British healthcare workers discovered DNA. They designed the first antibiotic. They invented the ophthalmoscope, the thermometer, the CT scanner and the MRI machine. They were the first to stop and start a beating heart and the first to conceive a baby in a test tube. They operated on me within weeks of being born, and recently gave my elderly relative first class health care when she broke her hip.
I am proud to work for the NHS. It's a wonderful institution that we should all be proud of. I remember I once asked a consultant why he went over and above what was expected of him, in effect doing the job of two consultants. Without a moment's hesitation, he replied; "the NHS took care of me so well in my training, that I owe it to the NHS". Echoing his sentiment, other than the well being of my patients, what underpins my dedication to the NHS is that the NHS has looked after me, and so I must look after it. Many of my colleagues have resisted offers to double their salaries in consultancy firms and plenty have refused offers of working abroad, for better working conditions, hours and pay.
I will attempt to explain the injustice surrounding the proposed contracts. You have heard the rhetoric. You have seen the petitions across social media. You have seen the facts and figures demonstrating a 30% cut in the salaries and changes in the working patterns of junior doctors, most of whom in my experience work tirelessly for their patients. If you were faced with a cut in your salary by a third, when you had only ever exceeded your targets, you would probably be left with a distinct feeling of injustice. You would probably consider seeking alternative employment.
What you may not realise, is that the contract changes go further than a simple pay cut. Female doctors will struggle to take maternity leave due to the contract structure, and even the choice of when to take annual leave will become more rigid than optional. The next Francis Crick (co-discovered the structure of DNA) or even Bruce Keogh (National Medical Director) will be denied the necessary support to pursue research degrees and perhaps the expertise it takes to run the only health service in the world that is free at the point of service.
What I find particularly insulting regarding the proposed new contracts is not the pay cut and changes in working patterns, but the government's smoke screen of patient safety as an excuse to push through the changes. In my opinion, the disharmony amongst the medical profession caused by the threat of the new contracts has caused a far greater risk to patient care than the current working patterns. We all know what the new contracts are about. Money.
For now, our rotas will remain covered. Our patients will still be seen, and the most vulnerable given first class medical treatment. But how long will this last? Junior doctors will begin to leave in droves. Already 40-60% of foundation doctors are choosing not to apply for specialist training. A third of GP training posts are unfilled. So are half of A&E training jobs. We have seen a dramatic rise in the number of applications for 'certificates of good standing' - the paperwork required to work abroad. Those who have gone to Australia, New Zealand and North America, are deciding not to come back. We are already facing a recruitment crisis that could alarmingly escalate. The future gaps in workforce will be the greatest risk to patient safety, not the current contracts, as the government is suggesting.
Overwhelming evidence shows that a valued, supported and motivated workforce leads to better health care and productivity (Sears Employee-Customer-Profit chain). Demoralising the junior doctor workforce will be the next great risk to patient safety.
This contract change is not only unjustified, but also plain and simply wrong. Goodwill is the oil that lubricates the NHS machine, and junior doctors its fuel. Both are at risk of quickly becoming in short supply.
Nick Aresti is a junior doctor working in London.