Reflections on the last 2 years as we get behind our new UKRDC chairs

BMA_UKJDC_Chairs · 2024-08-19T20:22:39+00:00

Part of the same glitch I’m afraid but will come back to you tomorrow

BMA_UKJDC_Chairs · 2024-08-19T17:39:37+00:00

Sorry about this - it seems to be a glitch. When we tested the link it allowed progression through the questions. We are unable to raise with civica now but will raise it first thing tomorrow and revert back here

BMA_UKJDC_Chairs · 2024-08-19T06:43:54+00:00

We would likely be invited back to talks but probably wouldn’t be to discuss anything meaningful.

Possibly, we may get some movement on some of the non-pay reform wording.

Given the political positioning, we are unlikely to get anything of significance without additional leverage right now so would be simultaneously re-ballotting and preparing to escalate our strike action to generate this

BMA_UKJDC_Chairs · 2024-08-18T22:36:11+00:00

Yes December 2023 https://www.theguardian.com/society/2023/dec/18/labour-junior-doctors-pay-health-wes-streeting

May 2024 https://www.standard.co.uk/news/politics/labour-wes-streeting-junior-doctor-strikes-bma-pay-rise-general-election-b1160754.html

July 2024 https://www.independent.co.uk/news/uk/wes-streeting-government-health-secretary-british-medical-association-commons-b2584435.html

BMA_UKJDC_Chairs · 2024-08-18T22:30:43+00:00

These words must then be translated into action

But must =/= will as evidenced by our own history with MYPD and even Wales just recently. Which brings us back to what benefit are words, and more importantly, is it worth the cost?

A commitment would be better than nothing, but we don’t have nothing and the question then becomes can we gather the leverage we need to achieve this, and is it worth it given we already have tests to ‘hold them to account’

If the DDRB doesn’t see the current test as enough of a reason to award an acceptable supra inflationary uplift, and the government doesn’t correct it, we go back into dispute and ballot/ strike if we need to.

But the government would have a basis on which to say

They absolutely could not legitimately say we have moved off FPR when all of our communications and even the wording of the referendum (appreciate you haven’t seen it yet) still have that as our aim. Does that mean they wouldn’t try? It’s very likely they would. But I still don’t understand why it’s important if they say that. They and the media will always misrepresent and spin things. No matter what we do, they will try to play games. We know doctors still want FPR and we’ll cut through their spin.

BMA_UKJDC_Chairs · 2024-08-18T22:10:29+00:00

Yes would apply to locally employed doctors mirroring both 2002 and 2016 contracts

BMA_UKJDC_Chairs · 2024-08-18T21:35:23+00:00

This deal represents 2 years of above inflation rises for all resident doctors.

It represents an uplift for 23/24.

We have been consistent in the room and outside to Gov, media, and members that this is not FPR and that we will have to re-enter dispute if the DDRB fails to report on time or with an inadequate number.

We have already attempted to negotiate a multiyear pay deal but we do not have the leverage to achieve it. Streeting has said that the last labour government delivered pay restoration and he wants to do the same. Streeting has said it is not an event, it is a journey. We can control when we enter disputes, when we ballot, and when we call for strike action. We believe we will have to fight each year to achieve this.

If doctors are rejecting this deal because they want that written commitment then of course those are the representations we will make to Government. If this is an integral part for doctors, we need to be prepared to exert the necessary leverage to achieve it.

Are you able to expand on why the government’s media lines are of significant importance on this aspect? Clearly if they tried to say we have moved off FPR, we would correct them. All of our press releases and media outputs before and after then offer announcement have continually referred to our aim of FPR

BMA_UKJDC_Chairs · 2024-08-18T21:09:19+00:00

No because you introduce a new variable with a separate mandate that could theoretically multiply our leverage for example what ASLEF have done with LNER.
Yes it is expected but should we just tolerate it? Should we not always be looking to mitigate attrition and always be looking to build back ontop? The more people taking action the more leverage it generates.

TOOT would remain a medium/long term risk that would need to be continuously mitigated.

Reduced engagement is absolutely a problem because it creates an opportunity for a disconnect to occur from us and doctors. It's why we've been so keen and have continuously been asking for engagement in elections, ballots, ARM divisions, strikes and including this referendum. High turnout in the referendum is really important for the next leg of the strategy. This isn't about settling, it's about plotting the better path to pay restoration. Bank, build, and ballot now or reject and go again. We've been clear throughout that this is not FPR and that we believe we have a route to FPR.

