This is intended to provide a quick summary of recent events, an outline of the current problems, including the contract, and whistle-blowing, and what we can do to address them.
In November 2015, after a new contract was proposed, 98% of 37,700 doctors voted to strike.
The contract was re-negotiated, and a new version was proposed. BMA members were balloted, and the Chair of the BMA Junior Doctors Committee, Johann Malawana, against the backdrop of Brexit and its uncertainties, supported the contract. Despite this, 58% of BMA members voted to reject the new contract, prompting Johann’s resignation.
Why did they vote to reject it? Was it that bad?
- The new contract means less pay for less-than-full-time-trainees (predominantly women). The government itself wrote: “Any adverse effect on women is a proportionate means of achieving a legitimate end.”
- Specialties with non-resident on call would also see cuts to their pay.
- Many were concerned the new contract would mean they worked more unsocial hours.
- The contract relies on new and untested mechanisms that would rely on engagement and senior support, such as the Guardian role, and exception reporting. Some anecdotal evidence suggests that obs and gynae trainees are not receiving support for these processes.
- Lack of whistle-blowing provision (covered below).
To strike or not to strike?
To combat government plans to impose the contract, five-day strikes were called by the new Chair, Ellen McCourt. These strikes were later suspended entirely. Notably, no clear reasons for doing so were ever provided by the BMA. The Chair of BMA Council, Mark Porter, stated the decision to suspend all strikes was related to patient safety.
A poll of doctors on the Junior Doctors Contract Forum on Facebook showed that of around 2640 doctors, 2500 supported three-day strikes. The BMA referred to surveys, but never released the results. Most doctors stated they had not received a survey.
Many doctors felt the only effective tool to combat contract imposition had been abandoned, with no justification, and no attempt to re-ballot members. This led to Ellen’s resignation, and she was replaced by Pete Campbell. He went on to cancel the mandate for strikes entirely.
Where are we now?
At the same time, the new contract was imposed on obs and gynae trainees. Pete Campbell stated the contract was still being negotiated, whilst Mark Porter told the BBC there were no further attempts to negotiate, and that the BMA will be working with the government to support implementation.
Whistle-blowing and Chris Day
Chris Day is a doctor who lost his training position after he raised concerns over staffing levels on an ITU – ‘whistle-blowing’. Employers are not allowed to fire people for whistle-blowing. The reason this was allowed is that Health Education England (HEE), the organisation responsible for training, is not legally considered an employer. Therefore they used this legal loophole to justify their actions towards Chris Day.
Chris Day, at cost to himself and his family, decided to fight this legal loophole. He has received no support from the BMA, and has managed to raise almost £100,000 through crowdfunding from doctors and the general public to fight this in court. His fight will support doctors, and ultimately will enable doctors to raise concerns about patient safety without threat of losing their jobs.
The BMA initially denied this loophole exists, and confusingly went on to state they’d fixed it with the new contract. A leading employment lawyer, James Laddie QC, has given an independent opinion on this, and feels the BMA have failed to fix the loophole.
Chris also highlighted the case of Prof Edwin Jesudason, forced out of a job after whistle-blowing. Prof Jesudason states the BMA’s legal team told him to drop his case and destroy documents, and that after he refused, the BMA are suing him.
Justice For Health
A group of committed doctors, under the banner of Justice For Health, took Jeremy Hunt to court, regarding his decision to impose the contract. Ultimately, using ‘legal acrobatics’ he denied that he was imposing the contract.
However, HEE, an organisation linked to the Department of Health, have told Trusts they will not be provided with funds to pay trainee doctors if they do not impose the new contract. Therefore it remains clear that the government is imposing the new contract, by threatening to withhold funding from Trusts who do not do so.
What can we do?
Our union, the BMA, has failed to ensure whistle-blowing protection – which is not safe for patients – and has allowed a sexist and potentially unworkable contract to be imposed on us – which is not fair for doctors. They have demonstrated a clear lack of transparency and accountability. Between September and October 2016, over 1000 doctors left the BMA.
Whilst the current contract dispute appears to be lost, in the current political climate, it is certain that our profession will face future attacks. Future attacks on our profession will affect all 54,000 trainee doctors, and ultimately will also affect our patients.
In order to mount an effective opposition, and prevent this happening again, we must do three things:
- We need to engage with what’s happening. Yes, the whole thing can be confusing, but if we don’t keep ourselves up to date, and fight for our profession, who will? In order to engage, we have to educate ourselves. Whilst the Facebook forum may not be full of positivity, it is at least an open source of relevant information. I feel BMA updates alone do not provide the full picture.
- We have to recognise that the BMA has failed, and without significant pressure leading to massive internal reform, it will remain ineffective. I have written an open letter to Mark Porter calling for a Vote of No Confidence in the BMA, with 615 signatures to date: https://goo.gl/forms/XyEnTvT54G4dkOOf2
- We have to unite, and form a grassroots movement. 54,000 united doctors can achieve a great deal. Please enter your email address on the above letter. With enough motivated and engaged doctors, we can get a movement started.
Thanks for reading.