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.

I would also like Gummer to come back and explain how the Tories intend to ensure that a&e and obs and gynae have enough doctors specialising in them in the future?

These two already struggle with recruitment and they are two specialities with are very unsocial hours heavy. If you were a Dr choosing a specialism once the new contract is in place then surely you would be even less likely to choose one with lots of weekend work if you weren't financially compensated for it? You're going to pick something like dermatology instead.

I must say, I can't help feeling that the weekend effect is surely down to the very basic fact that at the weekend, we are less likely to attempt to access healthcare unless it's an emergency. Because, you know, most people are fairly sensible and if they can wait until Monday they probably will.

My knee really hurts atm, actually. I think I have done something a bit crap to it and it's not v good. But I'm going to wait until Monday to get a same day appointment with my GP because apart from the bits where my daughter keeps sitting on it, I am basically fine. I'm not going to die from a hurty knee. OTOH, I'm asthmatic. If I was having an asthma attack, I would totally be going to hospital and ringing my brother to babysit because that's stuff that can kill a person. I'm not going to die from a painful knee. Isn't it just mostly down to people being mostly quite sensible about how ill they are? Or not? It is v interesting (but clearly not a reason to fuck all the doctors over).

The differing reponses of the two debaters on this thread (Rodriguez v Gummer) is making me think more generally about junior doctors v politicians.

Both groups are government employees and work to seek to serve the feneral public... apparently.

However, in my experience, doctors work extremely hard to analyse data, diagnose and then very tactfully but honestly communicate their findings to patients, families, colleagues. They are specialist at open, non-misleading communication.

Politicians, on the other hand, seem to strive to obfuscate and mislead (sorry, spin) their findings on a daily basis, as this case has shown (fex misreporting of Freemantle conclusions, cherry picking parts of the new JD contract to talk about).

Should we not hold politicians to the same high standards as doctors? Why not? Both groups are in positions of power over their patients/consituents? Both groups serve the public.

We wouldn't be happy to be seen by a doctor who's commitment to accurate and fact based communication held the same shaky standards as a politician's, that's for sure.

I think politicians get off too lightly with their spin. They are highly responsible, highly paid civil servants. We should hold them to much higher standards of thruthfulness, as befits their senior position.

Though as that might not magically transpire, may I suggest that some of you highly intelligent & dedicated doctors aim to become MPs at the next election? It certainly seems an easier job than medicine! Better pay and conditions too!

Please excuse my typos everyone.....

I would certainly vote for a medical Dr over a career politician at a general election. As long as they weren't A Tory Dr obviously!

Does anyone know why the Labour Party are not more heavily wading into the debate. Could the bma not petition Corbin to oppose more (or are they and we don't hear about it?)

No idea why this isn't getting more attention from either the media or Labour.

I have to say seeing all the lies from the Tories makes me even less likely to believe anything they say. I always knew they would spin, that they'd go back on their word but to lie like is is staggering! And it makes me more likely to vote to leave Europe because I just can't believe anything they say anymore.

Thats the thing. As a Tory voter (now ex) they have lost all credibility in my mind, much like a child who keeps getting caught out in his lies. The other thing I have noticed is just how extreme the media manipulation and message management is in the mainstream news. I always suspected it was there to a degree - more as a consequence of shoddy reporting - and thought the cries of 'bias' and other silly stories were simply conspiracy theorists or people banging on who had lost an argument.

Then my doctor friends went on a demonstration in January - there were 8000 of them, and.... nothing reported. Anywhere. The same old government story line keeps getting put out there in the press, when open letters from large medical bodies have been published in letters sections etc etc. Now my view is that the media is clearly highly controlled, and this includes the BBC. The more I look (and in other areas of news) the more clear the manipulation is.

In light of this, I am also deeply worried about the state of democracy in the UK. The only way we have to call politicians to account it seems is to vote them out at the next election. The media dont hold MPs to account anymore it seems. MPs are protected, and are free to say what they like to the public, whether its lies or truth or whatever.

when I was a junior doctor ( a very long time ago :)) we worked on very very long hours, and every other weekend ...all weekend...as well as the week day job. When I started weekends were paid at half the hourly rate, on sundays i got less then the porters who got double time.
we campaigned locally and got our jobs and rota re banded and paid a fair wage...we CANNOT let the goverment turn back the clock to those days for our junior doctor.