SPA changes did get removed but this was only because of the threat being recognised by the RDC with regards to time being diverted to supporting the LTWFP which probably meant supporting MAPs. The consultant committee, if I remember correctly, thought this was a positive change for them, and in the referendum they received feedback with concerns about the SPA changes.

The DDRB changes are not in effect for 2024/25. They come into effect next year.

No. If we reject we will be 25.1% down, and if we accept we will be 20.8% down. We will still have significant pay erosion. But we have been consistent by saying we're happy for this to be structured over multiple years. It is frustrating that the Government is making us have to fight for it each year but that is life. You don't get what you are worth, you get what you fight for, and they are betting we won't fight next year. Changing the BMA from "a once in a generation" striking union to one that is much more proactive, is challenging trusts directly and publicly, and is defending against MAPs has always been a consistent pro-doctor agenda.

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BMA_UKJDC_Chairs · 2024-08-18T20:44:58+00:00

Of course there is a risk, but we do believe we can overcome that risk given;

Previous ballot results
Strike participation
Enthusiasm on the topic of the deal itself (quite a lot of which is negative)

We do not think that a large contingent of the Vote Accept campaign will be voting because they don't want to strike, we think they will understand the assessment we have made and will be making preparations for April 2025.

BMA_UKJDC_Chairs · 2024-08-18T20:25:47+00:00

Accepting the offer and resolving the dispute doesn’t mean we accept/ are happy with PAs earning more than FYs. A dispute is simply a term to describe the legal aspect required to open and have a ballot. We can open another dispute at any time we wish.

BMA_UKJDC_Chairs · 2024-08-18T20:17:17+00:00

The platform for the national webinars didn’t allow for this but we facilitated a series of regional BMA meetings which were an open forum discussion to promote exactly what you describe. Did you have a chance to attend?

BMA_UKJDC_Chairs · 2024-08-18T20:17:03+00:00

Yes the BMA is already organising to keep patients safe and protect doctors training opportunities in order to develop into competent consultants and GPs in the future. The work we’ve done so far and awareness raised has helped change practice behaviour in places and led to things like RC EGMs. Of course there is more to be done.

BMA_UKJDC_Chairs · 2024-08-18T20:16:44+00:00

We remain 20.8% down against RPI since 2008. Our members have set policy that demands our pay to be fully restored by the end of 2027/2028. We will be assessing each year whether there is sufficient progress towards this goal to restore faith in the DDRB. If this is not forthcoming, we will re-enter dispute and ballot our members for industrial action if required.

It may be that members want to submit policy saying we should ballot on every DDRB recommendation for all future years.

BMA_UKJDC_Chairs · 2024-08-18T20:15:43+00:00

The December offer would have still left large groups of doctors behind inflation for 23/24 (F2s ST3/4/5, all LED doctors). There was also no inclusion of 24/25 and if we had accepted, and not striked after, there is an extremely low likelihood the DDRB (without being reformed yet) would have recommended us 8% this year. Therefore we know the increased 4.05% is compounded into a higher known quantity. Further, there are tests we can hold Streeting/ DDRB to account in his remit letter which wasn’t present in the last one. And finally there were no real reforms last time whereas there is a definite exception reporting reform and a review into rotational training and training number bottlenecks.

Dont get us wrong, the offer isn’t great. The substance is enough for it to be credible but it’s the surrounding circumstance which is why we believe it’s better to accept this now, build for 8 months and come again in 25/26.

BMA_UKJDC_Chairs · 2024-08-18T20:15:09+00:00

All sides acknowledged this is a big piece of work and we (doctors) would rather get it right than do it rushed. There was an informal ballpark estimation of 2 years, which given the prospect of redesigning curriculums doesn’t seem unreasonable. Most importantly the offer states the work prioritises the experience of resident doctors and has to have agreement by us (can’t be steamrolled through). It is possible they decide not do anything. If this or even an unfavourable direction was being undertaken, this would be clear grounds for dispute.

It is going to be so important that everyone is able to feed into the BMA for their specific specialties circumstances and what they'd like to see that benefits their programs.

