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David Dalton letter

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Dear Sir David,

We are writing in response to your recent letter concerning the Government’s continued attempt to impose a contract that is overtly regressive and ultimately dangerous for the public.

We quite agree with your opinion that the Government’s message has become muddled as regards 7 day services. Not only has the government yet to define what is meant by 7 day services, but the use of 7 day service reforms to justify a poorly thought through junior doctor contract appears extremely ill advised, especially given that NHSP’s survey revealed only 6% of providers saw the existing contract as a major block to reform. It is also salient that emerging evidence demonstrates that the government’s 7 day reforms are not cost effective1.

There are undoubtedly already worsening systemic recruitment and retention problems in both primary and secondary care; notably the consequent rota gaps are already posing a significant patient safety risk as a result of excessively fatigued junior doctors. There is clear evidence that recruitment and retention was already deteriorating before the threatened contract imposition as demonstrated by the Foundation survey, while the dangerous rota gaps have been acknowledged by numerous professional bodies and NHS Providers.

Fundamentally the government’s proposed contract seeks to allow 7 day reforms to be provided on the cheap by redefining antisocial hours as plain time and nights as day. The increase in basic pay within an overall neutral pay envelope inevitably means that this new contract will see antisocial hours rewarded significantly less than under the current contract. Notably recruitment and retention is already worst in specialities with the most antisocial hours, and this is where this regressive undervaluing of antisocial hours will hit hardest, impacting negatively on the already brittle recruitment and retention situation, and thus threatening the safety of patients.

Fundamentally something has to give: either this ill-considered contract will be imposed resulting in a significant increase in dangerous rota gaps and avoidable patient harm, or the overall pay envelope must be expanded to reward this increased volume of antisocial hours and thus protect against this dangerous exacerbation of the recruitment and retention crises.

It is clear that if the Government wishes to expand services, it should fund this expansion properly and safely, as attempting to expand services without paying for it will lead to a workforce meltdown and it will make 7 day improvements totally unachievable and unsustainable,

Yours sincerely

1. Appleby J. A 7/7 NHS: what price equity? BMJ (Clinical research ed) 2016; 352.

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