Government plans to impose a new contract on trainee doctors will jeopardise the seven-day emergency NHS it says it wants to improve. The proposed contract reduces pay for trainees in all acute specialties by as much as 15%, and economic modelling shows a much worse impact on anaesthetic trainees.
Extending “normal time” significantly reduces pay for doctors with a major out-of-hours urgent and emergency workload, disadvantaging those already delivering a seven-day service. Other proposals for pay progression affect those undertaking additional training or taking maternity leave.
Consultant and trainee anaesthetists are doctors most likely to be found at work at night and weekends, in the operating theatre, maternity units, intensive care units and emergency departments – anywhere the sickest patients are found. Trainees are more likely to be selected for entry into anaesthesia if they undertake additional training, and more than 50% of anaesthetic trainees are female.
How can this not impact on recruitment and retention? Smaller district hospitals already struggle to fill anaesthetic rotas, and cautious figures suggest a need for at least 25% more anaesthetic and ICU doctors by 2035.
Being paid less, to work longer out of hours, will make it difficult to recruit the next generation of anaesthetists. A sudden jump in requests for GMC certificates of good standing (needed by doctors planning to emigrate) suggests the current generation will vote with their feet (Junior medics warn of NHS crisis as doctors pack bags, 23 September).
Excellence in patient care comes from a happy, healthy, highly motivated workforce, and morale among trainees is at an all-time low – this is not just about pay.
As leaders in the specialty of anaesthesia (16% of all consultants in the NHS and about 4,500 trainees), we urge the NHS in England to rethink its current contract proposals, which will have the opposite effect to what our patients (the general public) want – the right number of the right doctors delivering world-class emergency care, 24 hours a day, seven days a week.
Dr Andrew J Hartle President, Association of Anaesthetists of Great Britain and Ireland
Dr Benjamin Fox Chair, Group of Anaesthetists in Training
Dr Jairaj Rangasami President, Difficult Airways Society
Dr Roshan Fernando President, Obstetric Anaesthetists’ Association
Dr John Andrzejowski President, Neuroanaesthesia & Critical Care Society of Great Britain and Ireland
• My vocation has been publicly vilified to fulfil unscrupulous political agendas. An emotive response from colleagues and patients (#ImInWorkJeremy) has illustrated doctors going above and beyond. In my experience, these acts are the rule rather than the exception. Junior doctors stay after their shift ends to provide unexpected essential care for patients, and we do so willingly, but this willingness must be protected from abuse. The new contract will cease to financially penalise those trusts where these “unexpected events” occur disproportionately, often as a result of disregarding minimum safe staffing standards.
It is untenable for the viability of the NHS to depend on the continuing goodwill of junior medical staff, especially as financial recognition of that dedication is systematically eroded by our politicians.
In real terms, as a junior doctor in an acute care specialty, my take-home income will reduce by 30% from August 2016. “Standard hours” will also extend to 7am to 10pm Monday to Saturday. Working 2pm to 10pm Tuesday through Saturday is an unsociable shift pattern, but now represents “standard hours”. Shift work like this has deleterious effects on interpersonal relationships, and on mental and physical wellbeing.
This paints a bleak picture for both the future of the medical workforce and the NHS. The welfare of frontline medical staff is inextricably linked to the welfare of patients who are dependent on care provided by these doctors. If unilateral imposition of a draconian contract for junior doctors succeeds, other groups of NHS workers will undoubtedly be next.
Dr Kylie-Ellen Edwards
London
More letters on the NHS:
• Addenbrooke’s managers are not to blame for hospital’s difficulties
• General practice is facing a perfect storm
