Doctor contract talks will be tough but can be achieved

Illness is never scheduled. For increasing numbers of patients to continue accessing the same high standards of care, seven days a week, we need to use our people, buildings and equipment effectively and efficiently as possible.

For this to happen, we are changing the way we work in the NHS.

The desire to move quickly to greater provision of seven day NHS services has recently attracted many headlines and comments - some helpful, others less so.

Doctors are at the forefront of NHS care: as individuals they are the people we trust in a crisis. As professionals they lead teams to continually drive the improvements in care that we all benefit from. But the way we access care is already changing and doctors contracts’ need to change too.

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Weekend work is the norm

The current consultant contract allows an “opt-out” for providing non-emergency out of hours care.

Although this opt-out clause may be rarely deployed, its existence can inhibit service planning for employers, as well as on some occasions increase the rate of payment for out of hours work, in a manner that does not bear comparison with non-medical members of their teams.

The activity on social media recently from doctors working weekends across the country, told us what we know already; that weekend working is the norm for many.

‘The doctor contracts were designed to drive down unacceptably long hours’

The issue isn’t whether consultants work on a Saturday and Sunday, but what work should be done, how often, how frequently, and at what price?

Junior doctors remain one of the hardest working and most critical parts of our NHS, combining challenging work with demanding education and development.

The reality is that the contracts they are employed under today were principally designed to drive down the unacceptably long hours that had been worked by previous generations of doctors.

These contracts need to be updated, not least because a large proportion of junior doctor earnings remain variable, leading to unpredictable earnings for individuals and an adversarial and unwieldy bureaucracy for them and their employer.

Modern and reformed

We began again discussions with the British Medical Association on the future of both consultant and junior doctors’ contracts following the publication of the independent Review Body on Doctors’ and Dentists’ Remuneration advice and recommendations on these contracts. Our default setting is to seek agreement through discussion. 

With the BMA this focused on the essential reform and modernisation of both contracts to ensure that going forward all doctors are employed on terms that are safe, fair and affordable.

The DDRB was also clear that we must ensure that doctors have appropriate safeguards, especially around the contractual limit to the number of hours they can work.

‘A negotiated agreement would be the best outcome for all parties’

Let’s be really clear: there is no expectation that their new contract will save the NHS money, so I was very disappointed that the BMA’s junior doctors committee could not bring themselves to talk to us. 

As a result, our challenge now is to implement a new contract, which despite what the social media rhetoric of recent weeks may say, is fair and reasonable and supports the postgraduate training of doctors.

We have started discussions with the consultants on their contracts and hope for an outcome which must be fair, but modernised and reformed to ensure that they reward those who make the greatest contribution, and in future, better reflect the position for staff working consistently in the most intense positions and during the most onerous times.

A negotiated agreement, if it can be achieved, would be the best outcome for all parties, but we know that this won’t be easy.

It will require ourselves and the BMA to continue to work collaboratively, with determination, pace and purpose, but we believe this can be done.

Danny Mortimer is chief executive of NHS Employers