying the same strategy again will come to a different resolution or is this a holding pattern whilst the BMA investigates the legal avenue. I just don’t see what this course of action is meant to achieve.
In the discussions it was felt many forms of action would be unlikely to get uniform involvement hence we would lose significant momentum. Single day of action provided a massive discharge problem which certainly I noticed at my hospital 2 consecutive days will create massive disruption in conjunction with keeping the public much more happy regarding the type of action they perceive to be safe.
If we are not to go down the route of sustained industrial action can the action not be spread over a number of weekdays to minimise the chance of trainees failing their ARCP and being put back 6 months due to poor numbers secondary to strike action?
A pragmatic approach should be taken in order to not be the only one getting put back at your ARCP, my favoured option would be to swap into the on call on the day of your list, you may take the hit with a busy shift but you could attend your list and get your numbers. Remember by not participating in industrial action you will be actively helping the government impose this contract. Industrial action has been strategically placed on Tuesdays, Wednesdays and Thursdays to minimise the perception of possible patient safety issues and weekend handover.
Perspective strike action is dated over the London Orthopaedic changeover, is this wise? And on this topic will ST4’s in London be pay protected as they started in October not August?
The BMA JDC has been careful to avoid pan-specialty college exams and are well aware they have hit induction days but induction can be re-arranged by trusts. Strike action on non-clinical days is better for patient care generally. The issue of pay protection for ST4’s in the London area they simply do not know and suggest neither do the government. We recommend a capture of this group and a signed letter to the Prime Minister to poke further holes in what looks like an impossible task of implementing a contract that certainly does not have the problems ironed out of.
What is the staggering drop in payment for non-resident on calls about?
The current system of banding includes 3 areas of your pay, an availability allowance, payment for projected work done and weekend rates. Under the new contract we would likely see a similar system for projected hours worked with any ‘exceptional events’ meaning overnight disturbances more than projected hours would be documented and paid with your next pay check. This may end up with people who are disturbed regularly having a nice bonus at the end of the month but in my experience of NHS administration we are clearly not geared up for this kind of reporting and remuneration.
Assuming we manage to re-enter negotiations why would be campaigning for a payscale where an ST3 gets paid the same as an ST7?
The BMA’s proposed pay structure is front loaded – higher pay at a junior level that is relatively flat. There are two reasons for this, one it aims to reduce the gender pay gap should our female colleagues take time out for children but also with the increase in basic and therefore pensionable pay and an NHS pensions scheme that has seen cut after cut this will also avoid overpaying your pension pot. Lastly the money earned over the course of your career as a junior doctor would be the same as under the current system.
How can you help?
Chief Executives need to feel the pressure of how angry we are about the contract e.g. people moving foundation tracks and training tracks away from Royal Salford Teaching Hospital due to Sir David Daltons complicity in this issue. Whilst I don’t suggest you up sticks and leave your trust, speaking to your TPD about avoiding trusts whose chief executives were complicit in the negotiations could be an option but I would favour meetings with your chief executive outlining the many holes in this contract, if we put enough pressure on them they will have to out pressure on the DH to think again about imposing a contract that is unsafe and unfair.
I do believe that as orthopaedic surgeons we have very clearly defined trauma and elective streams that not all medical specialties can boast, we also have faith that our consultant colleagues can both cope and provide adequate trauma cover whilst we strike.
Whilst you can be assured I have fought the corner for orthopaedics it is still imperative that all BMA members toe the union line on days for industrial action. Only by providing a united front can we hope to gain enough leverage to prevent the imposition of a contract that may spell the end of the NHS within our career lifetime.
Keep strong in this time of crisis
BMA Specialty Observer
British Orthopaedic Trainee’s Association