Doctors are striking for the first time in over 40 years. We do so with a heavy heart, as it goes against the very ethos of our vocation. Yet the fact that more than 98 per cent of us voted to do so speaks volumes about the current impasse.
In 2012 – long before any talk of a seven-day NHS – our union, the BMA, began negotiating in good faith on a new contract. Two years later they walked away because the government were refusing to listen to their concerns, threatening to impose unsafe changes on doctors regardless.
Tens of thousands of us took to the streets, to social media, wrote letters to the press, met our MPs and talked to the public – we even recorded a hit single. Still the government would not listen.
Finally, with the threat of strikes looming, and at the eleventh hour when it was too late to reinstate cancelled procedures, the government agreed to the very reasonable BMA request of talks mediated by Acas. Now these have failed because of government intransigence and, having exhausted all other options, we feel we have no choice but to strike before it is too late and this contract is a reality.
The latest offer is much improved. But important differences remain. The existing, effective system for monitoring our hours is to be abolished. The proposed replacement is inadequate, leaving doctors vulnerable to being pressurised into working long beyond their rostered hours, something that can ultimately jeopardise patient safety. It’s like asking people to drive within the speed limit – while simultaneously removing speed cameras and fines.
There’s more. Under the new proposals, doctors working an 11 hour shift will get just one 30 minute break. Worse, there are no requirements for rest periods for those who provide an on call service overnight, when they could be called in frequently. These doctors could be asked to work both the day before and the day after one of these “non resident” night shifts. Effectively we could be working 72 hours continuously. As this arrangement costs less and requires fewer rest provisions (less time away from work) than having resident staff, hospitals will have a powerful incentive to make such 72 hour shifts commonplace. Overworked and tired doctors make mistakes, so getting these arrangements wrong is tantamount to gambling with patients’ lives.
The government argues that these changes are needed to provide a seven-day service. Extra money is promised for the NHS, but our wage bill is set to stay constant (and for the record, we are not asking for a pay rise). The only way the sums add up are if existing staff are stretched more thinly.
11 years ago I quit my job as a management consultant to retrain as a doctor. I’ve lost count of the number of doctors who have asked me for advice about going in the other direction in the last six months. Morale is at a record low. Only 52 per cent of doctors finishing their second year of work after graduating chose to stay in the NHS last year, down from 71 per cent as recently as 2011. The consequence has been vacancies in every specialty, with as many as half the posts in A&E unfilled. The shortfall? It’s covered in part by the rapidly eroding goodwill of those doctors who stay, but increasingly by costly locum staff at the taxpayers’ expense. A new contract that encourages doctors to stay is urgently needed.
And this is the crux of it. There is a real danger that many doctors will leave rather than work under conditions they feel are unsafe and unfair. The government has refused to listen, risking patient safety in pursuit of a rash and ill-conceived manifesto commitment to an as-yet undefined seven-day service.
As a taxpayer and a patient, I’m not worried about a strike – our consultants will ensure emergencies are covered and patients are safe – but about a contract that prompts a mass exodus of doctors. That’s why when junior doctors say they are striking to save the NHS, it’s not just rhetoric. If you care for the NHS, please support us.
Dr Hugo Farne is a junior doctor and a specialist registrar and clinical research fellow in respiratory medicine