Health

Junior doctors' row: BMA fears 'uphill struggle' to sell deal

Junior doctors on strike Image copyright PA
Image caption Junior doctors have staged several strikes in the row over contracts

Junior doctors' leaders fear they could face an "uphill struggle" to convince the profession to accept the new contract agreed with ministers.

It was announced on Wednesday that the two sides had reached a deal after talks at conciliation service Acas.

The terms will now be put to a vote of more than 40,000 BMA members in June.

But there are fears at the union that the profession could reject the deal despite it believing it is the "best and final" way out of the row.

Health Secretary Jeremy Hunt called it a "historic agreement" and a "win-win" for the government and junior doctors.

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Media captionHealth Secretary Jeremy Hunt hailed the agreement as "historic"

'Accept terms'

And a host of NHS leaders have already come out to urge junior doctors sign up to it, but there has been some negative reaction on social media from frontline doctors.

The British Medical Association has said it will be urging members to accept the terms and will be explaining why in a series of road shows with the profession in the coming weeks once the full contract is published.

Which side has won?

The revamped contract includes several major changes from the one which the government announced in February it would be imposing. These include:

  • The basic pay rise being reduced from 13.5% to between 10% and 11%
  • Weekends no longer being divided up between normal and unsocial hours, instead a system of supplements will be paid which depend on how many weekends a doctor works over the course of a year
  • Extra pay for night shifts being reduced from 50% to 37%
  • Extra support to be made available for doctors who take time out, such as women who go on maternity leave, to enable them to catch up on their training and thus qualify for pay rises - after claims women were being unfairly penalised
  • Junior doctors getting an enhanced role in advising and liaising with the independent guardians who keep an eye on the hours doctors work
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Media captionJunior doctors' contract - what's the deal?

BMA junior doctor leader Dr Johann Malawana said: "What has been agreed is a good deal for junior doctors and will ensure that they can continue to deliver high-quality care for patients."

But behind the scenes there is a concern the BMA may not be able to convince the profession and it could be an "uphill struggle" given the strength of feeling among the frontline.

There is also frustration at what the BMA sees as aggressive briefing from government following the announcement on Wednesday.


Analysis

The fact that something has been agreed is a major breakthrough, but this dispute is still a long way from being over. The problem the BMA faces is that emotions are running so high.

The profession has been incredibly united throughout. Some 98% voted in favour of taking strike action last autumn and whenever union leaders have taken soundings since, the overwhelming sense has been that doctors have wanted to fight on. If this hadn't been the case the leadership would probably have agreed a deal long before now.

The BMA leadership is hoping as the weeks pass and they get a chance to explain the contract and doctors read it for themselves ahead of the vote they will come to share the view that it is the best way forward. Perhaps not better (in terms of weekend pay) than the existing contract, but at the very least an improvement on what was going to be imposed.

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Royal College of Paediatrics and Child Health president Prof Neena Modi, who was one of the most vocal critics of the government's decision to impose the contract, said she wanted to see a "positive outcome" in the vote.

And Stephen Dalton, of the NHS Confederation, which represents health managers, said he was pleased an agreement had been reached, adding "we very much hope" doctors support the new package.

The government has refused to be drawn on what it will do if doctors reject the deal, although it did not rule out imposing it.

Mr Hunt told the BBC the deal was "very good for doctors", while the government had secured its "important red lines for delivering a safer seven-day service".

Asked if he took some responsibility for lengthy dispute, he said: "I don't think you can go through what we've been through in the last 10 months and say that everyone hasn't got lessons to learn, including the health secretary."

Mr Hunt said he understood there was a "lot of anger" about issues which "extend well beyond their contract", such as training.

Speaking later in the House of Commons, he said the dispute had been a "matter of great regret".

Shadow health secretary Heidi Alexander said the deal proved an agreement had been "possible all along".

"It's sad that it took an all-out strike of junior doctors to get the government back to the table," she said.


Timeline of the dispute

December 2012 - The government invites the BMA for talks over new contract

October 2014 - BMA withdraws from talks

July 2015 - Independent pay review body publishes recommendations for a new contract

August 2015 - BMA refuses to re-enter talks

November 2015 - The government makes contract offer to junior doctors and BMA announces strikes

December 2015/January 2016 - Talks re-start at conciliation service Acas and strike for 1 December called off

January 2016 - First of four strikes, involving emergency cover being provided, is held

February 2016 - Ministers announce imposition of contract following second strike

April 2016 - First-ever all-out strike by doctors held in the history of the NHS

May 2016 - Talks restart after intervention by leaders at the royal colleges of medicine, leading to a deal being agreed at Acas

June 2016 - Ballot of junior doctors begins over whether they should accept the deal, result expected in early July

August 2016 - Roll-out of the new contract starts for those starting their first job in the NHS after medical school

October 2016 - August 2017 - Most of the rest of the profession moves on to the contract


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