By Holly Bancroft
In August 2016 a new junior doctors contract will be put in place. It is the culmination of years of fraught negotiation between government ministers and doctors and is set to impact the lives of junior doctors unequivocally for the worse.
Over the more recent months the dispute has made national news headlines as strikes and protests have impacted operations at hospitals across England.
On the 12th of January, in the first strike by hospital medics in 40 years, up to 38,000 junior doctors walked out over the new contract being offered by the government. Following this, on the 10th of February junior doctors came out on a second 24 hour-strike to which ministers responded by imposing the new contract.
This decision came after the British Medical Association had refused to negotiate on the key issue of whether Saturday should become part of a junior doctor’s normal working week. The mood amongst junior doctors in the regions in and around Durham is far from happy.
When speaking to Palatinate Sandip Nandhra, a junior doctor who has worked at the University Hospital of North Durham and Sunderland Royal Hospital, said:
“I think everyone is pretty angry. We’re disappointed they’ve taken what we call the ‘nuclear’ option without actually listening to the people at the coal face”.
The new contract will change what constitutes as unsocial hours, with regular hours now constituting till 5pm on Saturdays. Sandip explained it saying, “They are suggesting that normal hours are re-classified. The issue we have with that is that is that a lot of us work long hours. I could work the same 8 to 8 shifts that I work regularly but I won’t get topped up.
“Basically doing what we are doing now for less money. They say that we will get a pay rise but it’s nothing like the increase we would have got under the previous contract.”
This is all part of Jeremy Hunt’s plan to deliver better care at the weekends following research showing that patients are more likely to die if they are admitted on Saturdays or Sundays.
A study published in September’s British Medical Journal showed that Saturday had a 10% higher risk of death and Sundays 15% compared with Wednesdays.
However these statistics may not show the full picture. Patients admitted at the weekends do tend to be more ill than those admitted on weekdays, although the researchers did try to account for this in their findings.
More importantly though, because of the way this new contract defines ‘normal’ time, a junior doctor could work Monday to Saturday on the trot and not receive any compensatory rest. Spreading doctors more thinly and giving them less rest could have huge safety implications.
Therefore, although the contract is trying to increase patients well-being it may unintentionally lead to more medical slip-ups.
This concern is particularly relevant following the recent analysis by the Press Association which found that in the past four years more than 1,000 NHS patients in England have suffered from serious medical errors that should never have occured.
There has been concern shown by some of the national press that the contract will spur more doctors to move abroad. Marcus Cassop Thompson, a Durham University medical student, told Palatinate:
“Everyone knows doctors will leave and I think this will be a secondary crisis that arises from recent events.
“I often see an irony in the fact that the conservatives supposedly value market discipline, but when doctor’s leave for Australia or elsewhere they cry about loyalty. This seems like a contradiction.”
Fred Barker, another Durham University medical student, added, “Under the new contract, incentive for students to start their careers in the UK will likely fall to a point where we are annually losing hundreds of doctors to other countries.”
Although going abroad does seem like a very real option for many doctors, Marcus said “I just can’t accept moving away from the UK as a solution. The future of the NHS is right inside a political arena that seems to be changing at a rapid pace.
“Up to now I think the junior doctors have composed themselves well, and people really did seem to side with and have more faith in their doctors than the government.” The North East medics who went on strike earlier this month said they’d had fantastic support from the public.
Sandip, in his interview with Palatinate, stressed that “the big thing for students to understand is that the new contract is penalising those in less than full-time training.”
In the new contract you have to work 1 in 4 Saturdays to get extra pay. However, this leaves out those who will still work some Saturdays but just not every 1 in 4. This is particularly harsh on those who have a child and whose partners also work Saturdays.
“It is penalising parents and women. There is a big human rights issue, questions on fairness. The contract doesn’t really address that.”
However, there are still those who would point to the 11% rise in pay and question the anger expressed by junior doctors. It is important to note that this increase is built in to offset losses from other changes in the contract, such as lower earning for working evenings and weekends.
For example, those doctors who are assigned ‘non-resident on call’ shifts do get better pay but for this often have to stay on site in hospital accommodation, away from family and friends.
There are clearly lots of issues that could be debated, but in the wake of Jeremy Hunt’s announcement of 11th February junior doctors seem to have no choice but to accept the contract.
Speaking to Purple Radio on the new development, Caolán Duffy, another Durham University medical student, said: “To be honest I do feel a certain sense of disappointment at how he’s handled the situation.
“The large consensus in the medical student community, and in the medical field as a whole, is that Jeremy Hunt has been completely unprofessional and possibly incompetent in the way he’s handled this whole situation, but I do disagree with the personal scape-goating of Jeremy Hunt.”
Jeremy Hunt must have had cabinet approval to impose the contract. As Sandip said to Palatinate, “Jeremy Hunt made that decision but so did the rest of the Tory government.”
This is true, yet interestingly the government says that 90% of the terms in the revised contract were agreed upon by the British Medical Association. The situation is causing many junior doctors to despair.
Fred Barker, when speaking to Palatinate, said: “The more doctors who are overworked, underpaid and undervalued within the NHS, the less the once-rewarding career will be something worth holding on to in the UK. I, like most medical students, am a passionate lover of everything the NHS stands for, but unless there is a drastic change in the government’s attitude towards preserving our healthcare system, even junior doctors could lose faith in it”.
So what’s next and can anything be done? There is talk in legal circles that this sort of contract imposition is legally questionable, an avenue the British Medical Association may choose to pursue, particularly as BMA sources said that junior doctors attending meetings this week have told the union they think the contract will prove unworkable for many of them.
Whatever is planned, the dispute doesn’t seem to be over yet. “It’s a long and draining process ahead. There’s a lot of uncertainty.” – Sandip Nandhra.
Illustration: Olivia Howcroft