Monday 9th May 2016- The British Medical Association: BMA re-enters contract talks

‘The BMA will today re-enter talks with the Government over the junior doctors’ contract.

It comes after the Academy of Medical Royal Colleges called on both sides in the dispute to return to the table — with negotiations chaired by a third party.

Five days of ‘intensive talks’ from Monday to Friday are planned and ACAS chair Sir Brendan Barber will lead the negotiations.

BMA junior doctors committee chair Johann Malawana… said he hoped ‘real progress can be made’.

He said: ‘The BMA has agreed to re-enter talks with the Government on outstanding issues in this dispute, which include, but are not limited to, unsocial hours.

‘Junior doctors’ concerns extend far beyond pay, and our principle in talks will be to deliver a fair contract that does not discriminate against women or any other group, one which addresses the recruitment and retention crisis in the NHS and which provides the basis for delivering a world-class health service.

‘The BMA will also call for any contract offer — agreed or not — to be put to a referendum of junior doctors, as is usual following a contract negotiation.

‘We hope that with both parties back around the negotiating table, real progress can be made to end this dispute through talks.’’

The Telegraph:

‘Doctors are due to be moved onto the new contract over an 18-month period starting in August.

As it currently stands the new contract offers an average basic salary increase of 13.5 per cent and a 19% increase in the basic starting salary.

Those who work one in four Saturdays or more will receive a pay premium of 30 percent for all Saturday hours, however the BMA has demanded that any Saturday working, regardless of minimum number of days, attracts the premium rate.

Four strikes took place between January and early April, but they only affected routine and non-urgent care.

Last week’s two-day strike, however, was the first in the history of the NHS to affect all forms of care, including Accident & Emergency departments, intensive care and maternity units.’

Related Articles:

BMA re-enters contract talks

Junior doctors prepare for fresh talks over contracts- The Guardian

BMA agrees to re-enter talks over disputed junior doctor contracts- The Telegraph

British Medical Association to reopen contract talks with Jeremy Hunt- The Guardian

Junior doctors’ contracts: Fresh talks under way- BBC News

Thursday 4th February 2016- The Telegraph: Team GB athlete dies from meningitis after being told by A&E doctor she had stomach bug

‘A young Great Britain athlete died from meningitis just hours after a junior doctor on his first week in A&E wrongly diagnosed a stomach bug, an inquest heard.

Ellie Penrose, a promising 18-year-old triathlete, was taken to hospital by her family after complaining of a headache and sensitivity to light.

She was seen by newly-qualified Dr Don Hettiarachchi who diagnosed gastroenteritis and dehydration and sent her home with paracetamol and ibuprofen.

But an inquest heard she was “inappropriately discharged” from Hull Royal Infirmary, in East Yorkshire, after the “failure in care”.’

‘Hours later, her parents Tom and Pauline dialled 999 after finding her critically ill on her bed at their home. She was taken to hospital, but died later the same day from “overwhelming sepsis” caused by meningococcal septicaemia.

Hours before she died last August, Miss Penrose discovered she had excelled in her A-levels and was destined for university.

Dr Hettiarachchi admitted to the Hull inquest he was “not 100 per cent sure” of the root cause of Miss Penrose’s illness when he saw her in the hospital at 3am on August 12 last year.

With no consultant available, he consulted with fellow trainee Dr Ayman Ghoneim in a corridor before discharging her.

Coroner Professor Paul Marks asked if he had considered meningitis and Dr Hettiarachchi replied: “I did. When I examined her there was no rash. There was blotching on her face. I felt it was more viral.’

‘Questioned by the Penrose family’s lawyer, Dr Hettiarachchi added: “I did not treat it as meningitis because I felt it didn’t fit with the general picture.”

Asked if he would have done anything differently, he replied: “Lots of things. I would have consulted with a registrar or above.”

Dr Hettiarachchi accepted he did not highlight key observations – crucially, Miss Penrose’s high blood pressure, low pulse rate and skin blotching – to Dr Ghoneim, but denied a claim that he had already reached a diagnosis.’

Related Articles:

Team GB athlete dies from meningitis after being told by A&E doctor she had stomach bug

Team GB triathlete Ellie Penrose died after her meningitis was misdiagnosed as stomach pains, inquest hears- The Independent

Triathlete died after doctor failed to diagnose meningitis- The Guardian

Monday 1st February 2016- The British Medical Association: Junior doctors press ahead with industrial action

‘Junior doctors in England will take a second day of action after contract talks ended without agreement.

Action will take place from 8am on Wednesday 10 February to 8am on Thursday 11 February, with junior doctors providing only emergency care during this period.

Trusts across England have been informed of this change to the originally planned action, which would have seen the first-ever full walkout with no care provided by junior doctors.

The decision comes after talks between the BMA, NHS Employers and the Department of Health were unable to reach an agreement on the issue of unsocial hours.

Originally planned as a full walk-out, action on 10 February will instead mirror that taken on 12 January with junior doctors providing emergency care only until 8am on 11 February.’