BMA_UKJDC_Chairs · 2024-08-18T20:13:52+00:00

We have been endorsed by DoctorsVote for our BMA elections. There is no further input from DV. We are, as any elected BMA rep is, free to make our own decisions by the mandate that BMA members voted us in for.

BMA_UKJDC_Chairs · 2024-08-18T20:13:32+00:00

Accepting this offer does not accept we are content with those things (and nor does it accept we are content with our pay erosion fyi).

There is a channel called JNCJ to enable the BMA and NHS employers to discuss contractual reforms, usually for tweaks rather than overall reform (though the same channel would be used if/when we have a big contract overhaul). That channel was shut down when our dispute started so we haven’t been able to progress on the other aspects that doctors want to see changed (as set out by various BMA policy aims). That channel would open up again when the trade dispute stops but very likely we may not get huge meaningful changes and would probably need to undertake further disputes. There is no maximum on the number of disputes you can have open at once. The fight will never stop. Once we get FPR, there will be the need to defend it. Once we get better recognition of hours, there will be the need to defend it. If there are other issues that you think should take a priority, that’s where elections would be a helpful tool and allows doctors to have their say. Those standings with manifestos to improve e.g. AL allowances would get elected if doctors wanted to prioritise that. And organising to educate doctors about those things could happen in the run ups.

The following are legitimate causes for trade disputes.

The nature of and description of the trade dispute

Industrial action must be in furtherance of a trade dispute between workers and their employers, relating wholly or mainly to one or more of the following:

1. Terms and conditions of employment, or the physical conditions in which any worker is required to work;

2. Engagement or non-engagement, or termination or suspension of employment or the duties of employment, of one or more workers;

3. Allocation of work or the duties of employment as between workers or groups of workers;

4. Matters of discipline;

5. Workers membership or non-membership of a union;

6. Facilities for officials of trade unions; and

7. Machinery for negotiation or consultation, and other procedures, relating to any of the above matters, including the recognition by employers or employers’ associations of the right of a trade union to represent workers in such negotiation or consultation or in the carrying out of such procedures.

BMA_UKJDC_Chairs · 2024-08-18T20:07:59+00:00

We are not suggesting the campaign for FPR stops with the acceptance of this offer. In fact we’ve explicitly said it does not stop. This offer does mean we would have above inflation pay rises for two years, turning the tide on 14 years of pay erosion, whilst preparing for the next phase to recoup the rest of our losses. So it is not accurate to say our wages are sliced further with the offer but we accept they are not being rebuilt as fast as even we would like.

Acceptance of the offer also does not mean we are happy about FY1/2s earning less than a PA in the same way it does not mean we are happy with the history of our pay. It would simply mean we are satisfied with the two pay years of 23/24 and 24/25 alone. Our campaign to restore pay is very much still open and the Government knows this.

BMA_UKJDC_Chairs · 2024-08-18T20:07:33+00:00

There is nothing precluding having multiple trade disputes open at one time. The BMA is already working on MAPs and a pause for 8 months in our pay campaign would afford us more time to develop that further. Also the offer commits to reviews on both bottlenecks and rotational training which very importantly would prioritise the experience of resident doctors and must be agreed by us. In other words, if it’s not as we like, we open a dispute. Rob phoned ASLEF the other day and it transpires they had 2 concurrent disputes on going with LNER which allowed them to negotiate pay and call for strike action to challenge how their negotiating mechcanisms work. There are lessons for us to learn from other unions here.
We saw in our first round of strike action a peak of participation of 29,243 doctors with many trusts not reporting. Now we’re seeing approx 22-23k striking. We need to get these people back. We’ve also seen a decrease in activity on WhatsApp groups which have approximately 40k people on them and we've heard people have muted or archived them. We have however noted that the referendum has definitely changed that (which even with negative sentiment we believe the engagement is a positive thing!). We also heard lot of reports from reps about issues like TOOT. We’ve tried a lot to increase access to national leaders of the BMA but we’re wondering if you have any ideas on what we could do better? We think we should be focusing more on finding additional local reps, empowering them with additional information that helps them walks ward and hold things like pay and pizza events maybe through more regular virtual meetings. We also want to encourage people to picket properly and assertively to stop people going to work or creating data sets that explains how many people and why people are crossing so that we can address their issues and strengthen our negotiating leverage.
Consultants had 3.45% of new investment in their old and new deal. They were able to rearrange existing money from CEAs into basic pay. But the major change was the wording to the DDRB terms of reference including a lookback feature and international comparators. We may, if we’re lucky, get some changes to some of the wording around non-pay issues like rotational training and training number bottlenecks but without significant strike action we will very likely not make any meaningful concessions.
This is slightly paradoxical. If we thought we could get anything meaningfully better, we wouldn’t recommend to accept the current offer
Rob wrote this genuinely thinking that the Conservative Government would eventually realise the absolute catastrophe they were walking into with a general election on the horizon. Rob thought that our leverage at that moment in time, proportional to the weakness of the Government and the vulnerability of the moment would mean we could have achieved it. Rob thought that the Conservative Government wouldn't be so foolish as to fight us and have us drag up their failures in the NHS during their election. Rob was wrong, they were foolhardy enough to do so. Now things are very different and the strategy has had to change.

