Dr Louise Irvine’s junior doctors letter in this week’s Farnham Herald

Dear Sir

Dr Louise Irvine

Dr Louise Irvine

The overwhelming vote for strike action (98% in a 76% ballot turnout) by junior doctors tells us just how angry they are about the Government’s decision to impose a new contract on them. Who are the junior doctors? The term makes them sound like newly qualified doctors but in fact they are doctors at any stage of training before they become consultants or GPs, so most of them have many years experience as doctors. There are 56,000 of them and they form the backbone of the NHS. Don’t be misled about Hunt’s claims that the contract is about 7 day working. Junior doctors already work 7 days a week, 24 hours a day. If you are admitted to hospital in the night or the weekend junior doctors are there to treat you. I have seen typical rotas of juniors that I teach – they show long 12.5 hour shifts spanning nights and weekends. They also work many more hours unpaid. One junior wrote to me:

“On my first 3 days of Obstetrics & Gynaecology I did 8 hours of unpaid work – I stopped counting after that. It has been fairly common for me to finish normal day shifts late around 1-2 hours extra and this is true for all the juniors.”

I am constantly struck by how incredibly hard working, committed and caring these doctors are. I don’t understand why Jeremy Hunt seems to be doing all he can to alienate and anger them. Does he not understand their concerns? Why is he threatening to impose a contract that junior doctors universally condemn as unfair and unsafe? Why won’t he agree to re-enter negotiations with no preconditions, or even to use ACAS arbitration*?

The juniors say the contract is unsafe because it removes vital safeguards against them working excessively long hours. They already work grueling 12 hour shifts and many hours unpaid, so anything that will make this even worse will be dangerous – tired doctors make mistakes.

The contract is unfair because it will extend what counts as “normal hours” paid at base rates from 60 hours a week to 87 hours a week. A large part of junior doctors’ pay is for nights and weekends – obligatory parts of their rotas and not “overtime”. Increased basic pay but reduced pay for nights and weekends will lead to an overall pay cut for many specialties. Ironically the specialties that will be most badly affected are the ones with the most antisocial hours in their rotas, such as acute and emergency medicine and surgery.

This will make recruitment to these specialties, some of which are already dangerously understaffed, even more difficult.

The Society for Acute Medicine said it was extremely concerned by the planned changes to junior doctors’ terms and conditions. They warned that exacerbating the shortfall among emergency doctors would be particularly unwise as their role is central to the NHS’s smooth running: “In the winter of 2014-15, acute medicine played a pivotal role in keeping the NHS afloat by maintaining the quality and safety of patient care and also working collaboratively to help relieve the stresses on our A&E departments.”

I worry for the future of my profession and for the NHS if the junior doctors lose this struggle. Leaders of medical royal colleges have warned that the “imposition of the contract presents an immediate risk to the provision of healthcare throughout the UK, and an ongoing threat to healthcare for generations to come”.

The new contract will deter young doctors from staying in the NHS, make vacancies even harder to fill in key areas of care and endanger the quality and safety of treatment that patients receive. Already the numbers of juniors applying for a certificate of current professional status so they can move abroad has increased astronomically – over 3500 in the 10 days following the announcement of the Government’s decision to impose a new contract on junior doctors when the GMC normally gets only 20-25 such requests a day. The number of doctors failing to apply for specialty training after their foundation years has dropped to a record low of 59%.

Professor Jane Dacre, President of the Royal College of Physicians said: “Our junior doctors need to be valued, supported and motivated to provide great care for patients, and the new contract needs to reflect that and encourage them to stay in the UK.”

Hunt’s actions are putting the whole NHS at risk. If we can’t recruit and retain the very best of our young people to work for the NHS; if we alienate a whole generation of young doctors; if we force many more to contemplate leaving the UK or even leaving the profession altogether and if we force those who remain to work longer antisocial hours for less pay, that will do untold damage to the NHS.

If we care about the future of the NHS we should support the junior doctors. They don’t want to strike –but they feel they have no option. Jeremy Hunt could get the strike called off tomorrow by agreeing to re-enter negotiations with no threat of imposition. Let’s all show our support for the junior doctors and urge Hunt to agree to genuine negotiation.

Dr Louise Irvine

GP , trainer and Programme Director for Specialist Training in General Practice in Lewisham

  • ACAS involvement had not been agreed by Jeremy Hunt at the time of submission of this letter to the Farnham Herald.
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