Guest post: Junior doctors are being "backed into a corner"

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Junior doctors are being balloted over new contract proposals - proposals which we see as unsafe and unfair. More than 25,000 of us have already taken to the streets in an attempt to defend our patients, the NHS and our careers - and we know this is creating a huge conflict between the government and the medical profession as a whole. However, we believe this is a battle worth fighting.

This week, the Health Secretary Jeremy Hunt offered us what he described as an 11% rise in basic pay. But this is not about pay - increasing the offer by 100% would not make this contract safe for our patients or fair for us.

The media coverage so far has focused on our pay: to be clear, we are not asking for a pay rise - we just don't want a reduction in pay, which is what we're currently being offered. This is because we are currently paid at a higher rate for working evenings and weekends. Under the new contracts, 27 hours a week which are currently paid at that higher rate and are not voluntary will now be paid at the lower, basic rate. What's more, many medical families use babysitters for 15 or more hours while working on weekends; factor in our reduced pay, and the cost to family life, and you will see why we consider these proposals to be unfair.

The Doctors' and Dentists' Review Body said that if supplementary pay for antisocial hours was removed, the increase would need to be at least 14.9%, higher than the 11% offered in yesterday's soundbite.

The new contracts will affect a large proportion of our workforce. A junior doctor is any doctor who has graduated from medical school and is training to become a GP or hospital consultant - usually a 10-year process.

I am a junior doctor. I'm 37 years old, with a bachelor of science degree (3 years), a medical degree (5 years), a son (6 years) and 10 years of experience as a junior doctor. How will the proposals affect someone like me?

Well, taking time out of training, for example for research or maternity leave, will lead to the removal of pay increments. For many female junior doctors in their 30s (and they represent a large proportion of our workforce), this will have a huge impact on their salary when they return from maternity leave.

These are effectively financial penalties for having children or doing medical research. When I return to clinical work in 2017, on the proposed contract, I will be working more antisocial hours for a lower salary than I was paid three years ago - despite being more qualified. I'll also be earning less money than less experienced colleagues doing the same job.

As a junior doctor, there will be some weeks when I only have one day with my son. I may be on a regular rota working evenings and Saturdays as standard. I love my job - it is both a pleasure and a privilege - but is it fair to work more antisocial hours for less money? I also worry about future doctors and the future of academic research. Who will go on to invent the pioneering treatments and techniques of the future if doing so is financially punitive?

We're also deeply concerned about safety. At present, our hours are capped with patient safety in mind: if hospital trusts don't ensure junior doctors are working legally safe hours, they are fined. The DDRB proposals remove these penalties. Imagine if similar safeguards were removed from airline pilots' contracts? We cannot let this happen.

An online parliamentary petition has attracted more than 220,000 signatories and 43,000 junior doctors believe the proposed contract is bad. The Royal College of Paediatrics and Child Health has stated that it could be "gravely damaging to the health and well-being of children" and 200 consultants from Great Ormond Street Hospital have denounced the proposed contract in an open letter. There are also concerns about the recruitment, retention and morale of the junior doctor workforce in the UK.

So we find ourselves backed into a corner by a government many of us voted for only a few months ago. We are supported by our consultants, whose contracts also face changes including longer hours and removal of clinical excellence awards given to those at the top of the profession. It is my greatest wish that our ballot does not result in a strike, but our consultants and nursing colleagues assure us they will cover the front line.

Our problems with the proposed contract go far beyond pay. Junior doctors are passionate about the NHS, and we hope you will support us as we are trying to support you. We know the NHS, like its workforce, needs investment and support to make it deliverable for the future - but it is an institution we are proud of and believe is worth fighting for.

Photos: pixelsbySavo

Read the Government's response to this post here.

Dear all,

As a south London junior doctor I am, along with my colleagues very much affected by the current ongoing debate with the Department of Health and the Secretary of State, MP Jeremy Hunt with their planned imposition of a new contract for all junior doctors.

We are facing the might of the government's spin and media machine and as such we have collectively decided that we need to speak to the members of the public in order for us to be able to help people understand the nature of the debate and why we are so worried about the future of our NHS and the patients we serve.

