4 September 2016 - ATDG - It is Worth Waiting for a Better Outcome
9 June 2016 - EMTA Junior Doctor Contract Guidance
Please see below for the EMTA guidance on the new junior doctor contract. It is intended to inform your voting in the forthcoming referendum. Download the zip file below for a copy of the guidance, a sample rota calculation, and several of the references used. It has been checked by the BMA, as is up to date as of close of play today, 9 June 2016.
EMTA has played a large part in drafting the statement signed by members of the Academy of Medical Royal Colleges Trainee Doctors' Group, which represents the vast majority of trainee doctors in the UK.
OPEN LETTER TO SECRETARY OF STATE FOR HEALTH: TRAINEES WARN IMPOSITION OF CONTRACT THREATENS FUTURE OF UK HEALTHCARE
Members of the trainee committees that sit on the Academy of Medical Royal Colleges Trainee Doctors Group (ATDG) have written an open letter to Jeremy Hunt, Secretary of State for Health, to express their concerns with proposals to impose a new employment contract on all doctors in training in England in 2016.
The signatories to the letter represent the vast majority of Royal Medical Colleges across the UK and their associated faculties, and they represent the voice for training and standards for doctors in training in the UK.
The group states that the imposition of the contract presents an immediate risk to the provision of healthcare throughout the UK, and an ongoing threat to healthcare for generations to come.
The letter informs the Secretary of State that the failure to provide safeguards in terms of hours and working conditions will detrimentally impact upon the safe treatment of patients. The training of doctors would also be compromised and the contract would negatively impact the recruitment and retention of doctors in the UK, where there is already a shortfall.
Dr Gethin Pugh, Chair of the Academy Trainee Doctors Group, said:
“The doctors in training that we represent have significant concerns regarding the potential impact on patient care as a result of imposing these changes.
“At a time when we are already facing significant problems in the recruitment and retention of doctors in the UK, any contract must ensure it supports education and training as well as service provision across all specialties, to maintain safe and effective care for patients.
“We must value and support the doctors that deliver this care.
“The possible implications for the future sustainability of the NHS should not be underestimated.”
Dr Rosemary Hollick, Vice-Chair of Academy Trainee Doctors Group, said:
"Morale is at an all-time low and we are facing a crisis in the recruitment and retention of doctors. Imposing contractual changes upon junior doctors will only serve to exacerbate this.
“By removing the safeguards that facilitate a safe and supportive environment in which to train, these changes will further devalue the role of doctors in training and directly compromise patient safety and quality of care."
The full text of a letter send on September 23rd 2015 to Jeremy Hunt is below:
Dear Mr Hunt,
We write as members of trainee committees who sit on the Academy of Medical Royal Colleges Trainee Doctors Group (ATDG). We represent doctors in training from a broad range of medical specialties and provide a coherent, informed and balanced view on issues such as education, promoting excellence in training and high quality patient care relevant to all doctors in training.
We have significant concerns arising from the proposals for the new employment contract to be imposed on all doctors in training in England and its implications for patient safety and maintenance of a sustainable medical workforce.
The proposals are directly at odds with the stated priorities of the NHS, and the stated aims of the Review Body on Doctors’ and Dentists Remuneration (DDRB). The Scottish and Welsh governments have already declared that they do not intend to impose the proposed contract changes. Imposition of the contract presents an immediate risk to the provision of healthcare throughout the UK, and an ongoing threat to healthcare for generations to come.
Impact on patient safety
Doctors in training already work extensively out of hours, but benefit from some key employment safeguards that penalise trusts from forcing excessive and dangerous hours from their medical workforce. Despite this, specialities with the highest out of hours commitment such as Emergency Medicine, Acute Medicine, Paediatrics and General Practice already show deficits in recruitment. The proposed contracts fail to offer safeguards on hours and working conditions necessary to ensure the safety of all the patients treated within the NHS, and risk a return of exhausted doctors and rise in medical errors inherently linked to clinicians forced to work under such unsafe conditions.
Impact on Training
Excellent training ensures excellent patient care, and is reliant upon a safe and supportive environment in which to train. The proposals would see an increase in the amount of work provided out of hours, and risk a reduction in the amount of supervision and training provided. Training is already significantly eroded by the demands of service provision, but the proposed changes risk further compromise of the quality of doctors patients rely upon to provide healthcare and medical leadership in years to come.
Impact on recruitment and retention
The NHS currently has shortfalls in both recruitment and retention of medical staff in front line services. The proposed new contract regards most evening and weekend work as normal time, which is a further disincentive to recruitment into posts that involve substantial evening and weekend commitment. The Shape of Training review specifically aims to introduce greater flexibility in training, yet the proposed changes risk directly penalising doctors who choose a more flexible career path. This risks compromising the numbers of doctors with formal training and experience in medical education, management or academic research, and disadvantages those training less than full time.
Failure to promote these additional abilities within medicine may lead to a loss of the diversity and skill mix within the profession that is essential for the continued delivery and development of high quality patient care; the foundation for innovation that allows us to remain at the forefront of healthcare in an increasingly competitive international market is at risk.
Whilst we understand the financial pressures on the NHS, we are extremely concerned that the proposed new contract will damage the standard of care available to future patients. We would urge NHS Employers to reconsider any imposition so that all sides together can work out the best approach for a sustainable medical workforce and to ensure we deliver the best care to patients both now and in the future.
