At Last weeks Emergency Services Collaborative meeting in London I asked
John heyworth to put the contract question to prof Alberti.
There is likely to be further refinement of the new contract if accepted to
acknowleldge the unique nature of Emergency Department consultants-ie.
recognition they have implemented flexible working patterns -they have case
load of emergencies-they are interested in emergencies in contrast to almost
all other specialties
>From: Steve Meek <[log in to unmask]>
>Reply-To: Accident and Emergency Academic List <[log in to unmask]>
>To: [log in to unmask]
>Subject: Re: Consultant contract
>Date: Wed, 17 Sep 2003 13:52:17 -0700
>
>I shall also vote no.
>As Andres says, managers and thus also the politicians will control us via
>threat of witholding pay progression, making us prioritise according to
>targets rather than clinical need.
>There are 'specialty specific' reasons I won't vote for it and I'd like the
>views of others on this.
>Like many other places, We in North Bristol do weekday late and weekend
>shifts, rewarding ourselves with compensatory days off - not
>overgenerously, around time and 1/2. We have developed the rota and
>managers have concurred (though taken little interest). Why would I want to
>sign a contract that reduces this to time and a third? The weekends are
>punishingly hard. It doesnt take a great leap of imagination to see the
>situation where failure to slog through the minors relentlessly enough
>leads to a ticking off and failure to meet one's target and so no pay
>progression.
>What do those others who work shifts think?
>I really cant see any advantage for us or patients in this contract. I fear
>that there will in fact be a yes vote, as some are simply resigned to it,
>and others feel they have made their principled stand and now want to just
>take the money and have a quiet run up to retirement.
>I'm not sure about industrial action. We are still seen by even the
>broadsheets as greedy, lazy fat cats who obstruct modernisation, sadly,
>though virtually every new idea the government has come up with in
>emergency care was given to them by consultants. Until public opinion has
>been swayed (God knows how, with the BMA as our trusty sword), industrial
>action would be disastrous.
>Steve Meek
>Frenchay
>
>"Andres I. Martin" <[log in to unmask]> wrote:
>Hi, sorry to bring politics back to this forum but the BMA has not give us
>much time, we need to think fast.
>
>I just enclose a copy of an e-mail posted in the BMA contract forum by
>someboby signing as AATHOW. It deals with a few interesting points:
>
>
>
>BMA SPIN DOCTORS
>Not content with avoiding ?renegotiations? with John Reid because he did
>not like it and agreeing his ?tweaks? to the 2002 Framework in a few July
>days, our negotiators are now trying to portray this deal in the best
>possible light.
>
>It is a betrayal of the aspirations of the consultant body as expressed at
>the 21st May LNC representatives meeting, who stood firm against local
>deals and wanted a good new national contract.
>
>In the New 2003 National Consultant Contract for England - a Summary by the
>BMA?s Consultants and Specialists Committee CCSC September 2003 on the BMA
>website, Key New Features are put forward as part of an ?improved offer?.
>
>KEY NEW FEATURES
>
>* - ?There is a clear full time commitment of 40 hours per week ( or less
>if some work is in premium time) - any additional work must be by agreement
>and paid for.?
>
>Our present contract is based on a 35 hour week.
>The guidance issued on the BMA?s CD-ROM states in the section on How to
>review yourworking hours (Hospital Doctor 15 May Page 2) * ?Make a claim.
>You can then either make a claim for extra notional half days to have this
>extra work paid for, or seek to agree with the trust a reduction in
>workload down the minimum commitment of ten notional half days (35 hours) a
>week.?
>
>How is increasing our basic working week by 5 hours a step forward.?
>Radiographers do a 35 hour week. Other NHS staff a 37 hour week.
>
>
>
>* - ?any additional work must be by agreement or paid for?
>Is not that what trade unions are for? Most other unions achieved this
>principle in the last century.
>The BMA argue that consultants work many unpaid extra hours. Why is this?
>It is because up to this May there was no determination by the BMA to make
>sure our present contract was honoured.
>Acceding to a longer working is sheer capitulation. What is to stop it
>happening again ? Presumably the BMA is relying on management. A dubious
>hope !
>
>
>
>
>* - ?No discrimination between new and existing consultants?.
>
>In last year framework, established consultants were only to be asked to do
>7 programmed activities( PA)s of direct patient care, and new consultants
>8.
>On the present contract, there are only 5 to 7 fixed sessions and the BMA
>advice was strongly against agreeing to more than 7. This horrible
>compromise whereby everyone would have to do 7.5 patient contact PA is
>being dressed up as non-discriminatory. !
>The fact is that 7.5 patient contact sessions is alot more work, not
>withstanding all the claims that you can write your letters and attend MDMs
>in this time.
>
>
>
>* - ?Job plans drawn up by agreement, with a clear appeals mechanism?
>
>
>This is dangerously misleading.
>In the new nhs contract (england) September 2003 Para 7.1 it states ? You
>and your clinical manager will seek to reach agreement in the scheduling of
>all activities. We will not schedule non-emergency work during premium time
>without your agreement?
>So there is an explicit agreement about Out of Hours work, but not one for
>basic hours. The strong implication is that non-emergency work during basic
>hours can be scheduled without your agreement. Sure the manager will seek
>to reach agreement with you, but say they do not? After all, the trust has
>to move over to 7am to 7 pm working.
>When your next appraisal/job plan review comes up, the matter would be
>raised again. If you still did not cooperate, you could forfeit the next
>pay increment as ?performance at job plan review informs pay progression?.
