A new contract proposed by the government has led to junior doctors protesting on the streets and a threat of strike action. They fear the contract will cut their pay by up to 40%, force them to work more antisocial shifts and put some off becoming GPs or A&E medics.
Junior doctors and healthcare professionals who’ve responded to a Guardian call out tell us current hours and pay are barely sustainable now and forewarn that safety and patient care will be compromised if the new contract is imposed next summer.
Here is a selection of their responses.
‘If the contract is imposed I will leave medicine. This is a line that cannot be crossed’
The workforce has never been more demoralised and dejected than it is now, and the junior doctor contract set to be imposed on us will break us. Our hours are unsociable as we already work a 24/7 emergency rota and will do for the duration of our Junior Doctor careers, but we are currently safeguarded against being exploited by our trusts by the current financial penalties which can be imposed on our trusts if our hours exceed those in our contract. This means that you don’t have an exhausted surgeon who has worked a 120 hour week operating on you at the end of a 13 hour shift who hasn’t been able to take his 15 minute break/4 hours worked, who hasn’t had time to eat or go to the toilet all shift.
This situation is commonplace in the NHS already and the safeguards will be removed and the problem exacerbated under the terms of the new contract. You wouldn’t let a pilot fly your plane in this condition, why do you ask this of your doctors? On top of the multi-pronged attack on our profession and conditions set out in the new contract, and whether or not you think junior doctors are paid fairly for what we do, it is not safe, not fair and certainly not sustainable for the NHS workforce to expect us to accept a pay cut predicted at up to 40%.
I love my job, I have worked incredibly hard to get myself here but I am not a machine. If the contract is imposed I will leave medicine. This is a line that cannot be crossed.
Dr Claudie Sellers is a CT3 Anaesthetist in central London.
‘The proposed trainee doctors contract will have a significant impact on the safe delivery of care to our most vulnerable patients’
The proposed trainee doctors contract will have a significant impact on the safe delivery of care to our most vulnerable patients.
Doctors in training will be left undervalued, overworked and many will unfortunately seek alternative career paths outside our excellent specialty training schemes.
Doctors commit a huge part of their early adult life to vocational training; the current hours and pay barely do justice to the sacrifice and commitment most of my junior colleagues display. To further financially discriminate against them is wrong and would undermine the whole ethos of lifelong medical training within the NHS.
Dr Michael Patterson is a consultant in Intensive Care & Emergency Medicine at a central London teaching hospital.
‘The specialities hit the hardest will be those on the front line - A&E, acute medicine, elderly care, general practice, obstetrics’
I think it needs to be made clear that we are opposing the imposition of the new junior doctors contract as, first and foremost, it is going to be disastrous for patient safety, and for the future of the NHS. Why? Because the specialities hit the hardest will be those on the front line - A&E, Acute medicine, Elderly care, General Practice, Obstetrics.
These specialities already face serious shortfalls in staffing (48% in acute medicine, 25% in obstetrics, 600 unfilled GP posts). The new contract (which removes the extra pay for working antisocial hours and takes away the pay supplement for GP trainees) is going to worsen what is already a serious recruitment crisis. Which means less doctors in A&E - so a longer waiting time. It means less GPs - so less appointments. It means even more reliance on agency and bank staff to fill rota gaps (which costs more money) - further bankrupting the NHS so there will be even fewer resources.
It means that the junior doctors who do stick around, will be even more exhausted and even more demoralised (the proposals extend junior doctor working hours and remove key safeguards that prevent us working unsafe hours). There is a direct correlation between concentration levels, exhaustion, and safety. Would you let a pilot fly an aeroplane after a 90 hour week? I know that I wouldn’t want my relatives treated by someone at the end of a 15 hour shift. This is how mistakes happen, this is how teams become dysfunctional, and it is patients who will suffer harm as a result.
Alice Beardmore-Gray is a Junior doctor who has just finished Foundation training in London.