We are holding our first public meeting at the Horniman Gardens in Forest Hill this Saturday 7th Nov from 10am-12pm and will be available around the bandstand area stop. We will also be joined by the Shadow Health Secretary MP Heidi Alexander from 10am.

Please come along and ask us any questions you have about this very important issue.

Thank you for reading and sharing this with your friends and family.

Best wishes,

Dr Ravin Mistry
Anaesthetics Registrar & Junior Doctor
GMC Registration No 6077680

It is such a shame that the government has chosen to target such a hard working group of people. Their proposals are poorly thought out and seem more likely to worsen hospital care at the weekends than to make it better.

Society needs to have an honest conversation. What kind of health service do they want and how much are they willing to pay for it.

You can only ever get two of: good, fast, cheap... When it comes to healthcare. At the moment the UK lags behind most European and western countries when it comes to health spending , doctors pee head of population ... Yet still comes top in many league tables.

Many people will look just at the spun headlines - 11% pay increase or junior doctor - salary starts at £23,000 and can go up to £60,000 - that's 3 or 4 times what I earn.

When you look deeper , an 11% increase is on one part of pay - basic - while the 'banding'/supplement for working antisocial hours is decimitated.

A conflict of interest - I have doctors in my family. One - who qualified 7 years ago - was a children's doctor - now is training to be a GP. Her additional paediatric training will make her a better GP. Yet someone in her position would lose out over £8000/year under the new contract - the extra paediatric experience - the exams she paid for out of her own pocket - the Christmas days she spent looking after sick children - this is all attacked not rewarded.

What is the right level of pay for a junior doctor? These days it takes 4 A* at A level , entry into a top uni , 3 undergrad degrees over 6 years, upto £80,000 debt on graduation , 1-3 postgraduate diplomas, perhaps a PhD - research into diseases such as cancer , dementia etc... Up to 10-15 years as a 'junior', working 24/7... Fixed time off, missing weddings birthdays Christmas funerals , moving around the country every 6-12m,... They are the people we see whenever our loved ones end up in hospital - in A&E resus, in cancer clinic , performing surgery to take out an appendix or unblock an artery in someone's heart.

And what is the hourly rate for this kind of doctor - at the moment between £10-20/hour based on experience and seniority.
What is the hourly rate for a hospital consultant? Around £35/hr.

£10/hr is what my cleaner earns. Aldi say their graduate entry programme starts at £40K going to & £63K and you get an Audi A4.

They are paid a moderate wage - yes it is above the average wage in the UK , but is lags behind many other comparable professions.

while all the doctors I know love their job and their patients, I don't think many of us would sit back and meekly accept the imposition of a worse contract. It will harm their patients - tired Drs make mistakes , it will destroy what little family life they have and it specifically attacks women , those with families who may work part time and those that are already doing the greatest anti social emergency work.

9% of doctors in Australia trained in the UK. 4% in Canada. Sarah Woolston - Tory MP - who's daughter is a junior dr says her daughter left for Auz and the hospital where she works , the entire A&E is staffed by Brits.

Australia , NZ , Canada offers them a better quality of life - and many more will leave if this contract is imposed. There are already shortages in many areas of medicine, the population is getting older with more health problems. Where will our doctors come from?

Some people say that this attack of junior doctors is the first step in attacking everyone who works in healthcare - to break all the professions that care for us when we are at our most vulnerable. To allow the profitable bits to be sold off to private companies.

The anti BMA (Union) rhetoric from Hunt is wrong. Most doctors don't like their union very much. All the noise and protests you see on the streets - that's grassroots activism , nothing to do with the BMA.

I would encourage you all to support our junior doctors - tomorrow's future consultants and GPs.

Write to your MP writetothem.com

Write to your local paper or national papers

Write to the health secretary

There's a petition here
you.38degrees.org.uk/petitions/value-junior-doctors-and-all-nhs-staff

Okay , crazy 5am rant over!

Thank you for your comments and interest. If you have any questions or want to know more information or details about these issues please let me know and I will try my best to answer.

Thank you op.

I would be very happy to see my tax bill rise and NHS staff including junior doctors all properly paid. The NHS is brilliant. Obviously it has its flaws but we are so incredibly lucky to have it, and we will miss it incredibly if we are foolish enough to let the tories destroy it.

