Our NHS? The Junior Doctor Contract

On the eve of a junior doctors strike day in England we look at the context, current state of affairs, and explain the social media catchphrases you really need to know to inform yourself, and others, of the hands and future of your health. As one future doctor articulates, the on-going action and discussion around the government proposed contract is ‘the latest flash point in the ongoing cold war between two ideologies: health as an unalienable right versus health as a consumer commodity or service.

 

#juniorcontract

In 2012, a new contract (pay and hours) was proposed to the British Medical Association (BMA) citing ‘outdated’ and ‘unfair’ current set-ups that date back to arrangements made in the 1990s. Since then, in 2014, talks broke down between the government and the BMA, becoming increasingly fraught since current Health Secretary Jeremy Hunt re-opened them with a view to push the contract through. Although no agreement has been met, earlier this month ministers declared that the contract would be implemented this summer.

In an attempt to move to a “seven-day” NHS, the number of baseline standard hours doctors are expected to work prior to receiving overtime will rise from 60 to 87 hours per week. Hunt has suggested that any doctors who experience a cut in pay would be covered by pay protection, but this guarantee is potentially vexed and has, at any rate, only be confirmed until 2019. So too, this has been called a bribe to pacify current junior doctors, at the expense of future recruits. Of course, it is important to remember that junior doctors already work unsociable hours – including weekends, in fact they form the majority of the staffing at such times, but they are currently fairly rewarded for such commitments with pay bonuses and prioritisation of patient safety.

Discarded placards. Image reproduced with permission from Garry Knight.

 

#juniordoctor

‘Junior’ is a loaded and invariably unhelpful word to couple with ‘doctor’. It unwisely suggests professional or chronological ‘-lessness’. In terms of hospital personnel and their structuring, a junior doctor refers to any qualified clinician between the start of their first job post-graduation through their first two foundation (F) years (F1 and F2) until they acquire a consultant position. Which can mean a decade as a junior doctor, or longer, based on their hoped for, or possible, professional development. Of course, pay is stratified across this group based on experience and specialism, but is largely in keeping with pay rises to be expected from public sector jobs.

There are approximately 55,000 junior doctors currently working in England, comprising one third of the medical workforce.

Image reproduced with permission of the BBC.

Image reproduced with permission of the BBC.

 

#juniordoctorsstrike

This is the course of action taken over one and two day stretches by junior doctors and associated professionals as a figurative stand against imposition of the new contract. Since late in 2015, there have been several 24 hour strikes planned which were later cancelled, or streamlined so that emergency care was not affected. There has been heated debate over the morality of such action, which is supported by the doctors’ trade union (the BMA) as to whether this puts patient lives at risk unnecessarily. The flipside to this, is that any other profession can conduct such industrial action, as per the Underground strikes in central London in the New Year, and that the imposed contract will put incalculable lives at risk, so such preventative activity is, unfortunately, necessary.

The strike days are not, as would be largely warranted, a well-deserved opportunity to have a lie-in. Certainly, there is no judgement passed against those who make use of it to this end, for strategic (a bonus win in the eat-work-sleep-repeat cycle of a junior doctors’ existence) purposes or ideological ones (some question the efficacy of such participatory protest, citing policy as the only game-changer) but on these days, the vast majority of junior doctors will be picketing at their place of work. From first hand experience, I have been woken up by my partner heading back after a day’s leave to Colchester General Hospital on the first morning train from Liverpool Street to join his colleagues at the hospital entrance, and found myself emerging at Russell Square several hours later, to be met by associated parties from Great Ormond Street Hospital and University College Hospital sharing leaflets, information and personal stories.

Image Credit: A Bow-Bertrand

Image Credit: A Bow-Bertrand

 

#NotSafeNotFair

The bottom line is that, under the new contract, the vast majority of junior doctors will have to work more unsocial hours for no extra salary pay. Certainly, under the contract due to be implemented, no doctor will be able to, or obliged to, work consecutive weekends without his or her agreement. Although the upper limits of hours doctors will be allowed to work per week will be capped and lowered from its current level, the BMA and many of the professionals it represents have highlighted that having to work more unsociable hours would likely impact patient safety. Indeed, this has been the subject of recent research, with increased deaths dubbed the ‘Hunt effect’.

How would you feel if you had to work a three-day ‘regular’ week from 8am-8pm Monday to Wednesday to then change gear and continue managing health and saving lives on Friday, Saturday and Sunday night of that same week? Harried? Exhausted? Emotionally drained? Dissatisfied? Worried for your own health and those under your care? Isolated, having to miss out on socialising that happens amongst your regularly employed peers over the weekend? All of these, and more.

Being a junior doctor is more than a question of pay and getting the job done. It is a vocation, a craft, and a hard-earned skill: none of which should be stretched beyond reasonable limit.

Image Credit: A Bow-Bertrand

Dame Vivienne Westwood came out in support of junior doctors at strike action along London’s Pall Mall earlier this year. Image Credit: A Bow-Bertrand

 

#paycalculator

The Health Minister launched a pay calculator in late February which offers an estimated breakdown of earnings under the incoming contract and the areas where pay protection may apply. Back in 2015, Hunt suggested the contract offered an 11 per cent pay rise, but junior doctors outline that, in real terms, there would be a pay cut of 26 percent. Furthermore, this so-called 11 per cent rise in basic salary is offered in exchange for increased evening and weekend work.

As a benchmark, the current starting salary for a junior doctor is just below £23k per annum, with additional payments for working unsociable hours and conducting coroner’s reports. At the most simplistic level, as of this summer, when junior doctors move upwards through roles, they will be paid less than the person doing that same position the year previously.

 

#moetmedics

The Sun tabloid is well known for hard-hitting, accurate journalism, ahem, intrigue, scandal, and paper tits. Earlier this year, they ran a typically reliable feature titled ‘Moet medics high life of docs leaders who are heading up NHS strike’ further sub-titled ‘Pics show champagne-swilling lavish lifestyle enjoyed by striking Moet medics’. Following a remarkably thorough Twitter and Instagram stalk of some of the most vocal junior doctors opposed to the new contract, The Sun’s article presented a truly exclusive (read: outstandingly awful. Self-conscious oxymoron) photo diary of doctors having time off, on holidays, at a beach, out for dinner, with a pachyderm. An article to launch a thousand others, junior doctors replied with typically on point, if wearied, humour, flooding this hashtag with images of the quotidian doctor, living it large. A serious case of scraping the barrel. Also associated with #smearthedoctors.

 

#IAmTheDoctorWho

This is a Twitter hashtag adopted by current junior doctors highlighting just how important their work is: real stories, in real time, from real doctors.

Screen Shot 2016-03-08 at 19.38.09

Screen Shot 2016-03-08 at 19.38.32

 

@theBMA

The British Medical Association (BMA) is the trade union and professional association representing doctors and has almost 38,000 members.

 

@Jeremy_Hunt

Jeremy Richard Streynsham Hunt is a British Conservative Party politician, the Secretary of State for Health, and the MP for South West Surrey. He was previously Culture Secretary and has variously also been described by several terms that rhyme with ‘hunt’. His Wikipedia page offers a lively source of entertainment from witty editors and enthusiast biographers alike.

Image Credit: A Bow-Bertrand

Image Credit: A Bow-Bertrand

 

So there you have it. It’s up to you to decide whether you support the Junior Doctors’ contract slogan it’s everyone’s fight.

 

Image Credit: Wire Feeds

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