BRITISH MEDICAL JOURNAL
819
2 OCTOBER 1976
staff willing to accept the necessary drop in salary in ordef to accept the doubtful privilege and the increased responsibility of a consultant appointment. Moreover, Europe is close at hand and even more doctors, both junior and senior, will be seen seeking a reasonable salary outside the United Kingdom. If the BMA really has the interests of hospital doctors in mind they must sink their differences with the Hospital Consultants and Specialists Association and Junior Hospital Doctors Association and combine with them in some realistic proposals to put before the Department of Health. Otherwise, in the long term the patients will be the greatest sufferers.
man of the highest integrity. However, the JHDA was complaining that they had been denied access to the literature which supported the HJSC's view that the Department of Health had altered their previous position. The documents to which I referred-that is, the reports of the Review Body, House of Commons Expenditure Committee, and the Price Waterhouse audit-were all obtainable through the normal official channels, including HMSO. There was no further information. It does seem extraordinary that the JHDA apparently do not know where to obtain information from."-ED, BM7.
have never before in medicine seen unrefuted accuracy (however unpopular or inconvenient) subjected for that reason alone to public ridicule and snobbish innuendo. I would be interested to know what the 17 signatories of the letter feel about the agreement announced in the BMJ (4 September, p 595) that in return for being paid without abatement while on leave (which all of them are) some doctors will be willing without additional remuneration to cover the extra work occasioned by the predictable absence of colleagues on leave and study leave. This was not my understanding of their local representatives' wishes. N H N MILLS
BARBARA CLAY PATRICK DONNELLY
SIR,-I write in reply to the letter of Mr K J J Tayton and his colleagues (1 1 September, p 646). Since February 1976, when we first realised the existence of differing opinions as to the exact implications of the new contract, my colleagues and I have informed the junior doctors' representatives on our Appeals Committee, to which all matters of dispute have been referred as they arose, of the details of our view of the contract. Contrary to the statement of Mr Tayton and his colleagues, these representatives have understood quite clearly our view even though they did not accept that it is what their negotiators had concluded with the DHSS. We have made written appeals to the Welsh Office (February and June 1976) as well as many telephone calls in order to obtain a ruling on the accuracy of our interpretation. Individual copies of the second letter were sent to all junior hospital practitioners in Gwent, and the Welsh Office replies, which on each occasion endorsed our view, were always passed to the Appeals Committee. The circular of 12 July exactly matched our policy. There has thus never been any doubt in our minds that the content of the implementation circulars must differ from the understanding held by the Hospital Junior Staffs Committee, which Dr D F H Gueret Wardle sets out (21 August, p 480). As I submitted an article to you including the evidence which showed why we held our opinion I am at a loss to understand why you declined to publish this carefully reasoned account, yet accept a letter consisting only of clearly unjustified personal abuse. As you know, I have never claimed alone to understand the contract nor to have done so "with ease." No health authority seeks to judge the rights of the juniors' case (Dr D Hall, 28 August, p 532), but my authority can claim that its interpretation of the circulars is exactly matched by central guidance, the basis on which NHS terms and conditions of service are administered. I concluded my unpublished article, "I cannot end without paying tribute . . . to the consultant and junior doctor members of our Appeals Committee who have striven patiently and repeatedly with us not only to understand the contract but to implement it honourably: and not least to the overwhelming majority of junior doctors in our area who have shown exemplary restraint and willingness to be guided by their chosen representatives during a difficult time in which it now appears obvious that the prudent employing authorities have been punished and the rash rewarded." Your readers must judge whose contribution more nearly approaches the standards of presentation they wish to see in submissions to a professional journal. The letter from Mr Tayton and his colleagues may be unique: I
Ebbw Vale, Gwent
Princess Margaret Hospital,
Swindon
