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.

Lanchester...could I ask what your job is within the Health Service?

theredjellybean Sat 20-Feb-16 12:39:35

So where have all the Aussie doctors gone ? and why?

I only just re-joined, (new email address) drawn here by the debate subject and looking forward to seeing Ben Gummer actually answer the points raised.

I would rather see the NHS working properly for 5 days a week, and know full well that hospitals are open 'out of hours', 7 days a week for emergency care. I have had to take my kids there several times over the years, always out of hours.

As for where our docs could go, dont forget most of the arabic countries, and a whole raft of companies, including pharmaceutical companies who would welcome doctors with open arms in a whole range of jobs. I used to work in this sector so I know.

As for doctors married to other doctors - thats about 30% of medics I have read - we will lose half of them overnight as one of the docs in the partnership will need to quit medicine under the new contract, at least based on the small representative sample of my friends. What is more, after the new contract is taken into account, while they will be worse off, the financial impact of one half quitting will be negligible. After irregular unsocial hours childcare costs are taken into account (a nanny looks like the only viable option because of the inconsistent nights, evenings and weekends) and other obligatory costs that they have e.g indemnity insurances and obigatory exam fees, they will actually save money by one of them not working. Thats 15% of our docs gone overnight if they all quit under the new contract, and before any consideration of any going to work elsewhere or overseas. The NHS cant afford to lose any docs as far as I can gather, as there already are not enough in place, right now. This contract is making people having to choose between a vocational profession that they love and their families.

They shouldnt have been put into this position, and when it falls apart there is only ONE organisation to blame - our current government.

lelemidwife Sat 20-Feb-16 12:46:55

erm.... I hope you realise that the NHS is not just the concern of NHS Staff ?

No Taxation without representation ...and all that ?

OP :
"..... 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. "

And what exactly do you think that the rest of the population does when they have children? They either stay at home and look after them or they go out to work and pay for childcare.
You and your husband are LUCKY that you can AFFORD to choose which of those options that you prefer.
Most people have no choice in the matter.

So your solution is for the doctor you quote to quit? Or magic up a nursery which is open at 3am in a Saturday morning?

You say millions voted for the Tories, but are you aware of what percentage of the population actually voted for them?

easterlywinds Sat 20-Feb-16 13:00:21

Look its pretty obvious ... initially there may be jobs on offer in Aus and NZ but because the populations are small they simply do not need many doctors, and any demand will soon be met. Excess supply of doctors from the UK will not be welcomed by the existing doctors there, and will be resisted by them as it would affect their potential earnings.

Come on ..you doctors are supposed to be able to add up.

honeysucklejasmine Sat 20-Feb-16 13:04:57

doctors have the same problems and challenges as everyone else. Why should we listen to their special pleading?

So, how many doctors cab we afford to lose then? I agree, we won't permanently haemorrhage doctors to Aus and NZ, once the positions are filled. But, how many is that? Can we afford to lose them, do you think?

Bearing in mind existing staff in this country retiring etc, it won't be easy to magic up new doctors to replace them. We already have a shortage.

Special pleading?

Is that what you'll be doing, when you are trying to get hospital treatment in an emergency and there's only one doctor in the A&E?

The Employer is allowed to offer a revised contract. The Doctors do not have to accept it.
Doctors can get together and make a business case to the private sector to enable them to set up their own medical schools and build their own hospitals and employ themselves under whatever conditions and salaries that they wish.

Example rota. If this is accurate then what about Hunt promising drs never having to work consecutive weekends.

all doctors in mid staffs and other such situations were referred to the gmc and held accountable.

we are now one of the most tightly regulated and monitored professions.

your view that doctors are elitist, lazy, nest feathering old boys clubbers is widely out of date .

when we had the last general election i do not recall the then health secretary mentioning anything about junior doctors contracts or an imposition of anything if it was not agreed...i would not have voted for the conservatives if they had.

agree a culture change is required, we can start with top heavy over inflated salaries for managers of hospitals, we can start charging people who turn up at a&e or out of hours gps with trivial self limiting illnesses, and we can start by demanding that all professions provide a 7 day a week service...starting with MPs.

I asked to see my MP on sunday afternoon ( the only time I am now not at work as a gp working 7 days a week )and was told i couldnt as it was his day off.

there are lots of job in australia Lanchester because it has a growing population and wants to staff its hospitals well, not just with skeleton staff.

they need more doctors then they train basically.

plus they have system in primary care whereby surgeries can open effectively as a private GP surgery out of hours, so GPs can work as many hours as they want and make more money or not work such long hours and make less. The surgeries are often owned by 1 gp who then employs lots of others to keep the surgery open, often 24 hrs a day. The point being if you want a convenient routine appt on a sunday you pay for the privilege.
the gp owner pays the working gp an ehanced rate to work sundays and keeps some profit .

so lots and lots of lovely jobs....and no the aussies i met never felt resentful, because all jobs have to be offered/advertised to them for a period of time ( used to be 2 years but sure changed now) first and health authorities have to make a business case proving they cannot fill the post with a local doc before they can advertise it.

