The Blog

Why Imposition Is Damaging to the Longevity of the NHS - A Medical Student Perspective on Becoming a Junior Doctor

I am a medical student in my penultimate year of study at the University of Manchester and it's with a very heavy heart I concede that I may not see out my long-held ambition of becoming a doctor in anything more than title.

I am a medical student in my penultimate year of study at the University of Manchester and it's with a very heavy heart I concede that I may not see out my long-held ambition of becoming a doctor in anything more than title.

At the heart of my uncertainty regarding the future lies the heavily publicised junior contract negotiations. The saga came to a crescendo in horrific fashion this Thursday with the imposition of the contract by the Secretary of State for Health, Jeremy Hunt, in an act tantamount to bullying. Through imposition, an unmistakable message was received; the Department of Health does not take the welfare and concerns of healthcare workers seriously.

What I find most troubling, is the remorseless manner in which the government intervened in the face of industrial action which had ended only hours previously, and in doing so setting an unacceptably dangerous precedent for future disputes. In the aftermath Mr. Hunt even had the gall to argue that he had shown clemency in what I can only suspect was an audacious attempt to induce Stockholm syndrome. In a rather juvenile show of bravado, he then revealed that he in fact could have imposed any contract he pleased, as though he expected a show of appreciation for his self-perceived benevolence.

The imposition of the new junior doctor contract has prompted a premature, unexpected and very difficult discussion on the topic of where I see myself in the future.

Having witnessed how indiscriminate ill-health can be, and the transformational effect good healthcare can have on ones life, I am a true believer in the virtues of the NHS. It may be imperfect, but in spite of all its shortcomings it remains a system that largely adheres to the beautiful ideal that healthcare should be free and allocated based on clinical need rather than ability to pay. I chose to pursue a career in medicine because I knew that my own sense of contentment would only come from a life dedicated to helping and caring for others, but my principles would never allow me to exploit that need for personal or institutional profit. Even in the face of persistent denigration, with the Secretary of State himself suggesting that a 'Monday to Friday culture' was endemic amongst junior doctors, my loyalty to what I view as the greatest healthcare system in the world remained unwavering. Having reaped the benefits of a world-class medical education in the UK, I felt somewhat obliged to give back. However, in light of recent developments, there is no way I could wholeheartedly commit myself to a life in the NHS. It isn't a decision I take lightly, but if legitimate grievances regarding patient safety and the deterioration of working conditions are being overlooked now, what confidence can I have that it will not happen again during my working lifetime? I would love to devote my life to the care of others in the NHS but I have too much self respect to allow myself to enter a working environment where institutional bullying has become the norm.

This debate has spanned several years now and as a prospective junior doctor, I have major reservations surrounding the safety and fairness of the imposed contract. At a glance, it appears to improve patient safety, reducing the maximum number of hours a doctor can work a week to 72. However, upon closer scrutiny it transpires that the reforms also bring about a redesign and weakening of protective frameworks that monitor and penalise employers who overwork their doctors.

The new contract also redefines normal working hours as 7am to 9pm, and reclassifies Saturday as a normal working day. This translates to an increase of 20 hours to the normal working week of a doctor, meaning they can be expected to work later, and at weekends on a regular basis without receiving any supplement to their wage for working unsociable hours. The imposed contract has been 'cost-neutral' meaning that not a single extra pound has been added to the junior doctor wage bill despite the extension of the normal working week. It is nothing short of exploitation for an employer to demand workers give up more of their time without a corresponding rise in pay. It is primarily an issue of fairness rather than greed, and I would challenge anybody who unfairly labels doctors as mercenary to reflect on how they would react in a similar situation.

As a medical student, I spend a lot of my time as a fly on the wall in the hospital and in doing so I gain a sobering insight into the life of a junior doctor. I watch intently as they put their own troubles and dissatisfaction aside, bounding into the room with the scintillating vitality that the public have come to expect from their doctor. I sit there awestruck by their versatility acting as a sensitive educator, confidant and above all else a much needed companion to their patients, giving them hope through their darkest hours. At no point is there ever a request for a show of compassion in return and as the doctor exits, the patient could be forgiven for believing that their doctor is truly content with life.

Out of earshot of their patients, all illusion of a charmed life is quickly abandoned. It is not uncommon for the working day of a junior doctor to begin well before their family rises in the morning, only for them to finish and return to a family soundly asleep. I overhear stories from doctors distraught that they haven't spent time with their children and partner in days. For many, their only solace is the weekend, a sacred time for nurturing their young family.

The new contract only serves to exacerbate an already abhorrent situation outside of work. The current state of affairs whereby doctors may go days without seeing their loved ones is unacceptable. All junior doctors work weekends under the current contract to deliver urgent care. At present, we have a situation whereby Saturday is regarded as unsociable, meaning that where junior doctors are expected to work weekends, they can do so with the knowledge that their family time is valued and is reflected in the rate that they are paid. Under the new contract the situation becomes intolerable. With the extension of normal working hours, and as Saturday transitions to becoming a frequently worked, routine day, a significant blow is dealt to the ability of a doctor to maintain a life outside of work and raise a family. Should we choose not to fight the imposition we are effectively agreeing that in becoming a doctor we opt out of any semblance of a work-life balance.

As the government embarks on its bloody crusade to provide 7 day elective services in spite of an unwillingness to invest in the necessary training of more doctors, it doesn't take great intellectual leaps to understand why imposition occurred. In its current iteration, the new contract quite patently represents an erosion in the working conditions of the junior doctor. With more hours in the normal working week alongside weaker protective safeguards, it will ultimately be the patients who suffer. What will inevitably emerge under the wholly unreasonable demand to deliver this manifesto pledge on a shoestring budget, is a pattern of catastrophically overworking an already stretched junior doctor workforce. The concept of tiredness leading to poorer performance isn't new and in accepting the imposed contract we are all implicit in the creation of an unsafe NHS where mistakes are commonplace.

To their very core junior doctors are selfless and incredibly resilient, but even they have a breaking point. What we see now is the recoil from years of successive governments undervaluing a workforce that makes great sacrifices to serve the population. For the dispute to be boiled down to being about pay shows a complete lack of insight on the part of the government. The negotiations transcend the issue of pay, involving elements of fairness, safety and merely recognition of the needs of a junior doctor as a person. It is a disgrace that it even has to be intimated, but doctors are human too, entitled to a life outside of work with their family as well as the right to practice in a safe environment where they are valued. If I am to serve others in the NHS, it is not unreasonable to expect this as the bare minimum before making a commitment. I absolutely want to help others, but I refuse to let it come at the expense of my health and happiness elsewhere.

With the above reasons in mind, I hope you can at the very least appreciate if not support my reasons for a faltering commitment to a career in the NHS. Although a sense of fulfilment from helping others might get me up in the morning, the last I checked it couldn't pay the bills, nor could it make up for lost time with your family. It is evident that I am not alone in my sentiments either as the NHS slowly haemorrhages exceptional doctors overseas in pursuit of better working conditions. At this point in time, I cannot say for certain that I will not follow suit, but for the moment I am ready and willing to fight on behalf of the British people for a system I strongly believe in.

Before You Go