‘BMA junior doctors committee chair Johann Malawana said: ‘Over the past few weeks, we have welcomed the involvement of Sir David Dalton in talks about a new junior doctor contract, which recognises the need to protect patient care and doctors’ working lives.

‘His understanding of the realities of a health service buckling under mounting pressures and commitment to reaching a fair agreement has resulted in good progress on a number of issues.

‘It is, therefore, particularly frustrating that the Government is still digging in its heels.’

He added: ‘The Government’s entrenched position in refusing to recognise Saturday working as unsocial hours, together with its continued threat to impose a contract so fiercely resisted by junior doctors across England, leaves us with no alternative but to continue with industrial action.”

Related Articles:

Junior doctors press ahead with industrial action

Next week’s junior doctor strike on- BBC News

Jeremy Hunt digs in as junior doctors announce new strike- The Guardian

Junior doctors’ strike to go ahead on February 10 after negotiations fail, BMA says- The Independent

Junior doctors’ 24-hour strike to go ahead from next Wednesday- The Telegraph

Tuesday 19th January 2016- The Independent: Second junior doctors strike called off after talks between the BMA and Government

‘A planned strike by junior doctors scheduled for next week has been suspended after talks between the British Medical Association and the Government.

The 48-hour strike had been due to take place from Tuesday to Thursday 26 to 28 January but will now not go ahead, the BMA said.

Dr Johann Malawana, the chair of the BMA’s junior doctor committee, said differences still existed between negotiators but that there would now be more time for talks before the next wave of industrial action hit.’

‘A third planned strike in February remains in place and will go ahead unless “concrete proposals” are put on the table, the BMA says.’

Related Articles:

Second junior doctors strike called off after talks between the BMA and Government

Junior doctors’ strike suspended as talks to end contract row continue- The Guardian

48-hour junior doctors’ strike called off- BBC News

Monday 4th January 2016- The British Medical Journal: Junior doctors are set to take industrial action, says BMA

‘Junior doctors are set to take three days of industrial action, after negotiations between the association and the government over the terms of the junior doctor contract broke down on Monday 4 January, the BMA has said.

As The BMJ went to press the association announced that the action would take place in January and February, after the government failed to meet junior doctors’ concerns over changes to the contract.’

BBC News (Junior doctor strikes back on as talks fail); Jeremy Hunt’s response:

Related Articles:

Junior doctors are set to take industrial action, says BMA

Junior doctor strikes back on as talks fail- BBC News

Junior doctors announce they will strike next week- The Independent

Junior doctors in England to strike next week after talks break down- The Guardian

Saturday 5th December 2015- The Guardian: Almost half of junior doctors left NHS after foundation training

‘Almost half of all junior doctors are opting not to continue their training in the NHS, threatening a “disaster” that senior medics fear will worsen the service’s shortage of frontline clinicians.

This year only 52% of junior doctors who finished the two-year foundation training after medical school chose to stay in the NHS and work towards becoming a GP or specialist – the lowest proportion in the health service’s history and down from 71.3% as recently as 2011.

The official figures reveal sharp rises in the number of junior doctors shunning the NHS and opting instead to work in academia, as a locum medic or simply taking a career break.

The extra pressure on NHS staff created by the growing demand for patient care, disenchantment among junior doctors, and an increasing trend towards gap years are all being blamed for the trend.

“To see such a large number of doctors leave the NHS in such early stages of their careers is incredibly worrying, and can only worsen the recruitment crisis we are already seeing in many parts of our NHS, such as A&E,” said Dr Johann Malawana, chair of the British Medical Association’s junior doctors committee.

“The government must focus on ensuring we have the valued and motivated workforce needed to meet rising demand across the country, as to lose any more doctors in the early stages of their careers would be a disaster for the NHS”.’

See:

Almost half of junior doctors left NHS after foundation training

Monday 30th November 2015- The Guardian: Doctors’ strike called off after Hunt lifts threat to impose new contract

‘Junior doctors called off three days of planned strikes that would have seriously disrupted NHS services after a last-minute agreement to hold further talks with Jeremy Hunt to try to agree the details of a new contract.

The dramatic breakthrough in the increasingly bitter dispute arrived only hours before the first strike was due to begin at 8am on Tuesday, which would have left many hospitals in England offering only the very limited range of services usually seen on Christmas Day.’

‘It came following five days of discussions, overseen by the independent Advisory, Conciliation and Arbitration Service (Acas), between the British Medical Association (BMA), NHS Employers and Hunt’s Department of Health (DH).

The BMA agreed to call off walkouts planned for 1, 8 and 16 December after the health secretary finally bowed to their repeated request to drop his longstanding demand – albeit temporarily – to impose a punitive new contract on England’s 45,000 junior doctors if agreement was not reached, largely on terms he had dictated. His stance had sparked huge anger among the affected doctors in training, 98% of whom voted for strike action in protest.

