Guest debate: The imposition of the new junior doctor contract

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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.

"We don't use that term to describe ourselves"

This is interesting and maybe it needs to be put out there a bit more. So called junior doctors are actually highly trained professionals. Senior House Officers or Senior Registrars sounds an awful lot more serious.

Also, if you don't use this term to describe yourselves, may I ask where it has come from? Because it sounds like so much spin.

To those who voted the tories in, I genuinely don't understand why. This is what they have always always done - from right to buy to the bedroom tax to the poll tax and more - they have always been people who take good things away from those who need them most. Did you really honestly think it would be different this time?

My Dad says the same about labour always bankrupting us!!

I don't think we realised what effective blockers the liberals were.

We don't remember Maggie. Some lessons must be learnt by doing.

Unfortunately the government has called us that and to avoid more confusion we have had to adopt it over the last 8 months. We thought it better to explain to the public who Junior Doctors were rather than use different nomenclature. People still get confused between medical students and trainee doctors or doctors in training.

I remember Maggie and all her shite.

I see your point, Paola. But I do think it's damaging your very sensible and reasoned stance. The government has called you that in order to negate the points you make. Oh, they are only JUNIORS, what they think doesn't matter. As always they are trying to make it a thing where the people who have power keep it and those who don't get more of it taken away. I have emailed my MP btw and will let you know what he says if he replies.

I think there would be a greater public outcry if most people realised that the 'junior' doctors being affected are not medical students or only those within only a year or two of qualifying, but relatively senior professionals who are carrying out operations, running clinics and often taking sole responsibility for large numbers of very sick patients at night. Not 'junior' roles at all.

Hello all

Alas, it sounds as though there was a bit of miscommunication between MNHQ and the DoH on Friday afternoon, and we were a bit previous when we said that Ben Gummer would be coming back on to the thread. We're really very sorry about this - it's most unfortunate.

As a general rule we encourage guest posters to engage on the thread, but they're under no obligation to do so - these are guest posts rather than webchats. In this instance the debate is between the two participants, Ben Gummer MP and Dr Rodgriguez, rather than directly with MNers.

But if folk would be interested in a webchat, we'd be very happy to put out an invitation to the DoH to see if anyone would like to come on?

Would like to see if anyone would, Kate, but I doubt they'd have the balls it.

Well then you shouldn't have called it a debate if the other side didn't want one. It's not a debate if two sides just state a case without further engagement. I think you got this one badly wrong MN to be honest but their failure to come back and answer reasonable questions is telling.

If I was a JD maybe I too would be a

Medical LUVVIE

DAAHLINGS, aren't we simply wonderful ... extraordinary ... national treasures,
we are amazing really !
and our public are so grateful ... so very very grateful [they better say so] ...
Our sheer dedication and sacrifice and selflessness must be rewarded and recognised financially.
The public have trained us and so we must be paid like quite wealthy businesspeople.
Otherwise would simply break our hearts to be forced to strike.
We love our patients so much !

JDs posting to JDs posting to JDs. Group think rules OK !

Kate I would love it if MNHQ could get someone from DoH to a webchat.

Let's see them try to refute the points raised so cogently on here by Dr Paola and others.

Won't hold my breath though.

Gosh Lanchester, that's a remarkably goady post.

Trolly, even.

Lanchester I have asked you the same question now 3 times and all you do is come back and spout nonsense.

Either discuss the issues raised here like a grown up or find somewhere else to play.

all the posts by lanchester have been ill-informed and downright insulting. Sounds like someone who has a massive chip on their shoulder . The posts are so ridiculous they add absolutely nothing to the argument and are better just ignored

twofalls Sat 20-Feb-16 16:54:10

"Lanchester perhaps you could point the doctor who posted about the problems of childcare under the new contract in the direction of a nursery that is open on a Sunday or 2am to help them with their childcare."

I already answered that point.

Also perhaps you could answer the question I have asked several times now - how can doctors who are already stretched (many, many references to unfilled rotas) cover more days without more doctors?

Doctors need to have pensions cut and pay rates cut.
Then less doctors would actually be saying that they are no longer financially motivated and want to work part time / retire early.

