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.

Lux we support you 100%. If there is anything in particular you think would help then say.

Ben.... Where are you? What, clocked off at 5pm? Surely not?

He probably clocked off the second he'd agreed to come back.

MNHQ how can this be a debate if one of the debaters only dictates then legs it?

Gummer and the Tories are looking more and more idiotic over this. I'm guessing Ben wasn't expecting this response and doesn't have a clue what to say?

I'm guessing he's realised you can't argue bollocks with intelligent, well researched people who aren't prepared to take his word that something is true when it blatently isn't.

I am not in the least surprised that Ben hasn't returned! Not a v impressive showing, though, compared to Dr Rodriguez's intelligent and reasoned posts.

Longjumping, I think pretty much anyone would like a pay rise, if one was offered. But that's not the point here - junior doctors have not asked for a pay rise at all, nor are they getting one. It's been explained earlier I think that despite the government's insistence that they're getting a rise, in real terms the vast majority will be getting a significant pay cut due to the changing of unsociable hours. The fact is they are being asked to work more hours for less money.

I am not bothered about the whole 'NHS privatisation' issue.

NHS consultants are doing private work already. GP practices are private companies with an NJS contract.

I had excellent care in a private gastroscopy unit doing work on contract for NHS.

The NHS employs privately contracted locums to cover the desperate staff shortage.

What I cant stand is the pretence that we are going to get a 7 day NHS with the same number of junior doctors who will be paid less. Its impossible to make that proposition compute. Its quite simple - that proposition is going to be a disaster for patient care and deeply unfair to loyal NHS employees who already go far beyond complying with the letter of their existing contract. Its just a kick in the teeth and exploiting the goodwill and professionalism of junior Drs .

And what I can't stand is the doctors' claim that this is about patient care rather than their pay. If they were honest and were striking for more money then I would support them ....but they are being dishonest and pretending that they are protecting the NHS

longjumping they can't "be honest" about wanting more money, because that's not why they're striking! They never wanted more money. They haven't asked for it, they are holding out for it.

The only financial aspect here is not wanting to take a pay cut. For the same work. And this is a small issue in comparison to the rest of the problems the contract has.

But you clearly have a one track mind about this, and can't see the facts through you self-righteous anger.

FFS. aren't holding out for it.

Doctors want to be paid extra for working on Saturdays for God sake! No professional person would ask for that, check out staff don't get overtime for Saturday, teachers, accountants, solicitors don't get extra overtime pay....the doctors are being greedy and expecting the public to support them in the name of " save the NHS" .
I would be quite happy if it were privatised, why not.?
Bupa hospitals do a good job, and before anyone says they cherry pick they are currently doing a lot of NHS work , and doing it well

Gosh, LongJumping. It's almost like you're not listening to the actual doctors on this actual thread posting about their actual wants.

It's almost like you have a very specific agenda.

I'm going to skip the rest of your posts. You're here to tell me what I should be thinking, but you're not explaining why.

No they don't! They want to continue to be paid as they currently are. That's not the same thing!

Would you not be a bit miffed if your employer decided to reduce your wages for working the same hours you always have? Would you accept the pay cut with barely a shrug? How would you feel when people accused you of money grabbing when you asked if you could please keep your existing salary?

I would be quite happy if it were privatised, why not.?

I wouldn't be happy with that. I do not think that healthcare is an appropriate thing to be privatised. Anything that is privatised is, by its nature, intending to make a profit, not to provide the best possible service for the available money. Plus privatisation brings in all kinds of problems with infrastructure.

Teachers, accountants, solicitors are not expected to work the kind of antisocial hours that doctors do week in and week out. Did you not look at the rotas earlier in the thread? I know teachers do lots of out of hours work but in their case things like marking and paperwork can be done at home where necessary so don't have childcare costs etc. And quite frankly all the accountants and solicitors that I know personally are really very well off and get generous annual bonuses etc. I would be very much in favour of a generous pay rise for teachers, btw. I think they are very much undervalued in today's society.

longjumping being faced with a pay cut is an issue for JD's with this contract but patient safety is another as the contract removes certain safeguards which protect doctors from being worked to the bone.

Instead if financial penalties to the Trust for working doctors over the max hours, they will be 'overseen' by a guardian. A trust appointed guardian. There is no independent accountability here- leaving a real possibilty of trusts turning a blind eye to illegal rotas- and for any doctor that speaks up facing a real possibility of being ostracised. It already happens where juniors have blown the whistle on clinical matters.

Ultimately this will result in tired doctors. Really tired doctors. Really tired people make mistakes. Ergo it becomes a problem about patient safety.

The new contract also seeks to use the same amount of staff across more hours a neutral cost. So there will be less doctors working 9-5 Mon-Fri- reducing levels of staff to those which are already bordering on the unsafe.

