Jeremy Hunt’s enforced doctors contract spells disaster for the NHS.

A junior doctor responds to claims by Health Secretary Jeremy Hunt that the new contract is good for patients and good for doctors.

My name is Nadia, not the British Bake Off winner (although I’m told I make a mean lemon drizzle) but a junior doctor, an anaesthetic registrar working in London. Together with thousands of other junior doctors I took to the streets of London to protest against the new junior doctor contract due to be enforced upon us next year by Health Secretary Jeremy Hunt.

Mr Hunt chose the morning of the protest to declare during an interview on BBC Radio 4 that our union, the BMA was misleading junior doctors by misrepresenting the government’s position on the contract. A failed attempt to divide and conquer. The supportive shouts of “BMA, BMA, BMA” rang loud and clear for all to hear. To accuse junior doctors of being so easily misled is nothing short of insulting.

The BMA is due to ballot all junior doctors over the coming weeks for industrial action — an action none of us takes lightly.

Withholding medical care from patients is not something we want to do, but when faced with the alternative, to accept a contract which endangers both doctors’ health and the safety of the public, it is the lesser of two evils. We have received unprecedented and overwhelming support from consultants, nurses and managers.

A study performed in New Zealand during their junior doctors’ strike demonstrating no increase in death rates reassures us that withholding our services will not bring harm to the innocent public, it will however massively stall elective services and, like the tube strike, cause a massive but temporary inconvenience to the public.

Mr Hunt has made several statements over previous weeks regarding the contract details in an effort to calm the anger within us.

He claims the public needs the new contract because under the current system there are fewer doctors at the weekend and more patients die at the weekend because of this.

Under the new contract junior doctors’ pay will not be cut, our hours will not increase, in fact the new contract plans to reduce the maximum weekly hours a junior doctor works from 91 to 72, we won’t be forced to work more than 5 nights in a row, our basic pay will increase by 15%. It all sounds so reasonable doesn’t it?

Almost too good to be true?

Every junior doctor in the country has by now looked at the new contract rules and used their intelligence to form their own conclusions. It is no surprise that we all have come to same understanding that the doctors in the BMA also came to, leading them to walk out of so called negotiations. The contract is unfair to doctors, and ultimately unsafe to patients. Every junior doctor fully supports the BMA in their decision to do so, and we are fully behind them. It is not they who are doing the misleading Mr Hunt, it is you and here are a few examples of how…

“Junior doctors’ pay will not be cut, their basic salary will increase by 15%”

Yet the take home pay of many doctors will decrease.

No medical degree is required to explain how this is misleading. Basic math is sufficient. Let me explain.

Junior doctors’ salary is made up of two parts A(basic salary) and B(banding). Banding is the way in which we are paid for our obligatory contracted hours, that are outside of social working hours, currently classified as Monday to Friday 7am to 7pm. These are often the most gruelling hours of work, dealing with multiple emergencies at once, with little opportunity for rest and food.

So A+B = Total gross salary

Pension contributions are deducted as a percentage of A, and student loan repayments and tax are deducted from the total gross salary, leaving us with our final take home pay.

If A increases, so does our total gross salary. Brilliant! So why has our take home pay gone down?

Because our pension contributions have increased and because the banding part of our salary is due to be removed completely and replaced with another method of payment for the unsocial hours element of our work. The new method reclassifies social hours from the current arrangement to include Saturdays, and extends social hours until 10pm on every day of the week including the Saturday. Mr Hunt has conveniently left these points out of all statements he has made about our pay arrangements under the new contract.

Although A is increasing, B is decreasing more. And that combined with increased pension contributions results in reduction in the final take home pay for a large number of junior doctors. The final blow is the junior doctors worst affected will be the ones who work more unsocial hours, the anaesthetists and intensive care doctors, the doctors in A&E.

The government has also failed to answer questions as to why the social hours have been extended to 10pm on every weekday and Saturdays, and how this will help to improve the NHS service provision. It seems like they are trying to get the same if not more work out of doctors but intend to pay doctors less than the current arrangement for these services.

So junior doctors pay will actually decrease for many of us, maybe not the majority but we are all united in our belief that whatever happens to our individual salary not one doctor should suffer a paycut as a result of the new contract.

2. “More people die at the weekend because there aren’t enough Doctors”

Let me make it clear, you are not more likely to die at the weekend than during the week. Mr Hunt frequently mentions that “there are 11,000 excess deaths at the weekend because there aren’t enough doctors”, he even said this in the House of Commons during a parliamentary debate on the issue, referring to a study in the BMJ published this Summer. This is what the study shows…

There are 40,113 deaths daily.

