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I received a text and this email for the BMA this morning.

‘This morning, we announced that junior doctors in England had voted overwhelmingly for industrial action, including a full walkout. This is an unprecedented decision, and the most categoric outcome of any BMA ballot.

Over 76 per cent of junior doctors voted in the ballot, with 99.4 per cent voting yes to question 1 – are you prepared to take industrial action short of a strike – and 98 per cent voting yes to question 2 – are you prepared to take industrial action including strike action – giving us a clear mandate to call for industrial action short of a strike and a full walkout.

While the BMA regrets the inevitable disruption that this will cause, junior doctors have clearly been left with no alternative but to consider strike action due to the Government’s continued threat to impose a contract that is unsafe for patients and unfair for doctors.

We have always been clear that we want to reach a negotiated agreement. To this end, and even with such a resounding mandate, we are keen to avert the need for industrial action and have, therefore, approached ACAS to offer conciliatory talks with the health secretary and NHS Employers to clarify the conflicting information coming from the Government over the past weeks.’

The imposed contract say will cut their pay by up to 40%, force them to work more antisocial shifts and put many off going into the specialities with the greatest shortages – General Practice and A&E, which will be affected most. The Government’s response has been to pledge that the contract will overall be cost neutral and that this is not about saving money but improving the service for patients. The have offered to increase basic  pay to make up the loss in pay and bring in special measures for those in the specialities that will lose out most. However they have only agreed to make these adjustments for the first couple of years and refuse to commit to them for longer.   

The Government also want to remove the penalties hospitals have to pay if junior doctors work work longer than the 48 hrs  a week ordered by the European Working Time Directive. The BMA is worried that this will lead to expectations by employers that hours will become longer which would lead to dangerously tired doctors.

The contract will reclassify junior doctors’ normal working hours as being about  48 hrs from 7am to 7pm between Monday and Friday, to 48 hrshours from 7am to 10pm between Monday and Saturday. They will lose out by no longer earning higher rates as evenings and Saturdays will be paid at the standard rate.
Basic pay for a newly qualified doctor is only about £23,000 . With the unsociable hours benefit it usually increases to about £28,000 – £30,000.

The government is doing this because it wants to create a 7 day NHS without significantly increasing spending. This pledge came about because studies have shown that you have a 16% higher risk of dying if admitted at the weekend rather than a Wednesday. This is mainly because admissions at the weekend tend to be emergencies rather than routine planned admissions and of course these people are more seriously ill. However even when accounting for this there was still a small significant increase in mortality, although much smaller. Headlines have of course not explained this and Jeremy Hunt himself either does not understand the statistics or is being disingenuous by saying that there are 3,000 people dying every year because of this excess mortality; it is incorrect to simply extrapolate the data.

The BMJ looked at the data and concluded that there would be some lives saved if the same standard of care was given to patients at the weekend as during the week but it was conceivable that if staff were simply ‘stretched out over 7 days’ , without increasing numbers, this would worsen cover and mortality rates during the week.

The BMA’s view is that it is ready to cooperate with the Government on ensuring good cover and more consultant input on the weekends and during the night but it does not support David Cameron’s plan to increase the amount of non urgent work done at weekends. David Cameron wants GP surgeries to be open seven days a week and hospital appointments and operations to be performed ‘so people do not have to take time off work’. 

A seven day NHS will be very hard to achieve without extra funds, This Government has pledged an extra 8 billion to the NHS this year but wants the NHS to make efficiency savings of £20 billion [out of an total NHS budget of about £100 billion]. And of course it is not just doctors that would need to work more hours but nurses, pathology staff, secretaries, receptionists and porters. I am not sure why doctors are being singled out [perhaps because we are perceived as more wealthy].We dont’ work alone.