The NHS, a lesson in politics: part XV

I’m back from holiday, can you see how tanned I am?

(I don’t have a tan)

I, like you have been reading through all 83 pages of Terms and conditions. I was going to do a forensic exposition of the contract, but its not worth it. You shouldn’t be listening to me; you should go to the BMA road show and actually ask someone face to face.

Vested interests

Go on, ask me what my vested interests are? Keeping my wife happy and making sure that being ill won’t bankrupt me.

Is my future career tied to the outcome of this vote? No. Am I trying to promote my business using this dispute as a PR exercise? No. As soon as this is over, I’m going back to stuffing rockets in garden furniture, in my shed, away from medics.

How does the contract affect me the “batman”?

I have read the Ts&Cs, ran the numbers, even though she’s LTFT the wife will not loose any pay. Crucially for me she’s now likely to come home on time. All I want from this contract is a fair work life balance. I want my wife back, you’ve had her for long enough.

What does the contract begin to solve:

Work life/balance but only if you, as a doctor, work at it. The old contract makes it exceptionally difficult for a single doctor to have any influence over how rota gaps are covered. The new contract means that if you are staying to fill a gap, the trust feels it like shingles. Rota gaps are provable, so its not like you can be persecuted for covering them.

Your hours are now limited with a big fat financial stick. This should translate into less hours worked by individual doctors. This is crucial for new F1 & F2, where overwork leads to a 50% dropout rate. (yes I know rota gaps. But you have to start somewhere in this vicious circle)

What the contract can’t solve:

  • General funding issues
  • Privatisation
  • PFI fuckery
  • The use of the NHS as a political football
  • the time it takes to train new doctors
  • Top down re-organisations

Now, I’ve been monitoring the forum, and noticing that lots of people are leaving. It appears to be dominated by people who have lots to gain from prolonging the fight. This leads me to the following:

What happens if I vote no?

I doubt it’ll do what you want it to do. A no vote will not stop the new contract, it won’t even allow another round of strikes. You’ll need to hold a ballot first. edit turns out the original ballot still holds /edit You’ll have to go on strike again. Without industrial action there is no incentive for the government to negotiate, so there is little to no chance of any contract change without prolonged industrial action first.

There are some very vocal people that tell you it’s illegal for Hunt to impose a contract. Whilst he doesn’t have the legal power to impose, he has more than enough levers to make it happen. So its not like the old contract is going to make a re-appearance.

More importantly a no vote will trigger a reshuffle of the JDC. Johann will be gone, and there will be much arsenic discreetly deposited in teas around BMA house.

Now as you may be aware, three people inside the JDC conspired to leak private whatsapp debates. This looked like an attempt to steal Johann’s crown and all the riches that comes with it (Ooo free house valuation!). Two of them quit, leaving one person behind to hose the blood off the floor, expatriate Johann’s gold fillings, dump his body in the waste compactor and order more cushions for the throne.

Do you really think that a back stabbing, filling-stealing arse as JDC Chair is going to fight for your future, especially if they were offered a juicy DoH job? I didn’t think so either.

Conversely there are some very well qualified people in the JDC capable of taking over. But do you really want a labour style meltdown, just as you’re trying to start renegotiations?

What my GP friends tell me is the whatsapp leak totally bollocksedup the GP and Consultant negotiations. Apparently someone from the DoH broke out in a big grin and said “good luck striking now, all about the safety was it?” It also put the brakes on any further negotiations to the Junior Doctor contract.

All this draws into sharp focus the elephant in the room: because of the whatsapp leak no one is going to believe that you’re striking about safety any more.

Finally, do you have the spare £4 million to fund the negotiations? In one of the many leaks from the BMA, was an email from a bean counter moaning about the sheer cost of talking to the government. Negotiators, Industrial action, lawyers and press consultants all cost mega bucks.

What’s my point? Pragmatism. Your new contract gives you the tools to halt overworking. Use them and then fight for other things, like nurse bursaries. If you want safety, you need nurses. A no vote just fucks up negotiations for GPs, consultants, without any improvement for you juniors

Q&A from the forum:

We should fight for a contract that has above inflation pay rises each year

Never going to happen. You’ve been given the illusion of generous yearly pay rises, when in fact you’ve been bumfucked by lady-inflation. The downward trend in real terms pay started around 2005, but you didn’t notice it:

pay graph

Inflation adjusted graph from here. Now its really fucking obvious that you’re being screwed, and can do something about it.

Guardians are weak.

