BRITISH MEDICAL JOURNAL
532
annually? The difference, for me. will mean the loss of £2900 gross before April 1979. Consultants of less than two or more than eight years' seniority will lose nothing in this way and there is no reason to doubt that frozen awards for merit will become payable immediately. BMA officials and spokesmen, in their pious pronouncements about those who pay no subscription but gain from the benefits of the negotiators' efforts, should be reminded that there are those who have not benefited and who have accordingly stopped subscribing. Many people in my situation feel that the BMA is an inept organisation fighting inadequately for family doctors and private practice and prepared to see fully trained specialists insulted with lower remuneration than their own juniors. I look forward to applying to rejoin the BMA when my salary is increased as sharply as the BMA subscription. ROBERT WOOD Abernethy, Perthshire * **The Secretary writes: "The answer to Dr Wood's question is to be found in paragraph 20 of the White Paper 'The Attack on Inflation; the Second Year.' The force behind the answer is an Order in Council under the Remuneration Charges and Grants Act 1975 which allows this breach of contract to continue until the incremental date of the consultant concerned. The representations of the BMA have secured that at least at that date normality is restored and the incremental scale (above an arbitrary ceiling) is not frozen for another year."-ED, BMJ.
Juniors' contract dispute SIR,-With reference to Mr N H N Mill's letter (14 August, p 424) may I respectfully submit that he, like so many others, does not understand the nature of the junior doctors' claim for regular "overtime payments" ? Once and for all let the facts speak for themselves. It was agreed between the BMA, DHSS, and Department of Employment on the basis of information gleaned from approximately 250 adequately completed and returned questionnaires from among 20 000 sent to junior hospital doctors in early 1975 that, in terms of hours worked per week in excess of 40-that is, so-called "overtime"-approximately 60",, were spent on call, waiting for work, sleeping, eating, etc, and the remaining 40", actually working. Herein lies mistake No 1 on behalf of the DHSS-they mistakenly believed that 60, of "overtime" payments would be at B rate and 40,, at A rate. This is not so, may I add. The arithmetic is simple: £C12 100 000 (cost per year of EDAs) £605 per doctor 20 000 doctors available for =
payment as overtime
Now for 40 hours overtime the cost of 100)) at A rate (300)) is almost twice the cost of 60)) at B rate (10%) plus 40(o at A rate (3000). This is why the annual estimate for the cost of overtime payments is now in excess of £C28m and also why the average increase in salary is of the order of £1000-1200 pa, plus the fact that eveSyone is now claiming his entitlement to overtime. Mistake No 2 is this: as agreed nationally the cost of 1 UMT/year is determined and fixed by base rate salary and by 300% and 1000
28 AUGUST 1976
What madness has come to pass in my of hourly rates of pay. The rates of 30)( and 10"(, were calculated knowing the money profession which makes it seem entirely natural for its younger members to demean available and hours worked-that is: Money available yr =£ UMT yr= £ UMT,52 wks themselves in this way ? Do we not realise that the acceptance of this system humiliates us by hrs overtime worked yr leading us straight to petty dishonesties, If payments are not to be made during annual unseemly internecine strife between, say, leave etc, then this should be revised to a surgeons and dermatologists, and inevitable 48-week basis; in my case: bureaucratic supervision ? 1 A UMT =J1-77 week =1C92 04 yr Do we not realise that our bumbling Therefore if I am not to be paid extra UMTs negotiations have been a long-standing source while on leave the cost of 1 A UMT should be of amusement to the cynic as he watches us 52 declare at one point that the long hours which 48 £177 = £ I92 we work exhaust us and, by clouding our Would this satisfy the Elephant and Castle ? judgment, endanger the lives of our patients Finally, it is my contention that doctors and at another point declare that we are should be paid extra UMTs for covering perfectly prepared to perk up and work these colleagues on leave, flexibility, secretarial work long hours provided we are paid extra for jO etc, or else they should not provide these doing ? In case I should be thought to be a starr3services. DEREK HALL eyed idealist with a private income let me say at once that I have been conscious all my Hartlepool, Cleveland professional life of the injustices and lack of intelligent planning which have existed within the profession. I know that junior doctors have Industrial action sometimes been exploited by their senior colleagues and have not always received from SIR,-For the past few years I have stood on them the example and guidance in the ways in the sidelines and watched with mounting which members of an honourable profession horror, indignation, and grief the way in should conduct themselves. I know that in the which the profession of which I have always career structure as it has existed intelligent been proud to be a member has diminished itself and able women who have been handicapped and has forfeited by this unseemly wrangle by family