1. Changes to Contracts, the DDRB, and how this impacts Psychiatry Trainees Dr Kelly Cruickshank. CT2 Psychiatry

2.  In 2012 the Government asked the BMA to look into negotiating a new contract for junior doctors. After 2 years of negotiating the offer from the Government was not acceptable and so the BMA decided to leave negotiations.  The Government asked an independent body (the DDRB) to undertake a review and provide recommendations for a new contract.  After the recommendations were released the Government asked the BMA to re-enter negotiations with the recommendations as the basis. The BMA could not agree to that and so the Government said they would impose a new contract from August 2016. What is the dispute about?

3.  The Government intends to impose a contract on junior doctors in England, from August 2016. The new contract is likely to be based on the recommendations from the DDRB (released in July 2015).  These broadly mean:  Plain-time extended to 7am-10pm Monday-Saturday  Higher rate of pay for 7am-10pm Sunday and 10pm-7am every day  The end of banding safeguards and banding payments  No effective replacement mechanism for preventing unsafe hours or for ensuring you are paid properly when shifts overrun  No payment for overtime, no financial incentive for employers to prevent your duties from overrunning, and no reassurance that it can work robustly to protect juniors from unsafe working conditions  The end of annual pay progression, with pay linked instead to stage of training  Replacing hours-based pay for non-resident on-call duty with a single 'allowance' to compensate you for being available What are the Government's plans for imposition of a contract?

4.  It is likely that the Government will impose the contract on all new junior doctors in August 2016 and all current junior doctors when they are due to sign a new contract (i.e. when they change employer or rotation).  There is also a possibility that they would 'fire and re- hire' trainees on a longer contract. Who will have the contract imposed on them?

5.  Over 99% of members surveyed about the DDRB recommendations of July 2015 said that they are not acceptable. On 13 August, the junior doctors committee decided not to re- enter negotiations with the Government.  The BMA wants to reach agreement on a new contract that protects patient safety and doctors' well being, but Government has confirmed that it will impose a new contract on doctors in training from August 2016.  On 26 September, BMA junior doctors voted to ballot for industrial action over imposed contracts. Despite the encouraging letter from the Secretary of State received on 8 October, questions still remain and The BMA still haven't received the concrete assurances we need to return to negotiations. Why don't we just negotiate a new contract?

6. These are the 22 pre- conditions that the BMA were told they must accept before any further negotiation could take place…… The only thing the NHSE would negotiate on was relocation expenses!?!

7.  They want to negotiate, but when they are told that there are 22 non-negotiable conditions to returning to contract discussions it’s not a negotiation!  The BMA want a fair and safe contract that protects doctors but also patients – it’s not safe for us to return to the days where we routinely worked 100 hours every week as juniors. We will make mistakes! What do the BMA want?

8.  The BMA wants the following concrete assurances in writing from the Government before we can agree to re- enter negotiations:  Proper recognition of unsocial hours as premium time  No disadvantage for those working unsocial hours compared to current system  No disadvantage for those working less than full time and taking parental leave compared to the current system  Pay for all work done  Proper hours safeguards protecting patients and their doctors What’s the BMA position at the moment?

9.  Ballots will be sent out in the next few weeks  The ballots will give members the option of voting to take industrial action and what type of industrial action  You must join the BMA by 23 rd October 2015 in order to be balloted What will happen with the ballot?

10.  At the moment, due to the legal requirements around balloting for industrial action the BMA can not discuss the exact specifics of what action would look like (it might open the BMA up to an injunction that would stop any action we voted for).  When we receive our ballots there will be detailed information about the possible types of action we could take (if we vote for it). What would industrial action look like?

11. YES!  All 11 Royal Colleges have stated that the proposed contracts will harm doctors and patients.  There has been cross party support from MPs.  There have been members of the public speaking out for us and attending our marches/demonstrations.  Hundreds of consultants have spoken out/signed letters in support of the juniors Do we have support?

12.  The aim of industrial action is to show how valuable junior doctors are – not to harm patients.  Junior doctors in NZ went on strike in 2006, during that time there was no change in rates of patient mortality/morbidity – action can be done safely! Will industrial action harm patients?

13.  Psychiatry is already massively undersubscribed…  In addition to the changes that will impact on all juniors e.g. increase in plain time, psychiatry juniors will also be hit in 2 other ways 1.The plan is to remove banding for non-resident on-calls and replace it with an “allowance” – almost every ST will be affected by this and a number of CTs too 2.The new contract will remove payment (to the junior) for things like MHA assessments – the trust will be paid but the junior will still be liable for any risk How does this specifically impact psychiatry trainees?

14.  Join the BMA – they are our legal voice in all of this  Write to your MP, get your family to write to their MPs  Sign the petitions available  Speak to colleagues, speak to other healthcare professionals, speak to the public  Make your voice heard when we are balloted  This is not just about our contracts, this is about the long term future of the NHS What can we do going forward?

15.  Johann’s response to the letter from Jeremy Hunt: https://youtu.be/xp6-jkaKiokhttps://youtu.be/xp6-jkaKiok  http://bma.org.uk/working-for-change/in-depth-junior-and-consultant- contract/ddrb-recommendations-analysis-for-juniors/10-reasons-for-not-reentering- 2015-junior-contract-negotiations http://bma.org.uk/working-for-change/in-depth-junior-and-consultant- contract/ddrb-recommendations-analysis-for-juniors/10-reasons-for-not-reentering- 2015-junior-contract-negotiations  http://bma.org.uk/working-for-change/in-depth-junior-and-consultant- contract/ddrb-recommendations-analysis-for-juniors/removal-of-vital-safeguards http://bma.org.uk/working-for-change/in-depth-junior-and-consultant- contract/ddrb-recommendations-analysis-for-juniors/removal-of-vital-safeguards  http://bma.org.uk/working-for-change/in-depth-junior-and-consultant- contract/ddrb-recommendations-analysis-for-juniors/premium-time http://bma.org.uk/working-for-change/in-depth-junior-and-consultant- contract/ddrb-recommendations-analysis-for-juniors/premium-time  http://bma.org.uk/working-for-change/in-depth-junior-and-consultant- contract/ddrb-recommendations-analysis-for-juniors/ia-infographics http://bma.org.uk/working-for-change/in-depth-junior-and-consultant- contract/ddrb-recommendations-analysis-for-juniors/ia-infographics Links