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FPH Statement on Junior Doctors

FPH Statement on new contract proposals for junior contracts

Key points:

  • FPH believes the proposed recommendations have the potential to jeopardise the diversity of the public health workforce.
  • FPH has concerns in relation to the unintended impact of proposed changes to junior doctors’ contracts in England which we believe could disproportionately impact public health training and its workforce.
  • Associated reductions in participation in on-call work beyond the minimum requirement will have a detrimental impact on the skills to respond to major health protection incidents as well as those essential broader skills necessary to risk assess acute risks to public health.
  • Removal of pay protection will be a significant  disincentive to enter public health later in a career and would therefore weaken the future workforce considerably.
  • Changes to on-call payments for trainees working on-call from home would mean a real term pay cut for public health.

In England, the initial proposals would increase disparity in favour of non-medical registrars.

About the UK Faculty of Public Health

The UK Faculty of Public Health (FPH) is  committed to improving and protecting people’s mental and physical health and wellbeing. Our vision is for better health for all, where people are able to achieve their fullest potential for a healthy, fulfilling life through a fair and equitable society. We work to promote understanding and to drive improvements in public health policy and practice. 

As the leading professional body for public health specialists in the UK, our members are trained to the highest possible standards of public health competence and practice – as set by FPH. For more than 40 years we have been at the forefront of developing and expanding the public health workforce and profession.

Potential impact on public health training and workforce by proposed recommendations

Public health is a unique discipline. It is one of the only medical specialties to admit both medically qualified and non-medically qualified applicants to speciality training. Furthermore, the specialty admits a broad range
of entrants from medicine with many having previous experience in other disciplines.  This diversity brings a rich range of skills, knowledge and experience, and strengthens the public health workforce immeasurably.  A single universal training programme with equivalence of qualifications regardless of background is a cornerstone of the current public health system.

FPH believes the proposed Review Body on Doctors' and Dentists' Remuneration (DDRB) recommendations have the potential to jeopardise this.  We are unable to comment on specific issues relating to terms and conditions of service. However, we do have concerns in relation to the unintended impact of proposed changes to junior doctors’ contracts in England which we believe could disproportionately impact public health training and its workforce for the following reasons:

  • Entry into public health is far broader than other medical specialties with recruitment directly from foundation training being considerably less common. This is essential as it brings the benefit of a far broader range of experience to the profession. Removal of pay protection will be a significant disincentive to enter public health later on in a career and would therefore weaken the future workforce considerably.
  • Changes to on-call payments for trainees working on-call from home would mean a real-term pay cut for public health. Concomitant reductions in participation in on-call work beyond the minimum requirement will have a detrimental impact on the skills to respond to major health protection incidents as well as those essential broader skills necessary to risk assess acute risks to public health. There is a risk that opting out of on-call work will also result in significantly different  training programmes for those wishing to specialise in health protection, leading to  the eventual breakdown of the universal training scheme into specialised strands. This would reduce the skill-set of the general public health workforce. 
  • In England, the initial proposals would increase disparity in favour of non-medical registrars. However, if in future, changes implemented in the doctors’ contract are carried into the agenda for change contract, non-medical registrars would be disadvantaged compared to medical colleagues in locations where new junior doctors’ contracts are not being implemented.  Further separation in the terms and conditions for medical and non-medical registrars will impact on the balance of recruitment.  Fracturing of the profession is a risk to the current approach of a single UK training scheme and equivalence of qualification and opportunity for all those completing training.

Additionally, as advocates for public interest in public health, FPH has a responsibility to highlight the potential impact on patient safety due to unsafe working hours. Key employment safeguards that penalise Trusts if they do not safeguard against their medical workforce working excessive and dangerous hours are being removed.  The proposed contracts fail to offer safeguards on hours and working conditions necessary to ensure the safety of all the patients treated within the NHS, and risk poorer health outcomes for the most vulnerable in society.  

Despite NHS Employers and NHS England recently committing to a programme to improve staff health and wellbeing, these proposals have the potential to undermine this initiative and will have a detrimental effect on the work-life balance of doctors and on the health and wellbeing of those working and training in public health. 

FPH is actively engaged in discussions with the Academy of Medical Royal Colleges to ensure that concerns specific to public health are considered.  Furthermore, FPH seeks to encourage all parties involved to ensure that adverse consequences are appropriately mitigated against by ensuring that the following principles
 are preserved:

  1. Protection of patient safety – Health impacts of any service change including changes in working practices and shift patterns must be assessed and appropriately mitigated against before implementation
  2. Universality of training – The universality of the training programme across the UK and the domains of public health is protected ensuring a flexible and diverse workforce fit for future challenges
  3. Encourage diversity – A workforce with a diversity of experience and skills is the cornerstone of the public health workforce and must be protected by encouraging applicants with the widest range of backgrounds and experience.

Written: 25/09/2015 , last modified: 10/02/2016