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.

To me every Dr is worth their weight in gold.
We all know this dumbass contract is a step towards the downfall of the NHS, nurses and midwives will be next and then HCAs.
We the public are not stupid, we can tell when the wool is being pulled over our eyes

Who was it that said " There are lies more lies and then there are statistics" ?

I am not a Dr but then I haven't studied for years to become one.
Appreciate what we have people before it's gone, in my humble opinion that is the object of the government

longjumping We never asked for a pay rise, we are happy with what we have. No one would be happy for their employer to turn around and say 'you will be working more for less money and that if you don't like it, tough'.

Our rotas are already understaffed, it will be dangerous to have even less doctors on during the week to cover those now covering the weekends. If even 1 % of Doctors decide to leave over this it will affect the service stretching us even further. You can already see it in your A&E waiting times. This will just get worse.

I am in no way surprised by the disappearance of Mr Gummer. Having written to him and my local conservative MP and received woefully irrelevant replies regurgitating the endlessly random party line I doubt he'll respond to any of the hearteningly sensible posts on here. I am a 42 yr old NHS consultant and was a "junior doctor" myself until 3 years ago. I fully support the juniors - their contract imposition is just the thin end of an enormously painful wedge the current govt is trying to ram into the NHS and it hard to believe that the service will still exist in any recognisable form by 2020. Please make your voices heard - sign petitions, write to your MP, we will have to make an enormous noise to turn around their plans and try to reverse some of the damage that has been done. The public need to let them know that they DO NOT have a mandate for NHS destruction and privatisation, and that a real debate into the future of the service, outside of party politicking is what we deserve as an electorate.

LongJumping if money is what it is about, then I'm certain that Junior Doctors will happily acquiesce, and return to their original, un-altered contracts for the same old rates they were on.

Phew. That's that one solved.

Good work FuckYou!

Hi Ben! Have you read the thread? Can you answer our questions?

I'm glad he's coming back but I will eat my hat if he does anything other than pedal the same old crap. He will pretend to listen but he won't. He will pretend to answer questions but he won't.

Yes, doom and gloom, the end of the NHS, just the same as every other change to working practices in living memory. But it's still here. And it'll still be here in 2020, it could take that long just to sort out this dispute let alone anything else.
Let's be clear, no-one's queried the concept of healthcare free at the point of delivery, in any meaningful way. As long as that persists, how else does anyone propose that these services get delivered?

You may disagree with the way certain things are handled, but 'the NHS' is so vast and complex that it would take several parliaments to dismantle it (and replace it with what?) even if that was the aim.
In the meantime, we, the public will have several opportunities to make our feelings known at the ballot box.

And as for privatisation, how does that differ? It's a dirty word but at the end of the day it's an organisation being paid to deliver services to the public for no charge. A bit like what happens now really. As a consumer, I don't care who employs you as long as I get a decent service. But we might get variable quality from the private sector! So, a bit like what happens now really. Mid-Staffs anyone?
If you supply the labour it should strengthen your hand. How would the government 'impose' a contract if it had to do it via dozens or hundreds of private sector organisations?

Rather than venting at the government, we should be looking to Labour to get their bloody act together. The lack of an effective, electable opposition means the current administration feel they have carte blanche to do what they like. And to a certain extent that is the case. We are in a paradoxical time of a government with a tiny majority which can behave like it has a huge one.

In this specific case I'd agree with a previous poster who proposed working to rule. And making it quite clear why you are doing it. Obviously don't get up and walk out mid-consultation, but if a shift ends before the waiting room is empty, well, so be it. Someone else will be left to explain why the remaining appointments are cancelled. Refuse shift patterns you feel are unfair or unworkable.
If the recruitment crisis is as has been stated, then junior doctors are in a position of strength. No trust can afford to sack them (or not renew).

By the way, I'm not Ben...

What a truly lovely and heartwarming thread. I had no idea that mumsnetters knew of the issues at hand. I remember previous threads from weeks/months ago where lots of posters thought junior doctors were whinging because a 11% pay rise wasn't good enough.

I am going to be affected by the new contract. In 3 years time when pay protection ends, I will end up taking a massive pay cut. I may have to go back to working full time to ensure that I finish my training within that 3 years as I am not sure we can afford that drop in salary. It is very depressing and disheartening. With the rise in basic pay and the massive cut in unsocial hours pay, maternity and women's health services are going to face severe shortages. The system is already at breaking point with trusts opperating with 20% gaps in their rota. The reason for this? Working conditions and pay for doctors is shit considering what we do. No one in their right mind with choose to do a speciality where you're routinely covered in up to 4 types of bodily fluids at 3am for less than £30/hour pre tax! Maternity services will suffer as a result of this poorly thought out huntonomics.

I think Ben's made an early dart for the weekend ---->

The problem with privatisation is that things are run for profit. A hospital run for profit is one that cuts costs, be that staffing or resources, in order to please their shareholders.

In France, I am told, hospitals are run by non-profits. There are benefits such as competition for staff, etc. But equally, the buying power of the hospitals are severely reduced compared to something like the NHS. Care is still good, as they are not trying to make money.

Happy to be corrected on this, it was just a casual conversation which I haven't fact checked to within an inch of its life.

