By Neil Wilson. Reposted with permission from Neil’s New Wayland article.
The strike action by UK junior doctors has an unreal quality. It lacks the media and political actions necessary to build support for the argument and force the government’s hand. You start to wonder whether the strike action leaders are interested in securing appropriate pay for foundation doctors or whether they are just part of the ‘Tories out’ movement. Therefore, the upcoming discussions with the new Health Secretary will be interesting, and where we may just discover the true motives behind the strike action.
In reality, foundation doctors – because there is nothing junior about them – are already being underpaid their proper contractual amounts. The uplifted remuneration is already due, including substantial back pay. They should demand it from their employers, and if necessary, they should enforce their contract in the courts.
What is the basis of this demand? The ‘Equality of terms’ section of the Equality Act 2010 which requires ‘Equal Pay for Equal Work.’
What is the necessary comparator? The work of physicians associates in hospitals, who undertake responsibilities that are a direct subset of the work of the foundation doctor. The numbers are straightforward.
A physicians associate receives a Band 7 agenda for change salary, currently £43,742. They have to do two years of medical study for this position and can’t prescribe.
A foundation doctor receives £32,398 for which they have done five years of medical study, three of which on placement within hospitals and general practice, including passing the GMC’s medical licensing assessment in year 4, the prescribing exam and spending a year working ‘for free’, essentially as an intern, in year 5.
Increasing the Foundation doctor’s base pay to the same as that of the vastly less qualified physician associate is a 35% rise.
It’s always surprised me that foundation doctors don’t already have an ‘Equal Pay for Equal Work’ action in front of the courts. It’s the most direct and obvious approach to rectifying this injustice.
How Equality of Terms Works
Where an employer employs individuals of different sexes who do equal work, the law imports an automatic equality clause into their employment contract. That clause is defined in s66 of the Equality Act 20101:
- if a term of A’s is less favourable to A than a corresponding term of B’s is to B, A’s term is modified so as not to be less favourable;
- if A does not have a term which corresponds to a term of B’s that benefits B, A’s terms are modified so as to include such a term.
If the employer wishes to disapply this equality clause, then it bears the burden of proof and needs to show that the differences arise due to a material factor with a legitimate aim.
If they can’t, then they have to pay up.
The Physician Associate Comparator
There is growing evidence that the NHS is employing physician associates in roles traditionally filled by foundation doctors. The South East School of Physician Associates proudly stated (in a rapidly deleted tweet), ‘If a doctor can do it, why not a PA?’2
Even the British Medical Journal reports3:
Originally [physicians associates] were envisaged as assistants to doctors to increase their productivity by relieving them of some routine tasks. However, in many hospitals and general practices they are being deployed to replace doctors, taking on increasingly complex roles, including the assessment and management of patients with undiagnosed problems.
Physician associates’ responsibilities are a direct subset of those of foundation doctors. They are trained to take medical histories, conduct physical examinations, diagnose illnesses, and develop management plans.
The distinction between the job titles has narrowed further with the decision to allow the GMC to regulate physician associates, to the extent that the British Medical Association has opened a judicial review over the extension of the term ‘medical professional’ to include them4.
The increased use of physician associates for tasks traditionally performed by foundation doctors undermines foundation doctors’ professional development and career progression, reducing the number of training places available. This affects the current generation of doctors and poses a threat to the future of healthcare in the UK.
Taking an equal pay case forward to the courts would force the NHS to detail and clarify the roles of physician associates and justify their pay bands relative to foundation doctors.
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- Equality Act [Internet]. Apr 8, 2010. Available from: https://www.legislation.gov.uk/ukpga/2010/15/introduction ↩︎
- Collins I. ‘If a doctor can do it, why not a PA?’ | BMA blogs [Internet]. 2023 [cited 2024 Jul 7]. Available from: https://www.bma.org.uk/news-and-opinion/if-a-doctor-can-do-it-why-not-a-pa ↩︎
- McKee M, Brayne C. Physician associates in the UK: some fundamental questions that need answers now. BMJ. 2024 Mar 19;q699. ↩︎
- BMA launches legal action against GMC over dangerous blurring of lines between doctors and physician associates [Internet]. [cited 2024 Jul 7]. Available from: https://www.bma.org.uk/bma-media-centre/bma-launches-legal-action-against-gmc-over-dangerous-blurring-of-lines-between-doctors-and-physician-associates ↩︎
A foundation doctor earns 35 K and they have much more training than Physician Associates who’s earnings are a on average 47K ! I Beg to differ …!. Studying Medicine takes five years . They study medical sciences for first two years ,that equates to a BSc. Next three academic years they’re taught medicine or how to become a junior doctor !At the ripe old age of 23 they enter into their career quite immature and pretty much clueless .As opposed to a Physician Associate who already have a BSc at 2:1 or higher in order to be accepted onto the rigorous two year 48 week per year PA course ! No academic 25 week per year medical courses here ! PA,s also have years of previous work / life experiences to offer as opposed to inexperienced young doctors ! Why these people put them selves on pedestals is beyond me ! Doctors make mistakes as we all know , but where would we be without experienced senior doctors ? Senior experienced doctors are worth their weight in gold in my opinion . Inexperienced doctors should have to start at the bottom and work their way up the pay scale of life ! Prove your worth people ! Disrespecting another profession with false information about their training and qualifications is a pathetic attempt to gather wrath from the red tops and Joe Public .