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The Weekly paper of the New Communist Party of Britain

White Coat Battles

by New Worker correspondent

Junior Doctors are about to embark on their tenth round of industrial action. Their union, the British Medical Association, say that despite making some progress in pay talks the Government has repeatedly failed to present a credible offer. The BMA offered the Health Secretary the opportunity to cancel the latest round of strikes before it was announced if she agreed to extend the mandate for strike action for four weeks. This she refused, hence the latest strike.

In order to continue the long running action the BMA is re-balloting for strike action and action short of a strike until 20 March to renew the mandate. Apart from pay, which has suffered a real terms cut of a quarter since 2008, overwork is a major issue.

Another issue adversely affecting Junior Doctors are the high fees they have to pay for essential and expensive postgraduate exams for speciality training. Other examples of doctors’ having to pay to be allowed to work come in the form of medical royal college membership subscriptions, General Medical Council fees and medical indemnity.

Increasingly doctors say employers should pay for these as happens in other high-skilled professions. A motion to this effect was passed at the most recent BMA conference.

Exam fees vary considerably and some doctors’ think the royal colleges are raking in a mint by exploiting their monopoly. The Federation of Royal Colleges of Physicians charges £460 each for parts one and two of the MRCP (UK) exam and £657 for a dermatologist’s exam. One college even charges £35 for their diplomas to be delivered.

As there are low pass rates for specialty exams, many doctors face these costs more than once if they have to resit. Three years of training exam costs alone will surpass £2,000. These payments cannot be spread using direct debits, but doctors can reclaim tax.

Oba Babs-Osibodu, co-chair of the BMA Welsh junior doctors committee points out that while most aspiring doctors are aware they must pay for postgraduate exams, the “ridiculously expensive” costs “especially compared to pay” do not become clear for many until they embark on specialty training programmes.

He cited his own case as a radiographer. He had to fork out £319 and £478 for two parts of an exam to become qualified as a Fellow of the Royal College of Radiographers, with another £487 and £728 next year.

“It’s an onslaught,” he complains. “There are always fees. When I became an ST2 I got a bit of a pay increase. Then, when I was trying to get a bit more comfortable, I was hit with this massive cost”.

London GP Gerard McHale, a former accountant who took up medicine later, pointed out that in his former life as a bean counter all exam costs were paid by his accountancy firm and he was given paid study leave. His firm also paid membership of the Institute of Chartered Accountants, the equivalent of covering a doctor’s GMC and medical royal college fees, but in his new, more useful profession he is on his own.

By contrast, GP trainees pay £470 for their applied knowledge test and, from last year, £1,180 for the new simulated consultation assessment.

Dr McHale added that in the accountancy trade, it is ‘taken for granted’ that firms cover exam fees and professional development. “The rationale is that they get the benefit. As you get more experienced, you can do more”, but in medicine doctors are paying for the privilege”.

Accusations have been made that the royal colleges make exams too difficult to make money from resits. One disgruntled doctor who narrowly failed found his senior consultant could not answer some questions which early career doctors were supposed to answer.

While some NHS Trusts offer study budgets this is very much a postcode lottery. Some trusts offer to pay doctors’ travel and accommodation costs when they’re sitting exams, but not all.

Doctors say the royal colleges could charge less in exam fees, which have largely gone online since COVID. Needless to say the colleges deny exploiting their position and only charge enough to cover their costs and they have to be tough to prevent another Harold Shipman emerging.

Further down the NHS food chain concerns about postgraduate fees are far from the minds of the porters, cleaners and other ancillary staff at the east London based Barts NHS Trust who are walking out next week over pay.

Last year a succession of strikes saw them brought into direct NHS employment. However Management has rejected their demand for the lump sum payment given to directly employed workers during the pandemic.

Sharon Graham of Unite warned “if Barts thinks that our members will go quietly into the night they have another thing coming. They have seen their comrades at other trusts rightly win this pay award and they will keep fighting and keep striking until Barts does the right thing and pays up.”

In particular at the East Kent Trust Unite recently secured the modest £1,655 award for many outsourced workers and other trusts have paid up.

London Regional officer Tabusam Ahmed added that “our members are some of the lowest paid in the NHS and struggling to make ends meet amid a cost of living crisis. They turned up and put themselves on the frontline during the pandemic just like every other healthcare professional yet Barts are trying to exploit a loophole to deny them the money they are owed.

“We will continue this fight, escalating the action we will take until our members get what is rightfully theirs.”

Last May Unite finally secured the transfer of the last of the 1,800 Serco workers into NHS direct employment. However even strike action in July did not persuade bosses to cough up the award. Meanwhile low paid security workers at Guys & St Thomas’ hospital have taken six days of strike action over several matters. Managers at the Trust are attempting to impose extended unpaid breaks (which would reduce wages) and refusing to calculate holiday allowance based on a 37.5 hour working week, victimising a trade union representative, and refusing to upgrade workers. Security staff also say Management does back them up in cases of confrontations with Saturday night drunks.

Regional officer George Dodo-Williams said “security staff are a key part of a hospital’s infrastructure. Strike action will inevitably cause disruption for both patients and staff but this dispute is a direct result of the unacceptable actions from Guy’s & St Thomas’ management.”