Yesterday NHS Employers published the terms and conditions of service for the new 2016 contract, which will be imposed from August. As a charity, the College is unable to negotiate terms and conditions but we can comment on their impact on the care of patients and the well being of doctors in training.
The government’s aim in imposing the new contract is to support the delivery of a ‘7 Day NHS’. It is not clear exactly what this means in terms of the range of services to be offered outside the usual working week. We know that most junior doctors already work in the evenings and at weekends and that they, in isolation, cannot provide a seven-day service without the rest of the health and social care system. It is likely that consultants and others working in the NHS will face similar pressures to work in the evenings and at weekends to fulfil the government’s promise of a ‘7Day NHS’. The College’s concerns include the dilution of weekday services unless there is significant investment in new staff, and a reduction in the quality of training for junior doctors if the workforce is spread more thinly across the working week. As it takes at least five years to train specialist medical and scientific staff, action must be taken immediately if the workforce required to provide a seven-day service is to be available in the foreseeable future.
From the beginning, I have had concerns about the impact of the new contract on those taking time out of training to do research or moving into pathology from other specialties, both of which are enormously valuable. I have also been concerned about the potential for the new contract to discriminate against certain groups of junior doctors, particularly those who train flexibly or take breaks for parental leave.
The Department of Health published an Equality Analysis on the new contract yesterday. The document states that features of the new contract will have a disproportionate impact on women, sometimes to their advantage but also sometimes to their disadvantage. The document concludes that any disadvantages can be ‘comfortably justified’.
Since 67% of the College’s registered trainees are female, these disadvantages will be particularly felt by those training in pathology. This will further damage junior doctors’ morale. I am also concerned that these changes might discourage women from entering medicine generally and entering traditionally female-dominated specialties, like pathology, in particular. It is essential that opportunities in all specialties are open to all junior doctors, irrespective of their sex and parental status.
The new contract does attempt to recognise those who follow a clinical academic pathway or take time out to do research, with academic premia being paid on completion of a higher degree.
Flexible pay premia will only be available for those changing specialty during training if they transfer to hard-to-fill training programmes or are changing because of disability. ‘Hard-to-fill’ specialties are determined by HEE and do not currently include any pathology specialties. Although the College has attempted to have several specialties added to the current list, it has not been successful. The new contract is likely to deter trainees from transferring to pathology from another specialty, something that happens relatively frequently and is welcomed as it brings cross-specialty experience and benefits both the trainee and the department in which they work. In particular trainees transferring from another specialty often do so as a result of collaborative research, during which they recognise that academic pathology is a more appropriate career for them than their original choice. Deterring such trainees is therefore likely to have an impact on the volume and quality of research in pathology and limit the scope for future collaborative research.
I have raised my concerns about the new contract on many occasions since negotiations began. Some of these have been addressed but many haven’t. Last week I co-authored a letter from the Academy of Medical Royal Colleges in which the presidents of the UK Colleges called for both sides to ‘step back from the brink’, asking the government to reverse the imposition of the contract and the BMA to call off its planned industrial action. We urged a return to negotiations.
The College will continue to make our concerns clear. We are working with our trainees to do what we can to improve the aspects of training that we can change. Good patient care relies on well-trained, motivated junior doctors. The recurrent blows to trainees’ morale do not provide an environment in which doctors can provide the best care to their patients. We must value our junior doctors and invest time and resources in their training and development. They are the much-needed specialists and GPs of the future.
The Royal College of Pathologists
1 April 2016