Monday, November 21, 2016

The BMA Bop

In August my new trust sent an email asking for candidates to become the hospital's Junior Doctor representative on the BMA local negotiating committee. I sent a very non-committal email back saying I was interested and would like more information. I was fully expecting that in the current climate there would be a deluge of willing volunteers and someone louder and more polished than me could give some soaring oratory to get the post. In the last trust I worked in we had 9 applicants for the post and an election had to be held. I had underestimated the apathy in my current institution.

After 6 weeks nobody had gotten back to me from the BMA so I assumed that they had found someone or hadn't got my email. If a week is a long time in politics, 6 weeks is an age. In this time the BMA had gone from losing a ballot, declaring strike action then cancelling said strike action. It was fair to say I wasn't overly enamoured with them as an organisation for declaring strike action then cancelling it in quick succession. They were entirely right to call action if 58% had not accepted the contract, but where the 4 x 5 days figure was plucked from and why it was called off I'll never know.

It was therefore to my immense surprise when I receive an email saying I had been voted in as JD rep at their meeting (which I hadn't attended and didn't know about) as nobody else had come forward. So in late September I was made junior LNC rep and had to hastily organise a picket and ensure departments could cover their work. I figured the situation must still be salvageable at a national level (despite only hearing about press releases through BBC) so I decided to give it my best shot.

I started by trying to gauge reaction to the idea of 5 days of strike action, in order to represent the views of local members. If you look back to my previous post I had originally planned not to strike. This was due to the financial implications of losing potentially 4 weeks pay as well as my training record; Health Education England had sent us an email reminding us we may fail our training appraisal if we missed more than 2 weeks of work. I sent an email out to all junior doctors and spoke to the juniors in my department of O&G as well as nearby specialities like paediatrics and anaesthesia. I also tried to get a view of the FY1s at their teaching sessions. From my conversations I got the impression that nobody really wanted to strike for 5 days even those who had voted the contract offer down. From my email to 150 doctors, I received a solitary reply, echoing these sentiments.

I had gone from someone who was not planning to strike and wavering on whether to keep my BMA subscription going to somebody visibly representing the BMA within the hospital and trying to organise a picket. Then it got very difficult for me. The job lot of strikes was cancelled (again I found out via BBC) without anything in it's place and without an explanation. I enquired higher up and advised that a JDC meeting a month away would clear everything up. At this point O&G registrars were being started  on the new contract. It appeared there was no going back. But hey, at least we got the now infamous stickers in the post to proudly wear whilst nothing happened.

The stickers that launched no ships at all

So whilst the JDC were navel gazing I had to face my colleagues at the junior doctor forum and tell them that I knew nothing about the cancelled strike action and no plans were in place. I was rightly given some upset words from my colleagues. I waited for news of our next move, my proud sticker starting to curl on my lapel. The next meeting of the JDC only served to lose another chair. I waited some more and on radio 4's today show Dr Porter effectively ended our dispute with the government. With the new chair of JDC assuring us we are still in dispute and are back at the negotiating table, you can forgive me for not holding my breath.

In the absence of any guidance I made a decision at this point to work with the trust to ensure that they had all the statutory systems in place required for the contract to be imposed, and hold them to account if they didn't. It is to be said that the trusts are innocent bystanders in this and with pay protection actually stand to lose a fair amount of money over the next few years because of the new contract. Here is where I feel I've actually been useful as a BMA representative.

Along with the very helpful Industrial Relations Officers I have been involved locally with almost every aspect of the new contract. I've helped to appoint a guardian of safe working, I've tested and decided on which exception reporting software is to be used. I've looked at FY1 rotas to ensure they are compliant. I've broken down the contract and it's minutiae with our first cohort to be imposed upon to reassure them that nobody is getting a pay cut or a change in their rota. I've reviewed the equality impact assessment from the trust - interestingly it being inherently unfair on LTFT workers was not mentioned.  We've agreed with the trust to postpone most doctors going onto the new contract until August 2017.

