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It Doesn't Have to Be Like This - The Government Must Listen to Its Own on the Junior Doctor Contract

06/04/2016 17:32 | Updated 07 April 2016

I'm a junior doctor. As an obstetrics registrar, in the London maternity units I work in, each registrar can deliver between five and 12 babies in any shift, sometimes more. The decisions I make have a profound impact on babies and families. The consequences of any mistakes I make will live with both families and the baby, as well as me, forever.

It has always been a challenging job, but especially so in the current climate. You rarely get any breaks or downtime on a shift. You know when you start your shift, for the next 12 and a half hours, at least, you are going to be constantly on the run, making decisions that are stressful and potentially life changing. I love my job - I often tell medical students that obstetrics is usually the one time a patient comes to see a doctor for a positive reason - but it's clear that morale is low and staff are overworked. This will be only made worse by the imposition of the new junior doctor contract, which is unfair and bad for the long-term delivery of the NHS.

Junior doctors want a contract that is fair and that delivers for patients, doctors and the NHS as a whole. We want a contract that recognises the long and unsocial hours we work, protects safe working patterns, and ensures junior doctors feel valued and motivated to keep hold of the GPs and senior hospital doctors of the future. We have seen the government try to conflate a seven-day service policy with the junior doctors contract. We already work seven days a week and provide services 24 hours a day. You simply cannot stretch an already overstretched five-day service over seven days. We are overwhelmed by the support that we continue to receive from patients and the public, but understand that some people may be confused as to why we are taking this action.

Let me be clear: this is not just about pay. The long-term effect on patient care is at the heart of junior doctors' concerns. The new contract changes what's classed as unsocial hours, extending what are defined as normal working hours by around 40 per cent across the week. The changes will hit those doctors who work the most unsocial hours, making it even harder to attract and keep junior doctors in areas of medicine where there are already staffing shortages such as maternity care and paediatrics. This could undermine the delivery of care in the long term if we can't recruit to these, and other, specialties.

Beyond this, there are outstanding issues which still have not been resolved. The BMA is committed to having genuine negotiations in good faith, and proposed a number of creative solutions to resolve differences in a way that met the needs of both sides. There are areas where what is being proposed is not just bad for junior doctors, but also for our patients.
One of these Issues is around non-resident on call shifts, where a junior doctor must be available at home, to be potentially called into work at short notice. These duty periods vary in intensity, but may involve a doctor being called into work multiple times during the night. Under the new contract, junior doctors would receive only a low 'availability allowance' for these duties (between five and 10% of basic pay), despite having to clear their whole day, and for many having to pay for their children to be looked after so they can get to hospital straight away. The use of this type of work pattern may mean that young doctors with families will simply not be able to afford to continue working.

It doesn't have to be like this. We are urging the Government to stop ignoring junior doctors' concerns and resume negotiations with us on a properly funded contract that will recruit and keep junior doctors rather than drive them away. We want Government to stop devaluing the vital work that junior doctors do, and work with us to make employment and training in the NHS safe, attractive and motivating. Lastly, junior doctors already work around the clock, seven days a week, and the do so under the current contract. We want the Government to stop branding junior doctors as a road block to extra seven day services and explain exactly what it means by a seven-day NHS and how it plans to staff and resource it when their own figures say it will require thousands of extra doctors and nurses, and billions of pounds in additional funding. Doctors' contracts are not the problem, but this contract is: it puts the long-term delivery of patient care at risk and the future for our patients, our profession and the NHS as a whole shouldn't be up for negotiation.

This current action was wholly avoidable, however the Government made no attempt to avoid this action, instead ploughing ahead with imposition. Politicians said junior doctors were being misled and that when they read the detail they will agree. However, junior doctors have now read the detail, it has simply confirmed their worst fears about a contract that is inherently regressive and a step back. The government needs to listen to the medical colleges, health charities and now some of their own back benchers when they say imposition of a contract is simply the wrong thing to do. We continue to offer the government the opportunity to find a negotiated settlement to preserve the future of the medical workforce and the NHS in this country.

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