>Also in order to achieve pay progression you would have to show that you
>had ?worked towards any changes identified as being necessary to support
>achievement of the organisation?s SERVICE OBJECTIVES in the last job plan
>review?. (F/work P24). As pointed out by a leading member of CCSC in July
>2002, ? However, the 3 month maximum wait will soon be upon us as a
>priority target and will be written into job plan objectives...... The
>Trust will.... refuse to pay porgression because you have some 3+ month
>waiters? ( Paul Miller as quoted 22.7.03 on doctors net ?Please think
>carefully about this deal? )
>
>PERFORMANCE RELATED PAY IS THE FIRST MECHANISM BY WHICH MANAGEMENT WOULD
>ENFORCE ?AGREEMENT?.
>In the new contract, pay increments from the date of appointment would no
>longer be automatic but performance related. The BMA Summary does not make
>this clear.
>
>What could the consultant do.? Appeal to the Medical Director. Then go
>through the appeals procedure which is said to be ?robust?. It consists of
>three people, the Chairman nominated by the employer, one representing the
>consultant and one from a list approved by the BMA/BDA with the Strategic
>Health Authority. The latter could be replaced at the consultant?s request.
>However, THE TRUST RETAINS THE RIGHT TO MAKE THE FINAL DECISION? (Heads of
>Agreement July 17th 2003) This fact is not mentioned in the BMA?sSummary.
>It simply states ?The panel makes a recommendation to the board of the
>employing organisation.?
>
>The Summary calls the proposed new appeals mechanism, ?clear?. Well Yes, it
>is very clear. Management decides.
>
>
>What is described here is an UNPRECEDENTED DEGREE OF MANAGEMENT CONTROL.
>Management will dictate to us using the threat of withholding pay
>increments and wielding the whip hand with appeals. This is true, despite
>the hopeful statement in the Heads of Agreement July 17th,? The new
>arrangements are emphatically not intended to diminish professionalism or
>override clinical judgement.? Whatever the intentions, they will, of course
>do just that, diminish professionalism and override clinical judgement.
>Targets will rule the day.
>
>Ian Bogle warned of this at the 2003 ARM. He said ?The suffocation of
>professional responsibility by target-setting and production line values
>that leave little room for professional judgement of individual doctors or
>the needs of patients ?...... ?It will turn professionals into bean
>counters answerable not their patients but to politicians, auditors,
>commissioners and managers under pressure to deliver on edicts, priorities
>and targets emanating from Richmond House.?
>
>
>* - ?the job plan will define the resources needed to deliver agreed
>objectives?.
>
>Well it may define the resources. We can do that now. But there is no
>guaruntee there will be the resources. Just try and get more secretarial
>support, or more junior staff.
>
>
>* - ?a greater proportion of the week, and all of the weekend, attracts
>premium rates?.
>
>This is spin for YOU WILL NO LONGER HAVE A 9AM TO 5PM WORKING DAY
>and YOU WILL RECEIVE BASIC PAY IN UNSOCIAL HOURS 7am to 9 am and 5pm to 7
>pm as there will be a system whereby basic rates are paid between 7am to 7
>pm Monday to Friday, in which the trust will run shifts.
>
>Changing the start and finish time of the trusts normal working day to 7 am
>to 7 pm, would cause a huge deterioration in the quality of doctors working
>and family lives. Having done years of one-in- two and one- in- three
>rotas, are we seriously being asked to get up at 6 am in the morning to go
>to work, and to contemplate a 3 pm to 7 pm shift, for basic pay?
>
>One of the aims of the Framework 2002 was to ? to support more rational
>planning of extra activity, for instance to help meet performance targets
>for waiting. The aim should be to allow, wherever possible, for extra
>consultant activity to be arranged on a planned basis and at normal
>sessional rates, in preference to the ad hoc arrangements and premium
>payments made for some current initiatives.? (Framework 2002 Page 13 Para
>6) That sentiment still exists. So if you do an evening clinic from 5 to 9
>pm, the first 2 hours are paid at basic rates, and only the second 2 hours
>attracts time and a third treatment. Waiting list initiative lists, at
>£500, would go.
>
>Premium rates? You can hardly call time and a third, a premium rate. An NHS
>pysiotherapist working in the hospital on Saturday, is paid time and a
>half.
>
>
>* - ?Additional 2 days annual leave per annum ( after 7 years in post )?
>Big deal.
>
>We are supposed to applaud these ?key new features? as being so much better
>than the June 2002 Framework. It just shows how aweful that was, that
>anybody could boast of these ?key new features?.
>
>THE NEW PROPOSED CONTRACT IS COMPLETERLY UNACCEPTABLE. We should vote NO.
>
>Our leaders are so timid. They say ? If a ?No? vote: * Highly likely that
>the Department of Health would go for local implementation * very unlikely
>to be any further talks nationally; * only realistic chance of achieving an
>alternative offer would be a sustained confrontation, including industrial
>action.?
>
>Have they chosen to forget the 21st May conference of LNC representatives?
>What are they afraid of?
>We just say No and stick to the present contract and stay national as we
>did in May and June. We make the present contract work for us until such
>time as we get a leadership which will forward a decent claim on our
>behalf. Not just accept the DoH?s framework or tweak of a framework.
>( NB The Welsh deal IS based on 9 to 5pm day. see Para 3.8 )
>
>AATHOW
>
>
>
>I do not agree with all the points raised in this e-mail, but I think is a
>good starting point for a discussion in the list. Remember we got very few
>days to decide something that is going to be with us for the rest of our
>working life.
>
>
>Andres
>
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