My hope is that the contract is an unworkable disaster. The exception reporting relies heavily on educational supervisors to discuss and change work schedules as needed, which is all potentially a lot of new work. They will receive no extra time or money for this. Trusts may well find educational supervisors sign off exception reports as one-offs and give the payments to the doctors as it is the easiest way to solve the problem. Once the money starts accruing we might see something positive happen in terms of working conditions. I would therefore recommend any junior doctor reading this to fill out exception reports for EVERY alteration to your work and training schedule and then keep hassling your managers, supervisors, medical staffing and payroll to get every bit of extra money you are owed. Your BMA rep should help you with this. If you are an educational supervisor I suggest you lobby the consultant negotiators to increase the time in your job plan for educational supervisor activity or vote with your feet and stop being a supervisor if the work is too onerous or not remunerated enough. If enough people are annoyed and enough money is being lost then government will have to listen. I fully intend to pile up exception reports on the trust,  as the juniors at every hospital I've ever worked at, work above and beyond their "rostered  hours". It's not unprofessional to be paid for what you work and the well of goodwill has run dry.

So considering I wasn't a fan of the JDC I still think there is positive work I can do for juniors locally within the  BMA. I believe in Unions and being a BMA rep isn't just a line on my CV.  I've been on the JD Facebook forum and there is a lot of ill feeling towards the BMA. Good. Once again, people need to vote with their wallets or nothing changes. If they start losing money by cancelled subs then they might realise they can't get away with treating our contract negotiations like a student debating club. There is a lot unharnessed anger on there but words (he says writing a blog), twitter rants, stickers, YouTube raps and candlelit vigils achieve very little.

It leads me to wonder what I would change about the BMA as clearly they have missed the mark nationally with the JD contract negotiations. As far as I was concerned the JDC were doing a great job up until they embarked on a roadshow to get a "yes" vote in June's contract referendum. It was this point they could have just accepted the contract or kept neutral in any referendum campaign. Then on getting a no vote they could have continued with the 2 day strike actions that had worked earlier in the year. The BMA isn't just a union, it's statement about Scottish Whiskey today shows that they try to be public health watchdogs; which is what I thought Public Health England were. I wonder if the make up of the JDC sets us up to fail. We are all unpaid volunteers with medical careers which as far as I know trump our role as BMA reps. It therefore is natural that having such a major national role for JDC can be full of distractions and conflicts. I'm not sure about this but I don't think the JDC chair gets to work on the job full time and take time out of training. Maybe having more legal or union minded non medics or even full time medics seconded to the role full time for a period  may help when developing a negotiating strategy. Lastly, the communication from BMA is patchy and leaky at best. Their email server tends to send mail out in slow batches so people get news in dribs and drabs, when we were getting news at all. I like the step that the new chair as taken to get himself added to the regional chat forums in order to get news and views directly to him.

 It was always going to be difficult job not to get screwed over as eventually I want my certificate of completion of training and already put up with a lot to get it. If there is a silver lining then the May 2016 contract is a sight better than the November 2015 contract and I'm not too ashamed to throw away my BMA badge holder. You never know where I could end up if I fell into this role so accidentally. I hear the catering at BMA house is fantastic; it must be as it comes out of my considerable subs!

Wednesday, October 12, 2016

September Strike

I originally wrote this post in September but deleted it after I became a local junior doctor BMA rep and realised it isn't exactly complimentary about them. I read the original post again and still agreed with the sentiment so am re-posting. I can still do a job for the BMA locally and not necessarily agree with what they are doing nationally (Stickers against imposition, anyone?)

As my twitter feed and previous posts here show, I wasn't too enamoured with the idea of the government imposing a contract that would result in worse hours and less pay. I went on strike in January and again in April. I waved a placard, canvassed for the BMA and put my point of view across on social and old school media.

Next week I won't be on the picket line.

The first reason is simple, I can't afford to lose £600. The other reasons are slightly more elaborate.

After ACAS negotiations the BMA emerged with what they said was a decent, albeit not perfect offer from the government. Upon reading the revised deal, I could see it was a vastly different contract to the original contract that was due to be imposed which I went on strike over. I attended a BMA road show where I was told that my concerns about a pay cut, unsafe hours, part time workers and reduction in pay progression had been addressed. New hours safeguards and adherence to EWTD were in place. A guardian of safe hours was to be implemented. An online hours breech system was to be introduced to accurately reflect how much we work. The BMA said this was the best they could get and we should accept it. I duly accepted it in the most recent vote. 58% of my colleagues didn't.

