Junior doctors are willing to go on strike again if Jeremy Hunt doesn't listen to concerns they still have about the new contract, the recently elected chair of the British Medical Association's junior doctors committee has told BuzzFeed News.
Last month Ellen McCourt, an emergency medicine trainee based in Yorkshire and Humber, replaced Dr Johann Malawana as the BMA's chief representative for junior doctors, after Malawana resigned after 58% of its members voted to reject the revised contract he had backed.
Despite the result of the vote, health secretary Jeremy Hunt announced he will go ahead with imposing the changes anyway, from October, and sees no more room for negotiations.
"There is no consensus around a new contract and after [the doctors' recent vote to reject the contract] is not clear that any further discussions could create one," he said in July.
Asked whether doctors would be willing to strike again to oppose Hunt's latest imposition, McCourt said "junior doctors have said to us that they are willing to do what is necessary".
This could include talking or action, McCourt said, adding that junior doctors "are still prepared to take what steps they need to secure a contract that they feel is fair and sustainable".
Following her appointment as the spokesperson for junior doctors, the first thing McCourt did was to identify exactly what issues her colleagues still had with the government's proposed deal by issuing a detailed survey to BMA members.
"Doctors didn’t reject this contract because they were angry with the government or because they were angry with Jeremy Hunt," McCourt told us after going over the feedback she received. "They just didn’t believe [the contract was] sustainable or fair.
"Forcing a contract on to juniors that they don’t feel that they can have confidence in, that they don’t feel is safe, is just not a road ahead they can accept."
This year saw junior doctors stage industrial action on several occasions for the first time since 1975, including a withdrawal of emergency care.
McCourt's unanimous election was welcomed by junior doctors on social media, who switched their "#IStandWithJohann" hashtag for the even catchier "#ISupportMcCourt".
Dr Amar Mashru, one of a group of junior doctors challenging the contract in the high court told us he hoped "Ellen will be a nice, fresh, optimistic force in
the negotiations going forward".
Despite McCourt being appointed at a difficult moment for junior doctors, who generally still believe the contract to be unsafe for patients and unfair for doctors but fear public support for their cause could be waning, Mashru felt she had "already demonstrated a desire to re-energise and remotivate people".
As new junior doctors began their first year of training after medical school this week, reports circulated that many were being told they must work under the new conditions already.
According to new starter, @BHR_hospitals saying #juniordoctors must sign contract. Is this legal? #juniorcontract
But based on the feedback she received, "Doctors have specific problems with specific issues," McCourt said.
Weekend pay, she found, was still a key area of concern. The dispute over the junior doctors contract, which has been under review since 2012, flared up in the summer of 2015 after Hunt said he wanted more junior doctors to work at weekends to create a "truly 7-day NHS".
In order to do this without employing more doctors or investing more in the budget from which doctors are paid, alterations to the amount which doctors are paid at certain times of the day or the week were proposed. This means that pay at weekends would be more in line with that which a doctor receives during the week.
But many junior doctors, particularly in specialties such as emergency medicine, paediatrics and intensive care, have said they already work a substantial number of weekends and would see their overall pay reduced under the arrangement.
Some concessions were made during negotiations that have taken place between the government and the BMA this year, but following the survey McCourt found that doctors still don't feel they go far enough.
"For those who already work 1 in 2 weekends," McCourt said, "the new contract would mean getting paid less per hour than people who currently work fewer weekends."
During the last round of negotiations, a series of leaked WhatsApp messages between senior members of the BMA's junior doctors committee described Saturday pay as a "red line", and government rhetoric has characterised junior doctors' opposition to the contract as a pay dispute.
But, McCourt said, "It’s never been about getting a pay rise. It’s been about not
disincentivising certain groups of people from continuing their careers as doctors."
As well as people already working a high number of weekends, those who take longer to complete their training due to caring and parenting responsibilities – a disproportionate number of whom are women – could see their pay cut under the new contract.
A junior doctor moves through training grades over a period that typically lasts 10-15 years. Under the current contract, pay-rises are awarded in line with years of service, meaning if a doctor takes longer to progress through the stages, as a result of taking time out for maternity leave, for example, they do not see their pay suffer.
The new contract would offer pay rises only when training stages were completed instead, which many believe awards speed over expertise.
The current contract, McCourt told us, "acknowledges that even if you’re working at a slower pace, you still pick up skills as time progresses, and you become a better doctor year-on-year", something many of those who voted to reject the new contract believe should be reflected in a doctor's salary.
Under the new contract, she said, "it doesn’t matter how good you are at those early grades – it’s how quickly you can progress through them that’s reflected in your pay."
Doctors did acknowledge that some improvements had been made with regards to terms and conditions for those training less than full-time, after the government caused uproar when its own equality impact assessment of the contract admitted its disproportionate effect on women's salaries was a “proportionate means of achieving a legitimate aim”.
But, McCourt said, "It’s still not sufficient – for the people who have the financial outlays of being parents or carers, it can make a career in medicine seem financially unviable." This echoes the cry of parents who are doctors who told BuzzFeed News that they did not know how they would pay for childcare under the new contract and were considering leaving medicine altogether.
Junior doctors also remain concerned that the workforce is simply not big enough to increase the number of services provided at weekends, meaning the changes would stand to create even bigger gaps in their rotas than already exist.
"With or without the imposed contract, this is something that really needs to be made far more public so that changes can be made," said McCourt. "Maybe that means more doctors need to be trained and recruited, or distributed differently. Our wards have to be safe, our patients have to be safe, and that’s our primary concern."
A new "guardian" role, a consultant or specialist doctor to whom junior doctors can report concerns about rotas and patient safety, has already begun to be rolled out, but McCourt said junior doctors "don’t yet have faith" in its legitimacy.
"Because it’s been such a fast process, there’s been no time to really make sure that these people have been appointed properly; that they have time to do their role, that they really understand the role that they’re doing," she said.
McCourt told us that some guardians could be responsible for 200 junior doctors, while others might be the point of contact for as many as 2,000.
A lack of whistleblowing protections means doctors worry about the implications of reporting issues to their appointed guardians anyway. A loophole was recently exposed that showed Health Education England, the body responsible for training junior doctors, was exempt from the employment law that offers such legal protections for whistleblowers because it's not technically an employer.
"We’ve gone back to the government to say that this is something doctors need," McCourt said. "All other NHS workers have those protections that junior doctors don’t."
She said that it was vital that junior doctors were able to report safety concerns without feeling like they were putting their jobs at risk.
"They need to be able to say when the wards are not safe," she said, "and when their patients are not safe, and not have to decide whether they putting their patients ahead of their families."
Despite insisting that the government will go ahead with the introducing the new contract in October, Hunt has said he is "willing to discuss both the way the new contract is implemented, extra-contractual issues like training and rostering, and the contents of future contracts."
Having ascertained the issues junior doctors still have with the contract, McCourt is holding him to that promise. "I took the main concerns of junior doctors to Jeremy Hunt and said that these are the things that junior doctors need to have confidence in," she said.
Doctors now await Hunt's response and what happens next – whether that is a return to negotiations, something Hunt has indicated he is reluctant to do, or more strikes – will be based on that. "It really depends how the government reacts," McCourt said.
"When Jeremy Hunt said to us in parliament on the day of the imposition that his door was always open and he was prepared to talk to us, we’ve taken that opportunity, we’ve gone and talked to him and said ‘these are the things we’re still concerned about’.
"What we now need to find out is how genuine that offer was. He might be prepared to talk, but what we really need to know, is: Is he prepared to listen to us?"