Dr Gethin Pugh, Chair of the Academy Trainee Doctors Group
Dr Rosemary Hollick, Vice-Chair of the Academy Trainee Doctors Group and Chair of the Royal College of Physicians of Edinburgh Trainee & Members’ Committee
Dr Judith Harrison, Vice-Chair of the Academy Trainee Doctors Group
Signed on behalf of:
Associate in Training (AiT) Committee, Royal College of General Practitioners - Dr Laura Armitage, Chair
Association of Surgeons in Training - Miss Rhiannon Harries, President
British Orthopaedic Trainees Association - Mr Mustafa S. Rashid, President
Faculty of Intensive Care Medicine - Dr David Garry, Trainee Representative & Dr Ian Kerslake, Trainee Representative Elect
Faculty of Sexual & Reproductive Health – Dr Laura Percy
Foundation Trainee Representative - Dr Charlie Williams
Ophthalmologists in Training Group - Dr Oliver Bowes, Chair, Dr Richard Lee, ATDG Representative
Royal College of Anaesthetists Trainee Committee - Dr Peeyush Kumar, Chair; Dr JP Lomas, Deputy Chair
Emergency Medicine Trainees Association - Dr Jon Bailey, President
Royal College of Obstetricians & Gynaecologists Trainees Committee - Dr Matthew Prior, Chair & Dr Jonathan Frost, ATDG Representative
Royal College of Paediatrics & Child Health Trainees Committee - Dr David James, Chair
Royal College of Physicians (London) Trainees Committee - Dr Ruth Dobson, Chair & Dr Giles Major, Vice-Chair
Royal College of Physicians of Edinburgh Trainee & Members’ Committee - Dr Rosemary Hollick, Chair
Royal College of Physicians and Surgeons of Glasgow Trainees’ Committee – Mr Alex Vesey, Chair, & Dr Stacy Smith, Vice Chair
Royal College of Psychiatrists Trainees Committee – Dr Matthew Tovey, Chair
Royal College of Radiologists Junior Radiologists Forum - Dr David Little, Chair
Royal College of Radiologists Oncology Registrars Forum - Dr. Michael Kosmin, Chair, & Dr Saif Ahmad, Vice-Chair
Royal College of Surgeons of Edinburgh Trainees’ Committee – Mr Richard McGregor, Chair, Mr Michael Kipling, Ms Alice Hartley, Mr Alex Arvold, Mr Peter Coyne, Mr Junaid Sultan, Ms Victoria Wilson, Mr George Markides, Members
Scottish Academy Trainee Doctors' Group – Members
Mr Mark McGivern, Specialty Registrar Public Health - ATDG Representative
From August 12th 2015: This year saw record recruitment to Emergency Medicine, reversing a trend of declining numbers at all levels of training in recent years. This was in part thanks to a sustained and effective campaign by the Royal College of Emergency Medicine. The DDRB has proposed fundamental changes to the way in which trainee doctors are paid. These changes will significantly impact all those whose job involves a considerable proportion of work outside of the normal working day, particularly trainees in Emergency Medicine.
Current estimates suggest that an EM trainee in a post banded 1a (almost all EM trainees) would suffer a pay cut of between 12 - 16% if this review is implemented. This fundamental disincentive to work in EM would undo the good work that has been done in improving recruitment and retention in EM over the last few years and is completely contrary to the message the RCEM has been promoting as part of its STEP campaign, and is extremely damaging to EM as a speciality.
The BMA has recently announced that it will not return to negotiations for a new contract for junior doctors.
It is the position of the EMTA Committee that the DDRB recommendations have nothing to do with improvement to service delivery or patient care; they are entirely to do with reducing the cost of the NHS wage bill.Doctors are being used as scapegoats: a sustained media campaign to reduce public support of doctors and to portray our profession as lazy and overpaid, together with misrepresented research aimed to instill fear in the general public, have been used to reduce our bargaining position in pay negotiations.By forcing change on doctors as the leadership of the NHS, the government will strengthen its hand in forcing similar degradation in working conditions on all other members of the NHS.The government recognises that in the public forum, nurses’ pay and conditions are untouchable.By driving a change in working hours through for doctors, they pave the way for forcing the same on all other Agenda for Change Staff, under the guise of fairness – when in fact it is anything but.
There is insufficient evidence that our week day working hours are out of line with other professions.Comparator professions are not suitable nor justified.
Saturdays should not be normal working time.This is not the case in any other comparable system.
The proposed pay structure specifically incentivises training doctors against taking jobs with acute on call requirements.This completely undermines attempts to improve recruitment and retention in acute specialities.
There is no justification for reducing junior doctor pay
Incremental pay should be performance and career progression linked, to motivate non consultant doctors to progress through their training to produce consultants.They could be linked to career milestones, incentivising people to complete postgraduate exams or postgraduate qualifications, fundamentally motivating doctors to become better trained.
Recruitment and retention premia are not effective if their only role is to normalise rather than increase pay.By definition, a premium is an additional extra, not part of a norm. They should not be used to patch over an ineffective pay structure
The pay deal as it is outlined currently will significantly demotivate the workforce and worsen recruitment and retention, leading to an increase in an already trending exodus to other countries offering better pay and conditions for equivalent work.