‘The skilled, talented doctors who make the NHS what it is are being driven out and the real sadness is that it’s our patients old and young who will suffer’
I work hard long hours including 1 in 3 weekends, 1 in 6 of my shifts is an 11.5 hour night shift and 1 in 3 of my shifts finishes at midnight. The work is about as intense as it gets in civilian medicine with constant workload, stress, seriously injured and ill patients requiring urgent and high quality care, which on the whole, we deliver given our recent CQC report.
I worked through Christmas (nights shifts all week) and will probably work the same this year as well as working 5 out of 6 bank holidays so far this year. And I am happy to work this hard as I have done for 8 full time years in the NHS putting the service first. In spite of this I see that depending on which version the government unilaterally impose I will lose between £300 and £400 per month with the new contracts. £4,000 per year! I can’t work out where or how I am supposed to be working harder or longer unsociable hours.
This story is repeated for all my colleagues the same or worse across the NHS. Sadly to keep paying my mortgage, support my family and pay my student debt (which I am still repaying) I fear I will have to leave the NHS as are hundreds of my colleagues. The skilled talented doctors who make the NHS what it is are being driven out and the real sadness is that its our patients old and young who will suffer.
OliverJM is a Senior registrar in Emergency Medicine (A&E) in an inner London Major Trauma Centre.
‘The proposed contract changes are alarmingly unsafe’
I left university with 60,000 debt and a starting basic salary of £23, 000. My basic salary is now (four years after graduating) 30,000. Because of debt I cannot afford to rent in London so live at home with my parents- not a great thing when you’re 30.
The proposed contract changes are alarmingly unsafe. I have experienced working excessively long hours and have often not felt safe at work due to fatigue. There is no safeguard for a doctor treating a patient when they are sleep deprived and highly stressed- they unwittingly become unsafe. We are almost permanently short staffed and on a near daily basis doctors are required to remain at work 1-2 hours past our contracted hours- this is not an occasional requirement of us. We will never get this time back, will never be paid for it and in fact we are rarely given any recognition from our employers.
We do it daily - not to get toil, bolster our pay or be praised - we do it because it is essential for patient safety - junior doctors have been plugging the gaps for a long time. I have a huge responsibility to my patients- to provide them with safe and effective care. I also hold a responsibility to myself and my family - both have taken second place for a long time and often at great personal expense. It is demoralising and heart breaking to watch as the NHS is slowly and systematically dismantled and put up for sale.
Amy is an A&E trainee in London.
‘I don’t want to work for another country, I don’t want to work for a private firm. I’m training to be a doctor to work for the NHS’
I don’t want to work for another country, I don’t want to work for a private firm. I’m training to be a doctor to work for the NHS, because it alleviates the suffering of people in this country purely because human life is inherently valuable, irrespective of the profit that can be generated. Anyone can read about the changes in the contracts and see that they are unfair and unsafe.
No one in their right mind goes into medicine for the money, they expect hardship and sacrifice as it’s the price you pay to touch people’s lives with your work, but when they deny us the right to a full family and private life and force us to work more for less, then we must take a stand. We know we aren’t the neediest group in society today, but we do care for them, and for that reason we demand support from the government. I don’t think that’s too much to ask.
Yet I feel this reflects a wider issue. I grew up intensely proud of the NHS, but today I fear that I may outlive it. We have seen government backed underfunding and understaffing reach dangerous levels in the last five years.
BenjiFM
‘The term junior doctor is misleading to say the least. These people are not newbie grads who don’t have a clue’
You might have private healthcare insurance already and think this doesn’t apply to you. However, private healthcare is provided by consultants and GPs who have all been junior doctors at one stage. The best private clinicians are those who also work in the NHS. Being financially motivated might be a good attribute for a banker but I promise you that is not what you are looking for in your doctor and healthcare team. And if, heaven forbid, you were to get really sick, the best place for you to be is in the NHS, in intensive care units staffed round the clock by, yes, you guessed it, junior doctors.