The daily average for Monday to Friday is greater. 40,448 deaths per day. The greatest number of deaths occurs on a Friday.

The daily average for Saturday and Sunday is less. 39,276 deaths daily.

So tell me again Mr Hunt how more people die at the weekend?

The 11,000 excess deaths figure quoted by Mr Hunt in several media articles is actually the number of deaths over 4 days, Friday to Monday inclusive. A misleading figure as deaths over a period of 4 days will always be greater than deaths over a period of the remaining 3 days. It is true that a greater proportion of patients admitted at the weekend are likely to be sicker, and are more likely to die, this is a phenomenon seen worldwide in other healthcare systems. There is no way to ascertain that excess deaths are due to there being less doctors at the weekend.

This is a classic scaremongering tactic in the hope the public will support the new contract because if they don’t support it, they will be more likely to die at the weekend. Already there have been several reports of patients delaying their presentation to hospitals at the weekend because they have been misled by Mr Hunt into believing this.

Mr Hunt also says the current contract means that hospitals are forced to roster three times less medical cover at weekends than they do during the weekdays, because under the current system there are financial penalties for this. The new contract will remove the financial penalties preventing them from doing this. In other words, the government wants more weekend cover without paying for it. These penalties were put in place to stop doctors being overworked, they are safeguards to provide the public with safe care. Remove the safeguards, remove safe care.

The on-call emergency cover during the weekends is currently exactly the same as during the week, there are less routine outpatient clinics, less routine surgeries, less routine investigations during the weekend (because they are not urgent) which is where less doctors are required. This is so that more doctors are available during the week for these services when they are in higher demand.

There is no evidence that allowing more routine appointments and surgery at the weekend will save lives. Of course it would be a wonderful idea if we could have these services every day of the week, waiting lists would go down, but without providing more doctors and the essential support staff, under the current financial climate, this is simply not possible without proper funding and resources, something which the NHS has been lacking for many years.

Furthermore if you move existing doctors to provide this service at the weekend then who will provide the service during the week? Or will it be the same doctors providing the service throughout the week resulting in an increase in their working hours, which contradicts Mr Hunt’s assurances that junior doctors hours will not increase. Which is it to be?

Even if the government succeeds in moving doctors from the week to the weekend to provide these non-urgent services, the new contract means that doctors won’t be compensated for giving up their weekends (perhaps every weekend) with their families and loved ones because of the reclassification of social hours to include Saturdays. So they will be doing the same or more work for less pay.

3. “Junior doctors hours will decrease from a maximum of 91 hours/week to 72 hours/week”

The safeguards to ensure this are being removed.

Under current rules, doctors must not be contracted to work more than 48 hours/week on average, they may still work a 90 hour week one week but are then compensated with time off to even out their average hours.

Hospitals are required to perform diary card exercises to monitor the hours that junior doctors actually work, as it is a frequent occurrence that doctors often work many hours a week unpaid, arriving early and leaving late in order to maintain a good standard of care for their patients. If a doctor is found to be working an excess of hours, the hospital is obliged to pay that doctor for these hours. This system means that hospitals do their best to ensure doctors work minimal excess hours in order to avoid this penalty, the patients benefit from this arrangement because their doctors are not overworked and are able to provide better care as a result.

The new contract will remove these monitoring and payment obligations meaning that hospitals will have no financial disincentive not to overwork their doctors beyond their official hours. It’s all very well saying it will be in the contract, but when the current reality is that doctors already work beyond their contracted hours with these safeguards in place, what will the situation be when these safeguards are removed?

When thousands of doctors, along with several politicians including those from the Conservative party, and every Royal College in the country are arriving to the same conclusions that the new contract is unfair, unsafe and simply not proven that it will improve NHS care, and when we have a sensible response to contradict every statement Mr Hunt attempts to make to justify this contract, why is the government so hell-bent on forcing this contract on junior doctors?

Mr Hunt has so far refused to openly debate with any junior doctor about this, maybe because he knows just what he would be up against.

The implementation of the new contract will lead to either overworked tired doctors which will result in less safe care for patients or less doctors available during the week when demand is high, it may also lead to poorer training of doctors resulting in poorer quality of care to patients. Either way, patients will suffer.

Many doctors will leave the country or the profession to find a better quality of life for themselves or their families elsewhere, and they have every right to. The NHS is barely surviving now, this new contract will kill it off completely. The government has failed to prove how this new contract will be better for doctors or the public, they are either unaware of the devastating effect it will have on the NHS or they simply do not care.

Either way this new contract simply must not be instituted in its current form.