However, an estimated 20,000 patients will not have non-urgent operations that were planned for Tuesday, such as cataract and skin lesion removals and hip and knee replacements, as the decision – announced at 7.05pm on Monday evening – came too late. They will have their procedures rescheduled.

An Acas spokesman said: “Following five days of productive talks under the auspices of Acas, the BMA, NHS Employers and the Department of Health have reached an agreement. Acas is pleased that the talks have been held in a constructive manner and cooperative spirit between the parties, that will allow an improvement in industrial relations.”

A detailed memorandum of understanding, which the three parties agreed, makes plain that agreement over junior doctors’ new terms and conditions must be reached “without undue delay”.’

Related Articles:

Doctors’ strike called off after Hunt lifts threat to impose new contract

Junior doctors’ strike called off but disruption still widespread- The Guardian

Disruption expected as junior doctors’ strike called off- BBC News

Junior doctors strike called off to grant more time for talks- The Independent

Junior doctors dispute: talks to resume in attempt to avert strikes- The Guardian

 

Friday 27th November 2015- The Telegraph: Junior doctors explain why they are striking

‘Faced with contract proposals they say would mean working longer hours for less pay, four junior doctors explain why they want the Health Secretary to look again at the issue’.

See:

Junior doctors explain why they are striking

Wednesday 25th November 2015- The Telegraph: Doctors ‘naive’ to think no harm will come to patients during strikes, says Harvard

‘Doctors are ‘naive’ if they think no harm will come to patients during strikes, analysts at Harvard Medical School have said, after studying the impact of previous walkouts.

Although industrial action does not usually result in extra deaths, it nevertheless leaves health services severely disrupted and delays medical procedures, they warn.

Dr David Metcalfe of Harvard, and colleagues, looked at the legacy of doctors’ strikes in high-income countries going back to the 1970s.

 They concluded that patients would not come to ‘serious harm’ provided that adequate provisions are made for emergency care.

However they warned that in South Africa, where only one emergency unit remained open for an entire province during a 10 day strike in 2010, the death rate rose by 65 per cent, mainly because people avoided using services until they were desperate.’

‘Under General Medical Council rules, British doctors are not allowed to strike unless they are certain that emergency rooms are staffed sufficiently and no patient is placed in danger.

However Dr Metcalfe said: “It would be naïve to imagine that industrial action can be undertaking without causing any harm to patients.[“]’

 

‘Around 98 per cent of doctors voted in favour of strike action earlier this month. The first day of action in December 1 would see junior doctors providing emergency care only, meaning planned operations and all routine appointments will be cancelled.

Further ‘all out’ strikes are planned for December 8 and 16 which would mean junior doctors will withdraw their labour entirely. The GMC has warned that they will take action if patients are left at risk during the walkout.

Doctors are angry about changes to their working contracts designed to provide a health services which operatres ‘seven days a week’. Jeremy Hunt, the Health Secretary, claims that staffing shortages at the weekend lead to 11,000 lives being lost each year. Patients admitted at the weekend are 15 per cent more likely to die.

Mr Hunt planned to raise overall pay, but stop doctors being able to claim generous overtime packages at the weekend. However he has since backed down and said that doctors can still receive overtime for working Saturday evening.’

See:

Doctors ‘naive’ to think no harm will come to patients during strikes, says Harvard

Friday 13th November 2015- The Independent: NHS junior doctor contracts: UK’s leading expert on patient safety Sir Robert Francis urges doctors not to strike

‘Britain’s leading expert on patient safety has stepped into the bitter row over the new junior doctors’ contracts warning that the future of the NHS is at stake as he criticised both medics and the Government for mishandling negotiations.

Sir Robert Francis QC, who led the public inquiry into the Mid Staffordshire NHS Trust scandal, urged doctors not to strike and said patient safety would be put at risk if three planned walkouts next month go ahead.’

‘In a letter to doctors, seen by the Independent, Sir Robert called the 53,000 junior doctors in England “the backbone of the NHS”. He said they “undoubtedly” have the right to be heard, but warned them to consider the “potential consequences” of strikes on the medical profession.’

‘He said: “It is of course possible that some modification in the contract may be achieved, but at what cost? The history of large scale industrial action suggests to me that it can be a catalyst for the replacement of the relevant service by often less satisfactory alternatives.”

Sir Robert said the “bland assurances” of British Medical Association (BMA) leaders that the strikes will not place the public at risk undermined their argument that the proposed new contract would damage patient safety.

Junior doctors in England are set to take industrial action next month, subject to the outcome of a ballot which closes on 18 November. Medics will walk out of all but emergency care on 1 December before two full walk outs from 8am to 5pm on 8 and 16 December.’

‘Sir Robert, in his response to a petition from 900 junior doctors led by Oxford cardiologist Dr Rachel Clarke, said in the letter: “I urge you not to put your patients at risk by the [strike] action the BMA has announced… I find it difficult to believe such action will be in anyone’s interests.”’

See:

NHS junior doctor contracts: UK’s leading expert on patient safety Sir Robert Francis urges doctors not to strike