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.

DrPaola and Kbob thank you for sharing the new rotas. I have always known junior doctors work unsociable hours but that shift pattern looks absolutely discombobulating. It must be very hard to have any normal rhythm to your life except one ruled by work!

Arranging childcare around a rota like that must be incredibly hard. Also social events and holidays.

I can see how much you have to dedicate yourself to work to be a junior doctor and I'm very sorry that your employer is repaying you with lies and spin.

Come on Gummer. Come back and respond to concerns. He knows how this thread is going as I've tweeted him. But he's too much of a coward to return.

Another person agreeing with the junior doctors. What the government is asking for doesn't make any sense on any level. If you want to make all the elective services run at weekends you either put more resources in or you dilute the resources the rest of the week. This stinks of undermining the service with a wider agenda to destroy it. It's disheartening how much of the popular media is unable or unwilling to look at something critically.

Did Ben ever come back?

The attempt to impose a junior Dr contract will only mean it is even more difficult to retain qualified medical staff.

The news this morning is carrying the story that 9 out of 10 hospitals are already breaching the maximum pay cap imposed by Govt on the fees they pay for locum Drs and nurses.

There is a shortage of staff and there is a labour market. The junior Dr contract will mean more staff just quit and become locums or they will move out of the NHS altogether for higher pay elsewhere.

The Govt is trying to cut costs with the junior Dr contract as it did in pushing nurses pay and conditions down but the backlash is that there then becomes aa shortage of staff and the NHS has ended up paying out £ 3 billion in locum fees.

That is madness. The Govt will reap what it sews and is indeed already happening. departments running under staffed and having to bring in expensive locums to provide emergency cover.

The Govt cannot make people work for less than the job is worth. It cant demand a certain quantity of junior Drs and at the same time refuse to pay the price of what those junior Drs costs. It can drive down the price it is willing to pay but the quantity of junior Drs coming forward willing to work at that price is not high enough already. Driving down the price even further means even less junior Drs will be willing to work for the NHS.

The Govt doesn't seem to understand how the labour market works.

I am a junior doctor (I'm a trainee GP) I have used this site for a while now as I am also a Mum to a 20 month old little boy.

Due to working in a GP practice now and being able to book my out of hours (oncall time) things are easier to arrange childcare wise. However even under the current system people struggle to arrange childcare. How they will manage this under this new contract and some of the example rotas I don't know. I only managed my last hospital jobs with my husband having to take annual leave from his (thankfully non medical) job to fill in our childcare gaps.

Currently no one seems to be able to explain how spreading a service that is struggling to provide 5 days a week routine care with weekends and bank holidays emergency care can be stretched to provide routine care 7 days a week with no extra staff without the quality declining.

Finally if this was actually a good deal for doctors then why aren't we taking it?

This is what they're planning: Rather than more doctors they're going to employ a short term solution that already has issues with incompetence and litigation - 'Physician's associates' and in some specialties like anaesthetics (the doctor who puts you to sleep for your operation and makes dam sure you wake up again) 'assistants' www.healthcareers.nhs.uk/explore-roles/physician-associateassistant/physician-associate. Their starting salary is 30k. More than a first year doctor. I personally would rather my tax money was spent on more doctors.

I don't have anything new to add as PP have said it, but want to add my support for junior doctors.

If there are any Drs on the thread I suggest that if the Govt impose the contract you work very strictly to contract hours and then only offer to work extra hours at a 'locum' rate. Rather than asking the empty threat of going o work in Australia the more important treat is for junior Drs to work strictly to rule of the contract with absolutely no flexibility or good will. The NHS will pay locum rates and junior Drs should push for those on every hour outside the strict contract hours they work.

That way the hours you work will all be paid for. Your locum hours at a premium unsocial hours rate.

Junior Drs must stop working 'free' hours unpaid. The BMA and Consultants must support junior Drs to stop hospital managers impose unreported overworking which they don't get paid for. The unpaid hours will balloon once the new contract is imposed.

I'm new to mumsnet but I have an 11 month old baby and am training to be a doctor. I'm also a single mum.