The term junior doctor is misleading to say the least. These people are not newbie grads who don’t have a clue. This 60,000 strong workforce represent the backbone of the delivery of NHS medical care. The term covers any doctor before they become a consultant or GP. For a hospital doctor, after their 5 or 6 year medical degree, this means 4 years of core training, 5 years of specialist training, and in some cases a 3 year higher degree and a 1-2 year fellowship. It is the medical registrar running the cardiac arrest call who will fight to resuscitate you, the anaesthetic registrar who will provide your epidural before your emergency C-section, the paediatric SHO who will be there if your precious newborn baby isn’t making the right noises, the A+E SHO who will suture up your rugby injuries, the surgical FY1 who will make sure you get your paperwork and medicines to go home safely after your operation, the psychiatric SHO who will make sure you are safe and get the right treatment when you are at your most vulnerable … I could go on.The government’s proposals suggest making the ‘normal working day’ 7am to 10pm Monday to Saturday (currently 7am to 7pm Monday to Friday). They propose removing financial penalties on hospitals where doctors work beyond the recommended hours. Back in the 80s/early 90s, when junior doctors were working >100 hour weeks, doctors died and patients died. Safeguards were introduced for a very good reason.
JuniorDoctor
“I don’t actually think the contract offer is such a bad deal as some have suggested”
I don’t actually think the contract offer is such a bad deal as some have suggested. The current contract, which uses various banding supplements, is outdated. For example, in the current system, two doctors in different jobs can be on the same banding but may work vastly different hours. The current system pays them the same. The new system attempts to address this by applying a more nuanced payment structure. In this new system some will lose out, but others will gain.
I’m also troubled by the gross misunderstandings and misconceptions fuelled by social media. For example, junior doctors will not be forced to work longer or more unsocial hours - it’s only the payment for these hours that are up for discussion. Furthermore, the proposal to increase basic salary by 15% seems to have been lost.
There are aspects that ought to be negotiated and clarified; the government and NHS England have repeatedly stated they are open to these discussions.
Ben is a Foundation Year 2 doctor working in the south west.
‘This new contract discriminates against those who take time out for maternity leave or similar career breaks and those who work flexibly’
This new contract also discriminates against those who take time out for maternity leave or similar career breaks and those who work flexibly. By choosing to follow an academic career and to work 80% of FTE while I bring up my young family, I am spending an additional 6 ½ years as a junior doctor rather than a consultant. I estimate (using the current pay scales) that I have given up a total of £238,868 gross pay to follow my chosen career path, combine work and family life and to try and improve patient care both directly as a doctor and indirectly through health care research.
I am currently on a one year sabbatical in the USA. My salary remains stable through the University (minus on call banding supplements) but we have paid all of the costs to move our family of four here and lived on one salary to achieve this experience. I have been offered an academic job here earning considerably more than I would within the NHS and I have turned this down. Last week I had an informal offer from a pharmaceutical company who offered me an 800% pay rise to work for them in drug development. They value my medical and academic training, which sadly is more than I can say for the NHS or UK government. However I have also turned this down as I have already made my choice to pursue a career as an academic physician.
The new contract will not affect me for long as I now have less than 18 months left in training. However it will affect my career until I retire as when I am a consultant I will rely on those junior doctors following me. I will struggle to work in a department that is understaffed as junior doctors leave medicine or leave the UK. My academic colleagues and I will struggle to keep momentum in UK health sciences research with an even clearer disincentive for anyone to take time out of their training to do a PhD or to enter academic medicine for the long term.
Laura Coates is an NIHR Clinical Lecturer in Rheumatology at the Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds.
‘The NHS is the best healthcare system in the world but it’s being eaten up by financial interests and I fear soon it will be a hollow shell’
I’ve just started my first job as a registrar in Woolwich. The responsibility is heavy: I’m the most senior children’s doctor at the hospital overnight, although consultants can come in if requested.
