Concise Explanation on the Junior Doctors’ Battle
How the NHS in the UK is thoroughly shafting the new cohort of junior doctors.
Update: 5/16/2016 Nothing too specific on this update, but I’m just doing a little recap that has since happened Dennis Skinner during and after the 2-day planned strike, accused Jeremy Hunt of “reveling” during the strike instead of seeking a solution. As a result, Skinner told him to wipe that smirk of arrogance off his face. As I mentioned, striking can lead to particular risks however the BMA and the senior doctors have said they would step in and fill the gaps. Although concessions have been “attempted” its led to pretty much a standstill and the BMA and the Government have reentered talks where the results will be known on 5/18/2016. Originally, people believed that this would be one sided and only the junior doctors would be fighting back but now the public is rallying behind them with the belief that “if they [junior doctors] say that this new contract isn’t safe, then we believe it isn’t safe either”. But something to consider, don’t just blame Hunt, blame his backing party. Hunt doesn’t really care because once his term is up, he’ll leave and just join some private healthcare organization and the party will keep on pushing it with the next health secretary.
Here is a nice little tl;dr image from Junior Doctors On Full Walk Out Source. The reason why the junior doctors are being smashed… essentially because of the cost inefficiencies of the completely government covered NHS. A beautiful universal healthcare scheme, wonderful in concept, but difficult to manage in practical realism. There is a need for cost containment, resource rationing, and policies that help to keep the costs from spiraling away while maintaining the equity/access, quality, and regulatory costs of keeping it functioning well.
Now, hopefully the infographic was a great way to get some context about the issue. I realize, being in the USA, this doesn’t really affect me directly but it is still an important issue because of the overall concept of universal health care while making sure that there are sufficient resources to provide the necessary services at an approved quality. Although the benefits of universal healthcare have been stated in a variety of papers, talks, conferences and what not, it’s still a very important and divisive issue. I realize that this may become ranty, so if it does and you don’t like it, you don’t have to stick behind to read it. The tl;dr above essentially provides all of the information and why it is bad. I’ve discussed the proposed single-payer system from Bernie Sanders before, so here’s a little snippet regarding universal healthcare in one of the most developed countries, the UK. One of the biggest points of contention is how the contract is only being imposed on England leaving Wales, Scotland and Northern Ireland alone. The difficulty with healthcare is that ethically and morally, you can’t really strike… you can’t really withdraw labor unless you’re looking for hospitals to fall and people to die. Simple and short, the government has essentially pushed the weakest cohort of healthcare to provide more services with more availability, for the same pay (thus reducing pay). The reason this contract is also being so opposed powerfully yet lacks public support is because it only affects the lowest of the low. The weakest cohort of the faction. The bottom of the totem pole, junior doctors. The more senior doctors and attendings are being left alone and although it is a pitiful shame what is happening to their underlings, they don’t really have the need to get involved (putting patient quality care aside). This was done specifically to break up the solidarity of the NHS doctors.
Although many of the concerns that will be raised in the NHS argument, are things that are currently seen in the American medical schooling system, it’s a shame that another country will not have to face the bureaucratic roadblocks while providing the “customer” the cheapest care based on resources designated to the customer. With the new contracts and as can be seen in the infographic above, a huge concern is the safety of the junior doctors as well as patients too. There are no significant penalties and all over the overwork reporting is done by the educational supervisor, and not by any safety guardian. In addition, the educational supervisor is similar to the attending that the interns rotate around under, they will be the ones who provide a survey and report at the end. Unfortunately, those reports will be used in references, coordination of training, as well as networking opportunities. In some more specifics, there are only going to be 48 paid hours week but many are reporting work weeks of 56+ hours, meaning those extra hours will not be counted or paid for in the rotations. Unfortunately, this could be an ok idea if there was the man power to cover, however there have been reports of loss of training and people leaving the medical profession, which will lead to an increased workload on fewer doctors, thus leading to obvious patient safety issues. There is a cost to hire more of these “safety guardians” however, what can they do?
Contrary to popular belief, it isn’t about the overtime. In terms of money, it is increasing the base pay, but it removes many of the things that are typically done to increase the multipliers for the pay period. As a result, longer and more unsocial hours will cost the same because the multiplier has been unchanged, but the “qualifiers” have been removed. Additionally, they will be planning to remove the financial benefits for doctors that take specialty jobs or elect to work in more rural areas in desperate need for more doctors. Although it’s really only the junior doctors being affected, many people are standing up against the “imposition” turned “introduction” of this new contract. I mentioned earlier that it doesn’t really affect the senior doctors, but even they realize that it will affect patient safety, outcomes, and worst of all, unironically not medical, it does not follow protocol, does not have a pilot, no testing environments… only a contract being pushed.
