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.

The problem with the current service is not the number of doctors or nurses on the shop floor but the lack of diagnostics such as ct scans, MRI's and the services of groups such as ot's, discharge coordinators and phlebotomy. That is what is needed to improve weekend service, extra doctors and nurses will make no difference without an improvement in other areas. Yet again a government looking for a scapegoat and ploughing ahead with privatising the NHS by bringing it into disrepute and it's staff to their knees

The new contract will do nothing to support seven day NHS services as it penalises doctors that work in specialties with lots of anti-social hours work. The only people that are celebrating are those that only work 9-5 as they are the ones that received a pay rise.

The nasty fight around the contract has caused immeasurable harm to the morale of doctors and workers in the wider NHS. Imposition was a very nasty move indeed.

It is really not clear that anything has been gained by imposing this contract but much has been lost.

Hello Ben,

You say that 8 independent studies show more people die when admitted at the weekend, that is not true.

2 of the papers you mention are actually the same paper but published in different years. Only 2 look at data from this decade and 4 are NHS reports which are not peer reviewed and not impartial and not independent.

There is in fact more studies refuting the weekend effect than supporting it. These studies are better conducted with more robust data analysis showing that the weekend effect does not exist.

If you wish to learn more about the studies quoted please head over to juniordoctorblog.com/2016/01/11/the-hateful-eight-an-exploration-of-the-evidence-presented-for-jeremy-hunts-weekend-effect/ which explains it all beautifully.

1. The Freemantle paper was published in September and yet Jeremy Hunt quoted from it prior to publication. Why did he have access to this data beforehand?

The weekend is also classed as Friday, Saturday, Sunday and Monday which obviously does not reflect what most of us count as a weekend. We know that patients admitted at the weekend are sicker than those admitted during the week. Patient deaths were actually higher on Wednesday but the government don't recommend patients don't go to hospital during the week do they? The very authors even concluded that ‘to assume these excess deaths are avoidable would be rash and misleading’

1. Ruiz et al showed that ‘weekend effect’ is seen across the world in varying health systems and we don't know why that is. This study did not look at staffing levels so we can not claim that this is the cause.

1. The East Midlands Clinical Senate is a consulting report from ATOS and hence NOT an 'independent study'. The numbers come from other studies looking at both weekend and weekday working. It found that clinical standards were being met 50-60% and those areas struggling, were where funding had been slashed such as mental health and transfer and discharge to social care.

How can we expand to 7 days when there is no sufficient funding?

1. 'NHS services, 7 days a week' is a again a policy document and NOT an independent study. This is the same work as before but says we need to improve 7 day emergency care not routine services.

1. Freemantle 2012 has been discussed in 1

1. AoMRC is again a report reviewing other studies. Shows us that consultant presence is important in emergency admissions and has nothing to do with Junior Doctor Contracts.

1. Aylin et al was an independent study which showed a tiny increased risk of death in weekend emergency admissions compared to weekday admissions and again did not account for how unwell patients were or staffing levels.

1. Professor Temple's report I cannot see when I follow the link on the Department of Health page. But again it is NOT an independent research paper.

Again happy to answer any questions!

Studies also show that doctors who work more weekends and more antisocial hours (like nights) die younger.

These rotas punish those in Accident and Emergency and those that provide our emergency care around the clock. We know that life expectancy is 30% lower in these groups of doctors when compared to the average population.

I'm not a doctor but work in the NHS. I just wanted to add my support for the junior doctors. This "weekend deaths" nonsense is infuriating - you are more likely to die on a Wednesday evening I believe. Numerous investigations have shown that actually nobody much is interested interested being able to do access routine services at the weekend, even if the government were willing to provide the extra funding for all the other staff & diagnostic services that would require.
I want to add that I think the mainstream (particularly BBC) reporting of this has even woeful and biased in two hehe governments favour so am really pleased to see so many people have seen through the lies.
This contract is neither safe nor fair and is the precursor to the wholesale dismantling of the NHS.

Bloody autocorrect, sorry for typos

There are so many flaws with the new contract it is a little difficult to know where to start. Disclaimer married to an exceptionally dedicated and hard working junior doctor and my parents were both NHS doctors, doing their junior years in the bad old days of the later 60's/ early 70's.

With the newly published 'example rotas' how, do a couple both working in acute specialties (and there are many people in this position) and have one or more children manage to both continue training? If both parents are working the weekend, where are they going to find childcare? Oddly enough, there is no state or private provision for childcare at weekends as these are anti-social hours, generally not considered par tof hte working week.

In such family set ups, even with the mooted pay protection, the reduction in real terms pay will mean that thye can no longer afford for both parents to work, so one or other will more than likely have to stop work altogether of find more 'family friendly' employment and given current societal norms- I give you three guesses as to wheter or not that will be the mother or father in this situation. So if you think about it, this government is more than likely going to drive highly educated, intelligent, hardworking women out of their profession. So much for being a government that eschews sexual equality and who ahve paid lip service to reducing the gender pay gap.

