Today marks the first in a trio of planned union action by Junior Doctors over changes to their contractual terms and conditions. It is the first large-scale instance of strike action by medics since 1975 and will affect thousands of patients as routine services and appointments are cancelled, with care restricted only to emergency services.

The media has reported on the crisis at length with experts and opinion being published from both sides of the picket line.

So what is this argument all about?

The Government’s position is that a new type of contract for Junior Doctors is necessary in order to modernise the medics’ contract and facilitate the creation of a fully operational seven-days-a-week NHS service. The proposals include changes to the working hours and remuneration which will likely result in Juniors working more frequent weekends, which, under the existing contract, they would normally have been paid extra for. Other issues involve the removal of existing safeguards to ensure doctors are not overworked with excessive hours which medics say could compromise patient safety and alterations to the system of guaranteed pay-rises to reflect qualification experience.

Initially, observers can be somewhat bewildered about an industrial dispute over a pay rise for what is already a relatively well-paid, yet highly-skilled, profession.  However, amidst an epidemic of statistics and speculation, there are several key concerns voiced by the doctors affected. 

While Mr Hunt takes the view that the changes will, in fact, involve an 11% pay rise, the doctors are anxious to stress that they already work weekends on a regular basis but this new arrangement would mean they may be scheduled to work weekends more frequently while only receiving the basic rate of pay. The BMA’s position is that doctors will lose their entitlement to their current premium rate payments and be required to work longer shifts which will have a detrimental effect not only on their wallets, but also their health. The medics argue that the changes will lead to overworked, tired staff which leads to mistakes that may compromise patient safety.

Further, the BMA suggests that restructuring the remuneration system will adversely impact the recruitment of medics as it may penalise those who wish to take time out for study/research or to retrain in another specialty. The proposal also raises an interesting question as to whether it potentially discriminates against any doctor who takes time out, whether for family care reasons or due to sickness because of the effect that may have on their career progression as well as the financial impact.

What now?

Last week, Mr Hunt explained that 15 of the 16 issues put forward by the union had been resolved, with the exception of weekend pay. However, this latest series of talks with ACAS was not enough to prevent today’s strike. It would appear that both sides remain entrenched in their conflicting positions, with each side stating that their respective views have patients’ best interests at heart. Unfortunately for patients, there are no immediate signs of a resolution. With winter now firmly upon us, the urgency for a resolution through focused mediation has become critical to avoid further strikes.

Lessons for Employers?

It is easy for businesses to assume this is simply an isolated public sector concern affecting only the health service. However, the vital principles of changing terms and conditions remain apply to all businesses of any size and sector. Revision of employees’ terms and conditions is regularly the underlying cause of industrial action. Employers can lawfully introduce changes using the following mechanisms:

  1. by express agreement between the parties
  2. a union agreement which is binding on the employees
  3. an agreement which is implied through the conduct of employees
  4. via termination of the existing contract and re-employing staff under a new contract

Communication and consultation are key. Neglecting the consultation process when negotiating revisions to terms and conditions can lead to claims for unfair dismissal and expensive protective awards. No amount of medication can heal the headache of industrial action – just ask Mr Hunt! Businesses must tread carefully when carrying out a precise consultation operation. Think ‘scalpel’ rather than ‘sledge-hammer’. Rushing the process or skipping the necessary steps are common causes of costly claims which can prove fatal to an employer’s business.