by Nima Ghadiri
The government is currently locked in a dispute with junior doctors over a proposed new contract. The organisation representing junior doctors is the British Medical Association (BMA), a trade union which was founded in 1832 and represents all United Kingdom doctors, not just Junior Doctors. The chair of the BMA’s junior doctor’s committee is Johann Malawana.
Chief areas of contention in the contract are: removals of national safeguards (fixed financial penalties) for organisations when Junior Doctors work long hours, cutting out minimum break requirements, re-designation of the normal working week leading to an added day when hospital resources are lacking, and disadvantages to doctors who work less-than-full-time and have families.
Jeremy Hunt, the Secretary of State for Health, has stated that the British Medical Association (BMA) have misrepresented Junior Doctors and has targeted the union aggressively in a bid to win public opinion. This has been echoed in much of the tabloid press, who have used social media photos of the BMA Junior Doctors’ committee in order to portray them as wealthy manipulators of the Junior Doctors that they represent.
Indeed, The BMA has had a tumultuous relationship with Junior Doctors lately. Many felt that the union did not fight hard enough following various events which have taken place over the last decade: Loss of House Officer Accommodation, shortages of training posts, the ill-received Medical Training Application System (MTAS), pay increases below inflation and consistently increasing GMC and examination fees.
Nevertheless, in this battle, Junior Doctor consensus (based on a Facebook group which is 63,000 strong) is that the BMA is working hard and representing the position appropriately, but is simply underpowered. Junior Doctors who have worked abroad, in particular New Zealand, will know just how underpowered the BMA is.
The New Zealand’s Resident Doctor’s Association “NZRDA” was founded in 1985. It represents only Junior Doctors, rather than all doctors. British doctors who move to New Zealand tend to be surprised about the power of this organization, which is very proactive and consistently anticipates future problems.
Over time, the NZRDA have (chiefly through their firebrand negotiator Deborah Powell) negotiated a number of improvements on an annual basis by means of their Multi Employer Collective Agreement “MECA”. These have included: consistent increments in pay, final year medical students being given a salary, free canteen food during working hours, training and membership costs being covered, presence of cross-cover and relief doctors to cover short-term absences, ease in going out-of-programme for family or travel. There is even a motivation for hospitals and clinics to ensure that their junior doctors claim all of their annual and study leave, as the amount not used becomes “cashed out” as a payment.
The NZRDA have been aggressive in the few instances when conditions have deteriorated. In April 2008, the NZRDA gave notice of a nationwide 48-hour strike over pay, conditions and ongoing issues of retention, as 40% of Kiwi doctors were moving to Australia. At the time, a first year house-surgeon in NZ earned 88,000 NZD (£40,000) on average. Junior doctors sought a 10% pay rise over three consecutive years ( twice that of other health service workers) rather than two rises of 4% over two years.
The strikes were widely seen as a success which brought the desired outcome for the doctors, caused no harm to patients (indeed, emergency department waiting times were markedly reduced), has improved retention of doctors and made New Zealand a very attractive destination for British and other doctors. They have also empowered the NZRDA to fight annually for better conditions.
In a hypothetical situation, what would happen If the NZRDA were transplanted to the negotiating table in the United Kingdom? Based on their track record, they would be keeping the government on their back feet. In particular, they would not hesitate to legally challenge the government, for example Jeremy Hunt’s assertion that we do not already have a seven-day emergency NHS has led to well-documented patient harm.
Unfortunately, the BMA may simply not have the strength to attack on all fronts in order to secure a fair and safe contract this time round. However, a Union is only as strong as the will of its members, and for the Junior Doctors this is currently very strong indeed. One outcome of the current dispute will be a galvanised and stronger British Medical Association. Which is precisely what the government don’t want.