All I can recall of that year was the over riding terror and tiredness...i am sure i made mistakes due to this. We all did.
What did I do ( and many many of my colleagues ?) ...I left for overseas as soon as i could, and stayed away for 10 years.

We CANNOT let our junior doctors go back to to this kind of situation, already the GMC has seen requests for certificates of good standing to go and work overseas rise exponentially.

This contract is not being imposed in wales or scotland, if I was a junior doctor and couldn't head down under , i would be going over the border asap.

This is going to cause such damage to the nhs in england as we will see hospitals completely unable to fill rotas and the costs of employing locums rocketing.

Some one up thread asked about the uptake of 7 days a week GP services....yes very poor...i have been here since 8 am and 4 out of 5 patients booked in have not shown up . But hey JH said this is what is needed !!!

This is the statement Jeremy Corbyn put on his Facebook page about the breakdown in communication. I doubt it was reported much

I've just released this statement in response to Jeremy Hunt’s announcement that he will impose a contract on junior doctors:

Jeremy Hunt's decision to impose a contract on junior doctors is provocative and damaging. Rather than helping to resolve this difficult dispute, his action will only inflame it.

The BMA has continued to table proposals to settle the dispute. The fact that the Health Secretary is now simply trying to impose his will rather than negotiate, demonstrates a lack of confidence in his own arguments.

We need to recognise the huge contribution junior doctors make and the years of training they go through to look after us. These are people dedicated to our health and our NHS.

Patients, doctors, the BMA and the public want an agreed settlement. What is now keeping this dispute going are the actions of the Secretary of State himself.

More strikes now look likely. If that happens, it will be clear that the blame lies with the government, not the doctors.

Even at this late stage, I appeal to Jeremy Hunt to go back and negotiate with the BMA.

This government is reckless with our NHS and is now prepared to put patient care at risk in the service of its self-defeating austerity programme.

I agree we should all try to do something.

I consider myself a reasonably well informed person and I don't believe anything Hunt says, and yet I had to read this thread to fully realise how bad these changes are for doctors.

What if we each tried to convince at least two people to sign the petition for a vote of no confidence in Jeremy Hunt?

petition.parliament.uk/petitions/121152

Good idea - that and get people to write to their local MP. There was an action plan sugested somewhere in the thread with other suggestions too. Petitions are useful, but they dont have to agree to debate the subject of a petition. Only consider it. I think MPs need educating as much as people do, and ultimately parliament is still where the power rests.

Worrying times. Already there are rota gaps with hospitals struggling to fill as Hunt has recently introduced caps to locum rates.

Just recently Great Ormond Street put out an email asking if any staff available to fill vacant shifts within the capped rates, as seeing an increase in gaps since it was introduced. Great Ormond Street FFS!!

And this will only get worse when junior contract introduced as doctors spread thinner combined with less available as left England for Scotland/Wales/Canada/Australia

Please spread the word, talk to MP, sign petitions. The press & BBC have been v biased in their reporting.

The posters on this topic are not a representative sample of public opinion.
They are largely medics whose conditions ate being put under greater public scrutiny , audit, and control.
"They do not like it up em sir, they do not like it up em !"
Hurrah for Jeremy Hunt

Lanchester, you sound a bit crackers to be honest.

The problem lies in media misrepresenting what we do and how much we get paid. We do not have 4 hour lunch breaks and consultants are no longer out on the golf course during working hours.

We as a profession must be incredibly wrong to have misread a contract proposal and not seen that is it great for us and our patients. If it was that amazing, we would be jumping up and down with joy seeing as we're getting a 13.5% pay rise as well! Sadly people have been taken in by the spin. We are normal working people who are entitled to fight for fair and safe working conditions like any other group of people. We are not asking for more than what we already half.

Ultimately I know that the public do stand with us!

I just want to know why Jeremy Hunt refuses to debate / engage / talk to any doctor live on TV or on the radio.

Surely he represents us and he still refuses to listen to our concerns on or off air.

He'd look a fool if he was interviewed by anyone other than a sycophant, Paola Let alone someone with any sort of critical thinking skills!

BMA Stop BLUFFING and STOP your attempts to morally blackmail the population into giving in to your demands.

Australia and especially New Zealand have small populations and require relatively few doctors.
Therefore over 95 % of British doctors would NOT be able to get permanent jobs there.

Wales ? the health service there seems to be frequently in the news for ridiculously long delays in treatment ... something seems wrong with the current NHS arrangements there.

