As doctors, we embark on a 40-year-plus career in the NHS knowing full well that work life is going to be tough. Long hours, a low starting salary compared to other professions (earning £23,000 a year, compared with the national average salary of £27,000), high levels of stress, regularly doing extra work for no extra pay, and emotionally difficult experiences with sick and dying patients await us.
Although it is also extremely rewarding and a privilege to serve and be trusted by the public, a medical career takes its toll on work-life balance. Doctors have high rates of mental health problems and alcohol dependency. Family breakdown is common.
We have therefore had a longstanding unwritten social contract with the state. We give a lifetime of work to the NHS, and in return we have job security and fair terms and conditions, including reasonable pay progression and decent pensions. Unfortunately, over the last several years the social contract has been eroded.
Medical students have average estimated debts of between £64,000 and £80,000 at graduation; free accommodation for doctors in their first year has been withdrawn; pay has been frozen for several years; pensions have been cut; and professional fees have spiralled.
The current dispute over the junior doctors contract is the straw that broke the camel’s back. Jeremy Hunt has torn up the social contract and created an irreversible breakdown in trust.
The government has had a clear agenda to force junior doctors into working more hours for less pay, to help deliver its nonsensical “seven-day NHS” manifesto pledge in the face of a £22bn NHS efficiency savings programme.
The Department of Health (DH) spin machine has outrageously claimed that junior doctors will be getting an 11% pay rise, but this is a cost-neutral contract. So while basic pay is going up, pay for unsocial hours will be cut.
To the embarrassment of Jeremy Hunt this has been pointed out by the Tory chair of the health select committee, Dr Sarah Wollaston. Since safeguards to prevent excessive hours are also being abolished, this opens the door for juniors to be used and abused like they were in the 1980s and early 90s. This is clearly an unsafe proposition for patients and doctors.
In addition, women who want to have children will be disadvantaged by their career breaks, and pay protection will be lost for future doctors. It’s a disgraceful situation that is uniting the profession against Hunt, the DH and this government.
Hunt won’t be forgiven for breaking the bond of trust with the medical profession and destroying the social contract. If he continues with his plans to impose the contract, there is no doubt that there will be an exodus of junior doctors.
One recent survey suggests as many as seven out of 10 may leave. Clearly such a survey is subject to bias during a dispute, but even if a tenth of doctors leave, it could be catastrophic for the NHS, which is already chronically short of doctors.
The only solution is for Hunt to resign and for David Cameron to appoint a new health secretary prepared to re-enter proper negotiations with the British Medical Association. That is the only possible way to rebuild trust and deliver a renewed social contract.