commitments have had a very raw with the Government a large part of the public deal and have been prevented from conrespect and affection which it had in full tributing as much as they have been willing and measure. able to do. Added to this they have smarted Surely there are many doctors like me who under the injustice that those imbued with the recognise that our profession has been treated hierarchic idea should view the rank which these with less than justice, who feel, to cite one women have been compelled to occupy as the example of the nefarious dealings of our highest rank which they were capable of political overlords, that the planned withdrawal holding. I could cite many other imperfections of private beds in State hospitals is monstrous, within the profession. Often our negotiators but who nevertheless are shocked and horrified have lacked foresight and have been less than at the way in which some members of our competent. I recognise these imperfections profession are acting in the face of this and feel that they should be tackled from injustice. within the profession and I am optimistic Surely there are other people like me who enough to believe that considerable progress cringe with embarrassment and shame when- has been made in many directions. All this ever the BBC announces that yet another group leaves me profoundly disturbed that when the of us is intending to take "industrial action." dispute is one primarily concerned with Surely there are other people like me who know remuneration a large group within our that in the intolerable jargon of the times profession (by no means always the same "industrial action" simply means that some group) is prepared to put its interests before doctors are prepared to react against acknow- those of its patients. No amount of sophistry ledged injustice by at the worst putting their will allow me to see it in any other way. patients' lives at risk and at the best seriously May I say to these people that at least nineaffecting their peace of mind and their tenths of the human race are and have always confidence in us. No amount of talking can been treated unjustly by the standards of the alter this fact. privileged ? May I remind them that this is an I entered medical school nearly 30 years imperfect world and it is unlikely ever to be ago in the confident belief that I was embarking otherwise ? May I remind them that they have on a career in which care for one's patient was freely entered the medical profession and that to be one's paramount consideration for the a physician should put his patient first at all rest of one's life. As a student and a young times whatever the personal sacrifice ? hospital doctor I was proud to be attached to We are an immensely privileged group of an honourable teaching hospital where every- people in that our fellow human beings bare one who entered our portals, be he duke or themselves before us, body and soul, in the dustman, received exactly the same high level absolute confidence that we will not betray of care. I was instructed and inspired by them, not because we have impeccable devoted nursing sisters (pre-Salmon Report, references as individuals but simply because but that is another story) and by consultants we are members of an honourable and unique and registrars who had never heard of over- profession. Can we possibly allow this trust, time. Certain people linger in my mind and this goodwill, this love which has accumulated will inspire me to the end of my days, people over the centuries to fade away because we like Muriel Crouch, George Qvist, and the feel, rightly or wrongly, that we are not getting late Lionel Norbury and Clement Price- our fair share of this scarce commodity, Thomas-we all have our own list of such justice ? "beloved physicians." In one's wildest dreams MARY J O'SULLIVAN one could not think of these people filling in an overtime sheet. Oxford
532
annually? The difference, for me. will mean the loss of £2900 gross before April 1979. Consultants of less than two or more than eight years' seniority will lose nothing in this way and there is no reason to doubt that frozen awards for merit will become payable immediately. BMA officials and spokesmen, in their pious pronouncements about those who pay no subscription but gain from the benefits of the negotiators' efforts, should be reminded that there are those who have not benefited and who have accordingly stopped subscribing. Many people in my situation feel that the BMA is an inept organisation fighting inadequately for family doctors and private practice and prepared to see fully trained specialists insulted with lower remuneration than their own juniors. I look forward to applying to rejoin the BMA when my salary is increased as sharply as the BMA subscription. ROBERT WOOD Abernethy, Perthshire * **The Secretary writes: "The answer to Dr Wood's question is to be found in paragraph 20 of the White Paper 'The Attack on Inflation; the Second Year.' The force behind the answer is an Order in Council under the Remuneration Charges and Grants Act 1975 which allows this breach of contract to continue until the incremental date of the consultant concerned. The representations of the BMA have secured that at least at that date normality is restored and the incremental scale (above an arbitrary ceiling) is not frozen for another year."-ED, BMJ.
