Finally an agreement between the government and the BMA seems to be emerging over the issue of the junior doctors' contract. The new proposal allows Jeremy Hunt to crow, in typical Hunt fashion, that he has forced junior doctors to work more hours at the weekend for no extra pay when, in typical Hunt fashion, this is not true. The BMA are pleased with the offer because, in reality, any junior doctor working a standard rota will continue to receive premium pay for unsociable weekend hours. It remains to be seen whether junior doctors will accept the contract when the detail has been made public but at least this represents some progress.
This would have been fantastic news nine months ago, it would have been good news six months ago but, with a final decision not likely till early July, this has come far too late. The damage has been done, and the damage is substantial. Had Hunt turned up to the negotiating table and offered to stuff junior doctors' mouths with gold and give them a one day working week, this would not have been enough to undo the cataclysm that is awaiting the NHS come August.
August is the month when most junior doctors change jobs. It is also the month when newly graduated medical students take to the wards. This August there will be many fewer doctors than there are supposed to be because this dispute, and the subsequent strikes, have prompted many doctors and students to reconsider their future in the NHS. The government seems to be in a state of denial about this but it is very real and very obvious to see for those working in healthcare.
Applications for the paperwork required to work overseas sky rocketed after the imposition of the contract. 300 doctors applied in just one day after the Secretary of State announced the contract imposition. Many of these applications may have been made in protest but thousands of doctors do leave each year and the number is rising year on year and the drain has undoubtedly been made worse because of the dispute.
The number of doctors looking to move overseas is a sensitive barometer of discontent but the absolute numbers who actually leave probably won't be devastating. More worrying is the number of doctors who are not progressing onto specialist training. After two years of general training doctors are expected to choose a specialism to pursue. Less than half, just 48%, of doctors are choosing to go onto a specialty training scheme. The knock on effect of this is that there will be 52% fewer junior doctors than anticipated on specialty rotas over the coming years and 52% fewer consultants available to the NHS in seven to ten years time than the government is anticipating.
Most worrying of all, however, are the indications that final year medical students are choosing not to take up jobs in the NHS. For the first time since medical careers were restructured in 2005 it looks likely that there will be unfilled posts for newly qualified doctors. A BMA survey has found that three quarters of medical students in England are more likely to start their careers outside of the NHS. It has taken five or six years and over £300, 000 of tax payer money to train each of these students and, if they don't start their training in the NHS, they are unlikely ever to return to it. This is a disaster the legacy of which will last a generation.
So it doesn't really matter now what happens with the contract. Come August the shortage of junior doctors will be worse than ever, rotas will be full of gaps and the existing workforce will be even more stretched than they are at present. This will perpetuate the downward spiral of NHS morale and the ongoing departure of valuable staff from the service. If only Mr Hunt had been willing to talk all those months ago.
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