Where next for Junior Doctors?

The upcoming referendum on the proposed new ‘negotiated’ contract for Junior Doctors has caused a great amount of debate and discussion. It has caused a certain amount of division. Between those who want to highlight the benefits of the new contract, particularly compared the previous ‘imposed’ contract and those who feel that it does not meet our core demands.

It highlights a clear demand from some to continue the fight. There are still clear issues with the contract particularly for less than full time trainees, those who predominately work high intensity evening shifts (predominately Accident and Emergency) and around cost neutrality and the wider state of the NHS.

It has been suggested that the key question is whether the government will continue with its plans to impose the contract if Junior Doctors vote it down in the coming referendum. I would suggest that a more important question is what are we willing to do if Junior Doctors vote no? This post is hopefully going to tease out some of these issues. My personal view is that we should vote no, with some of the reasoning for this highlighted in a previous blog.

The Referendum Result #

Referenda are always difficult. They give you a binary answer to a very complicated question. Junior Doctors will vote yes and no for a variety of reasons and motivations. Through debate and discussion we need to assess these reasons and come to a clear strategy to move forward, reunite the movement and reach our goals. The core issues remain the same, safety at work, equal and fair pay and the right to a work life balance. We can fight for these whatever the referendum result.

I’ve split these into a hard and soft yes and no to allow us to consider strategies moving forward.

The Soft No #

This could be considered the almost there but not quite option. Clear progress has been made in the last round of negotiations. But the negotiators did not extract all they wanted from negotiations. The equalities issues were not fully addressed and the contract will be implemented before a lot of the positive elements are a reality. From the system of exception reporting to the accelerated training system. These do not exist yet, and to introduce this contract without even knowing if they will work is unfair and unsafe.

If we vote this contract down, it leaves the government with a question to answer about imposing it. It is difficult to imagine this government returning to negotiate with the BMA, but not impossible, certainly if the alternative was the BMA and Junior Doctors fighting against the implementation of the contract.

This strategy brings with it risks. If the government was to move towards imposition it would almost certainly remove some of the most favourable bits of the contract towards junior doctors. I would expect them to look to redefine weekends, remove the role of the BMA from the contract and reinsert the variation clause allowing them to change the contract at will.

The variation clause would almost certainly be fought legally by the BMA, but that would be a significant loss compared to the government agreeing to negotiating all changes via the JNCJ(Joint Negotiations).

The Hard No #

There is a reasonable argument that this government can not be negotiated with in good faith. Their consistent demands this contract is cost neutral, (it isn’t) disregard for health workers and insistence on a unfunded and uncosted ‘7 day NHS’ make any negotiation nearly impossible.

The clearest argument in this camp would be to halt negotiations and discussions of a new contract altogether, until the future of the NHS was less in the balance.

This would be totally resisted by the government, and would lead to a very bitter campaign, much worse than we have already seen.

The Tactics #

The tactics of a hard or a soft no would be similar, but the emphasis would be different. In both situations the government will likely move towards an imposition scenario. This would currently give an August deadline for some Junior Doctors signing the contract and an ‘implementation’ date at the beginning of October.

There would need to be further industrial action which would need to be escalated further than we have seen so far. Other tactics would probably need to include forms of action short of strike. We would need to do a lot of work to build our LNC structures, as it is likely that the imposition scenario would overtake us and we would need to up our ground game considerably. (This actually needs to happen regardless of the vote.) Crucial to a no vote would be being able to get the plans off the ground straight away. We would need to see strikes resume before August and would need to engage the new foundation years straight away.

The Hard Yes #

This is on paper the easiest scenario, but actually when you consider the work required it begins to look less straightforward.

We vote yes, declare victory over weekends, patient safety and play up the virtues of the contract. We all sign the contract. The problem with this strategy is as mentioned before alot of the systems and mechanisms of the new contract require alot of work. There is a huge building phase required by Junior Doctors taking this route. If you think that by voting yes you can just go back to work, we will lose, big style.

The strategy would require a clear commitment from Junior Doctors to throw themselves into the Junior Doctor Fora which will be set up around the country, in order for them to be ready by October. We will need to be prepared for exception reporting, and some of the difficult internal struggles it is going to lead to with hospital management. Our Local Negotiating Committees and Industrial Relations Officers are not ready for this level of case work. We will need to make them ready.

Soft Yes #

A narrow yes vote would give potential for more negotiations around the edges. It is going to be extremely difficult for the government to implement this contract by October due to all the work required. We would need our JDC to push for this date to be pushed backwards as far as feasible. The government may be more willing to do this, as currently it still thinks it has won a narrative victory and so would probably care less about the actual implementation.

Summary #

Regardless of the result of the referendum, there is lots of hard work ahead. That’s before we even begin to discuss the long term sustainability of the NHS under another 4 years of Conservative government. The needed increase in staff and resources is not coming, regardless of what is written into the contract and I would have no faith in this government to deliver on such a promise anyway.

Regardless of the vote we need to turbocharge our representative structures. Our Local Negotiating Committees, our Regional Junior Doctors Committees and our Regional Councils.

We need to get ourselves to informed positions, with solid reasoning and then work with the decision the membership gives us. This is what we have done all the way through this campaign, lets not turn our back on ourselves now.