Scotland ? Nice scenery but a bit cold for 7 or 8 months of the year.
Take your parkas if you are going (and a mozzy netted hat for the brief but beautiful summer).
Plenty of deprived communities for maybe a few thousand NHS doctors to work in inner cities there in the southern belt of Scotland.

Sub - Saharan Africa ? Opportunities for junior doctors to show dedication there certainly. (remember all your vaccinations before you go though).

Eastern Europe ? Salaries not quite up to UK levels.

Western Europe / USA / Canada ? Don't really want many of you.

OR ALTERNATIVELY you could choose to stay here and work in the country that is your own country, and that has educated you, and where your relatives live, and where your working conditions and career rewards are far better than can be dreamt of by most of the population here.
you are LUCKY - Stop complaining.

The majority of the population want 7 day NHS working and

Support Jeremy Hunt

This debate is so simple

If you want a 7 day NHS, you HAVE to provide the money and resources to do that.

That's EXTRA money. The British public love their NHS and I'm sure would pay more taxes for it.

Now I hate to make assumptions based on facts. And I wouldn't want anyone to follow me in making the assumptions that I have made. So instead I'm going to state a couple of things I've noticed (and I am open and happy to be corrected).

The vocal Pro-hunt posters on this thread have very few posts, all seem to be within the past 6 months, all on... Shall we say rather limited subject matter.

The posters I see supporting the doctors (the vast majority) are split into new posters (who state they are doctors and joined to post) or long standing posters like myself who I see around the place from time to time.

Isn't that interesting?

Dear Ben Gummer
Please could you provide me with the statistics that show the rise in death rates in Maternity during the weekends.....I think you will find we already provide a 24 hour, 7 day week, 365 days a year service, but that is not what you are leading our families to believe. The number of women, partners etc that I have had to reassure that if they labour on the weekend and there are complications are they and their baby at risk since the ridiculous statements were are unbelieve....you are destroying every thing I work for, free, safe and unbiased care.
Regards,
Very Annoyed NHS Midwife

Lancaster..have you seen the jobs advertised in australia / new zealand ???

clearly not...there are literally thousands of them....

when i went to work there, it was a case that australia trained enough doctors per head of capita but the docs all wanted to work in major cities so lots of uk docs went and did jobs in rural areas...now that is no longer the case, jobs galore ...everywhere...so why don't our lovely junior doctors go work somewhere warm, sunny, with good hours and pay and conditions, where they are appreciated and supported not continuousy degraded by a goverment with a hidden agenda...oh yes and take their families with them !

oh silly me...they are....and those that are not , are doing it out loyalty to the nhs and public.

THERE ALREADY IS A 7 DAY A WEEK NHS

what exactly do you think happens if you are sick at the weekend ??? all the hospitals are closed with the doors locked and lights off ???

I think that DIRECT taxation could be increased to pay for improved healthcare.
BUT ......the problem is that vasts amounts of CURRENT (i.e. ingoring PFI etc nonsense) expenditure INCREASES were pumped into the NHS by the Labour Government and

MUCH of that huge amount of money went to featherbedding conditions and £ pay and pensions for NHS Staff.

For example the GP Contract changes made by Labour were ridiculously unaffordable
and detrimental to patient care.

During these well funded years there were various scandals and cynical medical negligence was evident
e.g. North Staffs - killing patients by neglect,
e.g. Countrywide cynical misuse of the so called Liverpool Pathway. Killing patients without informing them or their relatives - much less seeking anyone's informed consent.

Few or no doctors were held to account.

In fact the more they were paid by the country over time, the more some (especially senior) doctors seemed to feel that thy were an unaccountable
and special kind of anointed elite,
and the more they resented any attempt to monitor their performance.

A almost pathological sense of elitism and entitlement has increasingly befallen UK doctors over those years.

THEREFORE the public have learnt from that waste, and now want greater accountability of the medical profession.

The new Junior Doctors' contract is the beginning of a culture change that must happen in the NHS.

Millions of people in this country elected this government,
Millions of people DO support the efforts of Jeremy Hunt to prevent victimisation of brave whistleblowers,
and to make the NHS work well 7 days per week.

Hurrah for Jeremy Hunt - an honest and decent chap working hard for patients.

Hurrah for Jeremy Hunt - an honest and decent chap working hard for patients

You cannot be for real.

Who are you? Mrs Hunt????