Medical student Sophie Walton discusses the latest developments in the Junior Doctors’ contract dispute.
Junior doctors in England have voted not to accept the contract negotiated earlier this year. 42% voted for, 58% voted against, on a 68% turnout. Dr Johan Malawana, chair of the British Medical Association (BMA) Junior Doctors’ Council, resigned when the announcement was made.
It was hard to predict the outcome of the vote. It balloted junior doctors and medical students, all at different points in their career and all with different interests to defend. The united struggle has forced the government to back down on a number of issues, although ultimately not enough to convince doctors to approve the new contract.
Those who voted no voted against the principles of the contract and the bullying tactics used during the negotiations. Many consider the ‘closed envelope’ negotiations to have undermined the entire process. It is unrealistic to believe that it will cost no more to run an effective NHS, which provides care free at the point of need and which trains and pays staff.
To vote no to the contract was to vote against their day to day experience of austerity and to protect future doctors from ever more stressful jobs.
Anger with Jeremy Hunt, Secretary of State for Health, was one motivation amongst those that rejected the contract. He refused to meet with doctors and ignored the difficult decision to strike that many had made â€“ building the membership of the BMA far faster than any other dispute. Others saw the specifics of the contract as undermining patient safety and the values of equality and diversity in the work place.
Those who take less than full time training – mostly carers, and mostly women – were to lose out on career progression and pay. The contract said this would be mitigated by introducing a number of mentoring schemes and re-introduction programs. While all very good ideas that should probably be introduced in any future contract, they would only be sticky plasters on the integral inequality of the contract. Many also saw the requirement to work at least one in eight weekends to be eligible for any extra pay for working a weekend as infringing on family life.
Safeguards were introduced into later versions of the contract to monitor the number of hours junior doctors work. This was to be achieved by introducing committees within hospital trusts to review doctorsâ€™ hours and investigate cases where overly long hours have been worked. In fact the new contract included a mechanism for clocking the number of hours doctors worked beyond a standard shift, to give doctors proof for the overtime they do, both so that they could be paid for all work done and to recognise how much of the NHS is sustained by good will. Particularly post-Brexit it is feared this wouldnâ€™t be concrete enough to keep hours safe.
It is important to remember that although the majority voted no, many will be disappointed at the result. For a great number of doctors the proposed contract offered significant improvements over that which was initially imposed â€“ dedicated guardians to regulate hours, gains over the number of anti-social hours to be made plain-time and the preservation of pay top-ups for those in areas of medicine where it is hard to recruit. A large proportion of people voting yes wanted stability amid the uncertainty of NHS funding. What is most important is what happens from now. New BMA junior doctor negotiators and a new chair of the council are to be elected, and the process to improve working conditions for junior doctors does have to continue: the proposed contract was rejected, but the current working conditions are also unbearable for many junior doctors across the UK.
Regardless of how doctors and medical students voted, we must stay united to improve our working conditions, and to fight for an NHS that isnâ€™t left to fall apart around us.