I couldnt agree more. My neice is a doctor and overall her pay will go down by at least 20% after 2019. That is unacceptable and I completely sympathise that strike action is the only way they can get the government to listen!

Thanks for your post and support, mumsnet - to anyone reading: the New contract is dangerous, first and foremost. Then there is the compromise to those taking a career 'break' for parenthood and research, then the pay cut (17% or more for me).
Please be another voice against it, please write to your mps and support us if we decide to strike.

Dr Paul Robinson, 37
Emergency Medicine Junior Dr.
Gmc 7155887

Taryn Youngstein has made it clear to me - finally - what the term 'Junior Doctor' actually is, as opposed to what it implies. I had thought (and I believe a lot of the general public thinks) that a junior doctor was someone straight out of medical school - I now realise that they could be working in hospitals for over 10 years as doctors and still be entitled 'Junior'- a very misleading title.
I am dismayed that these hard-working, dedicated and vital members of our society have to think about resorting to strike action to receive a fair and mutually agreeable contract. Perhaps most worrying are the safety concerns raised by hundreds of senior doctors and thousands of their junior colleagues after reading the conditions to be imposed by this unsatisfactory contract. For the government to resort to Spin in the press to publicise and promote this contract for political gain is insensitive.
I give my whole-hearted support to the junior doctors in their protest.

Hi thanks for giving us this info, I've just signed the 38 degrees petition.
I'm not a dr and don't personally know many Drs but being pregnant (and having a few complications along the way) has made me realise how great the nhs is and how hard the staff work in hospitals and community services to treat us all and keep us well.
Mumsnetters reading this I'd encourage you to click on the petition, takes a couple of secs and could make a big difference! I used to be quite cynical about people power against government plans but in my local area the government tried to close down our local A&E and the 38 degrees petition was a big part of successfully blocking this plan- hospital is still open now!!
To all Drs who are also mumsnet members, thank you for the great job you do and you have my full support in contesting these plans which will have a severe impact on family life.

Have signed petition, thanks for all the shocking info.

I'm another one who had no idea that junior doctors are in fact anyone below consultant level and often people in their thirties with fifteen years of experience, rather than recent graduates. The government has been disingenuous in not clarifying who will be affected and the true implications. The attack on women on maternity leave, part-timers and researchers carrying out life-saving projects is scandalous. Who on earth can afford to take a pay cut of any sort - is there anyone in the whole of Britain?

I like to think I am well informed and catch up with the news numerous times a day but the true implications is this passed me by, probably due to spin. I'm so shocked that even this government has the audacity to put this scheme forward but I suppose those in charge will have private health cover.

The way to win this seems to be to shout the true implications from the rooftops until everyone sees the danger.

Good luck, we all need you to win.

Social media post from Maria Aspinell, Junior Doctor:

------

Mary Aspinall
4 November at 10:19 · Edited ·

Why Jeremy Hunt's 'pay rise' is not what it seems:

My basic pay as a junior doctor is £10.85/hour.

I get an extra £5.42/hour for frequently working nights and weekends.

Per month I earn £1886 from my basic salary and an extra £943 in supplements for working antisocial hours.

This totals £2829/month.

With Jeremy's 11% pay rise my basic pay will increase to £12.04/hour.

But I will no longer receive extra payments for working antisocial hours.

My new monthly wage would be £2092.

I would lose £737/month.

Jeremy is trying to sell it to the public as a generous pay rise, conveniently 1% higher than the 10% rise our selfless politicians decided to award themselves earlier this year.

He still continues to refuse to acknowledge or listen to our genuine concerns about the new contract with regards to safe working hours and patient safety.

I do not want to strike but Jezza isn't leaving us with many other options.

If only he would stop spending his time trying to create spin and press headlines which paint us in a bad light and make true efforts to re-engage with the BMA and restart negotiations.

UPDATE**

Since writing the post I’ve received an email from Health Education England with a 4 page letter from Jeremy Hunt attached. It provides further information on his newest proposal.

With regards to antisocial hours pay I would still receive my supplement of 50%. However the hours considered as antisocial would be greatly reduced. The 11% pay rise is supposed to offset this to ensure my wage stays the same.

I’ve crunched the numbers and under this system my pay would be £280/month less - not quite so drastic, but still a pay cut and not the tidy rise Jeremy would like the public to believe.

