Doctors don’t usually go on strike. In the last 40 years they have taken to the streets only twice to voice their dissatisfaction about working conditions. Given the BMA’s decision on Saturday to ballot its junior doctor members on industrial action over their proposed new contract, this statistic more than anything shows just how angry people are with the government’s plans.
As a second-year medic, it’s hard not to worry about what the proposed changes will mean for me. For current junior doctors, this anxiety can only become more pressing, as the contract is set to be introduced as early as August 2016.
One of the BMA’s biggest issues with the contract is the extension of routine working hours (or ‘plain time’) from 7am to 7pm on Monday to Friday to 7am to 10pm on every day except Sunday. This will inevitably lead to pay cuts for junior doctors who currently work evening and weekend shifts, as routine working hours are rewarded with the most basic rate of pay. In specialties involving a lot of out-of-hours work such as A&E and acute medicine, existing staff shortages will only be exacerbated if inconvenient working hours are no longer properly compensated with overtime rates.
The job of a trainee doctor is that much harder outside of the current routine working hours, as they are often left with huge responsibilities when fewer consultants are present. The new contract could lead to trainee doctors working longer shifts just to make ends meet, potentially risking the safety of the many patients under their supervision.
The extension of routine working hours for junior doctors could also have larger implications for the whole NHS. If this precedent is set, other professions within healthcare such as nursing (many nurses currently rely on overtime rates as a main source of their income) could fall victim to sudden contract changes.
The new contract has also been accused of being discriminatory against women, as junior doctors who work full-time will see their annual pay increase more quickly than those working part-time, many of whom are women returning from maternity leave.
The idea of rewarding those who progress through training rapidly may well be a good one, and could potentially lead to a larger number of highly-trained doctors in a shorter period of time. This point has a link, albeit a tenuous one, with the idea that staff within the NHS should be rewarded mainly on the outcomes of their patients, with less emphasis on the number of years they have been working, or the number of procedures they carry out.
Having said that, an inflexible contract that penalises women for having children is not fair, and efforts must be made to ensure that people who progress through training more slowly due to genuine, unavoidable reasons are not punished.
Since the new contract has been proposed, the GMC has received huge numbers of requests from junior doctors for certificates to work overseas. When combined with the very real threat of industrial action, it is no wonder that leading figures at the BMA are warning of impending disaster.
Few can argue that we need to see real change in how the NHS operates in order to cope with the huge challenges that it now faces. Some of this responsibility may well fall onto the shoulders of junior doctors. Despite this, the sudden and unfair proposed contract will not help the cause. Not only will it drive junior doctors away from the NHS altogether, but it might just put off prospective medical students and medical students alike from following a medical career. And that would be a disaster.