Junior Doctors’ Strike

To my utter and complete lack of surprise, the junior doctors’ strike is back on.  I don’t doubt that this will be greeted with pillory and rage by the mainstream media.

The junior doctors’ contract recently offered to the BMA by the DDRB as a baseline for negotiation is exploitative in the extreme, and poses a tremendous threat both to future recruitment of doctors, particularly GPs, and to the future of patient care in all aspects of the NHS.

Historically, medical staff are among the least likely to strike in the entire workforce – the industrial action will be the first NHS strike on this scale since the 1980s, if it goes ahead. Junior and trainee doctors in particular are woefully under-compensated and over-worked compared to equivalent positions in the private sector, particularly taking into account the length of University programmes and training, the cost of exams, and the cost of equipment bought out of their own pockets.

They do this work and pay these costs because they care about their patients. They work long official hours and even longer actual hours because they care. They work nights and weekends and on-call shifts because they care. They move house every year or so for three or four years, often travelling hundreds of miles, because they care. They go to work tired and come home exhausted because they care. They risk their health and wellbeing both chronically through overwork, and acutely through driving to and from work whilst practically asleep, because they care. The only reason that they are striking is that there are genuine risks to the care of their patients from this contract which eclipse the risk to the patients of striking. It is reprehensible that the DDRB and the Department of Health have allowed the situation to get this bad, and worse that they are considering forcing the new contracts through in the face of such stringent objection.

Junior doctors, then, are among the hardest-working staff in the medical profession. They routinely work official hours well in excess of the average for the country, and frequently at the very limits of the Working Time Directive; virtually all junior doctors work an average of 48 hours per week. That takes no account of the work which is routinely expected and needed, but technically not required, of junior doctors outside of their scheduled hours.

How should they prepare for a ward round that starts at 0800, when their  contracted hours also starts at 0800? They start at 0730 or 0700, unpaid. Or perhaps more to the point, how do they attend a ward round which starts at 0730 when their contracted hours start at 0800?  Junior doctors are, of course “not required to be there”, but will have no idea what is going on for the entire rest of the day if they choose not to “voluntarily” come in early.

Overtime is not allowed at all, and these vast numbers of extra hours worked are an open secret widely known but never formally acknowledged. Officially acknowledging the hours junior doctors actually work would put virtually every junior doctor’s employment in violation of the Working Time Directive.

Junior doctors in training routinely work highly demanding schedules of nights, weekends, and on-call shifts which already contribute significantly to tiredness on the job, which can be dangerous for both the doctors themselves, and their patients. The threatened contracts remove some protections which limit these shifts, as well as stripping away compensation for large parts of the highly unsociable and stressful hours and shift patterns. This is a worrying development.

In particular, GP trainees are affected. The Government has established demanding targets for numbers of new GP trainees, which have thus far gone unmet, because in part of the prevailing attitude that being a GP trainee is somehow less demanding and less important than being a secondary care trainee. This attitude is only reinforced by the callous and cold-blooded communications from the Government putting across GPs in particular, but medical staff in general, as not working evenings and weekends. But it is not the case. General Practice is a highly demanding profession, requiring an enormous breadth of knowledge and experience, and it seems inevitable that if GP trainees are paid less (which this contract would lead to) there will be fewer young doctors interested in training in that specialty. It is also a worrying problem from the perspective of staff morale – GPs who feel that they are valued less than their colleagues, and are underpaid for the time and effort that they put into their work are already becoming widely stressed and emotionally exhausted; the threatened contract can only exacerbate that problem.

The ‘24 hour NHS’ bandied about by the Health Secretary is a worrying fallacy – the NHS (including GP out of hours service) is already a 24/7 service, operating 365 days per year, unlike the Health Secretary himself. Cutting funding and making contracts worse for the staff will not improve service in the evenings and at the weekends, and will not improve recruitment levels or prevent the rapid brain drain the country is currently experiencing as doctors leave the UK to practice with better pay and conditions elsewhere. These contracts are both punitive to some of the hardest-working staff, in the NHS if not the country, and far worse, are outright dangerous to patient care in a time when the NHS is already being starved of funding and unjustly vilified in the press. The problems the NHS has, such as they are, seem to be largely due to chronic underfunding, and further cuts like these will only harm the service.

The threat of imposition of a contract which will have untold negative effects on patient care, on the recruitment of new doctors, and on the NHS as a whole, is only the latest in a long series of callous and calculated steps being taken by the Government to starve the NHS of the resources and funding it needs to do its job, so that they can justify its continuing privatisation and destruction.  Please join me in standing up for this great British institution.