I’ve read some of the response and there have been a few comments criticising me for complaining about my wage.

I didn't mean for it to come across this way at all. I believe I earn a fair wage for the job I do and I’m not asking for anything more. I do however want the wage to continue to stay fair for me and for future junior doctors.

The reason of this post was not to whinge but to put forward the point that Jeremy is not being completely open with the facts he is putting out to the public!

Hi mumsnet
I am a junior doctor of almost 40 but much more importantly I am the mother of 2 girls. We have all used the NHS as patients as well as doctors and I promise that this isn't about a pay rise. We would like not to get a paycut and I do worry about how I would pay for my childcare if working at 9pm on a Saturday doesn't get any sort of supplement and we are all getting less money than before but much more importantly this is about keeping the NHS functioning. The real problem is that this contract removed safeguards against working too many hours despite what Jeremy Hunt is saying. Removing the penalties means it's like saying you will reduce the speed limit but remove all the police and speed cameras. Doctors don't walk off the job when it's home time. We stay till we can hand over safely and this might be hours after we were due to finish. We do this willingly because we care. So you can roster us for fewer hours but if there are fewer doctors doing the work we will all end up staying longer anyway. Also this contract punishes the specialties where there is most evening and weekend work so no one will want to do a and e or obstetrics or paeds because they can't afford the childcare and because we do want to spend time with our families. Understaffed rotas are dangerous for patients. As an NHS user I don't want to have to strike but I fear that if this contract goes ahead the NHS will be unsafe every day. Thanks for reading

Thanks for your work and your care, Jannak.

If you'd like to know a bit more please watch and share this 3 min video about the junior doctors' contract, who they are and why this matters.
m.youtube.com/watch?v=T9891vEmUzw&feature=em-share_video_user
Many thanks

Thanks so much for explaining this to the greater world of Mums. We don't want a pay rise. We don't want less hours. On a personal level we want to ensure that our families have the same money to live on each month and actually see us occasionally.

On a professional level we want safeguards to prevent the hospitals overworking us and putting patients in danger from our exhaustion. We need to protect the medical students and newly qualified doctors from a ridiculously low wage which is unreasonable and will endanger recruitment to medicine.

The DoH and Jeremy Hunt have been heavy handed and bullying in their approach. They are blinkered in their demands for a 24/7 NHS at all costs. Though we support more staff and resources out of hours we appreciate that that will require money for more nurses, porters, radiographers, care assistants, cleaners, receptionists, technicians... etc. It cannot be "cost neutral". We are ALL already stretched so thin we could break at anytime.

We hope the public understand we cannot allow our precious NHS to break because of an unwavering and irrational manifesto from career politicians who have never done the work we do.

The strike will be covered by Consultants and those of us not eligible to strike. Emergency services will remain and no one will be ignored who urgently needs help.

This will be a taste for everyone of what junior doctors are worth because if this contract goes through there will be hardly any left in England anyway! Support us please we genuinely are doing this to keep you safe and so that the NHS can continue and so we can kiss our children at bedtime more than once a month!

Another medic mumsnetter, I have named changed back to an old name not to out myself.

To put the pay into context, as a junior doctor aged 37, after the childcare costs and professional registration fees were taken out there was £100 a month left from my salary. I don't live in London. I don't have a crippling mortgage.

Ten years ago we had just returned from New Zealand. We returned because fundamentally we believe in the NHS and all it stands for, and wanted to work for it. If this had happened ten years ago we would have gone straight back.

I am sure a lot of teachers would love to stand on the pick line with you showing our support, as we too as a profession are under attack from this government.
Unfortunately previous Tory governments changed the union laws which mean we can no longer strike to show solidarity.

Yes solidarity strikes are illegal.

But please consider writing to your MP (www.writetothem.com)

Sign the petition above

Write to local and national papers.

This is a fundamental attack on a profession who looks after us and our loved ones when we are at our most vulnerable.

Great post, would be voting yes/yes (to strike) if I wasn't on the wrong side of the border.

I am also a 37 year old junior doctor, mother of 2 and will be 'junior' until well into my 40s. And yes, pay is a big issue in the proposed contract, but for me this contract fiasco is about so much more than this, which is why it is so frustrating that the government/media spin is only focussing on this.

