After receiving an overwhelming mandate from the British Medical Association’s (BMA) ballot on industrial action, junior doctors in England are set to take part in strike action this week for the first time in 40 years. This action is limited to those training within England, as the governments of the devolved nations, including Scotland, have decided not to impose a new contract.
Junior Doctors constitute the majority of the medical workforce. If you enter hospital, as a patient, the likelihood is that a junior doctor will be the first doctor you see. In essence, the slightly misleading title covers every clinician from the moment they leave medical school towards those completing their 8th year of speciality training.
Contract negotiation is an unpleasantly complex process. In 2012, the process to update the junior doctors contract formally began and continued for two years until negotiations had stalled. Doctors’ pay is similarly a complex issue in terms of banding, grades, and financial penalties imposed on hospital trusts which roster doctors out-with of their agreed hours. The DDRB (Review Body on Doctors’ and Dentists’ Remuneration) is the independent organisation which provides the Government guidance on the issue. The review body issued recommendations, highly focussed around the Government’s intention to ‘introduce’ seven-day services across the NHS, which were unusually based on observations as opposed to evidence. Due to an inability for the BMA to agree to several wide discrepancies within the report, surrounding working hours and conditions, which would form the backbone of further negotiations, the association could not re-enter negotiations. As such, the Government went forward which the intent of imposing a contract, from 2016 onwards, onto the 53,000 junior doctors working in England.
[pullquote]Patient safety is the core reason why doctors are choosing to strike in the first place.[/pullquote]
Bluntly speaking, the idea of having to impose a contract, on any work force, is somewhat bizarre. Left with no choice, the Junior Doctors Committee went onto ballot over 37,000 of those working in England, in November, which provided the overwhelming mandate of 98% of those surveyed in favour of full industrial action.
In the short time onwards, the Secretary of State for Health, Jeremy Hunt, had accused those doctors of being “misled” by the association. Unsurprisingly, the statement appeared to not go down very well among a highly trained workforce trained to critically examine evidence. Similarly, the notion that “doctors must work weekends” was met with great levels of confirmation that, in fact, doctors do work weekends, as proved by anyone who has had the pleasure of visiting A&E during a Sunday evening or Christmas day – #ImInWorkJeremy. These highly dubious soundbites were combined with a continually rebutted reference, ad nauseam, to paper published by the British medical Journal regarding patient mortality at weekends which was met by the journals editor registering her own “…concern about the way in which you have publicly misrepresented an academic article” towards the health secretary. From this, it is rather easy to figure out why many doctors have trust issues with the current Secretary of State.
So why exactly are junior doctors taking part in strike action over this? Key issues relating to safety, pay, and training, have not been resolved despite continued attempts to negotiate. The current contract ensures that doctors are protected from working dangerously long hours by way of financial penalties towards the trust. The proposed changes plan to remove this penalty which is clearly a considerable risk to patient safety. Modifications surrounding pay progression propose a 30% increase in standard hours with A&E Doctors pay particularly decreased. The removal standard progression disadvantages those taking time out for medical research, volunteering, or to even have children. And finally, with training, 15 of the presidents of the Royal Colleges – the organisations responsible for postgraduate medical training – wrote to the health secretary to express their own concerns that the proposed changes would have grave consequences on speciality training.
The sustainability of the NHS, as a whole, will be greatly determined by whether or not doctors choose to remain within it. Unsurprisingly, since 2011 there’s been a downward trend in doctors choosing to enter speciality training. The most recent figures, from 2015, show that only 52% enter into such training (including General practice) after completing their foundation years. Doctors requesting certificates of good standing, a requisite for enabling them to practice abroad, showed a sharp increase in response to the threat of imposition. This may all be a massive coincidence but, in this particular case, I’d argue that – for once – correlation does indeed imply causation.
As medical students, this contract will be the one which we will enter into after completing six years of undergraduate education. I’ve yet to meet any junior doctor who considers taking part in strike action without their belief that it is truly a last resort. The apparent militancy of those doctors taking part, propagated by the less-than-savoury parts of the media, does not stand. Last week, I was far from surprised that a poll carried out by The Student Room showed that 37% of surveyed medical students no longer wished to study medicine, in light of this dispute. As students we don’t have the right to strike, yet the solidarity displayed in supporting our colleagues in England emphasises that these concerns are evident across all stages of medical training. Our colleagues studying nursing, similarly face such uncertainty with a disastrous decision to scrap nursing and midwifery bursaries, two professions similarly facing a recruitment crisis. We cannot have a health service which alienates those expected to keep it alive on a seven day-to-day basis.
Patient safety is the core reason why doctors are choosing to strike in the first place. If the government continues to refuse to make concessions and take part in meaningful negotiation, then the likelihood is that the long lasting effects of an unfair, and unsafe, contract will outweigh the unfortunate temporary walkout.
Jonathan Gibb is a third year medical student at the University of St Andrews and a deputy chair within the British Medical Association’s Medical Students Committee.