The Junior Doctor Contract: A Trojan Horse?

If there is a universal truth of any strike action, it is that public opinion will gradually shift against those withholding services from the public. This is especially true of the junior doctors, whose service is particularly crucial.

One does not have to look particularly far to see evidence of this. Op-eds lambasting the junior doctors’ “naivety” and condemning the BMA as a militant union seeking to destroy the government are splashed across the media. While not all commentators are quite so scathing, there is a definitely a growing sense of unease concerning the BMA’s motives.

The BMA has positioned its argument in terms of patient safety and reasonable working hours, trying to avoid getting embroiled in arguments about money. Inevitably however, an aspect of the contract negotiations has focused on pay, drawing criticism from an increasing number of former proponents as well as the usual critics. There is a growing feeling that the BMA’s primary concern is the remuneration of doctors, evidenced by the BMA’s rejection of cuts to unsociable hours pay despite the government’s concession that junior doctor’s basic pay will rise by 13.5% on average.

This criticism is wide of the mark however; the BMA has to argue about pay and resources because, from the government’s point of view, the whole debate is about pay and resources.

It is safe to say that the government did not enter negotiations in order to pay junior doctors more. The reason usually given for the renegotiation is that the Conservatives want to deliver on their widely supported mandate to deliver a seven day NHS. Naturally this will involve more doctors working on weekends, something that is made financially impossible within the current NHS budget because of the unsociable hours pay premium.

In a world without the NHS’ tight budgetary restrictions, the way to get more doctors working weekends would not be to cut unsociable hours pay and increase basic pay; if anything, you might expect the opposite. Ironically, the people who lose out under the Conservatives’ chosen approach are those already working the majority of their hours on evenings or weekends, the very thing the government wants to encourage.

Why then has Jeremy Hunt taken this approach?

Currently, the hike in basic pay will at least compensate, if not benefit, the majority of doctors. Only those working a high number of unsociable hours will be taking a pay cut. In the future however, the Conservatives envisage a much larger number of doctors will be working weekends, meaning a much larger number of doctors will be losing out. This, combined with savings from removing guaranteed pay rises, financially justifies the basic pay rise.

The fatal flaw with this approach is that this “much larger number” of doctors simply does not exist. The government is trying to stretch budgetary resources that just barely exist, while at the same time increasing human resources that simply do not. A leaked Department of Health internal document estimates that a genuinely seven day NHS will require 11,000 additional staff, including 4,000 doctors. It takes five years to train a doctor, and there are not 4,000 more doctors than normal currently in training. Even before the demoralising series of strikes and negotiations, there are already unfilled vacancies at the junior level.

A genuinely seven day NHS has to be accompanied by a genuinely commensurate increase in NHS funding and recruitment. The proposed new junior doctors’ contract looks attractive because it is meant to. But to accept it would be to sell out a future generation of doctors – either by restricting pay if enough are recruited, or by condemning doctors to work many more hours if recruitment does not pick up.