Also, The NHS should not require or allow
junior (or any) doctors to work for more than 48 hours per week.
The doctors should only be paid for 48 hours per week max.

Training years will need to be extended for junior doctors so that they get an adequate amount of training.

The government should bring in an arrangement for newly starting medical students so that they have to agree that they will repay the cost of any public contribution to their training if they work for less than 10 years in the NHS after becoming (say) a junior registrar.
The repayment due to the public purse would be on a sliding scale depending how many years they actually did work in the NHS.

Additional Medical schools and hospitals should be set up and funded privately. The Government might still be prepared to subsidise medical students on the same basis as above.

In the meantime Consultants should be forces to put in more hours themselves, and unfortunately we will need for some years to continue to recruit qualified doctors from abroad (which is depriving their own, often poor, countries of their expertise)

All the above will mean that there are enough doctors to cover 7 day working.

PLUS the fact that lots of JD s on this thread have already said that they NOW do 7 day working, and their main complaint seems to be that they want it paid at overtime rates.

BoreOfWhabylon Sun 21-Feb-16 11:15:20

"Gosh Lanchester, that's a remarkably goady post.
Trolly, even."

I just looked up the meaning of the word "Troll"
Wikipedia says ; ....Application of the term troll is SUBECTIVE
Some readers may characterize a post as trolling, while others may regard the same post as a legitimate contribution to the discussion, even if controversial.

So JDs, the intention is not to upset you but to educate you
and try and show you JDs that
the public are NOT ALL SUPPORTING YOU

At the moment you are just all posting to each other and reinforcing each other's group think.

Group think is dangerous and leads to error here.

Please note that it can also lead to missed diagnoses in your every day work.

Everything Lanchester posts is goody and troll-like. Maybe if we ignore him/her he/she will go away? hopeful

Goody? Goady

WhoAteAllTheDinosaurs

So people that don't agree with you must be ipso facto wrong
and you shouldn't listen?

You sound like a student advocating "no platforming" of others that might make you think about your own views.

Unfortunately your views do matter, and they need to be informed and challenged by debate...as do mine.

WhoAteAllTheDinosaurs
Sorry not "Unfortunately" - I withdraw that word in the previous post

Yes, ignore it and report it for goading as necessary. It only joined MN to post its rhetoric on doctor threads (plus a couple of recent anti-abortion, anti women's bodily autonomy gems). Go figure.

And please REPORT.

MNHQ yes please to a web chat with a minister from the DoH.

Please do ask Ben Gummer.

LineyReborn Sun 21-Feb-16 12:02:17

Calling for censorship is unattractive.

When a powerful group in society say that they cannot work 7 days because there are not enough doctors, whilst at the same time say that they already work 7 days and that they are happy to continue to do so as long as they get overtime rates, and at the same time say that working 7 days is dangerous for them and for Patients who are their "prime concern"....then there is obvious dishonesty ind inconsistency in the position of the the Medical Profession.

This dishonesty and special pleading and abuse of their position in society needs challenging.

twofalls
said that I had not answered her question and I have recently therefore tried to answer her two questions.

So, LineyReborn, If you don't agree with points I make you should be able to say where they are incorrect rather than trying to label and smear them to avoid having to respond properly and intelligently.

Just popping in to say that DH has just retired. (Thank goodness - he is exhausted).

He has worked roughly double his contracted hours for the entire time he has been a consultant in the NHS (23 years). Including nights, weekends and even during periods of booked annual leave.

Don't even get me started on the shocking working conditions - offices created out of broom cupboards, lack of secretarial and support staff, having to spend hours creating a business case, attending endless meetings, fighting your corner to get anything approaching adequate staffing for your department, paying extortionate amounts for parking then being unable to get a space unless you arrive at 7.00 am and being slapped with a fine if you have to park in the wrong place to attend an emergency.

The training period for "junior doctors" is around 10 to 15 years post qualifying and involves massive amounts of time, dedication and personal expense.

Just wanted to make that point for the benefit of goady posters who clearly don't know what they are talking about.

DH and I absolutely support the junior doctors. The lies and spin coming from this government are evil. Neither of us voted for this government: they are systematically dismantling and privatising the NHS.