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Junior doctors take protest to our streets.

Byline: Craig Thompson Chief Reporter

HUNDREDS of junior doctors will take to the streets of Tyneside today in protest at Government changes to their contract.

The march comes as it emerged they are to be balloted on industrial action next month in the escalating row, the British medical Association, said.

After negotiations broke down despite a series of letters between the BMA and Health Secretary Jeremy Hunt, the union insisted it had not taken the decision "lightly".

Junior doctors across England will be balloted for industrial action - which could include strikes - from Thursday November 5 to November 18.

Dr Johann Malawana, BMA junior doctor committee chair, said: "This is not a decision that we have taken lightly but the Government's refusal to work with us through genuine negotiations and their threat to impose new contracts that we believe are unsafe for patients and unfair for doctors, leaves us with few options."

The Government has said it plans to impose a new contract on junior doctors, up to consultant level, next summer.

The contract will reclassify doctors' normal working week to include Saturdays and up to 10pm every night of the week except Sunday.

Medics argue they will lose out financially as evenings and Saturdays will be paid at the standard rate rather than a higher rate.

They say this amounts to pay cuts of up to 30%.

Mr Hunt has indicated to the BMA that he will consider extending the current proposals so that more working hours on a Saturday could be paid at a higher rate.

But the BMA argues that Mr Hunt has failed to offer any guarantees on key issues such as pay and protection for doctors who wish to work less than fulltime or take parental leave.

If the outcome of the ballot on industrial action is in favour, the BMA will then discuss what form of action it might take.

The junior doctor: Sandip Nandhra I WRITE this as a junior doctor. I am 30, this is perhaps a contrast to the connotation the term junior usually provokes; a fresh faced 23-year-old.

"I work as a surgical registrar in Sunderland. I intend to take action in Newcastle, by means of a rally to publicise the proposed changes to the junior doctors contract.

I already work as part of a shift system that helps to provide 24/7 NHS emergency care. I absolutely love my job, meeting new patients, and trying to make a positive difference to their health and lives.

I have a family, my wife is a junior doctor too, she is a paediatric registrar. The NHS is something we hold very close to our hearts.

Many members of the public are often surprised when I remind them I am a junior doctor, especially as I go through the details of their upcoming operation, usually before 7.30am, 45 minutes before my paid shift officially begins.

The list officially finishes at 6pm, after which, I will complete a few ward patient checks, catch up with the ward doctor who has been held back by a few unexpected events, our paid shift ended at 5pm. This isn't an unusual occurrence this is our day-to-day routine.

I do this because I care about the outcomes of my patients, I care about the list running smoothly and safely with minimal hick-ups, and I want to know that the ward patients are well.

The NHS thrives on altruism; doctors, nurses, physiotherapists, pharmacists, radiographers, laboratory staff, clerical and administration staff all working to do their upmost for the patient care.

I am deeply concerned that if this contract goes ahead as planned it will put patients lives at risk, lead to unfair changes in the pay structure that could result in an instantaneous pay cut of around 30%, and be the beginning of the end of the NHS as we know it. By marching I hope to share my concerns with the general public.

In case you are not aware Mr Hunt has proposed a number of drastic and frankly appalling changes.

Firstly he has proposed a pay-cut by means of an increase in the normal working day hours from 7am to 10pm, Monday to Saturday inclusive. This means the out of hours pay supplementation will be dramatically cut resulting in an minimum real-time pay cut of 15% but for some up to 40%.

"But 'aren't doctors paid a lot anyway?' I hear you cry. Bluntly no. The basic starting salary for a doctor is just over PS22,000, with incremental rises to PS35,000.

"I for one could not afford my mortgage and my wife would have to work full-time and our parents would need to help out with childcare in the new proposed system. The increase in the normal working day hours will lead to more doctors working longer hours as Mr Hunt and team have suggested that the safeguards that protect our health and rest days are removed.

"I have missed birthdays, weddings, leaving do's, family occasions and Christmas to work weekends and bank holidays. I am not alone. The NHS is already running on a deficit of doctors, can we really afford to let these bright, passionate, motivated individuals leave the NHS; after all it costs the tax payer to train them - in excess of PS50K per doctor.

The health minister: Ben Gummer, Minister for Care Quality JUNIOR doctors in the NHS are among the best in the world - they are the leaders of tomorrow and the backbone of medical care in hospitals week in, week out.