Working to rule doesn't work when you're dealing with people. It's all well and good to say "walk out on the dot" but how do you do that in good conscience when there's someone in front of you needing care?

I think focusing on Labour is an odd angle to be taking on this.

This is our government hurting an institution that we love. Opposition or not, this is happening now.

It will take time to dismantle the NHS, so why stand back and let that continue? Let's invest in it instead.

One of the problems with this dispute has been the biased reporting by the press and BBC. The spin and smearing of junior doctors has been awful, no wonder they feel so demoralised plus frustrated their voices haven't been heard. However I think the BMA needs to make the public more aware of how this junior contract will affect everyone directly - patient safety, long waiting times, etc to get more public behind them (Rather than talking about pay & weekend working which certain papers have used against the doctors) Maybe leaflets in GP surgeries, A&E?

I am a doctor, and want to know exactly what ' 7 day a week services' mean. the govt has not been clear about this at all, it is just a soundbite that sounds good and allows dave and jezza and ben and co to sound good.

Basically we have a 7 day a week service now . If you are sick/ill or in an accident at the weekends, what do the politicians think happens ???

There are out of hours GP services , there is a&e and maternity and paediatrics and surgery and ....all working at weekends.

Ok you can not necessarily have your routine out patients appointment to have a dermatologist look at your mole on a sunday afternoon...but do we REALLY need that level of service ? It would be nice but funding this would be a huge tax burden and frankly impossible. Not to mention the fact we just do not have enough doctors to provide this .

In general practice, we are being told we have to open routinely 7 days a week, in the area i work we have a great federation providing this service in three locations, but this is being stopped and we are being told that ALL practices must open 7 days, there are not enough GPs to do this, and frankly it is not needed ( nice to have but not needed) ...how on earth am i supposed to work 7 days a week and maintain any family life ?

were is my work/life balance ? and the junior doctors new contract says no doctor will have to work 2 weekends in a row ...errr....what about the GPs ? I will have to work EVERY single weekend from April.

Hunt has lied to the house of commons. He said in parliament that Dr's would never have to work consecutive weekends. But the new rota allows for three weekends in a row to be worked.

Gummer, I would like a response to this please. I think it is a very serious offence to lie to parliament. I realise he's your boss and he's probably lying to you to. Use your intelligence and don't fall for it or he will distance himself and let you do the pr and look like an idiot. Which you do.

Maybe he's wait till after 5pm so he can claim unsociable hours.

Working to rule doesn't work when you're dealing with people. It's all well and good to say "walk out on the dot" but how do you do that in good conscience when there's someone in front of you needing care

I totally understand that, but unless you can set your conscience aside your good nature will be taken advantage of for ever more.
Plenty of doctors managed to leave their conscience behind long enough to go on strike, so it can be done. That's not a judgement, just an observation.

As for profit-making, this is controlled by target setting, something the NHS should be well used to. Miss targets, get fined. Of course private companies have to manage their costs, but public sector providers don't have a bottomless pit. And at least the fines would come out of shareholders pockets. Currently we fine ourselves.

Part of the problem with private care is that it really doesn't give you the same 'bang for your buck' that the NHS provides. When viewed against other health care systems the NHS is regularly viewed as providing a lot more for a lot less (I don't have a link currently).

Private health care can affordable if set up properly and many countries operate a decent system, but the trouble really hits people in the pocket for long term conditions; athritis, diabetes, Epilepsy to name but a few. If you think it doesn't have an adverse impact just look at the thread in chat form a lady in the US who's husband is in intensive care due to complications of a benign brain tumour. They can't afford as much treatment as would be classed optimum care and she says herself that the stress and worry has driven her to alcoholism.

A system that is free at the point of use is an amazing thing and we should all be working hard to ensure that it is not lost to private health care providers, in which certain right wing politicians have financial interests in.

J'S are not asking for a pay rise. They are just asking not to be asked to work more for less. I defy any worker, professional or otherwise to be happy with that.

jellybean GPS are definitely having a shit time of it too. As far as I'm aware., in some areas where practices have been open 7/7, uptake has been very poor because in reality people don't want to be seeing their doctor on a weekend

The strike was different as emergency care wasn't affected. Working to rule could well affect emergency care. You can't leave a ward mid consultation of a sick person when the night relief has gone to see a sick person in the next ward.

Guess clinic Dr's and gps could maybe get up and leave at 5pm. I don't think they will though.

I think the NHS is being set up to fail by this government; a deliberate & insidious process which will ultimately lead to it's demise.

The vast majority of the general public support the NHS & oppose it's privatisation. And of course the Conservative ideology is anti-public sector.

So the Conservatives can't be "seen" to do this. Instead there's the malicious media campaign & manipulative rhetoric to illustrate their narrative.

Luckily few of us are stupid enough to believe it.

I'm not a mum but I am a junior doctor. I made an account here because I wanted to thank everyone for the overwhelming support in this thread. Please don't abandon us yet. This isn't over. As a profession we have never been so demoralised and depressed, I have seen so many colleagues in tears over this, but we are not going down without a fight. We can't do this without the public's support. Help us. Please.

(PS I think Ben's deafening silence speaks for itself...)

Lux, please thank all your colleagues for us. We are behind you. This contract is not right.