No, they really aren’t. They have the power to unilaterally impose large fines, and within reason spunk that money anything. Even the CEO requires approval from the CFO before they can splash cash. CEOs could ignore a guardian, but after the first quarterly fine they’ll have to listen, if they want to keep their job.

But if I submit an exception report, I’ll be sacked

Firstly, how many doctors do you personally know that have been sacked? Right. That’s my point. It’s very hard to be sacked as a doctor. You are perfectly safe to exercise your contractual rights and submit that overtime claim.

So long as you follow the steps required of you in reporting your overtime, you’ll be perfectly safe. Remember, rota gaps are now systematically recorded. This is justification enough for overtime.

If I submit an overtime claim, I’ll hasten the death of the NHS.

No, no you really won’t. Right now the biggest risk to the NHS is brain drain. You are well aware of the rota gaps, and the obligation to cover them, regardless of your ability to cope. This has to stop. The most recent generic drug fraud could fund a ~18% payrise for junior doctors. Overtime for junior doctors is not a significant cost, given the potential impact

Money can be given to the NHS at anytime, but it takes at least 6 years to make an F1. Hold on to the staff you have now.

The contract is discriminatory

Well, I have some sympathy for this. The hourly rate of pay is now the same between FT and LTFT. This is different from the current contract, which paid more per hour to LTFTs from st8+. The chances of a legal challenge even being accepted on this is very slim, as both FT and LTFT are now paid the same per hour worked. Technically there is demonstrably less discrimination in this contract (as positive discrimination is still discrimination)

I leave the morals of positive discrimination vs equality to other people, it’s a very, very difficult subject to properly tackle. I just don’t have any answers to this.

But HR won’t be able to cope with processing the overtime payments

I’m going to let you into a secret: overtime and payroll are a solved problem. Depending on which timesheet system you use, its entirely automatic. You log your hours, your approver confirms it, HR are never involved.

If you have to email you HR department every time you submit your hours, it’s a breach of contract. Why? BECAUSE IT’S 2016 AND THAT IS NOT APPROPRIATE FUCKING USE OF TECHNOLOGY.

but rotas will be complex and hard to make!

Frankly, there is no excuse for manual shift coordination. Its 2016 for fucks sake, why are you still doing it by hand? Do you think that airline pilots are rostered in a big excel spreadsheet? No. Do you think zero hours contract employers like sports direct do it by hand? (bear in mind that they have to start paying employers NI and pensions if they work too many hours…)

Spunk out the £4k, plug in the level of staffing required to cover a full week, and let the computer do the rest. Bonus points for google calendar exports. Want to take a holiday? Sure, let the computer do the work. Congratulations, now one person can coordinate rotas for an entire hospital.

Don’t believe me? Just google rota software…

Overtime is whistleblowing

Not it is fucking not.

If I submit overtime they’ll put negative statements in my ARCP

Well they could, but as it’s a poor reflection on their teaching skills, and one could argue professionalism. More importantly, if the guardian approved your overtime, then it’s a valid claim. No ifs, no buts. This is bullying, this is where your union rep of choice comes in.

logging hours is not what professionals do

I love the class innuendo there. Lawyers, solicitors, accountant & engineers all log hours, so they can bill them to clients. Its a fact of life. I mean fuck, I have to fill in a time sheet too.

I mean you could continue to work for free, I mean thats really clever. Whenever I look for a new job, I make sure that there is scope for me to put in extra hours for no reward. I mean I go to work to avoid being with my family after all….

This cunt:

massive cunt

Fidelity clause is slavery…

The fidelity clause is really bad

The fidelity clause means almost nothing. Sure you can try and put a cap on wages, but if nobody wants to do it, they’ll have to raise wages until someone does it. Right now there is a locum cap, right now hospitals are offering £60 an hour for a SHO shift. Do you think that cap is working? The clause will just mean that a private company won’t be creaming of 50% of your hourly wage as an “administration fee”.

The fidelity clause is actually quite loose. In my contract I have to get approval for any other work done(regardless of who its for, or the nature of employment), more importantly anything, be it words, photos, art or dance is instantly my employer’s intellectual property, regardless of where it was created. (look up moral rights) You don’t have such a thing, be very thankful.

Final words.

Forget conspiracy, forget high politics, what does this contract actually allow you to do? More importantly, how are you going change it if you vote no? Apart from LTFT before ST3, it is a vast improvement on the current contract.

You finally have the tools to limit the hours you work, Supernumerary medical staff now make financial sense (just like every other safety critical job) Chose your vote wisely, as it doesn’t just affect you.