Junior doctors will leave in their droves if the government conitues with impostion. Application to work abroad have already increased 1000 fold since the announcement of imposition (link here

If we weren't already living in a country with a sensible government (Wales) my husband would almsot certainly opt out of his on call rota and supplement his pay by taking up what will be an abundance of locum slots. This is going to end up costing the NHS more in the long term. absolutely barking.

Thank you JunioDrPaola

JuniorDrPaola your post on research quoted by JH is very interesting. It's a shame the media aren't picking up on this, investigating it and holding the government to account.

Dr Rodriguez, the life expectancy discrepancy you quote is shocking. A previous poster also commented on the worrying stats for mental health and burnout rates amongst medical staff. I'm sorry to hear that.

Thank you for your very clear rebuttal of the governments assertions (including links).

I hope the government really starts feeling some pushback here. It should be hard for them (mostly non-scientists) to push lousy science on a population with a lot more analytical skill (scientists, but also anyone working with numbers, facts).

Ben Gummer - we're not bamboozled by your quoting of "studies" or your "stats". Here the government says there exists a causative relationship between weekend excess deaths and the number of junior doctors on the weekend rota, quoting Freemantle. However, Freemantle has repeatedly said that no causative relationship has yet been established and that to attribute these deaths to any factor without proper analysis would be misleading.

Why are you trying to mislead us? Why is the government, elected by US to serve US, instead trying to mislead us?

We can see through it you know, and it doesn't make you look good.

And from a personal point of view- I have little experience of using NHS hospital services . However, I have used them when I gave birth to both of my children. Incidentally, both of my children ahve been born on a Sunday morning.

In both instances, I experienced a high standard of care from dedicated, professional staff who made every effort to make sure I was cared for to the highest standard. My first birth was a long, arduous 4-day induction, initially being admitted on a Thursday- if anything I found the care I received better at the weekend. Then when it became apparent my baby was not coming out un-aided, I had a theatre full of HCPs ready and waiting for any eventuality including a registrar and consultant working past the end of their already very long shift to ensure that my baby was delivered safely. In no way did I ever feel that I or my baby where in danger because 'doctors don't wait weekends'.

Ben,
Why are you lying? Why will you (and Jeremy Hunt) not debate with the eloquent and intelligent medics who have offered to/asked to debate with you? Why will you not have a shred of common human decency and actually speak to the people who will be affected by this? Why will you not be honest about your agenda?
You are wrong in what you say, you know that. Doctors know that, and the public knows that.
I am ashamed to have a government this despicable and dishonest and cowardly.

NancyDroop It is incredibly frustrating to see statistics constantly misrepresented in the media with no rebuttal. Even the editor of the BMJ which published the Freemantle paper has written to Jeremy Hunt and asked him to stop misusing the statistics in the paper as it never looked at Junior Doctor Staffing levels www.bmj.com/content/351/bmj.h5624

It is becoming increasingly difficult to arrange childcare and that will worsen with the horrific shift patterns being introduced.

Ultimately we want a healthy work/life balance for ourselves as a family and a fulfilling career where we are able to dedicate more time to our patients, without feeling rushed or tired all the time.

Maybe we need to take the Government back to basics, with a nice illustration of the difference between correlation and causation.

Is this graph showing causation or correlation?

I want Ben to answer. I know you know Dr Rodriguez. You can put your hand down.

Here's the image :)

Did you get it?

Here's another clue.

Love that image FuckYou.

Hand straight up in the air desperate to answer the question

Sh, Mner, we know you know. Let someone else answer.

:o

I know, I know!

Does Ben though?

Ok, for all those who know, whilst Ben's having a think, why would it be silly, to cut government spending on science, space and technology, in an effort to reduce the numbers of deaths by hanging, strangulation and suffocation?

Just sneaks in ahead of Ben ITS A COINCIDENCE!

I agree with Jeremy Hunt. This is and always has been about pay. Why are the doctors not truthful and say they want a big pay increase. I know several junior doctors and the parents of junior doctors and they all claim to be fed up that they can't afford to get on the housing ladder or pay school fees. That is fair enough, but don't try and kid the public by lying that it about the patients.
I don't know anybody, except the doctors and their families who support them. It has led to some serious rows between friends

They don't want a pay rise at all. They'd have been happy with the old contract.

I don't think this thread classes as a 'Debate' because all of us are agreeing with Dr Paola Rodriguez and none with Ben Gummer and he hasn't come back to answer the many reasoned and extremely well informed posts here.

If this was a proper debate its pretty obvious the opposing side won - especially as the side proposing didn't answer any of the points raised.

By the way. I am voting Brexit too because the spin and false statistics being put out on that debate to frighten us all into voting to stay in the EU are as risible as those being put out by Govt on the Junior Dr debate.