That said, I will lose out with this proposed contract. I am currently on mat leave, previously worked part-time, and next year start a PhD in medical research, then will return to finish my training after that. I'm also the main breadwinner in the family as my husband gave up his job to set up his own business so he could work more flexibly and cover evenings/weekends/child sick days etc when I was at work, but his income is pretty low. So to be honest I'm not sure what the future holds for me and our family, and I'm pretty nervous.

A lot of things have already been well described above, and I could rant on and on as there have been so many misleading things written recently, but these are my biggest issues:

• a full 7 day non-emergency service at current staffing levels just cannot work. Doctors will be even more stretched and patients will suffer as a result. It would be great to work a weekend with full staffing as things would run more smoothly (easier to get tests done, easier to discharge people, etc) but way more staff would be needed across the board - healthcare professionals, social workers and support staff and that will cost millions, and there still needs to be recognition that weekends are anti-social hours and should be paid accordingly.

• the Health Secretary has shown a worrying lack of knowledge of how the NHS works and gross lack of respect for the medical profession, presumably to try to stoke up public opinion against us. Frankly this is the last straw after years of putting up with so much DoH s**t so the usually mild-mannered doctors are now furious.

• Women currently make up around half of the medical workforce. These changes are particularly bad for women, who are more likely to take time out for parental leave and work part-time, and will almost certainly affect recruitment and retention of doctors. Also doctors in the future will graduate with predicted £80,000 of debt. If I were now 18 and considering going to medical school I'm pretty sure I would choose to do something else even though I know from experience what a massively enjoyable and rewarding job it is.

These last points are not directly related to the contract, but I worry about the overall Tory game plan and that the current attempts to undermine and devalue NHS staff are just the next stage in the plan:

• chronic underfunding in the NHS has led to it being nearly at breaking point. So much money has been spent on PFI that hospital trusts are on the verge of going bankrupt (and the government is unlikely to bail them out like they did for the banks).

• the path to privatisation has already been set: The Health and Social Care bill in 2012 changed the management structure of the NHS to make it much easier to privatise. The Health Secretary even wrote a book on privatising the NHS. Now reports seem to be on the news every other week of the various healthcare services being sold off. If left unchecked the worry is that the NHS will be run into the ground and private firms will buy it up piece by piece, and our healthcare system is likely to suffer (and become very expensive) if that happens.

So please if you've got this far, please sign the 38degrees petition (above), write to your MP, talk about it to your families and friends.

Sorry for the long post, but at least it is typed so you don't need to decipher my terrible handwriting...

Signed the petition. Thank you to all medics; we all appreciate the work you do. I think the Tories have gone too far this time.

I am not entirely sure how you can assume "nursing colleagues" can manage in the frontline if you strike - we can't . Safety WOULD be compromised.

Your post lost credibility for me when you said many of you voted Tory ....

I support you.

Why are we so intensely critisising your pay over bankers or any other professional group? We happily bailed them out to the tune of billions..

Can anyone name a constructive thing a banker ever did?

All in our lives can talk about the use of a doctor or a nurse.

I have signed and will encourage thise around me.

Petition signed. Ex NHS staff here.

Aside from empathy and sympathy (frankly seriously lacking in the tory party and govt generally imho).

As a patient with mobility, long term I'll health in mh dx THANKS to all NHS staff for frankly keeping me alive!

Glad to see petition includes other NHS staff.

Start of a slippery slope.

As a patient I do not want DR's or an NHS which is

Demoralised, disenfranchised and exhausted!

"Yes solidarity strikes are illegal" does this mean a general strike would be? As imho that's the ONLY way Tories will start to listen to the people.

I stand with you. As a nurse in the NHS, I see this as a step in the very long list of attacks on NHS staff.

In the last 10 years, I've seen colleagues burn out due to stress, I've seen patients and their carers suffer due to cuts, despite the "increased funding to the NHS" which seems to be paid for by cuts in social services.

When nurses / midwives were ballotted for strike action, I said no, because I wasn't allowed to strike to highlight patient safety, only because of pay.

And it's shame that strike can only be about pay & conditions because ultimately Jeremy Hunt's actions are a major risk to patient safety in the NHS - and I hope the majority of the public back junior doctors, because it isn't just a pay issue any more.