Indeed, the current debate around proposed reforms to their contracts has highlighted their passion and dedication. That's why it saddens me to see them take to the streets of Newcastle to protest this weekend, based on misleading information from their trade union, the BMA. We have been clear this is about delivering a fairer, safer deal for doctors and patients. But the BMA has wilfully misled junior doctors on pay and working hours, causing unnecessary anger and upset. This week, they announced that they are balloting members on industrial action from 5 November - potentially putting patients at risk.

The Health Secretary has given cast iron guarantees that our intention to modernise their contract is not a cost-cutting exercise. The great majority of junior doctors will be at least as well paid as they are now and average earnings will remain the same.

The BMA has caused further uncertainty by publishing an inaccurate pay calculator, misleading doctors on proposals that have yet to be negotiated. To the BMA's credit, it recognised the confusion the calculator caused among junior doctors and as a result took it down.

I want to be clear on how we're making pay fairer: we will remove the current situation where two doctors working very different hours can be paid the same. We will remove the complex banding payments system and replace it by paying doctors for hours worked.

There will be an increase to basic pay, with proportionately higher pay for unsocial hours and additional payments for those working in hard-to-fill specialties such as emergency medicine and general practice.

Everyone working in the NHS wants to give patients the same quality care every day of the week. But the current pay structures result in some hospitals rostering three times more senior cover during the week compared to the weekend. Junior doctors that do work at the weekend often don't have the right level of support to deliver the safest care we all want.

Our ambition is to be the safest health care system in the world and to achieve that we need a culture of safe working hours for NHS staff.

The current junior doctors' contract incentivises long hours by offering financial incentives for working beyond the legal limit.

Our proposals will reduce hours, not increase them, as the BMA has led doctors to believe.

This will help to reduce burnout and improve patient safety. We are also proposing an end to the 'week of nights', experienced by many junior doctors and introducing a new limit of five consecutive long days.

Far from being left with no option but taking industrial action, the Department of Health and the Royal Colleges have continually urged the BMA to come back to the table since they first walked away last year.

"We believe in the NHS and its values, and are committed to delivering a contract that is safer for patients and fairer for doctors."

YOUR QUESTIONS ANSWERED Why are they protesting? The BMA's junior doctors' committee announced in August it was withdrawing from talks with the Government over new contracts, which they say involve pay cuts of up to 30% and the slashing of overtime rates for work between 7am and 10pm on every day apart from Sunday. The "unfair deals", according to the BMA, risk forcing promising young doctors to "speak with their feet" and move abroad. Is the dispute due to the seven-day NHS idea? Not directly. It dates to 2012, when the Department of Health called for changes to junior doctors' contracts in order to update terms and conditions agreed in the 90s. The BMA agreed to talks, but they broke down after two years, with the union complaining about the Government's "heavy-handed approach".

How much do junior doctors earn? Trainees have a starting salary of PS22,636 rising to reach PS30,000 within four years. Doctors in specialist training receive between PS30,002 and PS47,175, while those who make the grade can earn up to PS69,325.

What about cuts to pay? The Department for Health rejects suggestions doctors will see pay cut, stating the proposals would see the basic salary "around 15% higher than it is now". The changes will be "costneutral".

However, critics say plans to end automatic pay progression will hit doctors who want to take time out of training, as pay is now proposed to rise with experience.

So doctors who are slower training will lose out? The NHS Employers organisation, which is negotiating the contracts for the Government, admits the new system "is favourable to the majority who progress normally, at the expense of those who currently receive an advantage by taking longer to progress through training."

Would doctors be put off certain specialities? The Government insists not and will work to retain staff in specialities hard to recruit to, like psychiatry.

How will pay supplements change? The system will see trainees losing pay boosts they receive for working evenings and Saturdays, which will be treated as regular hours. Further supplements stand to be axed, including "out of hours" payments doctors can earn for extra work and the annual extras GP trainees get of around PS15,000 on top of basic pay, which boost pay.

What about working hours? Doctors will not have to work for more than 48 hours on average due to the European Working Time Directive, but they can opt out and work


Dirk |Bogarde in the 1954 hit film Doctor in the House
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Publication:Evening Chronicle (Newcastle, England)
Date:Oct 24, 2015
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