Junior doctors vs. Hunt - the whole truth?
I haven't written a blog about the junior doctors' contract dispute with the government until now - but Jeremy Hunt has forced my hand. His latest spin - delivered to the press rather than the doctors he's supposedly negotiating with - was certainly clever. Newspaper front pages across the land carried the headline '11% pay rise for junior doctors', the implication being that if they continue with strike action they must be greedy and grasping.
When interviewed, Mr Hunt repeated the same phrases time and time again - 'death rates are higher in hospitals at weekends' (when fewer doctors are working); the BMA refuses to sit down and negotiate with the government'; '99% of junior doctors would see their pay stay the same or increase under our proposals'. So let's pick apart his media soundbites one by one:
Higher death rates at weekends are down to doctors not working at weekends
This quote was designed to strike fear into all our hearts, with worries that our loved ones could die for simple lack of medical care in a first world country. Jeremy Hunt has repeatedly used the same key study from the British Medical Journal to 'show' that lack of staffing is responsible for 11 000 extra people who die each year within 30 days of admission to hospital on Friday, Saturday, Sunday, or Monday than on other days of the week.
That is until the academics fought back. First, two academic lecturers, in a letter co-signed by thousands of doctors, stated that: "It appears Mr Hunt deliberately and knowingly misquoted and misinterpreted the conclusions of a medical research publication in an attempt to mislead the other Members of Parliament and the UK public." Then Fiona Godlee, editor in chief of The BMJ, wrote to him publicly to point out that he had misrepresented and misused the article's findings to apportion blame. The academics point out that there are many reasons that could account for the difference, including
- Patients admitted at weekends are already sicker when they go in
- Patients admitted in the week are far more likely to be non-emergency admissions, in for routine procedures with a better outcome.
Of course, the government is also dead set on introducing 7-day working for general practice, despite GPs pointing out that there are already huge GP shortages and not enough GPs to cover the hours we do have. What's more, where 7-day working has been introduced, patients often haven't wanted or used the whole 7-day availability. An official review of pilot 7-day working concluded last week, 'The feedback from across the wave one pilots is clear in that some extended hours slots have proved more successful than others. Whereas weekday slots have been well-utilised, patient demand for routine appointments on Sundays has been very low.'
11% pay rise
The Health Secretary's offer does indeed include an 11% rise in basic pay - but this isn't by any means their whole pay, and they will be losing out significantly in other aspects. At the moment, they get standard pay if they work 'standard' hours of 7am-7pm, Monday-Friday, and more if they work 'antisocial' hours outside this time. The proposed new arrangements add an extra 30 hours to these hours. That means much if not all of this 11% rise will be offset by a cut in overtime pay for working weekends and from 7-10pm, which would be classed as 'standard hours'. So it's not a pay rise at all, it's just dressed up as one for the media and the public.
But don't take my word for it - take the word of Dr Sarah Wollaston, a Conservative MP and ex GP. She tweeted today: 'If the 'total pay envelope' is the same, you don't need to be a genius to see that there is not an 11% pay rise here; it's a redistribution'. Remember when I suggested that the Minister needed to do his maths?
The BMA refuses to sit down and negotiate with the government
The BMA started negotiating with the government in 2012, and talked until 2014 when they left the negotiations after no agreement was reached. The government asked the DDRB (Doctors and Dentists Review Body) to provide recommendations, but asked the BMA to use all these recommendations as a basis for restarting negotiations. Over 99% of junior doctors polled about these terms said they weren't acceptable - so the BMA has asked the government to think again before it returns to the negotiating table. They also want the government to remove its threat of imposing the contract without any further negotiation if the BMA doesn't agree by next year. I don't remember Mr Hunt mentioning that in any of his interviews.
99% of junior doctors would see their pay stay the same or increase under our proposals
This may be true today, but pay progression will be changed under the new proposals. That means that doctors who have currently seen their pay increase as they gain more experience and take on more responsibility will lose out if they don't work full time the whole time. Many women doctors reduce their working hours after having children. Under these new proposals, they won't just earn less because they're working fewer hours - they'll lose out more because they won't get the same pay progression. So while most won't lose out now, many of them will take a huge pay cut in future years.
When junior doctors start their career, they already have at least £45,000 of tuition fee debt (often closer to £70,000 after paying for rent and basic living) after five years of training. Their basic salary is currently £22,636 a year. I've heard many junior doctors say they simply won't be able to afford to stay in the NHS if their pay progression goes - and with so many women choosing general practice as a career, that could well make our current recruitment crisis even worse.
Finally, just a week ago Jeremy Hunt was forced to admit that his previous soundbite, that "not a single junior doctor will get a pay cut compared to their current contract", wasn't true - 500 doctors would be worse off. So I'm hardly surprised that junior doctors are taking his current announcements with a pinch of salt.
Patient's Clinical Editor Dr Hayley Willacy has also shared her view about this topic in our Healthcare Matters blog here.