Dark Times for the NHS

Although it was called off at the last minute, the junior doctors’ strike planned for tomorrow (Tuesday 1 December) showed just how close to the edge Health Secretary Jeremy Hunt has pushed the medical profession. Final-year medical student DAN SELLWOOD explains why his colleagues were prepared to put down their stethoscopes in favour of a one-day walkout.

Doctors and the British Medical Association (BMA) are hardly Trotskyists or  ‘militants’, as much as Health Secretary Jeremy Hunt tries to portray them this way. So what drove a profession of 50,000 to vote unanimously (98%) in favour of strike action?

Junior doctors protestAt the general election the Conservative Party pledged to provide a full seven-day NHS. They did so at a point when the NHS is under greater financial strain than at any time since it was created, and despite the fact that it currently provides a seven-day service with 24-hour emergency and on-call cover.

I’m a final year medical student and I assure you that if you go to A+E on a Saturday or Sunday evening you will receive the same care as you would every other day of the week. Since Hunt’s campaign against junior doctors began, there have been cases of people delaying going to A+E at the weekend and as a result have been harmed. This has been dubbed ‘the Hunt effect’.

The junior doctors’ contract is part of this push for a seven-day elective NHS. Here are the key points of contention.

Anti-social hours

Under the current junior doctor contract anti-social hours are classed as those outside 7am to 7pm Monday to Friday. In jobs where doctors are rostered outside these times they receive regular top-up ‘banding’ payments of either 40% or 50%. This happens, for example, in A+E, anaesthetics and paediatrics.

These payments are made on top of the base salary, which stretches from roughly £22,000 for a first year doctor to roughly £42,000 for a very senior registrar (in their seventh year of specialty training, or after a minimum nine years as a doctor). This banding payment usually makes up roughly a third of the total pay of a junior doctor.

Under the new contract, the government wants to extend what is considered normal social working hours to 7am to 10pm Monday to Friday and 7am to 7pm on Saturday. They also want to remove the banding system and replace it with reduced amounts.

The government have increased the basic pay by 11%, but this does not come close to covering the loss from banding payments. The only jobs that will do reasonably well out of this are jobs where there is currently very little anti-social hours work.

On top of this, incentive payments to try to attract doctors into under-staffed jobs, such as general practice, are to be scrapped. This will cut GP trainees’ pay by up to 30% – at a time when the government is saying we need an extra 5,000 GPs.

To try to bribe current NHS doctors, the government has also thrown in a payment protection clause for the next three years, athough thereafter pay will drop hugely.

However, payment protection does not apply to new doctors, current first year doctors, nor doctors returning from maternity leave, research or working abroad. As a result the immediate drop in income is enormous for these groups and many say they simply will not be able to afford to be a doctor anymore or will move abroad.

Financial safeguards

Currently there are financial safeguards to prevent employers forcing doctors to work ridiculously long hours. These were brought in to combat the dangerous working conditions doctors endured in the 1990s.

One junior doctor told me about some of the things that used to happen. In one instance, a consultant was particularly keen for the junior doctors working nights to stay on the next morning to review their overnight patients with him on the ward round. This sounds like a good idea in theory but it meant junior doctors were working from 8pm sometimes until beyond 11am the following morning.

Such practices were reported to employers but little was done about it until the threat of financial penalty was applied.

Hunt claims to be limiting hours, but his measures will be completely useless if he has removed the penalties that police them. It is the equivalent of setting a speed limit but then not having any speed cameras or police to check people stick to it.

Scrapping annual pay increases

At the moment, junior doctors receive an increase in pay each year as they move up a training level, for example from F1 to F2, ST1 to ST2, and so on. However, in the new contract these increases will be replaced by increases every few training levels.

On the face of it that change doesn’t sound too bad but it has serious ramifications. It will mean that if a doctor is working part-time they will not receive an increase in pay for many years, sometimes as many as 10, despite significant improvements in experience and increased responsibility over that time.

Doctors who wish to retrain will also be badly affected. Under the new rules, a doctor who has trained for seven years in a certain specialty and then decides to retrain as a GP will be paid exactly the same as a new doctor entering GP training. Of course, this is ridiculous because the doctor who has gone through seven years specialty training will have a great deal more skills than the more recently qualified doctor.

Low morale

Jeremy Hunt has completely lost the faith of nurses and doctors. The constant spin and patronising tone he has taken throughout this dispute has driven doctors to the edge. It is welcome that Hunt is now open to talks with ACAS although, as things stand, I think it is very unlikely that the issues will be resolved until he has left office and is no longer involved in the negotiations.

Morale in the health service is at an all-time low with record numbers of doctors looking to move abroad. The government’s made-up figures about how much it costs the state to train a doctor only makes matters worse. For the record, it’s estimated at around £150,000, which a doctor will have earned the NHS within a few months of starting work.

All of this is happening before we hit what is likely to be one of the worst winters for the NHS. These are dark times for the National Health Service and for now there is not much light at the end of the tunnel.

The latest information on the junior doctors’ strike can be found on the BMA website here.

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