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.

^prize awarded for the most irrelevant post!

I don't know a single doctor, healthcare assistant, nurse or physio who hasn't been physically attacked by a patient. I'd call that putting themselves at risk of significant harm.

Lanchester, im not saying that doctors aren't public servants but to be honest the semantics in their case is a bit irrelevent. I'm saying that MPs are more of a public servent than Drs due to the fact that they are elected by people and their actual job is to represent people,,,,,part of which surely is answering questions the public ask?

"You obviously do share a common self interest in maintaining the status quo.

That means you are conservatives with a small c - with regard to this issue of the Junior Doctors contract."

NO!

There is a general malign trend in public service organisations of all kinds that I have noticed in recent years that has been brought about by the need to cut the costs of Govt.

That trend is to pass ALL the pressure of cost cutting measures to front line staff. That is the laziest way to cut costs. Just dump on front line staff with no management effort at all to make the service run more efficiently.

The other thread on MN about what NHS managers do revealed a very large blind spot among managers that the service was grossly inefficient and bureaucratic. More to the point numbers of managers increase exponentially and on higher salaries than clinical staff with no discernible benefit.

The Govt of whatever stripe over the last 30 years at least has done nothing whatever to cut NHS waste and inefficiency. The GP thread on MN reveals that some GPs now are openly calling for patients to take responsibility for more of their minor care needs and over the counter prescriptions. Stop dumping what used to be hospital care on GP surgeries.

Cost cutting by forcing GPs and junior Drs to work dagerous numbers of hours per week for the same or even less money is simply a despicable way for NHS managmnt to behave. Its basically bullying front line staff while management protect their own positions

The public does not support NHS manageent and Govt ministers in dumping on front line staff when we can all see the vast numbers of managers and bureacrats and the obceelevs of waste. Cut the numbers of maangers, cut their pay, cut the waste and burecracy. Do what mangers are supposed to do whch is design systems and processes that deliver more with the same resources - without grinding down front line staff to the point they just leave the NHS or make huge ife thretening mistakes or collapse into ill health from exhaustion.

No irony in my earlier statement Lanchester, can you not see that one side has come back to debate and answer questions and the other has given a party political broadcast and fucked off? Agree with other posters too that MPs are elected by us to represent us, that is what I meant by a paid public servant.

I am finding your posts increasingly hard to follow to be honest. You obvioulsy have a personal gripe with Doctors, I am sorry if you have had a bad experience.

Back to the point in hand, many of us answered this question around Sunday lunchtime but funnily enough you haven't responded to any of us.

"".....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"

Thanks everyone for your feedback - we'll definitely have a think about whether 'debate' is the right word for these dual guest posts.

As we said up thread, we do encourage guest posters to engage with MNers (and did so here). Where that's not possible, we think it's still worth having the position articulated - particularly in situations like this, where the opposing view is put forward at the same time.

Thanks all.

Kate to be honest, the "opposing view" stated here by BG is the standard Tory position which can be found anywhere - all this has done is offered another channel for their spin and rhetoric. What is lacking is a debate, questions answered etc. Nothing in either of BG's posts remotely address any of the many questions people have about this.

Now, I think this has done them no favours at all, but in principle I don't think you should invite politicians to post unless they are actually prepared to engage.

I agree with twofalls. I don't think renaming the debates is the right way forward. If they don't want to debate/participate fully, then they shouldn't be involved.

oh ffs...'an honour to be a doctor' really ?????

why is it an honour ? to slog through years of hard study, end up with massive student loans, work ungodly hours, making endless sacrifices ( mine and my children/husband etc) and then get shafted by the goverment..and today so far i have been told by 2 patients to F**K off , and another who told me i didnt know what i was talking about because his crystal waving holistic therapist says he needs xyz expensive test and i disagreed and i am only 4 hrs into a 12 hr day.

yep its a real honour ....

twofalls Tue 23-Feb-16 09:25:52
"......
I am finding your posts increasingly hard to follow to be honest. You obvioulsy have a personal gripe with Doctors, I am sorry if you have had a bad experience."

I have had a LOT of experiences as a patient.
I would say about my experiences of consultation / treatment by doctors
25% have been very good indeed
50% have been quite good or certainly ok
10% have been quite poor
10% have been very poor
5% have been life changingly poor

I support the idea of an NHS ...IF it can be improved up to modern standards of accountability and efficiency,

but I do not feel so grateful to the NHS as some of the JDs assume the public must be ...for the way it works for patients at present.

I think the JDs and the BMA are hastening the demise of the NHS by refusing to accept the government's right to set the pay and conditions within the NHS.

By the way, I have already said in an earlier post how I think that 7 day staffing can actually be accomplished without substantial extra funding for the overall cost of JDs.

theredjellybean Tue 23-Feb-16 11:38:00
"oh ffs...'an honour to be a doctor' really ?????......"

Gosh ! I wonder why you decided to go into medicine ?