***The history of the BMA's attempts to "sink their differences with the HCSA" and the lack of response from that organisation was set out in a joint memorandum a few months ago (3 April, p 850)-ED, BMJ. Juniors' contract dispute SIR,-In your report on the Hospital Junior Staffs Committee meeting held on 11 September (18 September, p 712) you quote Dr I McKim Thompson as saying that "the Junior Hospital Doctors Association retained a professional adviser, who had been present at meetings with the Review Body, the House of Commons Expenditure Committee, and with Price Waterhouse at the time of the independent audit on EDAs. The JHDA was now saying that it had been denied all this access." As the professional adviser concerned I confirm that I did indeed take part in BMA meetings with the independent auditors, the DHSS, the independent Review Body, and the Commons Select Committee on Expenditure (whose minutes have of course already been published). I was as well given access to certain BMA documents relating to the new contract. I was therefore in a position to advise the JHDA on the substance of any discussions or agreements reached between any of the parties at the time. However, Dr McKim Thompson will recall the agreement between the BMA and the JHDA, with my concurrence, that I would treat as confidential any information I was to gain during those meetings. He will have observed that at Iio time during the most recent (para 204) dispute did I make any public statements that referred to any information I gained at that time, and neither indeed did the JHDA make any statements that claimed to rely on information I had given them as a result of my participation in those meetings. The conclusion that Dr McKim Thompson would do well to draw is that I did not divulge such information. I would like you, sir, to give Dr McKim Thompson the opportunity to confirm that he was not implying that I had broken any agreement to maintain confidentiality, nor that he is releasing me from any obligation to maintain that confidentiality. PETER MARTIN Richmond, Surrey
***Dr McKim Thompson writes: "I am in no doubt whatsoever that Mr Peter Martin is a
Medical manpower and hospital staffing SIR,-May I be permitted to point out how Dr D J Bell (4 September, p 589) has carefully avoided commenting on the crucial point raised in my letter (31 July, p 304) and has instead raised a number of controversial matters and has succeeded in clouding over a perfectly straightforward issue. In my original letter I tried to make the point that any staffing exercise based on a contradictory and false premise is doomed to failure. I submit that the first Progress Report of 1969 and its safeguards contained just such a contradiction because on the one hand it recommended that trainee and career posts were to be balanced, while banning a permanent subconsultant grade, and on the other hand it assured us that consultant work and standards were to remain unchanged. It is my considered opinion that this is an impossible hypothesis to reconcile in practice and that if consultant work and standards are to remain unaltered then the only way one can balance the training and career grades is to accept a subconsultant grade. This is a simple statement of fact and if Dr Bell disagrees with me I would expect him to show exactly why. It may well be necessary in the future to modify one or both of these statements, but at this stage it seems rather pointless to be drawn into a debate on the pros and cons of the subconsultant grade before correcting the basic contradiction that currently exists. Thus for the past seven years we have been attempting to reconcile the irreconcilable, and the sooner this mistake is admitted and rectified the sooner we shall be able to untangle the current chaos. G I B DA COSTA Shotley Bridge General Hospital,
Consett, Co Durham
Industrial action
SIR,-There has been much support for Dr Mary J O'Sullivan's well-written plea for sanity (28 August, p 532). It is comforting to know that in a materialistic and cynical world professional ideals still flourish. I agree with her criticisms, I acknowledge the duties and privileges, and I certainly share her shame; but I must take issue with her apparent acceptance of continuing injustice and her surely forlorn hope of spontaneous improvement. Any government that is able to create the illusion that it is providing a comprehensive health service will never raise its sights. One must expect an increasingly frustrated profession, greater emigration, a continuing drop
819
2 OCTOBER 1976
staff willing to accept the necessary drop in salary in ordef to accept the doubtful privilege and the increased responsibility of a consultant appointment. Moreover, Europe is close at hand and even more doctors, both junior and senior, will be seen seeking a reasonable salary outside the United Kingdom. If the BMA really has the interests of hospital doctors in mind they must sink their differences with the Hospital Consultants and Specialists Association and Junior Hospital Doctors Association and combine with them in some realistic proposals to put before the Department of Health. Otherwise, in the long term the patients will be the greatest sufferers.
man of the highest integrity. However, the JHDA was complaining that they had been denied access to the literature which supported the HJSC's view that the Department of Health had altered their previous position. The documents to which I referred-that is, the reports of the Review Body, House of Commons Expenditure Committee, and the Price Waterhouse audit-were all obtainable through the normal official channels, including HMSO. There was no further information. It does seem extraordinary that the JHDA apparently do not know where to obtain information from."-ED, BM7.
