Over the last 4 years, the NHS has been embroiled in a dispute with the BMA (British Medical Association) over the contracts for junior doctors. According to most media reports, the dispute has been about the hours and days of the week that junior doctors are required to work and their remuneration. But has the situation been more complex than this? Could the dispute also have been about other things too? Specifically from the PSC316 perspective, could it have been about a violation of the psychological contract between the junior doctors, the NHS trusts and the NHS itself?
The psychological contract, according to Rousseau (1989), relates to personal idiosyncrasies in the way that the employment contract is interpreted and enacted. The psychological contract, unlike the legal one, has no formal specification and is related to the beliefs and values associated with the reciprocal obligations that are perceived by both the employer and the employee. For further information see:
There are a range of issues connected with the junior doctors dispute that imply that the psychological contract, that may have existed for many years between the NHS, the NHS trusts and the junior doctors may have been overlooked. This could mean that the dispute may have been misunderstood and therefore misdiagnosed by the employers. As a result, is it possible that the wrong solutions may have been imposed? Some of those issues can be identified in the article from the Daily Telegraph dated the 27th November, 2015. This is attached.
At the time of writing, a new contract has been ‘imposed’ by the government on the junior doctors. This imposition was vehemently opposed. It was predicted that the imposition of the contract would lead to all manner of complications in the future. These included the threat that junior doctors would look for alterative work in Scotland and Wales, where a new contract was not even being considered. It was also believed that some junior doctors would go to other EU member states and other parts of the world. This would, if true, leave the NHS in a very vulnerable position.
This dispute is a particularly interesting case. It relates directly to the content of the 15PSC316 module. It has much to say about Human Resources Management and it also demonstrates the importance of human and social sciences in understanding industrial disputes as well in the attempts to find solutions. Requirements of the coursework:
- A report of 5,000 words maximum (excluding citations, references and appendices in the word count) that analyses the origins and the development of the dispute. Areas to consider in the analysis will include the psychological contract and could also include those more commonly addressed by the media like hours of work, remuneration of junior doctors and their expectations about career development.
- The style of the report may be in the form of an academic essay or constructed as a consultancy report to an imaginary client e.g. an NHS Trust. However, it is important that a high standard of work is produced whichever format is chosen and that academic rigour is applied throughout in the presentation of evidence. For example, whilst press and media reports may be cited and included such sources should not form the basis for the essay or for the report The use of the academic literature is also important.
- There should be a full a list of references (for all cited material) and a full bibliography. The reference list and bibliography are not part of the word count. The format of citations and references should follow APA requirements.
- The case study report or the essay should be submitted with a school cover sheet via Turnitin to the Module Leader no later than 1700 hours on 3rd
- Marks will be awarded for the following:
- The overall quality of the written presentation of material and the accuracy of citation and referencing using APA styles: 10%
- A diagnosis and critical evaluation of the factors implicated in the dispute and the complexity of them from HRM, human and social science perspectives (including the psychological contract): 40%
- A prognosis that involves a critical evaluation of the likely short and long consequences of the imposition of the new junior doctors contracts by HM government from HRM, human and social science perspectives (including the psychological contract): 30%
- A prescription, in the form of recommendations that are practical, valid and appropriate and which emerge from the application of human and social sciences theory (Psychology and Human Factors) and which offer alternative solutions to those imposed by HM government: 20%
More detailed information on marking criteria is attached.
Daily Telegraph Article
As leaders of the future NHS, junior doctors must come back from the brink
The discussions under Acas are a good thing. Junior doctors must resist the urge to strike.
Junior doctors on a protest march in London in October Photo: PA
By Helen Whately, MP
12:11PM GMT 27 Nov 2015
Yesterday, both sides in the junior doctors dispute spent nine hours in talks in a bid to prevent a potential strike next Tuesday. Today they resume discussions, in an attempt to end this increasingly bitter dispute.
Outside the medical profession, some people are asking what this is all about. To sum up: the health secretary, Jeremy Hunt, wishes to renegotiate the junior doctors contract to aid a move towards a more fully-staffed, seven-day NHS. After months of angry recriminations, last week, junior doctors voted to put aside their usual commitment to patients, their usual willingness to work under pressure for long hours, and their usual dedication to their vocation, to strike.
“Both sides in this dispute want a better NHS, but walking out cannot be good for patients.”
I know many cast their vote with heavy hearts, and, considering junior doctors have been offered an 11% increase in basic salary, and promised they won’t lose out on pay (with the reasonable exception of those who are working unsafe hours), what’s the problem?
From my conversations with juniors, they are sceptical about the pay offer, and in any case pay is only part of the problem. They are just as worried about hours, particularly extended shifts and antisocial rotas. They fear future rotas will make life more difficult, and don’t trust their employers to be flexible around family commitments. And though the new contract reduces maximum hours per week from 91 to 72, they don’t believe this will happen in practice.
This is the crux of the problem; a lack of trust between doctors and their employer.
Many junior doctors feel neither valued nor empowered. One junior recently said to me, “So much happens that we have no control over.” Research published in the BMJ in 2012 showed 79% of junior doctors didn’t feel valued by the NHS, and 83% didn’t feel valued by their managers. When they seek help from a senior doctor, they don’t always get it. When they raise a concern, it’s hit or miss whether they are listened to.
Something is wrong with the relationship between doctors and the NHS organisations they work in. Tackling this problem needs to be much higher on the agenda.
There is also an undercurrent of fear to this debate; fear about the future of the NHS. The NHS is going through difficult times, but I would ask junior doctors to look at the Government’s record. There are now 21,000 more full time clinical staff in the NHS than in 2010, health spending per head has gone up and the Government has committed an extra £10 billion to support the NHS’s own Five Year Forward View. The Secretary of State has set out a 25-year vision for the NHS. This Government is clearly committed to the NHS.
As part of that commitment, the Government wants better outcomes for patients. At the moment, patients admitted to hospital at weekends are more likely to die, taking into account that they tend to be sicker than those admitted during the week. The aim of the Government’s “7-day NHS” plan is to rectify this, by having the same standard of emergency care at weekends as during the week.
The case for this is still disputed by some doctors, but politicians are not the right people to make the case. Better to hear it from respected clinicians, like NHS England’s Medical Director Professor Sir Bruce Keogh, the Academy of Medical Royal Colleges, and the Royal College of Surgeons, who have all said that delivering the same standard of care at weekends is the right ambition.
Both sides in this dispute want a better NHS, but walking out cannot be good for patients. So, I ask junior doctors to try, over the remaining hours of talks, to reach a settlement. The investment in your training, and the trust that patients put in you, bring responsibilities. I know you embrace your clinical responsibilities, but you have a leadership responsibility too, to shape your future role and the terms that go with it. Talking, not walking out, is the way to work this out.
At the same time, there needs to be a serious conversation about what has gone so wrong in the relationship between the NHS workforce and the NHS as an employer. What needs to happen to restore trust and a mutual sense of value? Junior doctors should play a leading part in this conversation, because Junior doctors – not politicians – are the future leaders of the NHS.
Helen Whately is Conservative MP for Faversham and Mid Kent and a member of the Health Select Committee