Yes, and no.
Q: Has Jeremy Hunt won?
The health secretary has got his way in that from August 45,000 junior doctors in the NHS in England will start working under a contract that is, on key issues, very close to the one he first threatened to impose in September. It is also a contract that, by forcing junior doctors to work Saturdays more frequently, usefully lets him claim he has taken a big step towards delivering the seven-day NHS promised in the Conservatives’ general election manifesto last year.
The contract extends “plain time” – the hours in the week for which junior doctors are paid at a basic rate – in two key ways. Firstthe period will be extended from 7pm to 9pm between Monday and Friday. Second, Saturdays between 7am and 5pm will now count as “plain time” for the first time. That will help hospital chief executives roster more junior doctors to work then, without a rise in running costs, so helping to bring about a seven-day NHS (for which ministers have produced no extra money).
Q: Has Hunt convinced the public that his proposals are right?
Definitely not. Separate opinion polls this week, by Ipsos Mori and YouGov, found that people backing the junior doctors outnumbered those who did not, by two to one. Imposing the contract is unlikely to reduce that strong public support for trainee medics.
Hunt’s move could have serious consequences for the NHS short- and long-term. The main risk is that even more newly qualified doctors will decide not to continue their career in protest at a contract they think unfair. The numbers choosing not to stay in the NHS and start specialist medical training have dropped for the last four years in a row. Many of the medical royal colleges have voiced serious unease about this prospect and a worsening of the sometimes serious shortages of medical personnel.
Q: What does the new contract involve?
It changes a number of key aspects of the working lives of the 45,000 junior doctors working in the NHS in England, especially relating to hours and pay. The main change is the two-fold extension of “plain time”. Junior doctors will no longer be able to claim overtime pay for “antisocial hours” shifts, money that can contribute as much as 30% of their income.
Hunt’s chief negotiator, Sir David Dalton, chief executive of Salford Royal NHS foundation trust, insists that under the new system a majority of trainee doctors (everyone below consultant level) who work on Saturday will get paid at a premium rate if they do so at least one Saturday in four. That will mean 30% on top of their basic salary, less than they get now.
In return they will get a 13.5% increase to their basic pay, which starts at just under £23,000. The British Medical Association and NHS Employers disagree over whether that pay rise, with new terms and conditions, will mean doctors are better or worse off or neither.
Q: What happens next?
After two months of talks from December to January, there are no more negotiations planned. NHS trusts in England will start imposing the new contract from the start of August, initially on the new cohort of medical graduates starting work in the NHS for the first time. It is expected to take a year to get all 45,000 juniors on to the contract.
The BMA responded to Hunt’s announcement by pledging to continue its fight against the contract. It has so far given no details as to what that might involve. It might seek further industrial action and possibly stage an all-out strike. But while some members of the BMA’s junior doctors committee back that option, others, and the BMA’s leadership, believe that refusing to work in emergency care, including A&E and maternity services, could lead to harmfor patients, which would have disastrous consequences for doctors’ high standing with the public.
The BMA is seeking legal advice as to whether November’s ballot result, which showed that 98% backed strike action, remains a legal basis for further walkouts or withdrawal of labour. If it is not, then they may have to stage a second ballot to get a fresh mandate to strike.
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