have never before in medicine seen unrefuted accuracy (however unpopular or inconvenient) subjected for that reason alone to public ridicule and snobbish innuendo. I would be interested to know what the 17 signatories of the letter feel about the agreement announced in the BMJ (4 September, p 595) that in return for being paid without abatement while on leave (which all of them are) some doctors will be willing without additional remuneration to cover the extra work occasioned by the predictable absence of colleagues on leave and study leave. This was not my understanding of their local representatives' wishes. N H N MILLS
BARBARA CLAY PATRICK DONNELLY
SIR,-I write in reply to the letter of Mr K J J Tayton and his colleagues (1 1 September, p 646). Since February 1976, when we first realised the existence of differing opinions as to the exact implications of the new contract, my colleagues and I have informed the junior doctors' representatives on our Appeals Committee, to which all matters of dispute have been referred as they arose, of the details of our view of the contract. Contrary to the statement of Mr Tayton and his colleagues, these representatives have understood quite clearly our view even though they did not accept that it is what their negotiators had concluded with the DHSS. We have made written appeals to the Welsh Office (February and June 1976) as well as many telephone calls in order to obtain a ruling on the accuracy of our interpretation. Individual copies of the second letter were sent to all junior hospital practitioners in Gwent, and the Welsh Office replies, which on each occasion endorsed our view, were always passed to the Appeals Committee. The circular of 12 July exactly matched our policy. There has thus never been any doubt in our minds that the content of the implementation circulars must differ from the understanding held by the Hospital Junior Staffs Committee, which Dr D F H Gueret Wardle sets out (21 August, p 480). As I submitted an article to you including the evidence which showed why we held our opinion I am at a loss to understand why you declined to publish this carefully reasoned account, yet accept a letter consisting only of clearly unjustified personal abuse. As you know, I have never claimed alone to understand the contract nor to have done so "with ease." No health authority seeks to judge the rights of the juniors' case (Dr D Hall, 28 August, p 532), but my authority can claim that its interpretation of the circulars is exactly matched by central guidance, the basis on which NHS terms and conditions of service are administered. I concluded my unpublished article, "I cannot end without paying tribute . . . to the consultant and junior doctor members of our Appeals Committee who have striven patiently and repeatedly with us not only to understand the contract but to implement it honourably: and not least to the overwhelming majority of junior doctors in our area who have shown exemplary restraint and willingness to be guided by their chosen representatives during a difficult time in which it now appears obvious that the prudent employing authorities have been punished and the rash rewarded." Your readers must judge whose contribution more nearly approaches the standards of presentation they wish to see in submissions to a professional journal. The letter from Mr Tayton and his colleagues may be unique: I
Ebbw Vale, Gwent
Princess Margaret Hospital,
Swindon
***The history of the BMA's attempts to "sink their differences with the HCSA" and the lack of response from that organisation was set out in a joint memorandum a few months ago (3 April, p 850)-ED, BMJ. Juniors' contract dispute SIR,-In your report on the Hospital Junior Staffs Committee meeting held on 11 September (18 September, p 712) you quote Dr I McKim Thompson as saying that "the Junior Hospital Doctors Association retained a professional adviser, who had been present at meetings with the Review Body, the House of Commons Expenditure Committee, and with Price Waterhouse at the time of the independent audit on EDAs. The JHDA was now saying that it had been denied all this access." As the professional adviser concerned I confirm that I did indeed take part in BMA meetings with the independent auditors, the DHSS, the independent Review Body, and the Commons Select Committee on Expenditure (whose minutes have of course already been published). I was as well given access to certain BMA documents relating to the new contract. I was therefore in a position to advise the JHDA on the substance of any discussions or agreements reached between any of the parties at the time. However, Dr McKim Thompson will recall the agreement between the BMA and the JHDA, with my concurrence, that I would treat as confidential any information I was to gain during those meetings. He will have observed that at Iio time during the most recent (para 204) dispute did I make any public statements that referred to any information I gained at that time, and neither indeed did the JHDA make any statements that claimed to rely on information I had given them as a result of my participation in those meetings. The conclusion that Dr McKim Thompson would do well to draw is that I did not divulge such information. I would like you, sir, to give Dr McKim Thompson the opportunity to confirm that he was not implying that I had broken any agreement to maintain confidentiality, nor that he is releasing me from any obligation to maintain that confidentiality. PETER MARTIN Richmond, Surrey
***Dr McKim Thompson writes: "I am in no doubt whatsoever that Mr Peter Martin is a
Medical manpower and hospital staffing SIR,-May I be permitted to point out how Dr D J Bell (4 September, p 589) has carefully avoided commenting on the crucial point raised in my letter (31 July, p 304) and has instead raised a number of controversial matters and has succeeded in clouding over a perfectly straightforward issue. In my original letter I tried to make the point that any staffing exercise based on a contradictory and false premise is doomed to failure. I submit that the first Progress Report of 1969 and its safeguards contained just such a contradiction because on the one hand it recommended that trainee and career posts were to be balanced, while banning a permanent subconsultant grade, and on the other hand it assured us that consultant work and standards were to remain unchanged. It is my considered opinion that this is an impossible hypothesis to reconcile in practice and that if consultant work and standards are to remain unaltered then the only way one can balance the training and career grades is to accept a subconsultant grade. This is a simple statement of fact and if Dr Bell disagrees with me I would expect him to show exactly why. It may well be necessary in the future to modify one or both of these statements, but at this stage it seems rather pointless to be drawn into a debate on the pros and cons of the subconsultant grade before correcting the basic contradiction that currently exists. Thus for the past seven years we have been attempting to reconcile the irreconcilable, and the sooner this mistake is admitted and rectified the sooner we shall be able to untangle the current chaos. G I B DA COSTA Shotley Bridge General Hospital,
Consett, Co Durham
Industrial action
SIR,-There has been much support for Dr Mary J O'Sullivan's well-written plea for sanity (28 August, p 532). It is comforting to know that in a materialistic and cynical world professional ideals still flourish. I agree with her criticisms, I acknowledge the duties and privileges, and I certainly share her shame; but I must take issue with her apparent acceptance of continuing injustice and her surely forlorn hope of spontaneous improvement. Any government that is able to create the illusion that it is providing a comprehensive health service will never raise its sights. One must expect an increasingly frustrated profession, greater emigration, a continuing drop