My colleagues have that rejected that contract offer can strike and do so with a clear conscience that their demands weren't met, and I support them. My conscience will not allow me to strike over a contract that I was willing to accept. This also leaves me looking somewhat like a government stooge which I'm very much not!

The fact that the contract is still felt to be discriminatory to women, part time workers, academics and career changers (like me) seemed to be lost on the BMA at the time. Why couldn't they use their considerable resources to have the contract reviewed by the country's top legal minds? Why not re-ballot about whether 5 day strike action is the way forward. Conversely, why bother with the "referendum" at all if the contract offer was so good. Why come out so in favour of the contract initially and aid implementation when the response to losing the referendum was to undertake more intense strike action than before?

For me the contract was always about pay, but we seemed to be too scared to say it. It was always about pay but not in the direction some people think. I'll say it again because people don't seem to get it.


The thing is pay IS linked to conditions and getting the same pay but working more difficult hours IS linked to patient safety. They are not separate issues. We shouldn't have let the narrative get shifted to "Lazy, greedy doctors want more money!". It think the BMA have been outmanoeuvred by the government and now news outlets are running negative stories and the BMA appear off the pace. They look silly now that they are striking on a contract they took great effort to endorse. Don't blame on malice what can be explained by incompetence.

 The problem with more strikes is the possibility that this is used by the government to preface further erosion of the NHS as a free healthcare system. Rota gaps and service closures are de rigueur and all this can create a picture of a service in chaos.  I posted lots of ways we could have had industrial action that wasn't all out strike, even in my BMA feedback but this is the way it's gone.

The market value of my service is more than I'm currently paid as I work in a monopoly, and a I take that difference because I like working in a service that places patients and not money first. Even though I want to keep the NHS, paradoxically a private system would benefit most doctors financially. Market forces can't apply to me as I only have 1 employer option if I ever want to be a consultant so any strike action was never destined to last more than 2 weeks. Any longer than this and I would not be passing my appraisal for the year.

So what was my solution? We use the systems in the new contract to our advantage. Currently when I work late because I'm helping a patient I don't spend more time filling out overtime sheets or "breach forms" as nothing useful comes from them and I definitely won't get paid any more. New proposals to link e-rostering for our shifts and actually pay us a proportion of current trust overtime charges and would mean filling out these forms could actually make a difference. I jokingly used to count up all my unpaid overtime and call it my "NHS Goodwill Fund", but it stopped being funny after it quickly started mounting up. This is overtime not because I'm lazy or slow, but because patients are sick, theatre lists and clinics are crammed and there are definite rota gaps.

Much like when GPs shocked the government with their excellent adherence to receiving QoF payments I think junior doctors should have strongly adhered to new e-rostering rules and tell hospitals how much they are working and pester their "Guardians of Safe Working" to be paid for all of this extra work they are doing and the BMA would have something to work with. I estimate that the government thinks we don't work as much unpaid overtime as we do and 50,000 doctors showing their time receipts and giving hospitals big bills for this overtime is the way forward.

I think the contract issue is unwinnable as I will definitely still be working for my CCT and will end up sign anything put in front of me to keep my training number and mortgage paid.

So, overall I won't be striking, but I don't condemn my colleagues who will be, and I hope the public doesn't haul too much abuse at them. After all the public won't know how good they had it, until it's gone.

Tuesday, August 9, 2016

Northamptonshire Green Party Air Quality Crowdfunder

This crowdfunder is to allow us to monitor the air quality in Northampton and hold the council to account on their low emission strategy.

Friday, May 6, 2016

Personal Strike FAQ

Since the new junior doctor contract hit the headlines about 6 months ago, I've been asked my opinion by medical and non medical friends alike. Most  have been supportive, some confused, a few not supportive. I thought I'd direct them to a FAQ so I didn't have to keep repeating myself.

Why do you want to strike?

Like a good politician I will not actually answer the question, I will answer the opposite of the question to appease people who think I'm greedy.                  


OK, now I've cleared that up, I'll answer the actual question.

 I can see why the BMA wants to keep the narrative about patient safety, inability to cover rotas (seeing as we can't already) and discrimination to women and part timers. However for me when it comes down to it, I do not want a pay cut. As a trainee who has changed career I have benefited from pay progression in my years as a surgeon. With pay progression scrapped for career changes and academic trainees will doubly affect me. My argument for keeping  pay progression is that my experience in surgery has positively affected my work in this post pretty much everyday. The pregnant lady who I knew had appendicitis from her walk across the waiting room probably agrees.

