In this series of articles, medical students from across the country will discuss a range of topics from medical ethics to the NHS to public health to medical conditions to clinical governance.
Since 2012, the government (NHS employers) and the BMA (British Medical Association), the trade union for doctors working in the UK, had been negotiating for a new working contract for junior doctors. Note, this contract did not just affect the traditional FY1 and FY2 doctors (who are often referred to as ‘junior doctors’ in a clinical setting), but any doctor that was below the consultant level. These doctors can have up to 14 years of experience.
The Government’s Plan
The government’s aim was to make a ‘7 day NHS’ a reality and improve patient safety on weekends. Because of this, one of their main aims with the new contract was to make it cheaper to employ extra doctors at weekends.
The basic pay for junior doctors would increase, however, the premium pay that doctors would receive when they worked unsociable hours would reduce.
The government felt doctors were working too many hours and this could adversely affect patient safety. Therefore, they wanted to reduce the total number of consecutive days a doctor could work. The new contract stopped doctors from working more than 72 hours over seven consecutive days.
According to the Health Secretary, who was Jeremy Hunt at this time, the new contract conditions would improve patient safety and offer a fairer salary for full-time junior doctors. However, doctors did not agree with the government’s statement.
The Junior Doctor Perspective
The new contract proposed a change in the “standard” hours that doctors worked. Previously, junior doctors were paid a standard rate for working between 7 am to 7 pm from Monday to Friday. Working outside of these hours resulted in additional pay, which often increased the doctor's annual pay by 40-50%. However, the new contract increased the standard working hours to 7 am to 10 pm on Mondays to Saturdays.
The changes in consecutive working days also meant that employers would create new working rotas, which incorporated more unsocial working hours. Therefore, this meant that junior doctors would be working more unsociable hours for lower pay.
Furthermore, guaranteed pay increases were previously linked to years of work contributed to the NHS. But the new contract would be replaced with a system linked to progression through set training stages. This meant junior doctors with a shorter training programme would be more financially rewarded than those who were in programmes lasting several years.
Doctors who worked part-time were especially affected, including young mothers, because of this slower pay progression system.
The new contract introduced a pay structure that allowed junior doctors to receive a greater proportion of their pay early on in their careers. The removal of an automatic annual pay progression meant that part-time doctors would take longer to reach the next pay point. Over a lifetime of work, this would result in a loss of total income for these doctors.
Junior Doctors were also concerned that the contract would increase stress, tiredness and burnout among their peers, and that patient care will suffer as a result. The increase in antisocial hours was also not reflected in an increase in pay.
Junior doctors claim that Jeremy Hunt is trying to instigate a seven-day NHS while only willing to pay enough to support a five-day service.
The Strike and Ethical Issues
In November 2015, 98% of Junior Doctors voted to reject the contract, and in favour of industrial action.
This led to four Junior Doctor strikes between January and March the following year.
Each of the four strikes lasted 24-48 hours on 12 January; 10 February; 9-10 March; and 26-27 April.
On 12 January 2016, emergency care was still provided.
Junior doctors again withdrew their labour for routine care on 10 February 2016, leading to the cancellation of around 3,000 elective operations.
On 26 April 2016, junior doctors in England embarked on the first strike where they withdrew routine and emergency cover.
While the first three strikes were largely supported by the general public, the last strike met with backlash since A&E cover was reduced. The public stated that the junior doctors have a duty to improve patient safety and they failed to carry out this duty by striking.
Critics stated that doctors who striked went against the medical ethical pillar of non-maleficence by actively missing work and decreasing patient safety. However, protesting doctors stated that the new contract would lead to decreased patient safety levels in hospitals across England in the long term and this protest was thus necessary.
In September 2018, the junior doctor committee had reached an agreement with NHS employers to conduct a full review of the 2016 contract. This is because the BMA and its members were still not happy with the terms and conditions. The research outcomes from the review were used to improve the imposed contract. The new Junior Doctor Contract will bring a £90 million investment over the next four years.
The changes to the Junior Doctor Contract effectively increased basic salary but drastically reduced the supplements for on-call shifts outside of sociable hours – effectively meaning they were being paid less.
Junior doctors also claim that longer working hours, without a subsequent increase in pay, would lead to reduced patient safety.
This led to four Junior Doctor strikes between January and March the following year. Each of the four strikes lasted 24-48 hours on 12 January; 10 February; 9-10 March; and 26-27 April.
The new Junior Doctor Contract will bring a £90 million investment over the next four years.