Something earlier that I mentioned is how the American medical education system has been screwed over, but just because we’ve had it worse does not mean we should have the “it’s about time for them” mentality. We should fight for better conditions, regardless. With student loans, costs of living, fees, and training costs, many of these junior doctors are facing difficult times on not receiving proper compensation… worse enough is that the NHS is barely staying afloat and only remains because of the goodwill of the people. Overall, it is a very difficult situation to be in the middle of, it’s difficult because Jeremy Hunt and the rest of the Tory party know exactly what they are doing in their attempts to break down the NHS and push England and eventually the UK, into a privatized market. I believe that the solution should be a simple compromise, to step back and take a pause on the imposition of the contract and bring in some independent assessors to analyze the contract, while maybe running a smaller pilot program.
In a nutshell, the government is acting like: : “I’m big, you’re small. I’m right, you’re wrong, and there’s nothing you can do about it”.
The Following Post Is A Snippet From The Picket Lines
But isn’t this all about Saturday pay?
No. It’s about patient safety first. It’s about discrimination. It’s about service without funding, about a government that won’t listen, and about individual salary cuts. There are a lot of things being conflated and many, many different points being raised. Part of what’s going on is an attempt to generate a “7-day NHS”, which is a terrible way of describing what’s actually happening. The NHS is already 7-day. What’s being attempted is a 7-day elective service but with the funds, resources, and personnel for a 5-day service. So, the same number of doctors (and other healthcare professionals) will be spread more thinly attempting to provide an expanded service without the infrastructure to do so. In essence, we’ve got a bucket of paint barely enough for five walls and we’re trying to paint seven walls with it. That’s the additional service side of things, and there’s far more to be said about it in terms of ‘time to senior review’ and the actual manifesto mandate. It’s worth saying that it’s been acknowledged that the junior doctors’ contract is the one that least needs changing to make a 7-day NHS viable, as we already work 7 days.
The individual salary side of things involves the take-home salary of each single doctor – not the funding provided for services etc – and how a reduction there will simultaneously lead to unsafe hours. We’ll be paid less for working more hours – a decrease in take-home salary because of a reduction in banding. Doctors receive a multiplier on their weekly salary based on how ‘unsocial’ their week is – night shifts, back-to-back shifts, ultra-long shifts, etc. See my response in another reply below. The problem with this contract is that it removes a lot of the financial safety nets that stop us being overworked whilst simultaneously decreasing our pay. Trusts don’t want to pay doctors extra banding to work unsafe hours, and so they hire in rested locum doctors or arrange rotas correctly. If that changes, the result is twofold: one, we’re worked harder and on stupider rotas – a day shift followed by two nights, followed by a long day shift, followed by a half day off, followed by on call on the weekend, etc. It’s totally random and is designed to plug gaps in the rota rather than to give us any semblance of a weekly or monthly pattern, treating us as numbers on a spreadsheet. That disadvantages our formal teaching, which is done almost entirely during daylight hours, as fewer of us will be around in the daytime. This is dangerous for patients and dangerous for doctors; we’re already overworked enough (cf the anaesthetist who died when he fell asleep at the wheel recently driving home after a series of long shifts) and adding more work will just lead us to make more mistakes and patient safety suffers, as does our own personal health.
Two, it’s a take-home pay cut. We didn’t ask for the government to fiddle with our contract or our pay. We’re fighting against a decrease in our take-home pay when we have mortgages, kids, etc. There’s no reason to mess with our pay, reducing it and then claiming “doctors are getting a pay rise! Trust me!” because it’s patently false. The discrimination against women (who will need to take time off more frequently than men for maternity/paternity leave), doctors with disabilities/LTFT trainees is entirely unacceptable. Too many of us are already leaving the profession and this is just going to drain England of its doctors, who are leaving for places where they work fewer hours in safer conditions for more pay and in a better culture of collaboration.
A fully 7-day NHS is an admirable goal, but junior doctors are not the people preventing that from being a reality. Adding more doctors over the weekend will just leave us in hospital twiddling our thumbs, waiting for Monday when social care, OT/PT/SALT/hospices/district nurses etc etc are available again to finalise discharges. Massive cuts to community care, housing, and social programs have led to exit block from hospital into community, and from A&E into hospital. Junior doctors are not the bottleneck. And they know that.