Like many of my Junior Doctor counterparts, I've been getting very involved in the debate surrounding the Junior Doctor contract changes the Conservative Government are trying to enforce on Junior Doctors. If you haven't been following the discussion it has gone something like this:
Government: We are changing your contract. You can choose the colour of the paper we print it on.
British Medical Association (BMA): These proposals are ludicrous. And unsafe. People will die.
Government: We didn't ask for your opinion. Are you gonna sign or what?
BMA: Erm... we're not...
(Meeting ends)
The problem is that the press are reacting a lot like Newton's cradle in the way they're reporting. The claims vary: the government claims that the changes are not to do with cost and will not endanger the medical profession or patient safety. The BMA claims that the government are misrepresenting the 24/7 nature of the NHS and that the protections to prevent doctors working when tired are being compromised.
One of the areas that doesn't seem to have been specifically addressed is the claim that there will be no financial impact of the contract. I think as doctors we want everyone to realise that the money is obviously less important than patient safety. Of course that is true. The reason I mention the money now is just to make the following obvious: if you can be dishonest about money, you can be dishonest about anything.
So here is the maths behind what the contract would mean financially for me personally. Yes, it's taboo to talk about money. But some things are more important than social taboo.
The Hours:
My timetable for acute medicine this year finds me doing 846.5 hours over 18 weeks.
That's an average of 47 hours, which is within the normal contract.
It includes 21 nights (21:30-9:00) and 6 weekends.
Current Contract:
At the moment my pay over the year is £28076*;
This is divided over three different jobs = £28076/3 = £9333 per 4 months.
BUT my different jobs require me to work different amounts. For example, at the moment I'm on a General Practice placement which has no anti-social hours (more on anti-social hours later). I work a maximum of 40 hours a week on this job, no nights and no weekends.
On my acute medicine job, I have significant anti-social hours. I'm compensated for this by banding. Under the current contract, I get 50% extra pay because I work challenging hours.
For this 4 months that makes my pay: £9333 x 1.5 = £14000
£14000 pay / 846.5 hours of work = £16.54/hr
Proposals from the new contract:
The new contract is slightly harder to work out.
Firstly, there's a change in definition of unsociable hours.
Under the new contract the following are "social" hours:
7am - 10pm Monday - Saturday
Therefore, my 9:00 - 21:30 shift on Saturday no longer constitutes anti-social hours.
New Contract, current timetable:
Having scoured my timetable, I've found that I have 229.5 hours that Jeremy Hunt would consider "anti-social".
The idea has been that my base pay would be increased by 15% under the new contract:
£9333 x 1.15 = £10732.95
10732.95 / 846.5 hours = £12.68
Anti-social hours are, under the new contract, supposed to be paid at a surplus of 50%.
£12.68 x 1.5 = £19.02 / anti-social hour
846.5 - 229.5 = 617 'social' hours
617 x £12.68 = £7823.56
229.5 x £19.02 = £4365.09
Total = £12188.65
Cost-neutral?:
(Current contract total for 4 months) £14000 (£16.50/hr)
(Old contract total for 4 months) - £12188.65 (£14.40/hr)
Total £1811.35
I have two of these 50% banded shifts this year meaning that doubling the above gives me the reduction in my pay for the year:
£3622.70
However, aren't the government going to increase my pay even in my 'social' jobs - let's take that into account: £9333 (current) and 10732.95 (new)= £1399.95
£3622.70 - £1399.95 = £2222.75
So the government's 'cost neutral' plan will certainly NOT be 'cost neutral' for me. It will cost me around £185.23 / month. However, it will actually give me a different spread of my pay so when I am working least, I will be earning more than I currently earn. It's only my jobs when I'm on the harder shift patterns that I will lose out.
That's no 15% increase in pay, that's a 5% decrease in pay if the hours stay as they are. The only way the government could pay me a 'cost neutral' amount would be to increase my hours, and the people who would pay for that would be the patients.
It is distressing to see this all in figures and see the reality that the people who are hardest hit by this will be the people in specialties where they work the most truly anti-social hours.
If you have any questions/thoughts/opinions on the above leave a comment below.
*Calculations based on an FY2 salary
