Laurie Baxter remembers her time as medical staff committee chair for her trust as one of the most exciting, rewarding and humbling experiences of her medical career.
The achievement is all the more notable, given that she was the first staff, associate specialist or specialty doctor to have been elected to a role more usually given to a consultant.
But her lingering memory of 2011 is not of her achievements while representing permanent medical staff at Derriford Hospital, nor is it of her work as an ENT surgeon there. It is of her compulsory redundancy in September of last year, at the age of 59 and after 27 years of service at the Plymouth Hospitals NHS Trust.
Her associate specialist job had been earmarked as her department’s contribution to more than £30m savings by the trust, although she was among the last to know.
Out of the blue
The trust had a policy of reorganisational change or redundancy, requiring individual and collective consultation. But the initial proposal to make Dr Baxter’s post redundant came out of the blue.
‘There were no prior discussions with me before the proposal was to be announced,’ recalls Dr Baxter. ‘I would have discovered the wretched proposal as it was formally presented to a meeting of the joint unions representing all 4,000 employees if it had not been for the medical director, who intervened to tell me just 48 hours before the announcement. I was stunned.’
In the weeks that followed, Dr Baxter attended the medical staff joiners’ and leavers’ dinner without being able to reveal that she would be among those departing. She also went ahead with a goodbye dinner she had organised for the chief executive, although she wryly admits: ‘I stopped short of giving a speech.’
Being a US citizen, Dr Baxter faced taxation of more than 50 per cent on her redundancy pay in the UK and the USA, with further deductions as her PAYE salary got bumped into a higher tax bracket.
‘I don’t have anything like a full pension, and I didn’t know if I had enough to live on,’ she recalls. ‘I had just bought a house on Dartmoor. I still have kids in full-time education.’
Patients also started to find out before the redundancy had been finalised. Dr Baxter says: ‘They came in and asked what I had done wrong, as they didn’t understand that redundancy wasn’t dismissal. It was crippling, as I know that some of the patients were worried that I wasn’t making the best decisions for them or their children.
‘There is a stigma to being made redundant. People assume you must be a bad doctor or you must have done something very wrong, and it is going to take a while to change that.’
She warns that redundancy can affect every aspect of a doctor’s life, and advises those in a similar situation to get advice as quickly as possible on issues as diverse as pensions and retirement plans, future employment prospects, investments, health and personal support.
‘The process happens quickly,’ she explains. ‘With the overwhelming emotions surrounding proposed redundancy, it’s easy enough to let it just happen while being comforted by well-meaning family, friends and colleagues.’
Medicine has always been considered one of the safest jobs around, but with major reorganisation and cost savings under way, it has become a very real threat.
Advocating for alternatives
‘Redundancy is still, thankfully, quite rare in the NHS, but there are concerns that, as trusts merge and hospitals close, there could be an increase in it,’ says joint head of BMA regional services in England Janet Maguire.
She stresses that the BMA will fight medical redundancies where possible, looking into their legality and alternative ways of making savings.
Once a redundancy situation is declared, a clearly defined process, set out in the Employment Rights Act 1996, must be followed.
The BMA will feed into this, asking the trust to explain the reasons behind its proposals. It will also look at job planning, efficiency savings and whether the service could be delivered in a different way that brings more money into the department.
Sticking to process
‘We will make them justify the change,’ says Mrs Maguire. ‘There should be no impact on patient care, and they should look for voluntary rather than compulsory redundancies.’
A consultation process provides a further opportunity for the BMA and hospital staff to comment, and is mandatory when at least 20 redundancies are proposed. It should also occur when fewer positions are affected, as part of good employment practice.
If the proposed redundancy is at a GP practice, the BMA would provide advice about going through the process in a fair way.
Mrs Maguire says: ‘If it is a salaried GP who is being made redundant, we would represent them and raise all the issues to make sure [the practice] had thought of alternative ways.’
The BMA also offers emotional support, with a 24/7 counselling line and a sympathetic ear provided by the Doctors for Doctors service.
Mike Peters, who heads this peer-support service, says doctors invest so much in their work that they might experience something similar to a grief reaction when faced with redundancy.
He says: ‘There would be a sense of loss; there could be a sense of shame … What are people thinking? Do people believe it is a redundancy or a quiet way of getting rid of you?’
Dr Peters says a doctor can also feel isolated as a result of losing the routine of going to work and having to say goodbye to colleagues and patients with whom they have worked for a long time.
‘They have not done anything wrong, they are not up before the GMC or anything, but they are still not working,’ he explains.
Inevitably, some doctors are more at risk than others.
