On Thursday, after engaging in talks with the BMA since November, the Health Secretary Jeremy Hunt announced that the government will plough ahead with imposition of a new contract affecting 56,000 junior doctors in England in August 2016. What now?
This was a sad day for junior doctors and our NHS. It was a sad day for me. Since the threat of imposition of this contract in August 2015 many junior doctors have left for posts abroad, and as the news broke yesterday, many more announced on social media that they had put into action their plans to do the same. Specialty applications this year have plummeted. There is a real concern about how we will staff rotas come August, which is particularly pertinent as the introduction of a cap on locum doctor rates mean that our hospitals will find it increasingly difficult to recruit high-quality locums to plug the gaps.
The working lives of junior doctors have changed dramatically over the past 30 years. We treat increasing numbers of older, sicker patients. We are under increasing pressure to reduce length-of-stay and deliver efficiency savings. We work in teams that are increasingly fragmented due to shift patterns, and frequent rotation of posts. Gone are the days of working 100 hours plus in a week, apprenticed and learning all the time from our consultant and team; instead we spend our days off attending courses, completing e-learning modules and chasing after our supervisors to spend just half an hour completing vital assessments for our career progression.
These issues were a few that the BMA sought to address in the negotiation of a new contract. The government maintains that delivery of the new contract is crucial to delivery of a “truly 7-day NHS”, one of their manifesto promises. The Secretary of State Jeremy Hunt angered junior doctors by insinuating that we don’t already have a 7-day NHS, when junior doctors already work at weekends, nights and bank holidays. Doctors hit back through social media with the hashtag #iminworkJeremy. Furthermore, Jeremy Hunt still declares that junior doctors have been “misled by the BMA”.
The British Medical Association (BMA) walked away from contract negotiations in October 2014, as talks had stalled over a number of measures to ensure patient safety and doctors’ training and welfare. An independent review by the DDRB was commissioned. They were briefed that the contract recommendations must deliver 7-day staffing for no increase in the “current pay envelope”, i.e. total staffing costs. The BMA declined to re-enter negotiations in August 2015 following the publication of this review, as it was clear that the recommendations left little room for negotiation on key issues such as the proposed redefinition of normal working hours to include hours up to 10pm Monday to Friday and all day Saturday.
The government threatened to impose the contract unilaterally, and at this BMA members were balloted regarding industrial action. 98% of junior doctors voted in favour of strike action, and the BMA implored the government to drop the preconditions and threat of imposition and re-enter meaningful negotiations through the mediators Acas. These talks have since broken down, with a number of key issues remaining unresolved.
I’m a junior doctor on the road to become a geriatrician (consultant for older people). I graduated 5 years ago with £30,000 of debt (thankfully I started before top-up fees!) Under my current contract, I work 1 in 4 weekends, but could be rostered to work up to 3 in 4 weekends for the same pay. I have been frustrated by the government suggesting that changes to our contract are needed to increase weekend working – this is simply not true. What will change is our pay structure so that Saturday 3-4pm, and Thursday 9-10pm is paid the same as Tuesday 9-10am. This proves problematic for me. I have 3 small children, and childcare does not cost the same at 9pm as it does at 9am! If my “normal working day” is changed to 1-9pm, I will never get to have dinner with my family, read a bedtime story and give my kids a kiss goodnight. Junior doctors don’t mind working weekends and nights, it is what we signed up for, but we do want to feel valued.
However, my biggest concern is this: how can more doctors be rostered at weekends without doctors working longer hours, or having fewer doctors Monday to Friday when teams are already overstretched and regularly work over their rostered hours to keep patients safe? Both would seriously risk harm to patients and staff. #notsafenotfair
Jeremy Hunt has re-iterated that changes to our contract are just the beginning; that other staff groups will be next. Without increased funding, the NHS is set to fail as it is stretched even further to deliver the government’s political objectives. As it struggles to deliver increasingly impossible targets and savings, will our NHS then be sold off to the highest bidder? We will not let that happen.
I hope that you will take a look behind the headlines, and listen to the voices of your junior doctors telling you their stories. The Junior Doctors’ Contract – its everyone’s business!
Dr Hannah May-Miller is a CT2 (Core Medical Trainee) Junior Doctor. She lives, works, cares and worships with her family and her community in South West London.