The health secretary moved to defuse widespread anger at his threat to impose new terms and conditions on them by offering two major concessions and assurances that they will not see their pay cut or working hours extended.
Faced with England’s 53,000 junior doctors being balloted for industrial action, and amid growing unease at his handling of the row, Hunt has indicated that he is willing to rethink his plan to reclassify working on Saturday between 7am and 10pm as part of a junior doctor’s normal working week for which they would be paid at only the standard rate.
He has also pledged that existing financial incentives for recently qualified young doctors to go into emergency medicine or general practice – two areas struggling with too few medics – will continue so that the new contract does not exacerbate the existing shortages.
In a detailed and emollient letter to Dr Johann Malawana, the chair of the British Medical Association’s junior doctors committee, Hunt also sought to banish widely held fears that junior doctors – whose vital contribution to the NHS he lauded – would soon have to start working the 90-hour weeks that their predecessors did.
Hunt’s move revealed divisions between professional organisations that mostly represent more senior doctors, which want to see a negotiated settlement as soon as possible, and rank-and-file junior doctors, many of whom said Hunt’s olive branch was not enough.
Malawana said the BMA needed more detail before it could form a view on whether Hunt’s mixture of clarifications, reassurances and genuine rethinking of his plans could form the basis of a settlement. Many junior doctors, thousands of whom have recently protested in London and Manchester against the new contract, voiced their scepticism and belief that the BMA should seek further concessions from Hunt.
On pay, the health secretary rejected estimates by the BMA that junior doctors would lose up to 30% of their earnings, and blamed the union for fuelling their fears unnecessarily by issuing “significant misinformation” about the impact of his plans.
He wrote: “I am saddened by the distress being caused to junior doctors who were misled by the calculator on the BMA website into believing that their pay will be cut by 30% and that they will be asked to work many more hours each week.
“I have asked NHS Employers to develop the details of the new contract to ensure that the great majority of junior doctors are at least as well paid as they would be now.
“In addition, although the current proposal does not provide protection for those whose pay reduces when they change jobs, under an agreed move to a new contract we would be willing to consider such protection for individual doctors who would otherwise lose out. In any scenario, I can give an absolute guarantee that average pay for juniors will not reduce.”
On working hours, Hunt wrote: “I can give an absolute guarantee to junior doctors that this contract will not impose longer hours. No junior doctor working full time will be expected to work on average more than [the current] 48 hours a week. I want to see a work review system with teeth that ensures that juniors are not exploited and that addresses issues of overworking if they arise.”
Junior doctors have been concerned at plans in the new contract to extend the hours in which they would be paid at their basic rate – “plain time” – from the 60 hours between 7am-7pm Monday to Friday to the 90 hours between 7am-10pm Monday to Saturday. They fear that that would see them lose out on lucrative overtime payments for working in the evenings and at weekends and also see them compelled to work much longer hours than the average 48 they are contracted to do at present.
Juniors have highlighted what they said was the unfairness of being paid the same for working at 9pm on a Saturday as 9am on a Tuesday.
Hunt also assured juniors that “this is not a cost cutting exercise. I can give you a categorical assurance that I am not seeking to save any money from the junior doctors’ paybill. Whilst I want to see an end to automatic annual increments (with pay rises instead based on moving through the stages of training and taking on more responsibility), these changes would be cost neutral, rather than cost saving”.
But some medics said his pledge that average pay would not be cut meant that some junior doctors would still lose out financially.
Hunt’s possible backtracking on Saturday working, though not categoric, is the likeliest of his proposals to persuade junior doctors not to endorse or take strike action. “I would be pleased to discuss in negotiations how far plain time working extends on Saturdays,” he said.
The BMA is already under pressure from some juniors to seek to have all of Saturday counted as an antisocial shift which attracts overtime, and potentially weekday evenings too. However, Hunt has stressed that basic junior doctor pay will go up, though by an unspecified amount, in return for them working more flexibly as part of the move to a seven-day NHS.
Dr Maureen Baker, the chair of the Royal College of GPs, welcomed the retention of salary supplemernts designed to encourage young doctors to become trainee GPs. She hoped that Hunt’s letter “will help to unblock the current impasse. We are pleased that he has listened to our concerns, particularly around GP recruitment, with the inclusion of pay protection for doctors who change to shortage specialties such as general practice”.
Malawana said only: “It is encouraging that the health secretary has finally recognised the vital role that junior doctors play as tomorrow’s leaders across the NHS. However, questions still remain and we are urgently seeking clarification on the points raised in the letter.”
The Academy of Medical Royal Colleges, which represents all the UK’s 250,000 doctors professionally, backed Hunt’s call for the BMA to resume negotiations oveer the terms of the new contract, which is due to come into force in August 2016, that broke down last year.
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