4th April 2016

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Chief Executive GMC - registration, training and standards for doctors

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News and Comment from Roy Lilley
It generated a huge row before we knew anything about it, now that we know all about it... there has been a curious silence.
A bit like woodlands fall silent before a deluge.  Or, in this case the row and the walk out.  
On Thursday evening the new Junior Doctors contract popped-up on a website.  Since then a flurry of pedantic indignation on Twitter, next to nothing in the press.  My guess, unlike the HSJ, most didn't understand it
The document is just short of 80 pages and you'll have to be a real NHS Bobble-Hat to get your head around it.
That's the problem; it is a contract for +50k men and women, at different stages of their careers and lives, working in 150+ hospitals, 8,000 surgeries and everything in between, across +50 specialties.  It is full of exceptions and anomalies... the argy-bargy could go on 'till Doomsday.
Key points (that all come with heavy caveats, complications and multifarious doo-dah)...
  • Doc's will benefit from a 13.5% average increase in their basic (Not a raise, it's a redistribution of the current pay envelope).
  • Progress on a pay linked to responsibility and those who work the most intense and unsocial hours.
  • No more than 72 hours actual work should be rostered for, or undertaken by any doctor, working on any working pattern, in any period of seven consecutive calendar days.
There is no denying, it will make weekend working more affordable but without sympathetic rostering, could be a childcare nightmare for working/doctor/parents.
It is a labyrinth:
"Where a doctor is rostered to work a shift of any length starting on a Saturday, at a frequency of 1 in 4 or more frequently over the period of the rota cycle, an enhancement of 30 per cent of the hourly basic pay rate will be paid on any hours rostered to be worked by that doctor between 07.00 and 17.00 on a Saturday, as set out in the doctor's work schedule."
The sticking points? The 'What if's?'
For instance, there is a Guardian role (Page 36); a 'non-Trust-manager',  to ensure fair play.  There are 43 mentions of the role and task.  A JD asked on Twitter; 'What if they are not there?'
That's the issue; 'what if'?  There seems to me a corrosive mistrust of employers.  They are characterised as existing only to exploit, abuse and sweat-shop junior doctors. 

It's worth reflecting; employers, too are victims of this mess.  Victims of poor workforce planning, cuts, cack-handed negotiations and political interference.
The second issue is derived from the  accompanying document to the contract; an equality impact analysis.  It has attracted most of the attention so far; para 83-6 has caused a row (page 26 on).  

The structure of the new advancement pathways (nodes), the complexity of on-call availability, part-time working and maternity leave, it is admitted, in the text, could have an 'indirect adverse effect on some women'...  characterised by the Indy as treating women as 'collateral damage'.

The Tinkerman has shot himself in the foot.  His new problem now include child-care, discrimination and equal pay.  The legal situation is over-viewed in this must read from doctor and lawyer @dr_shibley.  The BMA are heading for the courts.  
I know enough about industrial relations to say, whatever is in this or any other contract, there will be those who will be determined to oppose it.  Iv'e always believed talks are the solution.  Sadly, now I feel this has all gone too far.  A new Secretary of State is probably part of the solution but the referendum will get in the way of that.
The JD shemozzle has gone beyond the contract.  It has become a lightning rod for arguments about austerity, equality, workload, pressures, targets, clumsy employers, the government, Brexit and all the rest... and now the Tinkerman.
The JDs are a hard group to engage with but they are the backbone of our workforce.  We don't have enough of them, they rotate, work insane hours and are so focussed on careers, safety, patients, carving out careers and trying not to starve to death... anything involving the management suite is the last thing on their minds!
Could this contract work?  Maybe not perfectly and the implementation planning should help revel the cracks.  Rota remapping (page 2) will be key.  Is it bad enough to drive JDs to the streets on the 26th and turn their backs on ambulances arriving to A&E?  You be the judge...
However, it is up to Trusts to realise they must make efforts to accommodate JDs with families and working partners, make out-of-hours breaks and refreshment civilised if they can't manage luxurious.  Careful rostering, sensible work schedules and induction, planned to recognise JDs are not a resource, but an important partner into the future.
Success now depends on the Trusts; demonstrating however transient in the service they may be, junior doctors are the health service of tomorrow and their employment experience will shape their trust in the future.

This will be a huge personal test of the leadership qualities of Chief Executives who alone could make this work. 
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Chief Executive and Registrar of the GMC
Niall Dickson
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>>  I'm hearing - contingency planning for full JD walkout on 26th includes closing some A&Es and redesigning flows to major centres to conserve resource.
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