I have no idea how I'm going to find childcare for nights and weekends or rotas like the example ones given.

I've given up a lot to follow my dream and study medicine in my late 30s but this contract issue is so disheartening. My life work balance seems to be even more out of reach, morale is at an all time low, the nhs is on its knees and the public will suffer.
I am now wrestling with many thoughts wondering if I should throw away the last 3.5 years of my degree and give up. I'd have a better quality of life with my son..

Anyway for all the reasons already mentioned this contract imposition is not safe and not fair.
Px

you are not fooling many people with your lies, Mr Gummer and those signing the petition about a non confidence vote petition.parliament.uk/petitions/121152 are largely from areas with Conservative MPs. You are not even fooling your supporters.

Of course the big question for you is not safety but cost and whether voters care enough about this to vote you out at the next election. I dont know. You are doing better fooling people with your lies about the economy but perhaps people will wake up to those lies before the next election. Personally I shall vote against any conservative candidate over this - and I'm also thinking of voting for Brexit on the grounds that anything this government wants seems to be a disaster.

Do sign this petition too, MPs should give something more for their totally unwarranted pay rise. petition.parliament.uk/petitions/120753

Come back and talk to us, Ben, you coward.

and Ben - if doctors vote with their feet and "7 day working" means you either can't see a doctor at all or you need to pay £1000+ a year for medical insurance with a big excess how long do you think the elderly will go on voting for you? Health matters more than 1p on income tax.

It's not even a question of thinking of doctors, their needs, their quality of life, their families (although obviously all those things are important too).

On an entirely selfish level, I want my Doctors to do their job well. This contract will jeapordise that. This contract will mean tired, demotivated, doctors for my children, for my family, for me.

This country is rightly proud of its NHS.

The Party responsible for destroying it will not bounce back in a hurry.

There's nothing wrong with admitting this was a mistake and getting rid of Hunt. I would have respect for the party who did that. Who listened to the people.

As I tell my children, "It's never too late to admit that what you did was wrong, and you're sorry."

Grow the hell up.

Another message of support for the junior doctors. I am sick of seeing MP's trot out the same old bullshit soundbites about how they apparently know what is best for doctors/patients. Quoting research that has been demonstrated as flawed or wilfully misinterpreted to try to justify their plans. This government (and Jeremy Hunt in particular) has shown nothing but contempt for one of our most challenging and necessary professions, while feathering their own nests with pay rises and awarding private contracts to their cronies. You cannot change the NHS to offer the 7 day service currently available Monday - Friday (I'm talking routine appointments, surgeries here. Most care is already 7 days!) and not pay more money to do so. You will just end up with a more limited service every day of the week, or staff working themselves into the ground to cover the inevitable gaps. Which means increased risk for patients.

I for one would be happy to leave my non-essential appointment/surgery until the following Monday, than have the doctor doing it so tired they make a mistake. You want a 7 day service, great. Then fucking pay for it!

It just makes me wonder how they decide what they put in the manifesto.

DC: I think we should have a 7 day NHS, people like the NHS.

GO: Excellent! How will we fund it? Cut malingerers harder?

DC: Gosh no! We'll just tell them to.

GO: And you think they'll do it?

DC: It's a vocation isn't it? They're a caring lot? They'll probably want to do it.

GO: Well they're obviously not driven by money or they'd be bankers!

DC: Well quite! So put it in. "More NHS for the same money" they'll love that.

GO: And if the doctors refuse we can say they hate the public and are money grabbing gits!

DC: It's a win-win for us. If the NHS collapses of its own accord then who am I to question it? Do we have anyone weasly to push it?

GO: I have just the man. Total James Blunt.

DC: Marvellous.

I then imagine a certain amount of Fnarr-ing went on.

I've been working for 10 years as a doctor and I'm still classed as a junior doctor. My husband is also a doctor. We have 2 young children.

I love my job. I hand on heart wanted to be a doctor since I was 13. I knew it would be hard work. I knew it would mean working nights and weekends. I knew some days would be emotionally challenging.