Lanchester Sat 20-Feb-16 12:52:46

lelemidwife Sat 20-Feb-16 12:46:55

erm.... I hope you realise that the NHS is not just the concern of NHS Staff ?

No Taxation without representation ...and all that ?

I realise it very well thank you but it's ok to have opinions on whatever you want when, firstly: you have no idea what actually goes on in a hospital on weekends when you don't Actually work in one and secondly: it's all well and good agreeing with something that's not going to affect you, your family, your career and your paitients safety.....Clearly you have no idea what you are talking about otherwise you would know we already provide a 24 hour seven days a week service. It's not about demanding and expecting too much it's about being treated fairly. We give up many extra hours of our time to stay on after our shift is finished in order to provide care, not because we are getting paid for it but because we care but there comes a time where our dedication to our jobs are taken advantage of and we as an NHS need to stand together because we are not going to be treated like we don't matter!

I had to take my elderly mother to A&E last night. It wasn't the first time, not will it be the last. The Dr that treated her was wonderful. It is not unreasonable that someone whose actions such as hers which can make the difference between life and death, should not be overly tired, and paid accordingly.

But then I believe that everyone should have the right to work decent sustainable hours, and get paid fairly for that. Junior doctors, people who work in Sports Direct, etc.

Junior Doctors do NOT have whistleblowing protection as evidenced by Dr Chris Day's case www.newstatesman.com/politics/health/2016/01/junior-doctors-arent-just-going-strike-theyre-trying-warn-us

If unsafe practices and unsafe staffing (which will worsen under this contract) is challenged we could lose our jobs.

There are very strange things going on in the NHS at the moment and sadly patients are the ones who will be most affected

The reducing night shifts worked down to 4 is bollocks. Friends have to work 4 nights, have a night off, then work another 2/3. That messes you uo so much more than working 7 straight, just to appear good on paper.
Also the rota's that say you aren't working more than 3 days in call in a row, but make you switch between 13 hour day shift and 13 night shifts 4-5 times in 2 weeks to appear good for the numbers. Whilst completing 11 13 hour shifts.
So work 3 night shifts, have a night off, work another night (say Thursday) finish 10am Friday morning and that day is counted as a day "off" despite having worked 10 hours, then back in Saturday for 3 13 hour day shifts (sat,sun,mon) back to a night shift Tuesday for one night! Finish night shift Wednesday morning, then back to day shifts Thursday. And repeat over 2 weeks. Finish 10 PM Sunday night after 2 weeks of this and back to your 9-5 ward job. Which you actually start unpaid at 8am and lucky to finish at 6:30. But when you ask for hours to be monitored, becuase 2 junior doctors on a different ward managed to finish at 5:30 for a week, all your rota's stay the same.

I'm really amazed - and not in a good way - that days where a significant number of hours have been worked are being spun as 'days off'. Wtf?

Not working today Jeremy?

Another example rota (general paediatric) - would you want your child treated by a doctor who's worked 80 hours in 8 days in a row?

(disclaimer- mum of F2 junior doctor applied to do paediatrics as speciality)

I've just joined mumsnet after reading this thread and being impressed by the depth of the comments. I am delighted to see so many well argued and intelligent comments on the destruction of the NHS. It's also heartening to see so much support for the Junior doctors. Coming from Facebook discussions where the majority of discussions are ruined by trolls it's really encouraging to know that people can see beyond the spin of the government and not be drawn by comments designed to ruin the discussion.
As the parent of an A&E junior doctor who left the NHS for Australia because she couldn't deal with the unfair conditions, I have a vested interest in this discussion. She left because the rotas were so hard and the intensity of the work so extreme that she had nothing left for a life outside work. Basically she couldn't hack it anymore. Many of her friends are doing the same thing and that is before the imposition of these new terms. What Hunt is doing will make sure that even more Dr's will leave the NHS because what he intends to is impose on them will be the very last straw on an already over burdened staff and system. Thank you to all those Dr's struggling every day to help their patients. I hope you all remain well and the general public support you in your fight against this government.

Canada is quite keen on British medics actually and the pay is a hell of a lot better there

Lanchester perhaps you could point the doctor who posted about the problems of childcare under the new contract in the direction of a nursery that is open on a Sunday or 2am to help them with their childcare.

Also perhaps you could answer the question I have asked several times now - how can doctors who are already stretched (many, many references to unfilled rotas) cover more days without more doctors?