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Guest debate: The imposition of the new junior doctor contract

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MumsnetGuestPosts · 18/02/2016 16:15

Last Thursday, I cried for our NHS.

I was listening to Jeremy Hunt explain why he had to impose a hugely unpopular contract on doctors. Just 24 hours earlier I had been buoyed by public support on the picket lines, and now here I was, left frustrated and incredulous at the government's action. Despite the Royal Colleges disagreeing with imposition, despite multiple demonstrations and overwhelming polls demonstrating public support against an unsafe contract, the government decided to unilaterally impose a contract that would supposedly allow them to fulfil their party manifesto. Even the Patients Association, usually staunch adversaries of doctors, spoke out against the government's imposition, calling it 'unacceptable'.

We keep hearing the Conservative Party pledge to deliver a 'truly seven day NHS'. This sounds like a lovely idea, which in theory every doctor would support (and, of course, we do already provide a seven day service, routinely working nights and weekends). However, without the necessary extra funding and resources it is frankly dangerous. The government has failed to fully examine the effect this contract will have on patient safety or staffing levels, focusing instead solely on how they can stretch a service without spending more money.

This was never about politics for the doctors. We are driven by concerns for the safety of our patients and the NHS workforce; we want to preserve the NHS for future generations. It is becoming increasingly laughable to hear the Conservative Party call themselves the party of the NHS. Our own Health Secretary refuses to engage and debate with junior doctors. Our Prime Minister has stayed eerily silent throughout this whole dispute, despite presiding over the first doctors' strike in four decades.

Our rotas are already under-filled. Many specialities face retention problems as more doctors leave to work overseas having struggled to maintain a safe work/life balance in the NHS. This contract will see many more doctors resign in despair, leaving a thin workforce spread ever thinner across seven days. We are being asked to do more for less and this is breaking a generation of doctors who are already on their knees with the continued underfunding of the NHS. Currently, one in two junior doctors chooses not to continue with their speciality training. The rate of mental health problems in doctors is worryingly high; it is only likely to get worse. All of this coupled with less robust safeguards on working hours will inevitably result in patient safety being compromised.

I never thought that I would have to strike as a doctor, but I know that any short-term disruption to my patients will be outweighed by the damage this contract will have on patients in the long term.

The government is set on changing the meaning of a weekend for all NHS workers, starting with us, the junior doctors. I have been a junior doctor for five years and have a little boy who is 20 months old. Under this contract, I could be forced to work every other weekend and more nights, spending more time away from my son. My husband is also a medic – many people marry within the profession – and we're already worried about juggling childcare under the new contract. If we end up working alternate weekends, we won't have any weekends together, but if we're in sync we'll have to find someone to look after our son during that time. We already struggle to arrange childcare to cover our night shifts, and the proposed weekend hours will only put a further strain on our finances, and our relationship.

The NHS is not perfect, but it is there for us in our time of need. Speak to any doctor and they will name you 101 things which need improving in the service before embarking on the alleged 'truly seven day NHS'. Our accident and emergency departments are crumbling under the weight of admissions; our mental health services are letting down the most vulnerable people in our society. Our GPs account for 90% of all NHS patient contacts and yet receive only 9% of the funding; our hospitals are filled with patients who we cannot discharge safely because funding to community services has again been slashed.

The government has used its nuclear option and we have been left reeling. We will slowly discover what the fallout will be for you - our patients - and for us - your doctors. Stand with us: your junior doctors need you more than ever.

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JosephineMumsnet · 18/02/2016 16:15

Last week we announced that we will bring in a new contract for junior doctors, a contract that is a better deal for doctors as well as safer for patients.

In our election manifesto last year, this government committed to an NHS that operates seven days a week. We want an NHS where it doesn't matter which day of the week you get ill - whether you need to see a consultant, have an urgent diagnostic test, or get the green light to be discharged from hospital. All patients deserve the same level of care any day of the week and we want to make this happen.

We have now had eight independent studies in the last six years which show that more people die when admitted to hospital at the weekends than during the week. No responsible government can ignore this.

Junior doctors are the backbone of our hospitals in the evenings and at weekends. The work they do is invaluable and we know that we need to get the right number of people working at the right time. The new contract will make it easier for hospitals to make sure there are enough doctors at weekends and will also protect doctors from working two weekends in a row, or even more hours than they do at the moment.

Some people have said that the new contract may be risky for doctors and risky for patients. This is absolutely not true. This contract will protect doctors and their patients.

The new contract reduces the absolute maximum hours a doctor can work in a week from 91 hours to 72 hours – with most doctors working a maximum of 48 hours. It also limits the number of nights that doctors can work in a row with no break to four, down from seven, and the number of consecutive long days that junior doctors can work will be reduced from seven to five. Every hospital will now have a 'Guardian of safe working', a brand new role to make sure hospitals stick to these new working hours and do not ask junior doctors to work longer than is safe.

Hospitals who do not stick to these new safer hours will be fined, and this money will be put straight back into doctors' training. Also, no doctor will be ever be expected to work two weekends in a row. We hope this will improve work-life balance - an issue we take very seriously.

Under the contract we have at the moment, doctors can get the same wage for working different 'unsocial' hours. For example, a doctor who works just one hour over the maximum shift length can trigger a 66% pay increase for all the other doctors on that rota. This is not a fair way to reward doctors for the hours they work, and is putting a real strain on our NHS.

Everyone wants doctors to feel rewarded for the essential work they do.

We have listened to junior doctors' concerns about pay and the increase we've offered in average basic pay has risen from 11% to 13.5%. Greater basic pay will also mean higher contributions to pensions from their employers and the potential for higher maternity pay. And let's not forget that no other public sector workers will see this level of basic pay increase this year.

Junior doctors did raise some concerns about how we defined these 'unsocial hours', so we listened to them and revised our offer. Now, all doctors working nights (9pm-7am) on any day of the week will be paid time and a half. Doctors working Sundays (7am-9pm) and Saturdays (5pm-9pm) will be paid an extra 30%, and regular Saturday daytime workers (those who work more than one weekend in four) will receive an extra 30%. In order to make the NHS a truly seven-day service, trainee doctors who work less than one in four weekends between 7am-5pm on a Saturday will be paid at normal rates. Other essential public sector workers, such as police officers and fire fighters, already work in this way – at plain time on Saturdays.

This new contract is necessary, safe and fair. It is a good deal for doctors, but importantly it's also a good deal for patients and for the future of our NHS.