What I didn't know was that one day the very same Government that helped put me through school (assisted place fully funded to attend a private school as my parents couldn't afford it) would turn around and say I lacked professionalism and vocation. That I needed to work harder than j already do.

I've looked at the sample rota. You see - I can't give any more than I already do. My children cry when we go to work at night. My daughters first sentence was Mama work Mama sleep now Mama no play after another night shift.

This rota is neither safe nor fair. I can't do it. I'm sorry to all the patients I won't be there for. As a family we cannot financially or emotionally afford for this new contract to go through.

My heart breaks at the though of this. To think the words 'I won't be a doctor anymore'

Hi all,

Just to let you know that we've invited Ben Gummer to come back on the thread to respond to your questions - hopefully this will be possible later today, we'll keep you posted.

That's great. I genuinely want to hear a response from the government that isn't "the BMA have lied to doctors and the public" or "this is a pay increase" or "weekends kill patients".

Because doctors and the public are more than intelligent enough to see the truth.

This is not a pay increase in real terms when you take into account the change of conditions. Either way it's not the pay that is he issue, it's the change in conditions. My husband turned down a job that offered him more money because it came with a longer commute and fewer holidays. The money was worth much less than the time.

The weekends thing is scaremongering based on an incorrect interpretation of the studies, and will have already resulted in people putting off seeking help until Monday. With potentially life-altering consequences.

If anyone else wants to write to their MP but can't think what to say, there's a handy letter available online that you could copy and paste or edit. Just click here.

I received a message from my MP Heidi Allen this morning, which I have copied below:

^"In short, I agree the whole Junior Doctor contract negotiations have been handled very badly. You may not be aware but I met a forum of Junior Drs at Addenbrooke's before Christmas - you can hear what I had to say here.... ^

In recent months, I have worked with the Junior Doctor chair of the BMA Johann Malawana, local doctors and our regional BMA chair to try and find a way forward. Indeed I am meeting some of them again later this week.

I have tried very hard to encourage the Secretary of State to come to the table one last time. Unfortunately he feels the BMA have handled this in such a way as to leave him with no alternative other than contract imposition. While I do agree that the BMA are not blameless in this whole episode, (there are two sides to a successful negotiation), speaking personally, I believe it is never too late. I do not believe an imposed contract is the right way to start a journey of significant change within the NHS, so will continue to do what I can as a backbencher to try and bring both parties back to the table."

Despite her conservative leanings, I do quite like Heidi Allen. Well done Heidi. Somebody talking some sense and talking back to us.

Hello all

We'll get in touch with the DoH today to let them know about the questions on this thread, and see if Ben Gummer or another representative would like to come back on to answer them.

@soapybox

Why has this been unpinned?

Did someone not like the responses they have had

Hello Soapybox

The thread hasn't been unpinned - pinned threads rotate in Active Discussions, so you will see a different selection each time you visit that page.

Apols for the double-up folks - we won't actually be asking them twice .

I'm not a Junior Doctor, but I'm a Junior Doctor's wife, and we have a nearly 2 year old daughter. I'm glad so many people can see through all the rubbish the government has said.

Lots of good points made and questions raised. That sample rota that Dr Paola shared - three weekends in a row after promises that no doctor would work consecutive weekends - is horrendous.

I notice that there are 4 consecutive long shifts in the first week of the sample rota - 1 short of the 5 needed to trigger the 48 hour guaranteed rest period proposed by the new contract - I expect there will be a lot of these, so they can get away with not having to assign the rest period they were trying to sell as a wonderful improvement.

Lots of good points made and questions raised. That sample rota that Dr Paola shared - three weekends in a row after promises that no doctor would work consecutive weekends - is horrendous

This.

MrsBB you say I won't be a doctor anymore, as your family won't be able to handle the hugely challenging juggling act of a rota like this while your husband is a doctor too.

JuniorDrPaola you also mentioned that your husband is a doctor and the new rotas will be difficult.

Will we see women pushed out of medicine in cases like this to take on caring responsibilities?

I know many families now only make things work by having one very flexible or stay at home spouse supporting a junior doctor's schedule.