Further the mooted new rota leaves little decent training opportunity for each JD as their contact time with seniors will be reduced. So decreased quality of training- also a patient safety issue.

And comparing JD's working nights/ weekends to other weekend working professions is misplaced. The situations are.ery different. When my husband works the weekend/ overnight he doesn't get time off in lieu, or the next day off as in retail/ airlines etc. If he is up in the night after being called to A&E for a specialist consult, he still has to go to work the next day. After working a w/e he still goes in Monday morning, effectively working 12 days on the trot. 12, long, knackering days. The 'anti-social' hours banding they get actually just reflect the workload, it's not simply being paid more to work a fucking Saturday.

Doctors working in acute specialties get told when their annual leave is. There is no choice. It is extremely difficult to swap shifts on these rotas- we had to forgo a honeymoon in such circumstances, so don't tell me that this is the same as someone who works in retail, flies a plane or catches up on casework at a weekend. I often work weekends as part of my job to get things done, but in no way is it the same as working these proposed rotas.

I could live wit privatisation if the companies involved were run on a 'not for profit' basis, and there were adequate safeguards in place to make sure that care standards are not being compromised. But at the moment, private contracts are being awarded for running of services with no increase in budgets, so these corporations have to make profit from cutting services and costs, and especially the wage bills. I think that is what the junior doctors contract furore is all really about - making services more attractive to private corporations. Now - if we had a highly inefficient NHS (which we dont: we spend less per capita on healthcare than almost any other country in Europe) then they might get this profit from making things more efficient. However, this isnt the case, so profit comes from cutting staff and services. How does that affect patient care? We dont have any way of knowing until a mid-staffs type of problem becomes self evident. The problem here is that private companies are not subject to Freedom of Information requests, so we have almost no way of knowing. The CQC (the organisation that is supposed to monitor performance) has had its budgets slashed, and I understand that Junior Doctors dont have whistleblowing protection... so if something is going wrong we are very likely not going to know. It all smells rather badly.

Long jumping, seeing as Ben hasn't come back and that you agree with JH perhaps you could explain to me how doctors are supposed to deliver a fully staffed 7 day NHS without a) all the support staff doing the same and b) with THE SAME NUMBER OF DOCTORS? Surely it just means there are less doctors on duty as they are stretched to cover more hours.

(Apologies for shouting. I didn't mean to but can't be arsed to edit.)

To all the doctors on this thread. Thank you. I hope you know that despite the shameful reporting in the media the public are behind you. What else can we do to show it?

And for what it's worth I think it's a total disgrace that Ben was giving an opportunity to spout his propaganda without coming back to answer some of these questions. However, the fact he hasn't come back says an awful lot.

Good question. What can we, the public, do to help in this? I am composing a letter to my local MP, but to have any impact I suspect it would need large numbers of these from anyone and everyone. Is there anything else? Whatever operational form it takes, I want an NHS that is funded directly by all of us and free to use at point of need, not a corrupt and broken US style system and am passionate about this. How can we help?

I will write to my MP, too.

I would also love to hear how we can help. I am horrified by this issue and would like to do something practical and effective that might make a difference.

PS Fucking Ben. He was never going to come back. Oh yes, another lie by our crappy government.

I have no words to adequately express how disgusted I am with this government's attitude to the NHS. I object to this transparent effort to undermine it one further, and would like to know exactly who is going to directly benefit when everyone who wants to have healthcare for themselves and their families has to pay for private medical insurance. Average healthcare costs in the USA for a family of four is £15,000 a year. I don't know about any of the rest of you, but we can't afford that on a joint income of less than £30k.

I wonder if the weekend effect is worldwide regardless of healthcare.

Writing to your MPs is a great start! We have found that arranging meetings work
well because it's a lot harder to dismiss your concerns when you're sat face to face.

Speak to everyone about this topic, at your church, playgroup and at the school gates.

Get in touch with your regional BMA reps web2.bma.org.uk/rjdcweb.nsf/vtwp?OpenForm who can put you in touch with your local hospital doctors or you can try contacting via the local hospital mess.

Speak to your local media about why this is important to you! Hopefully your local doctors will run more Meet the Drs events so support them. Can donate to fund PR for the campaign www.gofundme.com/v54b25jw

We have to ask ourselves why our Prime Minister remains silent on this topic. Write to Mr Cameron and Mr Hunt and tell them your thoughts on imposition!

There is sufficient homework for you lovely ladies!

I wonder if the weekend effect is worldwide regardless of healthcare

The second study that Ben Gummer was talking about (there's a link in his piece) shows a weekend effect throughout the world but we don't know why. I must say though, that there are many many more studies that refute the weekend effect. These studies are better, with bigger cohorts, better methodology and much more robust data analysis.

Thanks so much,Paola, that is really helpful. Will take my homework seriously! And if I get a reply from anyone I will report back.