 Seeing as my rota is not changing my previous post explained how I might get a pay cut. As a single income household with 2 kids and a mortgage I really don't fancy losing nearly £5k a year. I actually think a pay cut should be enough of a justification for industrial action but there we go. Entitled doctor opinion or not. Vocation is a wonderful thing which I have in spades, but unfortunately it isn't legal tender.

As I need to break even to pay my mortgage, my solution to the pay cut would be to work more locum shifts. This sort of shoots any "I'm really worried about the amount of hours I work" argument out of the water. However caps to locum pay would  mean almost a 50% cut in take home locum pay. The free market should be allowed to be free, except for public sector workers.

The other thing is that would sort of go against having another agenda for wanting to strike is a hypothetical situation where we were given the current contract and complete loss of hours safeguards but we'd all be paid 80 grand a year. Do you think we would all be out on the streets? I wouldn't be.

As it happens I agree with the wider argument from the BMA that the junior doctor contract is one facet of a wider campaign to undermine the staff in the NHS in an attempt to open it up to private investment. Others including getting rid of bursaries for student nurses and the health & social care act. This happens to be a convenient vehicle to voice concerns in general.

So you agree with the strike action, Why are you scabbing then?

Almost exactly the same answer. MONEY

I'd love to say my intense desire to keep my patients safe compelled me to cross the picket line. That was not really the case as at no point were any inpatients in any danger during any of the strikes.

It is the fact that I would lose £200 a day for each strike day that is what compelled me. When you are borrowing money from your Dad to pay your MOT and spending every other "rest day" in A&E locumming, losing £400 a month is quite a hit.

I was quite happy to work and let my colleagues strike, ones with no kids or money worries. You could say it is short sighted to not strike when you stand to lose out in the long run. That is what the government wants unfortunately, and my bank manager won't accept late payments because of my staunch principles. I can't afford jam today, so I'll worry about today now and worry about later, later.

What would it take to get me to be happy with the contract?

Well, I'm not really sure, which is why I've put my faith in JDC to negotiate for me. Probably a complete reversal and no change would satisfy me, but that isn't going to happen.

The problem with the old contract is that banding payments only have a few levels (50% 40% 20% 5% and nil) and this meant that people working wildly different hours could be paid the same. For example as a surgical registrar I worked a partial shift pattern with overnight on calls. The urology registrar worked every other Saturday and no nights. We were on the same salary. The new contract won't address this issue as the pay cuts will mostly affect those that work the most unsociable hours, making people like myself in Obstetrics worse off and people in day time "office" specialities better off.

So essentially, I'll be happy if the BMA are.

What would a 7 day NHS look like?

I don't know, and that is the problem. There have been no sample rotas, no plans to open clinics or theatres at weekend, no plans from our trust about how we will provide this "Truly 7 day NHS". What is the point of introducing a new contract if we don't change our working patterns. When I'm operating an elective list on Saturdays have the trust got plans to pay for ODPs, porters, scrub nurses, support workers who also need to be there? I don't think so.

Salford has managed to provide excellent 7 day emergency access to MRI etc. and have a Standardised Mortality ratio of 88 (This is good). They have done this with current staffing and contracts.

Didn't we pay for your training?

Yes, you did, and bloody good value for money as well. I'm old and lucky enough to only have £25k of student debt and the taxpayer put up about £175k over 5 years. That's quite an investment. One solution would be a golden handcuff to keep us in an NHS post for 5-10 years post qualification. That will only reduce numbers coming in the door or poor students attending. The thing is where would such a policy end? Teachers? Nurses? Police? Anyone who works in the public sector should pay back all their education fees? What about those working in private sector, they are using taxpayer education to profit someone else, is that right? Does this mean that nobody should get state funded education? Having a well trained workforce is good for the country but there needs to be good enough jobs to keep people there.

