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Junior doctors urged to re-enter talks as Hunt polishes contract

NHS Providers has urged the BMA to re-enter discussions over junior doctor contracts after claiming that the government’s latest offer provides a “firm basis” for negotiations.

The organisation, which represents acute hospitals, mental health, community and ambulance services, had previously asked that doctors respond “positively and collaboratively” to former contract promises by health secretary Jeremy Hunt in October.

But after Hunt revealed further details of the long-disputed contract yesterday – including adding an approximate 11% increase to basic pay – NHS Providers reiterated that now is the best time to reform and modernise the sector’s pay.

Its chief executive, Chris Hopson, said: “It is clear that the government has listened to the concerns of junior doctors. Our members have consistently told us the junior doctor contract needs to be reformed.

“In particular, that the pay banding system for junior doctors needs to be reviewed; that, as has happened in other sectors, pay premia for weekend and out of hours working need to be changed; and that, for junior doctors, pay should be linked to moving to a post with a higher level of responsibility.

“We would urge the BMA to return to negotiations in order to reach an agreement that is safe for patients and fair for doctors. Neither side wants a strike. The right way forward is a negotiated solution.”

Rob Webster, head of NHS Confederation, also perceived the changes as a positive step in moving the conversation forward: “Working together to agree a final contract is now the best way forward for all parties – and most importantly the NHS.

“I hope this is a positive step forward in ending this stalemate that is not benefiting doctors, patients or the NHS.”

Sir Bruce Keogh, medical director for NHS England who led of their major reviews into seven-day services in 2013, urged junior doctors to pay “careful and considered attention” to the government's new offer, which he believes will address the long hours and safety issues if implemented correctly.

But he added: “However, the only way to get this right is to talk, because getting the detail right will mean better options for those who deliver care and, consequently, safer care and better outcomes for our patients. It is particularly important for our patients and professional integrity that no action compromises urgent or emergency care in any way.”

But the BMA blasted the health secretary for taking details of the reformed contract to the media first after the Guardian published information the association had not seen.

“Junior doctors need facts, not piecemeal announcements and we need to see the full detail of this latest, eleventh hour offer to understand what, in reality, it will mean for junior doctors,” said Dr Johann Malawana, the BMA’s junior doctors committee chair.

“We have repeatedly asked for such detail in writing from the secretary of state, but find, instead, that this has been released to media without sharing it with junior doctors’ representatives.”

Dr Malawana, who has spearheaded the dispute against the government’s threat to impose a new contract for months, also criticised Hunt for his attitude towards negotiations.

The criticism was in reference to last week’s debacle, where Hunt admitted that a “small minority” of junior doctors would lose money as a result of the new contract, despite guaranteeing just hours earlier that no doctor would miss out.

And Dr Malawana stressed that Whitehall must remove its threat of imposition and provide further assurances before the association can re-enter talks.

Another threat of imposition?

Appropriately, Hunt sent a letter to all junior doctors this morning [4 November] confirming that no staff member would see a pay cut compared to their current contract – despite telling the BBC that 1% of trainee doctors would lose out if they are working beyond the current time limits.

His latest proposed basic pay rise, which is expected to affect three-quarters of doctors, would see a new doctor’s salary grow from £22,636 to £25,500 – but guaranteed annual pay rises will be scrapped, making pay directly tied to progress through training stages instead. Further information on the revised offer can be found here.

Sources have also told the Guardian that the proposed salary rise would neither cost nor save the NHS any money.

The revised contract fittingly comes just a day before the BMA is expected to ballot for industrial action, suggesting the timing is an attempt to dissuade doctors from striking.

Hunt added: “We again make the guarantee that no junior doctor working within the current limits will see a pay cut compared to their current contract. As we have consistently said, we will reduce the maximum number of hours that can be worked in any one week and are putting in place better safeguards, meaning the firm offer gives the best protection junior doctors have ever had against working long, unsafe hours.

“Our proposals offer better basic pay with increases based on responsibility instead of time served, a shorter working week and improved patient safety. I appeal to the BMA to do the right thing and come back to the table to negotiate for its members.”

Danny Mortimer, chief executive of NHS Employers, commented that they now want to work with the BMA to come to a conclusion by the New Year.

But a government statement used a different tone: “The government is clear that it will not remove this timetable [August 2016] for putting in place a new contract. This is because the BMA agreed as far back as 2008 that changes were needed to the current contract, yet since it walked away from negotiations in 2014 has continually refused to re-enter talks.

“We are clear that there is an imperative to reform the contract – and so we are setting out a clear timetable for implementation.”

Other reforms

As well as contract changes, the government also announced today plans to bring the working hours and service delivery of junior doctors into the CQC’s inspection regime on how trusts manage their medical workforce.

Doctors working in conditions they perceive as unsafe will be able to use the “reporting mechanisms” available to voice this issue, which will later be fed into the CQC’s inspections.

For more details of every main event in the longstanding contract dispute, access NHE’s exclusive timeline.

(Top image c. Neil Hall/PA Wire)