‘Often, the people who are most at risk from service redesign are SAS doctors,’ acknowledges Mrs Maguire. ‘The junior doctors tend to be more protected as they are in training, and the general move is towards a consultant-delivered service, so SAS doctors are squeezed in the middle.’
The situation has been highlighted recently at Pennine Acute Hospitals NHS Trust, where all 10 doctor positions flagged for redundancy are SAS grades.
Call for camaraderie
‘There is growing anger at the way SAS doctors are being chosen for redundancy,’ says BMA staff, associate specialists and specialty doctors committee chair Radhakrishna Shanbhag.
‘They are a particularly vulnerable group and a soft target. We would be very keen to work with employers to deliver the same efficiency savings without having to resort to these drastic, life-changing measures.’
Dr Shanbhag calls on doctors to join together to avoid redundancies. This could entail those who work more than full time sacrificing some of their extra programmed activities to save colleagues’ jobs.
‘This issue should bring doctors together in the spirit of each of us giving a little so no one loses out,’ he argues.
Academics at risk
Medical academics are also on the frontline for redundancies, with a dozen job losses threatened at Barts and The London Queen Mary’s School of Medicine and Dentistry.
BMA medical academic staff committee co-chair Michael Rees says these doctors are at particular risk because their contracts are with universities, which are in a constant state of flux.
‘University employment is more fragile, as [universities] can reorganise more easily,’ he says. ‘It is a particular vulnerability in academic life that [jobs] are more fragile than NHS posts.’
Among specialties, public health is perhaps most under attack following the government’s decision to move much of the workforce to local authorities.
Lessons for trust
BMA public health medicine committee co-chair Richard Jarvis says public health doctors are worried about the potential for redundancy. He stresses: ‘Public health as a specialty can ill afford to lose vital talent and experience through ill-thought through changes.’
While compulsory redundancy is undoubtedly a painful process, the lessons learnt can benefit other doctors.
At Dr Baxter’s former trust, a cross-specialty group of senior medical staff has been established to review all proposals for senior medical staff redundancies before they go to the joint staff negotiating committee. The process includes scrutiny by two senior clinicians with clinical director experience.
BMA industrial relations officer Richard Griffiths, who represented Dr Baxter, says this has already halted at least two proposed consultant redundancies.
Mr Griffiths says: ‘Rather than just complain about it, Dr Baxter ensured that lessons were learnt from her experience for the future benefit of all her medical colleagues. She ensured that the process was reviewed and discussed by the hospital medical staff committee.’
Doctors at the trust can also now place the maximum allowable funds from their redundancy package into a personal pension before taxation.
Through the BMA, Dr Baxter was introduced to Rachel Sartin of BMA Services, who provides independent financial advice to members of the association, and who worked with Dr Baxter’s accountant to find the best way to deal with the confusing choices surrounding redundancy packages, pension options, investment and taxation.
Dr Baxter says: ‘We realised that allowing doctors to create personal pensions for the maximum allowable investment of their redundancy package — before any redundancy funds are given directly to the doctor — made the potential taxation consequences and financial difficulties caused by redundancy less damaging.
Soften the blow
‘Plymouth Hospitals NHS Trust had never done this before, but once they had investigated they were most helpful.
‘It isn’t difficult at all. With Rachel’s help, I did it in a phone call. And it isn’t difficult for the employer; it’s just that they hadn’t done it before. It doesn’t cost the hospital trust anything, but it is something that makes the blow to the doctor less damaging.’
Happily, Dr Baxter’s redundancy has not meant the end of her career, and she recently became a fellow of the Royal College of Surgeons of England.
‘I have been extraordinarily lucky,’ she says. ‘Through my work with surgeons at [representative body] ENT UK, I have met many ENT senior medical staff in the four nations.
‘Many colleagues were appalled at the situation I found myself in. Just two days after my redundancy, I was offered a locum ENT consultant post.’
Dr Baxter credits Mr Griffiths for making her redundancy less traumatic, and stresses the importance of professional back-up for doctors. The BMA pays most of the legal fees if a doctor decides to fight redundancy legally, but she warns that the costs of private legal action can be huge.
‘In these times when doctors are vulnerable, they need to look at membership of a trade union for support,’ she says.
Support of hundreds
But Dr Baxter saves her greatest thanks for the staff at Derriford Hospital.
‘I got 200 cards, letters and emails from people wishing me luck,’ she says. ‘It was overwhelming.
‘The BMA and Richard Griffiths were terrific: their support allowed us to establish a precedent for fairness and financial common sense in any future redundancy proposals, but it has been the support of hundreds of colleagues from every medical staff group that has allowed me to depart with dignity. I will be forever grateful.’