Today is the day the ballot for junior doctor industrial action begins and it comes on the back of an eleventh hour 'firm, not final' proposal from Mr Hunt, Health Secretary.
Junior doctors however will have been largely disappointed yesterday that Hunt chose to break this current proposal via the media. Some have billed it as a last ditch attempt to avert the possibility of industrial action. If that is true, it is more surprising that Hunt chose not to send the proposal direct to the British Medical Association (BMA). As it stood, they were second in line to the media, giving them very little time to digest the complex proposals in time for the media storm that broke yesterday. Perhaps that was the plan. As a junior doctor my biggest fear is that by condoning the grossly misleading headlines 'junior doctors to get 11% pay rise', Hunt has firmly put to bed any hope of gaining back the trust of junior doctors. That is of course a sad and unhelpful situation for everyone; doctors, the department of health, our NHS colleagues and patients.
Disappointing as those tactics are, cutting off the nose to spite the face is never wise and generally serves to stand in the way of progress. So with that in mind, it is worth looking at what actually is in this 'firm, not final' offer. The document starts by once again suggesting that the BMA have mislead it's members. A tactic which is odd in every sense; not only because it suggests to tens of thousands of doctors that they haven't the faculties to understand the issues in their own right, but also because starting an offer by under mining the mandated union seems like a very risky move. They then swiftly make it clear that they have refused to concede to the BMA's first demand; to remove the threat of imposition.
It is worth making very clear that junior doctor have not asked for a pay rise, in any shape or form. Like other public servants, we have been subject to real term term pay cut year after year and now we will not allow the government to add further to this. At this point, if I thought writing 'I'm not looking for more money' across my forehead would help get that message out, I would do it.
The first surprise in these proposals is the caveat; for trainees already employed 'transitional pay protection arrangements' have been made. Alarm bells ring. Hunt is now saying that for those of us already senior enough to be registrars on speciality training programmes, we will switch to the terms of the new contract but continue to be paid by the old banding system until 2019. For those who are more junior than this, should it be the case that their new pay system leave them worse off, they would be offered 'cash pay protection' until 2019. Is this an attempt to divide and conquer? It certainly feels that way. Balloting for industrial action requires unity, what Hunt appears to be sowing here are are seeds of doubt. My sympathetic eye says, hang on, maybe it is because Hunt believes in his plan so much that he is willing to put his proposals to the test in this way. It is of course a move reminiscent of supermarket tactics; shop with us, if you could have gotten a better deal somewhere else we will give you the difference back. My sensible side says that if Hunt's proposals were so fair, he wouldn't be trying to bribe his current staff, presumably at the expense of those doctors not yet in a training programme or still in medical school. I cannot help but feel like I am being offered thirty pieces of silver.....and I will not be Judas in this tale.
The proposals do not concede either to offer what the BMA will view as sufficient protection to less than full time trainees. With respect to female doctors, they are clear that they plan to subject their proposals to a full 'impact assessment'. Alarm bells ring. If I was about to impose a contract on 50,000 junior doctors, I'd have sorted out that impact assessment first!
Junior doctors have been clear that de-incentivising less than full time training at a time when there is a already a recruitment crisis is short sighted. We have also been clear that these plans will further damage specialties really struggling to retain their staff; accident and emergency (A&E) medicine for one. Hunt says that he has an answer for that; cash incentives remain the order of the day. His plan for 'flexible pay premia' of £1,500 per year to registrars choosing A&E is again misguided. If you ask an A&E trainee what would make their life better, they will not ask you for £31.25 a week extra. The will tell you they would like to feel valued, supported and be given more opportunity to achieve a decent work-life balance. They would probably ask you extend and the same support to their nursing colleagues. They would probably also ask you for more doctors and more nurses. But they would not ask you for £31.25 a week.
In general terms however, their approach is not surprising. There is continued failure from department of health to recognise that this row is not solely about money. The government again yesterday lauded that they were "removing financial incentives....that encourage junior doctors to work unsafe hours". I am a doctor, please believe me when I say that the only thing that will keep me in work past my hours is your loved one who genuinely needs me. 50,000 junior doctors are frightened that when they are forced to spread themselves more thinly across seven days, that patients will be affected. They are frightened because they know having to 'ask your line manager' in advance of a staying late to help a patient is not only insulting to our profession but an entirely ludicrous idea. Junior doctors are frightened because they fear these plans will disrupt continuity of care, team structure and the quality of training experience available to doctors whom the NHS relies on to be world class.
I am desperate for progress, I am desperate for talks and I am desperate for the Department of Health to realise that extra money is not my motivation for working extra hours now, nor will it persuade me into accepting these proposals for the future. As a junior doctor I am saying, keep your thirty pieces of silver Hunt; but please, lets talk about patients.