As expected, Jeremy Hunt has just announced in the Commons that he will impose the junior doctor contract after he was advised that there was no longer any chance of an agreement with the British Medical Association on the issue. And as expected, the BMA has said that it does not accept the contract and is considering ‘all options open’ to it in response.
In response to the Health Secretary, Heidi Alexander warned that the new contract ‘could amount to the biggest gamble with patient safety’ that the Commons has seen because of the exodus of junior doctors from the NHS that this would cause. The SNP’s rather formidable Dr Philippa Whitford was a little more measured in her response, telling the Chamber that she did see that there had been progress, but that there were still problems with the contract, including whether the guardians who are supposed to impose fines for breaches to doctors’ working hours will really work as well as expected. She warned that now was not the right time to pour petrol on the fire and throw in the towel in the negotiations, while Health Select Committee chair Sarah Wollaston urged both sides to move forward in a constructive fashion. Wollaston was originally critical of the contract, but as the negotiations moved on, grew to be more critical of the BMA.
Hunt did announce a review of the factors that are lowering doctors’ morale, and named a number of those factors, such as ‘inflexibility around leave, lack of notice about placements that can be a long way away from home, separation from spouses and families, and sometimes inadequate support from employers, professional bodies and senior clinicians’.
But what is clear is that both sides have handled this dispute badly. Hunt did pour petrol on the fire from the outset with his comments about bringing back a ‘sense of vocation and professionalism’ into the contract for consultants, which doctors generally took as a suggestion that he didn’t think they worked hard enough, rather than a comment on the contract. Then his handling of weekend mortality statistics offended medics who argue that they would be heavily criticised if they tried to make the same claims in a peer-reviewed publication. This meant that doctors, already more disposed to trust the union that represents them and their colleagues in one-to-one disputes with their hospital trusts than they would trust a politician, turned to the BMA and expected it to put up a furious fight in these negotiations. It then became clear to the BMA that doctors were so angry with Hunt that to agree to a contract would be to appear to give into something the premise of which doctors disputed, as well as the details.
Now the question is, as Alexander told the Commons, whether the doctors will simply refuse to sign the contract, or leave en masse. The effect of today’s imposition will certainly not be to calm the row. And the effects, if doctors really are prepared to leave the country or even stop being doctors, as a result of the changes, might not be felt for some time.
Politically, what has been interesting over the past few weeks has been the shift in Conservative attitudes on the matter. Many Tory MPs were very worried about the contract itself, raising it in private and sometimes in public. But now very few – if any – have sympathy with the BMA, though they do not endorse the government’s handling of the row. What they are now wondering is how the Conservative party can possibly start to convince doctors that it is worth supporting – something it had to confront in the last Parliament with teachers.
The most extraordinary thing about this row is that Hunt actually took aim at consultant contracts, and few expected the changes to junior contracts to blow up at all. Quite the opposite has happened.
P.S. As ever, I declare my own personal interest, which is that my spouse is affected by these contract changes.
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