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The Royal College of Psychiatrists Improving the lives of people with mental illness

College responds to Junior Doctors' Contract Agreement

It’s not over. Not by a long way. There is much more to do. But we have definite progress. As you all know the most recent negotiations between the BMA Junior Doctors and the Department of Health have ended. We understand that a deal has been reached and that this is going to be put to a full vote of the membership. 

Just as the College didn’t advise our junior doctors whether they should or should not strike, we are not going to tell you how to vote. As before, you will make up your own minds. I can however make one or two observations that may assist.

No negotiated settlement ever gives anyone everything that they want. There is always compromise. Dr Malawana, who has clearly negotiated long and hard, has delivered more than most people can have expected.  Of course he won't be happy with everything and I suspect nor will you. I understand that , but I would remind you this is not the end.

I also know just how much effort you have all given to get this far. I know from talking to many of you that no one wanted to take industrial action, either partial or full, and those that did chose that path without enthusiasm and with a sober realisation of what that could mean for the public and our patients. That has not changed.

If this offer is accepted then most of you will, like myself, feel a sense of relief. This will be shared by the vast majority of the public and our patients and carers. The level of support for you has been extraordinary. Within the profession I have never known such solidarity, and it is clear that the public too was largely behind you. We cannot know what might happen should the action continue and I fervently hope we will never find out. But even if the offer is accepted and the industrial action comes to an end, this is not the end. 

From the start I have said this strike was never only about terms and conditions. It was about much more. At some stage, perhaps not immediately but soon, we need to look at all the issues that have brought us to this place. We need to look at the way in which your training has developed since the advent of Modernising Medical Careers which, not for nothing, was also known as Mangling Medical Careers. We need to see how this can be improved and how you can regain control of your careers and work/life balance. We need to look at how your efforts are rewarded, and I do not mean financially. All of this still needs to be done. I think that the industrial action has now paved the way for a fresh look and a new settlement in these areas. 
There is also a wider agenda.

We all know, because we work in the system, that the NHS is facing a critical financial crisis. We know that we are expecting too much for the funding that we have. We cannot deliver a service that is, as some say, the envy of the world on the resources that are deployed. We know that the NHS is the most cost effective health care system in the world, but it cannot continue in the face of rising demand and falling funding: 10.1% of GDP in 2010, 7.3% in 2014 and projected to be 6.6% in 2020.

We know also that we do not have enough staff to deliver what is now being asked. That is not an issue restricted to psychiatry, it is across the NHS. The Government’s manifesto commitment to create a “7 Day NHS” still requires a great deal of clarification about what that means, the evidence behind it, and how it is going to be to be resourced in the real world where, in my experience, you can only spend the same pound once. 

One of the things to emerge from this dispute is that these issues can no longer be ignored. The actions of our junior doctors have made that impossible. These are questions that cannot now be avoided. It is the role of the profession, united as I have never seen before, to ensure that they are not.  

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Re: College responds to Junior
As a psychiatry trainee, I'm very disappointed with the 'agreed contract'. It is quite amazing that the ability for junior doctors to whistleblow in line with all other NHS workers is being seen as a victory rather than something well overdue.

The rise in basic pay and the temporary specialty shortage premium will not compensate for the reduction in psych higher trainee banding from 20-40% to 8% for non-residential on calls. This will leave our specialty struggling to recruit as medical/surgical trainees earn more. The new contract also makes no recognition of the mandatory costs of training including RCPsych fees which post-membership are the highest published fees of any royal college.

The new contract also allows bizarre shift patterns to fall outside a classification of being antisocial. A 730pm-330am eight hour shift would not be antisocial, for example. And the secretary of state has today been heard on C4 news saying how junior doctors now cost 1/3 less on weekends - thereby achieving his aim of a cheaper workforce despite his protestations this was a cost neutral exercise.

Overall this is a bad deal for psychiatry trainees and I'll be voting to reject this contract.
Re: College responds to Junior
I would agree, sadly, with the above comment. The BMA has sold psychiatrists down the river before; remember getting rid of our early retirement clause? This was the start of the recruitment difficulties we have had. As my junior colleague states, this deal will not help our recruitment and retention difficulties. Maybe the college should support our trainees overtly by expressing disapproval of this deal.

The BMJ union rag / Sun equivalent, has been consistently anti psychiatry. I recall Richard Smith (the then editor) suggesting that psychiatry should not be considered a medical speciality, and should be separated from the NHS. On the basis of ‘keep your friends close and enemies closer still', we should keep our presence in the BMA, so we can put a spanner in their works when necessary. This advice would apply to the other referendum as well!
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Professor Wendy Burn

Professor Wendy Burn FRCPsych


Professor Wendy Burn became a consultant old age psychiatrist in Leeds in 1990 and now works fulltime in a community post. Her main clinical interest is dementia.

She has held a regional leadership role in this area from 2011 and was co-clinical Lead for dementia for Yorkshire and the Humber Strategic Clinical Network between 2013 and 2016.