I went on the protest today because I’m really worried about the future of the NHS. Financially I’m OK but many of my colleagues pay high rents and exam fees and would struggle if their supplement for working antisocial hours was removed. You already see doctors doing extra locums to pay for their weddings or a deposit on a flat: if the private health sector expanded in the UK you would see many doctors leaving the NHS and a two-tier system quickly established.
I feel the conservatives are needlessly trying to squeeze the NHS: setting it up to fail. I can see why: there’s a massive economic potential in private healthcare: relatives in Ireland paid €3000 for the birth of each of their children, we paid nothing. The NHS is the best healthcare system in the world but it’s being eaten up by financial interests and I fear soon it will be a hollow shell.
I’m proud of the fact that in one cubicle on our ward is the baby daughter of wealthy British-Singaporean city workers and in the next door cubicle is the son of Eritrean refugees who speak poor English. These two sick children are brought to hospital because they are sick. They are both provided with the same caring, compassionate healthcare by the same dedicated professionals because they are both young precious human beings who need help.
Dr Alex Armitage is a Paediatric Registrar at the Queen Elizabeth Hospital in Woolwich
‘In six years time we will have no new doctors coming through and we will be screwed’
My first year as a junior doctor was a baptism of fire. I ran entire wards for days on end with no senior input. I ran to cardiac arrests and did chest compressions till my arms and legs felt like jelly. I was covered in blood, piss, shit and sick. I got sick a lot. I stuck my hands inside people’s stomachs. I watched helplessly as people died quickly, and I sat with others as they died slowly. I comforted relatives, I was yelled at by relatives. I never yelled back but I cried in the doctors mess so. many. times. Heck, I even single-handedly gave one of the first faecal transplants in the country (that was messy).
I worked one weekend in four when there were only about six doctors working in the entire hospital, and one week in four I worked every day from 7am til 10pm. When I got home on those weeks I crawled into the bed of my two year old son and whispered in his ear that I loved him, and I hoped he heard me because he hadn’t seen me for a week, even though I was there when he was sleeping. I did all this for a salary of £22,000. And for love. Because most of the time I did love it despite all the tears and vomit. But it helped that I was paid a supplement to compensate for the antisocial hours at least.
And now none of these hours will be deemed antisocial and junior doctors will just get that basic rate of pay for the same responsibility and conditions. Given the choice now between training as a junior doctor, or a “physicians assistant” who will do much the same job but with no responsibility and a £50k salary from the start, well I know what I would choose. Which means in 6 years time we will have no new doctors coming through and we will be screwed.
Clare is a trainees GP in Norwich.
‘The degradation of our profession has occurred over a number of years through successive governments. In my case it has led to me choosing to leave the UK’
We, as Doctors (and indeed those in allied health professions) are in a difficult position as we are professionals who are answerable to a public body. We have devoted much of our lives and our freedoms at considerable expense in order to pursue a vocation that we chose to enter in the belief that we can be equipped with the skills to help individuals who are faced with ill health. We emerge from our training with large amounts of debt, and are then committed to a life of further study with further examinations and courses, all of which go towards improving our abilities as health professionals and our ability to help those patients whom we treat. We all do this not for personal financial gain, but for those people who we meet in our professional lives.
The degradation of our profession has occurred over a number of years through successive governments. In my case it has led to me choosing to leave the UK in order to take up a job in a country where Doctors are still regarded as professional people and respected for the efforts that they put in for the good of others.
In the case of the current contracts it is simply the last straw. We accepted it when the government changed training making it harder to change specialties, we accepted large cuts to our pensions, we accepted it when basic privileges such as being able to drink a coffee at work were removed. But this dramatic change to the contract, which has been swept into place with little care for the workforce who it affects or consultation with those people, all of whom are hard working people with families and mortgages is the final insult from an uncaring government who has taken advantage of a sympathetic work force for too long.
UKExpat
Some of the individuals who contacted us wish to remain anonymous and their first names or usernames have been used in this article.