Ignoring your last post, your post about how to achieve a 7 day service doesn't make a lot of sense. Limit juniors to 48 hours a week, but employ more- great but employing more needs to be funded. And where are these Drs going to come from?
Forcing consultants to work more? My husband does at least 5 hours extra a day, unpaid. He deals with the sickest patients in the hospital (no exaggeration) and is utterly exhausted and on the point of burn out. This is in no way unusual, read the other post above from the wife of a recently retired consultant.
Have you been forced to accept a 30% pay cut? What do you do? Would you? And for working longer hours? As those who know what it like in the NHS are aware there are many unfolded rota gaps already that juniors are forced to fill. This will only get worse.
Reducing pay will mean that nobody wants to do the job. Not only is vast amounts of it unpaid already, that amount of training, time away from family and more importantly level of responsibility - lives in your hands every day - is simply not worth it.

Unfilled rota gaps that should be.

I agree, lanchester your solution didn't really make sense. There is no way to achieve a fully staffed and functional 7 day NHS (not just emergency and critical care) without more docs, nurses, HCA, technicians, etc, which means more funding. Unless you make people work more of course. There is a good video of a child explaining it using Lego. I will try and find it.

Just read this in the New Statesman. Bearing in mind earlier points brought up about whether Junior Doctors have whisleblowing protection or not, it is worth reading: this government have been deliberately trying to ensure Junior Drs are excluded from this protection.

www.newstatesman.com/politics/health/2016/02/how-government-leaving-whistleblowing-doctors-twist-wind

Over 30 years of experience in a busy NHS hospital. Unfortunately, many of the junior doctors (whilst being good practitioners) have an air of arrogance about them. I think this is a generational trait. They used to have a certain respect for their elders (Consultants/Matrons) but now feel they are 'owed' for being important and blackmailing the general public.....well I think the oath 'first do no harm' may be in small print. We'd be stuffed if the nurses and non-clinical staff did the same (and they also work extra hours...)

I think suggesting that because some junior doctors are 'arrogant' and that it comes with their 'generation' is a little silly. Junior doctors are not a homogenous group. Their age range is between 23 years (for the newly qualified) up to those in their 40s. They do not belong to 1 'generation' and yes in a group of professionals, it is nigh on impossible not to find some who are arrogant. Human nature surely. Also the whole 'fight' is about the new contract forcing changes which will make doctors work longer hours which has been proven to be unsafe for patients and doctors alike (look back in media about the medical errors in the past) - so actually JDs are putting the 'first do no harm' ahead of potential personal gain (if the NHS fails and healthcare is privatised - health care workers are paid more in private systems fyi)

So three more JDs nationwide strikes have been announced recently by the BMA.
Are those strikes an accurate indication as to what extent the BMA and JDs really put the interests of each of their individual patients before their own financial interests?
Or vice versa?

Deejoda Wed 24-Feb-16 23:32:07
".... forcing changes which will make doctors work longer hours which has been proven to be unsafe for patients and doctors alike (look back in media about the medical errors in the past)...)"

Question: But in that case why have the JDs and the BMA not ever refused to work contracts with excessive hours?

Answer ? : Because they do not want a pay cut !

i.e. that means that the BMA and JDs already put
THEIR OWN PAY before patient safety
(and also before their own safety - according to you yourself)

lanchester you've obviously got some agenda. However, let me ask you a question. If you had a contract legally negotiated and it was ripped up and replaced with one that was paying you 30% less would that be OK? I wouldn't want to accept that so why should JD's.

Lynn I am forced to agree with another agenda. It is hard to have a discussion when the 2 parties are talking about parallel things. Simple point is that the hours many doctors in hospital specialties work are already long (longer than on paper) so this proposal which can only mathematically add up by increasing hours which most on here thankfully see - making the situation unteneble. Bearing in mind that DC's new invention of 10,000 new doctors is total BS in a string of lies being peddled by this current disgrace of a government.

I'm fully behind the JD's I wouldn't trust Jeremy Hunt et al as far as I could throw them. I speak as someone who has a long term health issue that often needs hospital treatment.

lynnm63

The JDs legally entered into fixed term contracts.
There is no legal reason why terms would always have to be the same for future fixed term contracts.
JDs can choose to walk away and maybe work somewhere else or do something else, where they can achieve the economic rent they require for their labour. Some JDs have suggested they would be better off doing factory work.... Obviously most people realise that the JDs are wrong in thinking that, and after a few months of standing on a factory conveyor line for 11-12 hours per day, they will soon be clamouring to get their old jobs as JDs back again ...at almost any price then offered by the NHS.

'Agenda'? What do you mean?
Unlike the JDs I do not stand to benefit financially from posting about the JDs contract changes.

JDs say current hours are excessive and dangerous for patients.
JDs say that they are happy to continue to work those excessive hours so long as the 30% extra salary involved continues to be paid in full.