We are on the eve of the doctor's strike over the proposed junior doctor contract. What are the reasons that this most conservative of professional groups is taking strike action? Is it just about the money?
The background to the doctors' strike is the righteous search by the Government to improve on standards of medical cover in hospitals and in GP practices. Jeremy Hunt, the Health Secretary has been charged with introducing '24/7' care into the NHS, to improve services. There is a cost to this effort and an additional need to limit spiralling NHS spending, currently running at 9.8% of our GDP, and at £115 billion in 2014/15, an increase of 15% from 2010/11.
One way of reducing expenditure is to cut the wages bill. Pay accounts for £45 billion of NHS annual spend. So, salaries look like a good place to start saving money. But this approach may not be reasonable. The typical junior doctor, starting work after a five to six year period of training has a basic pay of £22,636. A police constable earns £22,221. Payment for unsocial hours work adds to junior doctors' salaries, typically by an extra 40%. The Health secretary has offered to improve basic salaries by up to 11% but wants to cut unsocial hours' payments. For some doctors this will result in a pay cut. This prospect has proven unpopular with the doctors whose salaries have been reduced in real terms by 10.9% since the year 2000. Although current salary levels will be guaranteed until 2019, and secures current trainees, the juniors are worried about the financial status of doctors employed after 2019. But it is not just about the dosh!
More than money, doctors are concerned that the safeguards to protect working hours will be removed. There are concerns that this will affect junior doctors training because changing shift patterns will mean that they may not see their consultants whilst they are at work, which means that the opportunity for learning from effective consultant review of patients is reduced. In addition without the financial penalties imposed on hospitals for breaking the safeguards there is less incentive to prevent hospitals bringing back the unhealthy hours of yesteryear to cover an already struggling service due to dwindling doctor numbers.
This is not the first doctors' strike. The first strike was in November 1975, when one of the authors of this blog had just qualified as a doctor, and was working a one in two shift, a 120 hour working week. This was not a perfect way to practise medicine. It wasn't good for the doctors and... oh yes; it wasn't particularly good for the patients to be cared for by sleepless zombies. In 1975 we went on strike to establish the principle of 'overtime working'. We provided emergency cover and routine procedures were cancelled. The NHS did not close down, and care was maintained. We all worked even harder during the strike period because a skeleton service had been provided to ensure patient protection. The industrial action united the doctors just as it has this time around and no patients came to any harm because of the action. The strike was successful, and the principle of overtime was established.
Extended working hours continued largely unchanged for junior doctors until the 1990's when workers' conditions came under the scrutiny of the European Union. The European Working Time Directive, introduced in 1993 and modified in the year 2000, ensured that the working week was restricted to 48 hours and that no worker was allowed to work for more than 11 hours without a break. At the time, these changes were railed against by another Hunt, David, the UK employment secretary who claimed that the ruling was an attempt by the EU to introduce the Social Chapter 'By the back door'.
But the Working Time Directive led to a further improvement in doctors' conditions. However, these improvements have been largely lost because the numbers of junior doctors have been so pared down by local cost saving initiatives that a doctor's life has become hugely stressful. These costs savings have led to just one junior doctor covering hundreds of patients and this compromises care and is dangerous. Dissatisfaction with the enormous stress of working in the NHS has led to huge numbers of doctors emigrating or leaving the profession. It is no wonder that today's junior doctors are apoplectic! They feel demoralised and devalued. They should not be forced to strike. A compromise must be found that improves 24 hour care in the NHS but a compromise that doesn't disadvantage those that give so much to our nation.
If you would like to learn more about Professor Jonathan Waxman please visit his website:
If you want to learn more about the reasons behind the junior doctors strike you can watch me in the video below: