The DDRB deal damages our profession, our rights, and our patients

Dr Oscar ToHeadshot barts crest

Staff writer


1975, the last time doctors went on strike.

1975, the last time the medical profession went on strike.

The recommendations by the Doctors and Dentists Remuneration Body (DDRB) have been accepted by the Department of Health in England. Having rejected several years of recommendations for modest pay increases, the first call for cuts has been taken in full. These wide ranging proposals have but one shared theme; a culling of pay and a loss of rights for doctors. But the proposals mean far more than a decline of our profession but a wholesale attack on patients and the idea of healthcare itself.

First of all, the medical profession is now effectively being treated with contempt over their working hours. Routine working hours are now to be reclassified from 7am to 10pm on Monday to Saturday, an increase of 50%. What qualifies as unsocial hours has been sharply reduced, decreasing the pay associated with working at these times. Not that this actually matters now, because in addition, banding supplements are to be terminated which means that pay will no longer even reflect the unsociable nature of hours involved.

These changes reflect the devolution of the medicine from a profession to a service. So long as the customer is seen, it is irrelevant what the worker is paid. Your hours do not matter because all we are there to do is provide the service and get on with it. The type of hours we commit to the job are no longer important; the pay reflects how the government views the hours of our lives: irrelevant.

A further affront is the loss of pay protection. Pay is no longer protected should you decide to switch speciality, or take time out to do reasonable things like a Master’s degree to improve your practice, or heaven forbid, start a family. Your pay is now only directly linked to the level of training you are at, with no reflection whatsoever of your clinical experience. We look at our seniors for advice because they have seen it before and they can make advanced decisions requiring significantly more depth of thought than we can even contemplate at our own stage. This allows senior doctors that switch specialities a much greater deal of confidence between teams, leading to better management and outcomes for patients.

By not allowing pay protection for academic interests such as postgraduate degrees, we also stop medicine from advancing itself. People will opt less for research that allows the progress of medicine as a science, or gain the skills such as teaching that ensure that the next generations of doctors will benefit from the last. The choice to have a family is also eroded, in spite of all the experience that relations give to our ability to understand not only ourselves but our patients.

To ignore our experience and place value only on the letters that define our role turns us into nothing more than rungs on a career ladder; we no longer choose to ensure the best care for our patients or the education of our colleagues, but instead gun to the top with far less experience than would otherwise be the case.

Salary supplementation for GPs is also evaporating, meaning that GP trainees will now be paid significantly less than hospital doctors. However this is to be mitigated by ‘flexible pay premia’ that allows specific specialties to be targeted such as general practice. Nonetheless, this is no guaranteed supplement, meaning the government can just as easily cull GP pay once the numbers are filled (not that this scenario is particularly likely). This is simply another tool for the government to maintain a blank cheque that it can cash in later by docking pay, similar to the situation with pensions.

These changes reflect a government that thinks it is increasingly powerful and able to whatever it likes. Healthcare is now simply a number to be reduced in the deficit, likely the only beneficiary of this deal, ignoring all the lives involved in the suffering of illness. Much like cuts to benefits, they have a real impact on people’s lives that are all but lost on a balance sheet. And these changes will have a similar impact on the morale of staff and the care of patients.

Doctors are once again expected simply to put up with changes. Indeed, one further change is the loss of ability for doctors to move to other countries until after 5 years of work. This cynical move ensures that we are bound as indentured slaves that cannot exercise any kind of freedom in our own lives. The kinds of rights the media so readily want us to reject for people outside our borders or to the most needy in our own society.

However, the government appears to have forgotten that they have a slight problem within their own borders: Scotland has rejected the recommendations in full. This is simply playing further into the hands of an SNP that can call out England as a corrupt state that protects only the 1% and strengthen the cause for independence. There will also no doubt be a spike in applications for Scottish training posts in the coming years.

The government needs to remember that great movements happen when the interests of many disparate groups find mutual interests. Angering a middle class profession and expecting us to sit still whilst cutting away at the fabric of society is no smart move. The BMA must realise that solidarity is the way forward. We must first ensure that no further negotiations happen separately for consultant and junior contracts as a condition for returning to the negotiating table. United we stand, divided we fall. Furthermore, we must start to work with other professions to form a united front against a government that is intent on destroying worker’s rights. We must work with other professions, such as our natural allies in nursing and further afield in unrelated fields such as teaching. The BMA must realise that we can no longer fight alone; we must work together for a better Britain.

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