By Dr Faraaz Bhatti
Harming doctors. Harming the NHS. A new junior doctor contract is looming. Pay cuts. Unsafe working hours. Patient safety issues. Poor recruitment into specialties. Migration oversees. How could the government get it so so wrong? What does this mean for the NHS and most importantly for the patients? Here is my simplified analysis and opinion as a doctor in Emergency Medicine from the Yorkshire region.
First thing’s first. Definitions. This contract will target ‘juniors’. A junior doctor is an umbrella title encompassing those that have just qualified from medical school to those who are about to become a Consultant. So we are talking about a massive bulk of the medical workforce of the NHS with a wide range of varying experience. A wide range of skills. An undeniable asset to the health service.
The government’s proposals to inflict an awful contract on medics has sent a shockwave through the medical world. One which may be felt for generations to come. Unless, it is stopped in its tracks. The only way to halt the hammer that is chiseling away at our great National Health Service is to stop measures such as these that push hardworking staff to the position that we now find ourselves in. Doctors work day and night, providing a 24/7 service to the public. Hospitals are open seven days a week. All year round. Emergency Departments may be busier than ever, but have open doors to help those that need their care. They are staffed by doctors that are already stretched. So what will the contract achieve? In my opinion, very little.
Under the proposed rules – doctors will work more hours outside of current legal limits. Evenings and Saturdays will be considered as ‘normal working time’. Doctors will not get paid any differently for working on a Saturday as opposed to a weekday. This will result in many receiving as much as an astonishing 30% pay cut. With specialties such as Emergency Medicine already battling a recruitment crisis – the strain is only set to increase. Put quite simply, doctors will veer away from these specialties where rotas can be heavy on evenings, nights and weekend shifts. If recruitment suffers, so will trainee numbers and hence quality. Ultimately, patient safety will be placed at risk. A domino effect that can so easily be avoided.
The implications are far wider than simple financial unsustainability for the individual medic. More importantly the patient-centered care that we all strive to achieve may be hampered by tired, demoralised and financially insecure doctors. This latest move has left us feeling disenfranchised, unsupported and devalued by a government supposedly trying to improve the NHS. In order to improve a service one must first understand it – and many of my colleagues would agree that this is where Mr Jeremy Hunt has failed time and time again.
Health Secretary Jeremy Hunt in a letter to the new Chair of British Medical Association, Dr Johann Malawana however feels the new contract is not a cost cutting exercise and in his letter he states want the new contract to improve patient safety by better supporting a seven day NHS. Hunt argues that he is committed to ensure that the quality of NHS care is the same across the week and believes in eradicating the ‘weekend effect’ of excess deaths in NHS hospitals. Hunt writes for junior doctors, this means some increase in plain time working (backed up with an increase in basic pay) and a replacement of the banding system, and a move to paying for hours worked, with additional pay for unsocial hours. He further offers assurance that nights and Sundays will continue to attract unsocial hour’s payments.
The Health Secretary goes on to guarantee junior doctors that this contract will not impose longer hours. No junior doctor working full time will be expected to work on average more than 48 hours a week.
I am however not convinced. There is a worrying trend that many highly trained doctors are already seeking work abroad in places like Australia and New Zealand. This flood could turn into an exodus. The knock-on effect will leave the NHS with fewer trainees, more burden on those who are left and morale hitting rock-bottom – leaving them with little faith in a system that was originally designed to protect and safeguard patients.
A recent poll of 6,000 junior doctors revealed that only 24 per cent would stay in their job if the contract was imposed, with many looking to move abroad or change career.
So in a nutshell – this contract: a poorly thought out drastic measure with little overall benefit where doctors have been cornered into having to closely consider their own positions. On the balance of argument my colleagues will undoubtedly do what is clearly the right thing for their patients and for the NHS – and oppose the proposed contractual change under the guidance and support of the British Medical Association.
Junior doctors require much needed public support to keep not only the NHS alive but the very workforce that makes it what it is today. Should this contract be forced through, undoubtedly it will have a ripple effect for generations to come reshaping the NHS for the worse and threatening patient safety. It’s not too late! I’ll leave you with this thought. Perhaps the government should learn what every medical student knows. Primum non nocere. First do no harm.