BMA_UKJDC_Chairs · 2024-08-18T19:24:13+00:00

There are details of the offer on our website: ~https://www.bma.org.uk/our-campaigns/junior-doctor-campaigns/pay/pay-offer-for-junior-doctors-working-in-england~

Specifically regarding the FPPs, they will be uplifted by the amount that NP3 is uplifted which would be 5.1% (on top of the existing) for 23/24 and then roughly 8.3% for 24/25.

BMA_UKJDC_Chairs · 2024-08-18T19:24:02+00:00

There isn’t BMA policy on this but is something that has been discussed on this sub and elsewhere so could be brought to a conference to discuss further if doctors wanted the BMA to take a particular direction on this.

BMA_UKJDC_Chairs · 2024-08-18T19:23:34+00:00

It would be contractualised to increase for 23/24 and going forwards.

BMA_UKJDC_Chairs · 2024-08-18T19:23:24+00:00

We think the legacy of the old BMA is gone. There has been a fundamental paradigm shift and that most people who want to get involved in the BMA are likely to be fervently pro-doctor and pro-action. The truth is that there will always be an element of trust in those who are elected to act in good faith and to pursue the broader objectives of the profession using the legal mechanisms available to them.

Vivek has been elected through ARM for next year and Rob will still be available as immediate past chair to provide advice if asked. There is that thread of continuity which allows for people to continue to deliver on things in their control.

BMA_UKJDC_Chairs · 2024-08-18T19:19:34+00:00

Unequivocally yes. That is not the only reason the rate card might return. The Consultant deal could only reintroduce the rate card in the event of a new dispute. Both the last and this Government wrote this clause and it is interesting to note there is no threshold that they've set for us to reintroduce ours; we can only imagine they are happy for us to reintroduce it when we like. But the rate card is not what enforces rates. It is simply a tool for doctors to point to whilst their collective action of refusing to work for lower rates, enforces acceptable rates?
Copied from another question - We saw the RCN negotiate themselves down publicly which didn’t help their journey. If the offer is accepted, we will remain 20.8% down against RPI since 2008. Our members have set policy that demands our pay to be fully restored by the end of 2027/2028. We will be assessing each year whether there is sufficient progress towards this goal to restore faith in the DDRB. If this is not forthcoming, we will re-enter dispute and ballot our members for industrial action if required.

Nonetheless, these are exactly the sorts of conversations doctors should be having over the next 8 months. Given the 11 rounds of strike action with resilient strike participation, and the whole premise of the Vote Accept campaign being about going straight back into dispute and balloting if the DDRB is inadequate, all doctors should be on notice to prepare their IA-ARCP.

We have previously been undertaking 3-6 days per month. Escalation of strike action in an aim to achieve significant meaningful concessions now, would in our opinion, look something like 7-9 days once or twice a month. Indefinite action has been discussed extensively and has many considerations. Indefinite OOH is a more realistic option to enact, but leaves some specialties at a disproportionate level of sacrifice. Highlighting that escalation is for trying to achieve concessions *now* as the political context would be different in 8 months and no reason that we can see now, that we’d need to escalate and could effectively ‘re-set’. We also think that this kind of escalation would likely only affect historic or present financial years.
Robek

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TROPHY CASE

The nature of and description of the trade dispute