Junior doctors' strike: Where the Government and the BMA differ on the key issues

With talks expected to continue up to and even beyond next week's action, we look at where the two parties clash

The Government and the British Medical Association have clashed over next week's planned strike action by junior doctors. 

The Health Secretary, Jeremy Hunt, has claimed an agreement was close, but that the BMA had walked out after less than an hour of renewed talks on Monday.

Dr Mark Porter, chair of the BMA Council, says that the union had fully considered the new contract offer, and accused negotiators of “not taking the concerns of junior doctors seriously”.

With talks between expected to continue up to and, if necessary, after next Tuesday’s strike, we look at where the two parties differ on the key issues:


Safe working hours

What the Government says: Jeremy Hunt has insisted he does not want doctors working longer hours as it’s in “no one’s interest”.

On Monday, the Government offered new safeguards, including a “guardian” in every NHS trust to monitor hours. The proposal is that those hospitals that “consistently” breached the “absolute maximum” 72-hour week for a junior doctor would face a fine, which would be reported to the guardian, who would allocate it to improve doctor training, education or working conditions within the hospital. Junior doctors would also not be allowed to work more than four nights in a row – a new cap. 

What the BMA says: Negotiators are understood to consider the new working hours safeguards to be watered-down versions of what was discussed in talks. The BMA does not think they go far enough. The new financial penalties system is designed to replace an existing one, in which hospitals are forced to pay junior doctors significantly more if they are worked beyond their contracted hours. 

The BMA believes this is the only system with the “teeth” to protect against a return to the 100-hour week. 

Verdict: The new proposed system should be welcomed by the BMA as a serious attempt to engage with the issue, which has hitherto been largely ignored. However, the new measures risk being ineffective because the financial penalty ultimately ends up staying within the NHS trust. 

There is a possibility that hospitals would begin budgeting for breaches of junior doctor working hours – knowing that the money would end up covering their training and education costs.


Out-of-hours pay

What the Government says: Ministers plan to cut out-of-hours pay by reclassifying the hours that count as antisocial and qualify for extra pay. The measures are central to the Government’s plan to deliver more weekend hospital services – the so-called seven-day NHS pledge in its manifesto. 

“The current contract means we have three times less medical cover on weekends because hospitals can’t afford to roster enough people,” Mr Hunt said yesterday. “That is what we want to change.” 

To soften the blow of out-of-hours pay cuts, the Government has offered an 11 per cent basic pay rise. Mr Hunt has pledged that therefore 99 per cent of doctors will see their pay protected or increase – at least until 2019. 

What the BMA says: The doctors’ union insists the NHS keep the current definition of unsocial hours – any time outside 7am to 7pm, Monday to Friday. Fundamentally, the BMA says it wants an offer that fairly rewards junior doctors for the work they do – so far, it and the vast majority of junior doctors do not think they have one. The BMA warns this could have a devastating effect on morale and drive many doctors out of the NHS. 

Dr Mark Porter, chair of the BMA Council, said: “An 11 per cent pay increase doesn’t compensate when you take away a 31 per cent average payment for working the unsocial hours. Anybody can do the maths on that.”

Verdict: The Government wants more services available at weekends – a manifesto pledge it is determined not to break. 

The BMA does not object to more weekend services. But to deliver them Mr Hunt wants to cut weekend work payments, rather than pay more to recruit extra doctors or to maintain top-up pay. 

Junior doctors who feel pushed to the limit by the demands of their job will not accept this, and increasingly see their dispute as a battle to protect the funding and standards of the NHS. 

Given the two intractable positions, it is unlikely the deadlock will be broken, until more money is on the table.

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