Opinion piece by from Dr Louise Irvine:
On 26th and 27th April 2016, 54,000 Junior doctors will take part in the first ever all out doctors strike in England in opposition to government plans to impose a new contract that they say is both unsafe and unfair. This is momentously significant. That this strike is happening signals a total failure of Jeremy Hunt as Secretary of State for Health to value and support a vital component of the medical workforce who are integral to the delivery of safe and effective NHS services. Junior doctors feel forced to strike as a last resort to resisting the imposition of this damaging contract. What is it about the imposed contract that has elicited such a powerful, united and unprecedented resistance from a group of people not known for their militancy? It’s clearly not true that they are doing this because of some minor disagreements on remaining contract issues. It’s about something far more profound, that goes to the heart of the way that junior doctors’ work is structured. When the junior doctors say the proposed new contract is both unsafe and unfair, that is not just a slogan, it is actually the truth, and Jeremy Hunt and NHS Employers would do well to pay attention to the reasons why it is true.
One of the key issues facing the NHS is recruitment and retention of doctors in the specialities that deal with the most acutely ill patients because these are the specialties where junior doctors already work long hours with rapidly changing and fatiguing shift patterns, covering 24 hours a day 7 days a week. This includes A+E, acute medical and surgical specialties, paediatrics, obstetrics and anaesthetics. In these specialties there is already a massive workload and significant rota gaps which means doctors generally work far more hours than appear on their rotas.
This extra work is done out of professional obligation and is unaccounted for and unrecognized. This means that not only are rotas often in reality in breach of the European Working Time Regulations but have a serious impact on doctors’ fatigue and concentration levels and general wellbeing. This in turn makes these jobs less attractive leading to people leaving, difficulty recruiting, more rota gaps, and more of a burden on those who remain, with one doctor often having to do the work of two, creating a damaging cycle. This is bad for doctors but also bad for patients. It is this reality that any new contract for junior doctors should have addressed. Instead the imposed contract will make this worse.
Written evidence by the Cass Business School for the National Audit Office highlights the many risks to junior doctors in the new contract. It modeled the new junior doctors contract and concluded that:
“Fatigue of doctors and risk to patients are not mitigated by the new contract, which will negate any intention to increase quality of care and patient safety.”
“The new contract rules relating to rostering of junior doctors are insufficient to ensure doctors’ well-being and patient safety. It is well established that the fatigue impact of rosters greatly depends upon the way in which the work is distributed over a given period and not only on the total amount of work.”
“Due to the ambiguity of the contract rules, it must be noted that the proportion of night work and weekends may increase in comparison to current working patterns; reclassifying definitions of anti-social time and night duties may inadvertently encourage this and will not negate their physiological or psychosocial effects.”
These are exactly the points the junior doctors are making. It’s not just about “Saturday overtime pay” as Hunt would like us to believe. Let’s be clear – junior doctors night and weekend work is not “overtime” – it is part of their obligatory shift patterns designed to cover 24 hours, 7 days a week. Making it cheaper to employ them at night and weekend is a way of enabling hospitals to roster more of them during those hours thus shifting their working week into an even more antisocial pattern. And without any additional doctors this will just spread them more thinly during the rest of the week, without doing anything to fill the enormous gaps in provision throughout the week.
It is shocking that the government seems to have no concern at all about these criticisms of their enforced contract: that it will increase fatigue amongst doctors; that it will weaken the protections against being obliged to work excessive hours; that it will damage psychological wellbeing and work-life balance (especially harmful to doctors with children and discriminatory against women and single parents); that it will adversely affect recruitment and do nothing to reverse loss of doctors from key specialties; that it will add to the rota gaps and recruitment difficulties in these specialties. The new contract should have been an opportunity to remedy what is wrong with current junior doctor working conditions; instead it makes things worse. Like throwing fuel to the flames the government seems happy to sit back and watch the conflagration.
Jeremy Hunt’s declaration that there will be no more negotiation and the contract will be imposed shows that he either does not understand just what it is about the proposed contract that is so unfair and unsafe, or that he just does not care. This shows utter irresponsibility and failure in his duty as Secretary of Sate for Health.