Sending a thank you to the junior doctors

Today, for the first time, junior doctors went on a full strike. They’ve been backed into a corner by the government. I gave the doctors at the Guy’s and Tommy’s picket line a card and some cakes, and Dr Kitty Mohan was kind enough to retweet my message.

kitty mohan tweet

I’ve said it before, and I’ll say it again: I fear this contract will create many more ex-medics like me, but they may well be ex-medics who, unlike me, would have been better off staying in Medicine, and that’s what makes me sad.

Back when negotiations were still going on, the BMA managed to broker a much better deal than the one that was initially offered by the DDRB. A lot of progress was made on issues such as working consecutive weekends, a limit of 72 hours worked in seven days, pay for all work done, and leave for key life events (like weddings). 90% of the terms and conditions were agreed upon.

However, there are still some major sticking points. The issue of doctor fatigue hasn’t been completely resolved – under the current contract proposal, a shift that finishes at 1.59 am still may not be considered as a night shift, therefore doctors could be denied enough rest time. Also, if a doctor doesn’t receive adequate rest time, financial remuneration is being offered, but money isn’t the same as rest, and money won’t prevent tired doctors from making mistakes.

The issue of what constitutes ‘out of hours’ is also a sticking point. Doctors feel that redefining Saturday as a weekday threatens their private lives, particularly as many full time doctors already work two weekends per month anyway. Redefining Saturday as a weekday is a cheap way of having more junior doctors working on a Saturday, but with morale being so low and doctors feeling that they have been demonised, such measures will only serve to deepen the recruitment and retention crisis.

The financial aspect cannot be ignored. There are deep concerns that certain groups more than others will be financially penalised by the new contract, including part time doctors, doctors with a disability, doctors who are carers, doctors who take time out to do research, and doctors who are required to do significant further study (for example, oral and maxillofacial surgeons are required to do two degrees: medicine and dentistry). The fact that women will be the worst affected is another problem, as female doctors are more likely to need time out or do part time work, due to maternity leave and childcare. The new contract will

The deepest suspicion about this contract however, comes from Jeremy Hunt’s declaration that imposing the contract is necessary in order to combat the ‘weekend effect’. First of all, the existence of the ‘weekend effect’ is unclear, since the authors of that paper themselves said that to believe that excess deaths at the weekend could be prevented would be ‘rash and misleading’. Secondly, there is no provision planned for allied healthcare professionals – a true seven day service could not be delivered by extra doctors alone – there would need to be extra weekend cover from nurses, midwives, physiotherapists, theatre staff, porters and healthcare assistants, to name a few, for patients to be dealt with effectively and safely. There will also need to be significant investment in social care services if more elderly or vulnerable patients are to be discharged at the weekend. None of this has been modelled or apparently even considered by the government. Doctors are very worried that the quality of care will suffer if these things are not put in place.

The bottom line is this: how can you provide seven day services with five day resources, without spreading the workforce more thinly? Junior doctors are facing a severe staffing crisis already, and even a small increase in rota gaps could prove absolutely devastating for both doctor and patient safety.

 

 

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