Juniors' contract dispute SIR,-With reference to Mr N H N Mill's letter (14 August, p 424) may I respectfully submit that he, like so many others, does not understand the nature of the junior doctors' claim for regular "overtime payments" ? Once and for all let the facts speak for themselves. It was agreed between the BMA, DHSS, and Department of Employment on the basis of information gleaned from approximately 250 adequately completed and returned questionnaires from among 20 000 sent to junior hospital doctors in early 1975 that, in terms of hours worked per week in excess of 40-that is, so-called "overtime"-approximately 60",, were spent on call, waiting for work, sleeping, eating, etc, and the remaining 40", actually working. Herein lies mistake No 1 on behalf of the DHSS-they mistakenly believed that 60, of "overtime" payments would be at B rate and 40,, at A rate. This is not so, may I add. The arithmetic is simple: £C12 100 000 (cost per year of EDAs) £605 per doctor 20 000 doctors available for =
payment as overtime
Now for 40 hours overtime the cost of 100)) at A rate (300)) is almost twice the cost of 60)) at B rate (10%) plus 40(o at A rate (3000). This is why the annual estimate for the cost of overtime payments is now in excess of £C28m and also why the average increase in salary is of the order of £1000-1200 pa, plus the fact that eveSyone is now claiming his entitlement to overtime. Mistake No 2 is this: as agreed nationally the cost of 1 UMT/year is determined and fixed by base rate salary and by 300% and 1000
28 AUGUST 1976
What madness has come to pass in my of hourly rates of pay. The rates of 30)( and 10"(, were calculated knowing the money profession which makes it seem entirely natural for its younger members to demean available and hours worked-that is: Money available yr =£ UMT yr= £ UMT,52 wks themselves in this way ? Do we not realise that the acceptance of this system humiliates us by hrs overtime worked yr leading us straight to petty dishonesties, If payments are not to be made during annual unseemly internecine strife between, say, leave etc, then this should be revised to a surgeons and dermatologists, and inevitable 48-week basis; in my case: bureaucratic supervision ? 1 A UMT =J1-77 week =1C92 04 yr Do we not realise that our bumbling Therefore if I am not to be paid extra UMTs negotiations have been a long-standing source while on leave the cost of 1 A UMT should be of amusement to the cynic as he watches us 52 declare at one point that the long hours which 48 £177 = £ I92 we work exhaust us and, by clouding our Would this satisfy the Elephant and Castle ? judgment, endanger the lives of our patients Finally, it is my contention that doctors and at another point declare that we are should be paid extra UMTs for covering perfectly prepared to perk up and work these colleagues on leave, flexibility, secretarial work long hours provided we are paid extra for jO etc, or else they should not provide these doing ? In case I should be thought to be a starr3services. DEREK HALL eyed idealist with a private income let me say at once that I have been conscious all my Hartlepool, Cleveland professional life of the injustices and lack of intelligent planning which have existed within the profession. I know that junior doctors have Industrial action sometimes been exploited by their senior colleagues and have not always received from SIR,-For the past few years I have stood on them the example and guidance in the ways in the sidelines and watched with mounting which members of an honourable profession horror, indignation, and grief the way in should conduct themselves. I know that in the which the profession of which I have always career structure as it has existed intelligent been proud to be a member has diminished itself and able women who have been handicapped and has forfeited by this unseemly wrangle by family commitments have had a very raw with the Government a large part of the public deal and have been prevented from conrespect and affection which it had in full tributing as much as they have been willing and measure. able to do. Added to this they have smarted Surely there are many doctors like me who under the injustice that those imbued with the recognise that our profession has been treated hierarchic idea should view the rank which these with less than justice, who feel, to cite one women have been compelled to occupy as the example of the nefarious dealings of our highest rank which they were capable of political overlords, that the planned withdrawal holding. I could cite many other imperfections of private beds in State hospitals is monstrous, within the profession. Often our negotiators but who nevertheless are shocked and horrified have lacked foresight and have been less than at the way in which some members of our competent. I recognise these imperfections profession are acting in the face of this and feel that they should be tackled from injustice. within the profession and I am optimistic Surely there are other people like me who enough to believe that considerable progress cringe with embarrassment and shame when- has been made in many directions. All this ever the BBC announces that yet another group leaves me profoundly disturbed that when the of us is intending to take "industrial action." dispute is one primarily concerned with Surely there are other people like me who know remuneration a large group within our that in the intolerable jargon of the times profession (by no means always the same "industrial action" simply means that some group) is prepared to put its interests before doctors are prepared to react against acknow- those of its patients. No amount of sophistry ledged injustice by at the worst putting their will allow me to see it in any other way. patients' lives at risk and at the best seriously May I say to these people that at least nineaffecting their peace of mind and their tenths of the human race are and have always confidence in us. No amount of talking can been treated unjustly by the standards of the alter this fact. privileged ? May I remind them that this is an I entered medical school nearly 30 years imperfect world and it is unlikely ever to be ago in the confident belief that I was embarking otherwise ? May I remind them that they have on a career in which care for one's patient was freely entered the medical profession and that to be one's paramount consideration for the a physician should put his patient first at all rest of one's life. As a student and a young times whatever the personal sacrifice ? hospital doctor I was proud to be attached to We are an immensely privileged group of an honourable teaching hospital where every- people in that our fellow human beings bare one who entered our portals, be he duke or themselves before us, body and soul, in the dustman, received exactly the same high level absolute confidence that we will not betray of care. I was instructed and inspired by them, not because we have impeccable devoted nursing sisters (pre-Salmon Report, references as individuals but simply because but that is another story) and by consultants we are members of an honourable and unique and registrars who had never heard of over- profession. Can we possibly allow this trust, time. Certain people linger in my mind and this goodwill, this love which has accumulated will inspire me to the end of my days, people over the centuries to fade away because we like Muriel Crouch, George Qvist, and the feel, rightly or wrongly, that we are not getting late Lionel Norbury and Clement Price- our fair share of this scarce commodity, Thomas-we all have our own list of such justice ? "beloved physicians." In one's wildest dreams MARY J O'SULLIVAN one could not think of these people filling in an overtime sheet. Oxford
