How has additional funding for middle grade doctors been spent and what progress has been made on new contracts

2.9  The Deputy of St. Martin of the Minister for Health and Social Services regarding the growth fund to improve the hospital middle-grade doctor service:

Will the Minister give details of how the million pound growth fund to improve the hospital middle-grade doctors' service has been spent and outline any progress regarding the new contract for these doctors stating what the position will be in relation to those who cannot agree to provide compulsory prospective cover because their hours are already long and onerous?

The Deputy of Trinity (The Minister for Health and Social Services):

Health and Social Services have completed negotiations with the British Medical Association and Hospital Consultants and Specialists Association and reached a heads of agreement regarding the new pay and terms and conditions of service for middle- grade doctors. The doctors' representatives have recommended to their members that they should accept the revised terms and that the negotiated contract offers financial and contractual betterment going forward. The million pounds has been split between the pay of the 2 categories of middle-grade doctors, with £600,000 being spent on staff grade doctors and £400,000 on the fewer in number but most senior associate specialists. Following the positive conclusion to the formal negotiation detail of the offer, a new contract was circulated to middle-grade doctors on 19th August inviting the 53 doctors to express an interest to transfer to the new contract. Health and Social Services have received 42 positive expressions of interest to date and no negative returns. Middle-grade  doctors  are  in  the  process  of  drafting  their job  plans  the outcome of which will determine the contracted number of programmed activities. The effective date for transfer to the new contract will be 1st October 2012.

1. The Deputy of St. Martin :

I do not quite think the second part of the question was answered. I want to know what the position would be in relation to those who cannot agree to provide compulsory prospective cover because their hours are already long and onerous. Does that mean they will no longer be employed or a separate contract will be made out for those particular people again who cannot agree?

The Deputy of Trinity :

So far, as I said, of the 53 doctors, 42 have had positive expressions but the work will continue and the offer of the new contract is continuing on middle-grade doctors agreeing to provide prospective cover for planned absences where it is safe, reasonable and practical to do so and it is anticipated that most of these will be for most specialities by October 2012. But where there is not, prospective cover will be implemented where specialities are fully established and do not carry a high level of vacancies, those discussions will still take place with relevant doctors prior to implementation of a prospective cover.

2. Senator S.C. Ferguson:

In her email of 13th July 2011 to the middle-grade doctors, the Minister said: "I have also commissioned an investigation into the issues raised by the questions of the middle-grade contract, including working patterns and hours of work. The findings of this investigation will be reported to me before the end of this week and I will share this information with States Members and yourselves." This is to the middle-grade doctors. Will the Minister confirm whether the investigation has been completed, whether it has been circulated; certainly, it has not been circulated to States Members; and if not, why not?

The Deputy of Trinity :

Yes, I did do that and the review has been completed and I saw a draft at a Ministerial meeting last week, and it is just in the process of being really finalised and should be out within the next couple of weeks and I will circulate it to the list that Senator Ferguson mentioned.

3. Senator S.C. Ferguson:

With respect, why has it taken so long because the findings of this investigation in July will be reported to me before the end of this week?

The Deputy of Trinity :

One of the officers who was doing that had had time off during the summer because summer time is when most officers wish to take time off with their children. I understand that the middle-grade doctors had some correspondence from you, Senator Ferguson, which they wanted to discuss and report back as necessary.

4. The Deputy of St. John :

I hope the Minister will allow me a little bit of breadth here because not being a medical person - although I have a couple of doctors in my family - could the Minister explain to us what a middle-grade doctor is and whether we are referring solely to the medical practitioners or are they doctors in  other fields,  i.e., maybe a dentist or whatever. Could she explain so that I can get my head around this particular one please?

The Deputy of Trinity :

Middle-grade doctors and associate specialists are the important level below consultants. So it is the ones that are initially at registrar level and where there is I think we have, as I said, 53 doctors in that area and there are staff vacancies and they do play a very important role because, at the end of the day, the hospital could not function without them.

5. Deputy A.E. Jeune :

So can the Minister please confirm that the Verita recommendations on increasing staffing numbers have occurred and whether she believes there is equity across the different departments and specialities in terms of the way the duties fall out, 1 and 3, 1 and 4. Does she believe there is equity?

The Deputy of Trinity :

There are several parts to that question. Verita, in one of the recommendations, did comment on the high use of locums and yes, we did agree with that but one of the reasons for the high use of locums is that compared to their U.K. counterparts, the salary was at a lower level and the terms and conditions were different. So that is why implementing this revised terms and conditions and the extra million pounds is vital because to be able to reduce our level of locums, we need to retain and recruit more middle-grade doctors. So with the new contracts in place, that will be easier. Regarding working times of different departments, it is a complicated issue and I know I have many times given written questions regarding that in the last session.

6. The Deputy of St. Martin :

I just take issue with the last answer the Minister gave. I think the reason there are so many locums working is because I think there are still 4 consultants on restricted duties. However, my final question would be that, given that in a previous written answer the Minister admitted that some middle-grade doctors are on duty for in excess of 100 hours per week, can the Minister assure Members that the use of the growth budget will lead to a reduction in the unacceptable hours worked by doctors?

The Deputy of Trinity :

Yes, the Deputy plucks a figure out of the air. It is not easy negotiating all different numbers of hours because there needs to be proper cover and if someone is called away, sometimes someone can step in - another colleague can step in. So that is why the hours vary and, as I have said, I have done many answers regarding the working times and hours. I do take issue with Deputy Hill about using the excluded doctors. This is middle-grade doctors. They are extremely important in the running of an effective hospital and if they are sick and a long time off work or due to personal reasons or whatever, then we need to fill in with that locum and that locum does cost. As I said, we have 6.5 vacancies and it is because we are not attractive because our terms and conditions are behind U.K. times. So putting this into place is vital.

[16:00]