Here I will put paid to the myth that your taxes pay for all my post graduate training is not good value for money. Whilst HEE pay some of my salary I can guarantee you that the time I spend in post graduate "training" is actually spent providing a service at a cut price. All the discharge paperwork, cannulas, radiology forms, coding paperwork actually contributes to the running of the service, not just my "training". So beware people who quote £500k as a training figure as that includes my salary for all my years in training. Of course, my post graduate "training" isn't passively looking over a consultants shoulder and absorbing knowledge. A lot of service work goes into it as well. If I do an appendicectomy at 2am on my own, am gobbling up your money being trained? Or am I actually providing a service within the remit of my current skills?

What is your solution?

Unless enforced ill health, misadventure or a better long term alternative comes along, I won't give up my National Training Number. This puts me in somewhat weak position with regards to the new contract. Now I have a family and a mortgage and am not yet a consultant so I can't just up sticks and leave for Oz like last time. So whatever happens I'll be at work in August. I can't say the same for my colleagues. In my department alone we have 1 going to Scotland, 1 moving abroad and 1 leaving medicine all together. I know the plural of anecdote isn't evidence but I did a teaching session for our 14 FY2 doctors last week. More of them were moving away, locumming or taking time out than staying for a specialty post. Maybe a zero hour, poorly trained cohort of juniors is what the government want?

Next BMA action could be to not sign any one up to a new post in August and instead form a locum agency to outsource trusts own doctors back to them at locum rates. Then nobody has to strike and it will show you how much a medical workforce could cost. Indefinite emergency only care is an option but suffers the same problems that caused me to scab this time. We could work with the deaneries to give all trainees 3 months "out of program experience" so nobody had to lose their training numbers and nobody starts work on August 5th. This is difficult to achieve seeing as HEE is a government agency.

The NHS is a monopoly employer so I can't just go and work and train at the hospital down the road.

Do you want to bring down the government?

Well, Yes. I'm a member of a political party which isn't the conservative party, so seeing the government brought down would be great. Just not over the JD contract dispute. There are lots of reasons not to like what is going on in the current government, but it's not out of character is it? People knew what they were voting for and they're getting it.

Friday, April 22, 2016

New junior doctor contract is a pay cut: A proof

Many people have eloquently expounded the problems with the contract from a patient safety point of view.  The government have said I won't get a pay cut, and some of my non medical friends have asked me what my problem is as I'm getting a 13.5% pay rise. So I thought I would compare my current pay with the proposed pay from the new contract. Hopefully I can prove I am getting a pay cut despite the government assertion that I'm getting  a 13.5% pay rise. #algebra

I have a 1:8 rota where I work 7 nights (8pm-8.30am) every 8 weeks and 1 Saturday and 1 Sunday day shift every 8 weeks (8am-8.30pm). I also work 5 long weekdays every 8 weeks(8am-8.30pm). Every other day is a normal working day or rest day. As far as I know our department is not planning to change the rota despite the need for 7 day services. I therefore will be working the same hours in August as I am on now. Our rota is EWTD compliant, i.e. we work no more than 48 hours per week on average. Just for the record, I've worked a very similar 1:7, 1:8 or 1:9 rota in every hospital job I have had in the UK, so I don't work a particularly unusual or busy rota, I'm not in the small minority.

Prove by contradiction that new contract will result in a pay.

I will use the assumption that I will not get a pay cut.

Current pay = Proposed pay

Current pay is a 50% banded job  = 1.5x (x = basic salary for 40h/wk normal working days)

Proposed pay: (source NHSE)
 Nights attract 50% uplift
 Sundays attract 30% uplift

 87.5 of my 384 (48hrs per week x 8weeks) hours over an 8 week period are nights. ~23% which attract 50% uplift

and 12.5 of my 384 hours over an 8 week period are long day Sundays. ~3% which attract 30% uplift

No uplift is attracted for weekday long days or Saturday long days. This means 74% of my hours attract normal rate.

New basic salary = y = 1.135x (13.5% payrise)

Proposed Pay breakdown: 0.74y + [0.23 (1.5y)] + [0.03(1.3y)]

multiplying out gives us:

0.74y + 0.34y + 0.039y = 1.119y

substituting y = 1.135x

New pay = 1.27x

1.27x =/= 1.5x


I'm OK for 3 years as my  pay protection is worth the ~4.8k a year I will lose. This is an appreciable amount of money. This is stated very clearly on my NHSE pay calculator. This won't help the new doctors starting  this year or doctors coming from abroad who will be worse off than I am, despite doing the same job.

Not fair is it?