#notsafe

Yesterday NHS employers released the full contract they plan to start imposing on all junior doctors from August 2016. You can read the full terms and conditions here: http://tinyurl.com/j6ce84u

This contract needs context to explain why junior doctors and those who design our rotas are throwing their hands up in despair.

Firstly, it is important to understand that many hospitals already don’t have enough Junior Doctors. This is particularly true in certain areas, such as the North East of England, and particular specialities, such as General Practice.

GP Training Recruitment Rates by Area 2014-2015

Trainees rotate through different specialities during their training, as service provision. This is particularly important in Accident and Emergency and on medical inpatient hospital wards. Where there is a gap, either the hospital can attempt to find a locum (agency) worker, or they can ask their existing junior doctors to cover the slack leading to more intense work with greater out of hours commitments.

Since 2010 the number of Junior Doctors continuing on to specialist training has been decreasing year on year. There are many reasons for this. But the data is clear. In August it is going to be more difficult than ever before to staff our hospitals appropriately with Junior Doctors.

The contract removes the monitoring system, which included heavy fines for trusts who overworked their juniors, and replaces it with work scheduling and payments based on the individual doctor overworked.

Despite a heavy cut in locum pay contained within the contract, it will still be cheaper under the new contract to over work junior doctors and pay the individual fine, rather than finding another doctor willing to work that shift.

Junior Doctors will be contracted to work an average of 40 hours a week, they can be forced to work an extra 8 hours on average without recourse before the European Working Time Directive becomes prohibitive. At this point the junior doctor can opt out and work a maximum of 56 hours a week. Even if they don’t opt out they will still be forced to work if the service could not cope with them finishing their shift.

This contract takes a system, which while flawed, forced hospital management and junior doctors to work together to ensure that juniors were not being overworked and completely changes that relationship.

It will now be in hospital managements best interest to:

• Strong arm Junior Doctors into opting out of the European Working Time Directive.
• Overwork their Junior Doctors and pay the fine, rather than trying to find more doctors.
• Encourage Junior Doctors to take last minute internal locum shifts, rather than getting the enhanced rate payment they are entitled to for overworking.

Alongside this, without monitoring (which was collective) and with individual work scheduling it will be up to the individual junior doctor to fight to ensure that they are paid fairly for their work. There is a clear power differential, and we can have no trust in hospital management to play fair.

The outcome for patients will be overworked doctors, struggling to cope with doing the job of two or three doctors, fighting with hospital management for recognition of the hours they are working.

This only one part of the reason we are unhappy with the proposed contract, there are whole host of other issues which make this contract unacceptable.

From the very beginning we have argued that this contract will be unsafe for patients. We were right, and we must do everything within our power to stop the government imposing this contract and putting patients in harm’s way.