14th April 2016

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Niall Dickson Boss of the General Medical Council in conversation with Roy Lilley
'We feel generous deal'
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News and Comment from Roy Lilley
Whitehall, London; the main road through government.  All the big offices of State are there or there abouts.  On one side the menacing gates of Downing Street; courtesy terrorists and protesters, no longer accessible as it was in the days of my childhood.
Almost opposite, the brooding presence of Richmond House.  Home of the Department of Health.  The official address is Richmond Terrace.  It is a listed building that rose from the demolition of a row of cottages.
The end of the day plunges its turrets and forecourt into deep shadow.

I was there yesterday.  A sunny day but bitterly cold in the shade.  Sitting forlornly behind a shaky looking decorator's pasting table, elegantly covered in a genteel, white table-cloth, surrounded by TV cameras and journalists, two junior doctors, dressed in scrubs.
They looked pale, pained and perished but they had a plan:
... to ambush the Tinkerman and force him to make good his promise that; 'His door was always open to talk to junior doctors'.   They intend to sit vigil 24-7 until he relents and speaks to them.
I suspect the Docs might end up in their own hospitals, suffering pneumonia, before he stops using the back passage to get to his office.
It is an eye catching wheeze.  Little more.  But, you have to admire their perseverance if not their perspicacity. (My interview with them here along with surprise appearance of...)
I've spent the week thinking, talking and reflecting on the strike.  How we got here is of no further interest.  What do we do now?
Mark Porter, the Chair of the BMA is as invisible as the Tinkerman.  By all accounts there is a split at the highest levels in his union; strike all-out or not, creating an exquisite, moral dilemma for some members.
Let's assume the JDs strike all-out on the 26th April, my guess is the press will have them for breakfast.  You can bet they will express the row, in un-nuanced headlines;

'A strike about over-time on Saturdays; puts our kids and yer granny at risk... who do they think they are.'
The JDs will 'lose', for there is nothing for them to win.  The BMA broken.  Membership will fall away.  A disastrous strike that will lose public sympathy.  Mark Porter's leadership has a lot to answer for.  Johann Malawana, the JD leader, already a target for the press, can expect more of the same.
Various legal challenges, in-train, will make the lawyers richer and the public no wiser.  Whatever there is to win in the courts will be a pyrrhic victory.
The urge I have is to move this mess out of the shadows of Whitehall, into a warmer more sunlit landscape.
I am convinced the future lays in talking, a national-template contract and local discretion. 
It is as unrealistic to expect a contract of employment for Sainsbury's to be the same as a corner shop, as it is for a huge teaching hospital in the metropolis, to have staffing and rota needs identical to a DGH in the sticks.
Is this a work around?
  • Get the Guardians in place in the next 10 days.  It will demonstrate good faith.  Get on with it.
  • Ask Trust chief executives to talk direct with their local JDs.  The BMA will try to stop this.  Let the JDs decide for themselves.  The grass-roots are clearly hacked off.
  • Share rota and schedule data; find out where the gaps are and decide how close to a seamless 7-days they can get. 
  • Sign-off a local deal, with the Guardian, that is safe and workable. 
  • Send it to the CQC, who, after all, will have a say if 7-day JD working leaves gaps and endangers safe working.
If the Trusts need help with the modelling and talks, crack the whip and get the Confed earning its subscriptions.  Tell HEE to keep their noses out and be constructive and helpful. 
Local deals, in a national framework, seems to be doable, and viable.  They can be reviewed annually and as resource and staffing allow, move towards the manifesto promises the elected Government is perfectly entitled to make.
In the end this dispute will be solved by talking; not around a pasting table in Whitehall, but around the desk of the Chief Executive in the Trusts. 
Is this a perfect answer? No.  Does it avoid either side from having to climb down?  Yes.  Could it prevent a long hot summer of grief and aggravation?  Of, course.
But, alas it won't change the way the sun shines in London and it won't warm up Whitehall.
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Talking with the Junior Doctors during on the first afternoon of their 
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In discussion with Roy Lilley all about his report and the price of bog rolls!
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>>  I'm hearing - such is the extent of the row at the BMA over the junior doctor's complete walk out, Chair Mark Porter is powerless to intervene and has gone missing?
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