An embattled disagreement between the British Medical Association (BMA) and the Government has come to an abrupt, less than ideal end, as a new baseline for junior doctors’ contracts working under NHS was announced 19 May.
In an effort to shut down the threats of widespread strikes taking place for another six months throughout the NHS among junior doctors uncomfortable with demanding workloads and what they deem inconsistent pay for hours worked, new terms were agreed upon – but not without resenting opposition.
The news comes after a nine-month debate surrounding the pay and required work hours of junior doctors, especially those who regularly work during off hours, such as late evenings and weekends.
Since the debate’s vocal start, the BMA vehemently fought for junior doctors’ rights, but threw in the towel as the Government was unwilling to budge on its position. The end result cannot easily be defined as a long-term win for the union or for the Government, although some progress has been made.
The agreement made among the BMA and the Government clearly highlights that the Government held steady in its position that the need for longer hours at NHS facilities trumped the overarching desire of junior doctors to be paid a premium for those extended work hours. Despite numerous walkouts and cancelled operations over the course of late 2015 and bleeding into 2016, the Government opted for a small change in junior doctors’ contracts – a far cry from the sweeping positive changes called for by the BMA and its underserved members.
The Updated Contract Terms
One of the underlying purposes of the updated terms for junior doctors within NHS is to ensure the fidelity of the health system remains intact. In order to satisfy the seven day NHS, or one that provides health advice and service to patients on an extended schedule, the Government desires to maintain more doctors on staff during off hours, reducing a reliance on agency workers. To this end, the updated contract terms for NHS junior doctors include the following provisions:
- Working hours: Daytime hours worked on Saturdays and Sundays will be paid at the normal rate, while shifts that begin at or after 8pm and last more than eight hours will be paid at an enhanced rate of 37% for all hours worked. This percentage is less than the 50% currently paid for late/weekend hours worked.
- Pay: Junior doctors will receive a percentage of annual salary for working more than six weekends throughout the year, ranging from 3% up to 10%. Basic pay rates across the board will increase between 10% and 11% – a decrease from the initially proposed 13%.
- Other considerations: The Government plans to aim new terms at reducing discrimination against those who take leave specifically to care for others, such as new parents.
The majority of the new contract terms will be implemented in August of this year, if approved by the nearly 40,000 junior doctors’ involved in the BMA’s ballot taking place June. Full implementation is expected to take place between October 2016 through August 2017.
The Concern Over Patients’ Safety
A long-hours standard is already in place within NHS facilities, especially among junior doctors who represent the most substantial portion of the workforce within health agencies. The new contract terms were argued so passionately in an effort to not only compensate junior doctors for their hard work and often strenuous workload, but to also ensure the safety of patients being treated. However, the Government’s priority has long been to enhance the hours made available to those patients, and some would argue, without much consideration given to the junior doctors who actually deliver patient care.
The struggle of implementing the seven day NHS plan in a safe and beneficial way comes down to the newly agreed upon contracts. The proposed terms do not explicitly provide safeguards against working extended hours which naturally lead to overt exhaustion – a need that should be taken seriously for those providing patient care. According to a number of leading figures at medical royal colleges, the terms and conditions of the new contract have the potential to deter recruitment and reduce overall doctor morale, both which have a direct impact on the quality of patient care. It is difficult to argue that the combination of extended hours and less pay for hours worked is a move in the right direction for quality medical care for patients throughout NHS.
The NHS Litigation Bill
The growing need for quality patient care is witnesses explicitly in the total outlay from NHS trusts for medical mistakes – a startling £4.5 billion over the past five years. While this leads one to conclude that patients are consistently let down by medical negligence, the expense also poses questions about the high cost of litigation. The Government points the finger at excessive charges by lawyers in the field for the quadrupled legal bill of the NHS, but the issue can also be correlated to the difficulty of working with the NHS on medical error or negligence claims.
According to a representative from Patient Claim Line, a team of medical solicitors in the UK, the way in which the NHS operates has a direct impact on the total financial output for medical error claims. The agency is known for lagging in response times as it relates to the investigation and assessment of potential claims, ultimately causing the total cost of legal assistance to rise substantially. It is not a stretch to believe that claims could take several years to process through the system, making it nothing short of challenging to determine the true size of the problem.
The new junior doctors’ contract terms pose a viable threat to the safety of the doctors providing care, patients needing that care, and the sustainability of the NHS as a whole. In an independent report recently released, Health Secretary Jeremy Hunt stated that preventable harm has the potential to cost the NHS nearly £2.5bn per year, attributing the £1.3bn spent by the NHSLA on litigation costs as part of the problem.
With these costs representing one of the more shocking expenses associated with poor care received by patients, it makes little sense that the new contract terms would be more in favour of the seven day NHS than protecting the needs of junior doctors. As the new contracts are imposed over the course of the next year, it is highly likely that the number of medical mistakes – and the litigation bill – will rise.