The Government and the British Medical Association (BMA) have reached an agreement over a new contract for junior hospital doctors – but the dispute is far from over.
♥First, the details of the new contract have to be examined by doctors and the public. Doctors’ income is made up of their basic pay plus extra payments (expressed as a percentage of their basic pay) for working evenings, nights and/or weekends. The Government originally wanted to reduce the premium paid for working these unsocial hours – but offered to increase the basic pay as a broad brush sort of compensation. Doctors were reluctant to give up the principle that working unsocial hours should be properly remunerated. The new compromise reduces the increase in basic pay (from around 13.5% to somewhere around 10-11%) and reduces the premium paid for working night shifts (from 50% 37% of the basic hourly rate). These savings will be used to pay a supplement to doctors which depends on how many weekends they work. There will also be extra support for women doctors who take maternity leave and more scope for doctors to work with the independent body which scrutinises how many hours doctors have to work. Although these basic details of the new compromise have been made public, it is not clear if doctors will be happy with the new terms. Some have already expressed doubt on social media – but we need a bigger public exchange of views to see how the compromise stacks up (especially the small print).
♥Second, although the BMA is recommending the new deal to doctors, its members will have to vote to endorse it. The Government’s first offer was extremely unpopular: some 98% of doctors voted to take industrial action against it. The Government hoped that when strike days were held, public sympathy for the doctors’ case would diminish, leaving them isolated. However, public sympathy for the doctors increased over the course of the dispute, as patients and potential patients saw doctors on picket lines and at rallies and heard the detail of the case. The massive vote for industrial action shook the BMA out of its comfort zone. To its credit, it did follow the mandate and authorise, organise and defend strike days and these have been successful in forcing the Government to re-open negotiations. However, that is not to say that the BMA wants to spend any more time pursuing this industrial dispute. The last strike event, a two day strike without daytime emergency cover, was almost the last tool in their bag. If doctors reject the new compromise, it is hard to see what action they could take to force further concessions from the Government. There would have to be longer strikes, again without emergency cover, and it is hard to see how long this could be sustained. If the doctors reject the new compromise by 98% again, this would give the BMA a new mandate to use on top of the knowledge that the Government could not tough it out and impose its original new contracts. Such a result is unlikely. There is an old trade union adage of “quit while you’re ahead”. It may be wise for the junior doctors to accept this compromise (if the new terms are in any way workable, once the small print has been scrutinised). The feeling that they have beaten the Government (even if they have had to compromise on their own offer in order to do that) would see junior doctors continuing to work but with a massive increase in morale and sense of their own power. This could be channelled into the new campaigns to come.
♥Third, it remains to be seen what the Government’s next step is. It always claimed that the need for new contracts arose out of a desire to deliver a “seven days a week NHS” – without explaining what on earth that meant. We have always had a seven days a week emergency service in the NHS. The question now is whether the Government wants to deliver a seven days a week non-emergency service, with routine appointments being booked at weekends (or at least on Saturdays). To do so, it will have to impose new contracts on other NHS staff – nurses, technicians, porters and cleaners. Doctors who feel they have had a victory could help those groups of workers resist unfair change. Doctors who try to carry on the dispute could, if the Government reverts to its plan to impose new contracts regardless, find they were fighting a non-existent fight – leading to demoralisation and confusion. If the Government does start booking routine appointments on Saturdays, it could carry out more of the NHS’s activities on fewer sites, allowing it to sell off hospitals (a move which would help plug the deficits being racked up under PFI schemes). Doctors would be a vital part of any campaign to halt such closures and sell-offs.
Doctors face a difficult decision in the next few weeks, with the ballot due to be held in June. Whatever the outcome, there will be plenty more to do to keep the NHS safe.
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