Junior doctors are not prepared to accept changes to their contracts that would negatively affect patient care and doctors’ safety. In July, the health secretary attacked doctors’ professionalism and commitment to patients in a deliberate mischaracterisation of the care they and other NHS staff deliver to patients every day and night of the week. At the same time he gave doctors just eight weeks to agree to new negotiations on a potential new contract for junior doctors (Hospital consultants face ultimatum, 16 July). It has quickly become clear that the so-called negotiations on contracts for junior doctors offered by Jeremy Hunt do nothing to address our concerns and are instead an imposition in all but name. It is for this reason that junior doctors have rejected the UK government’s offer to re-enter negotiations.
By simply going along with a government hell-bent on getting something signed, sealed and delivered as quickly as possible, we would be letting down junior doctors and the patients for whom they care.
The British Medical Association is clear that what the government is proposing for junior doctors is unacceptable. To get the BMA back around the table it is vital that the government reverses its position on extending routine working hours from 60 hours a week to 90; removing vital safeguards that discourage employers from making junior doctors work dangerously long hours; making changes to pay so that it no longer matches the experience junior doctors gain through their training.
Junior doctors are not prepared to agree contract changes that would risk patient safety and doctors’ wellbeing. This has been our position all along and – in the absence of any attempt by the government to address our concerns - remains our position today.
It is time the government puts an end to the attacks on doctors’ professionalism, reverses its hardline stance and works with junior doctors in a genuine negotiation for a contract that is good for patients, doctors and the NHS.
Dr Andrew Collier and Dr Kitty Mohan
BMA junior doctor committee co-chairs, British Medical Association
• Your editorial (17 August) is correct to highlight that George Osborne’s austerity agenda is the most important issue facing the NHS. Though he has agreed to ringfence the NHS budget, this still equates to cutting back, because healthcare inflation runs at 3-4% a year due to rising demand, increasing population and expensive new medical technologies. To make up that 3-4% gap the NHS was asked to make “efficiency savings” of £20bn between 2009 and 2014, known as the “Nicholson” challenge. This has not only resulted in a crisis in A&E and general practice, and a steep increase in cancelled operations, it has actually resulted in a fall in NHS productivity (according to the chief economist of the Health Foundation) mainly due to the costs of recruiting agency staff (£2.5bn a year) needed to keep the service running after so many permanent staff had been laid off or not replaced. Yet, despite the worsening crisis, Osborne is inflicting the same prescription at an even higher dose of £22bn of savings by 2020. Coupled with cuts to public health budget and local social services, there is no way the NHS can sustain safe and effective comprehensive services. This is why there has been such outrage over Jeremy Hunt’s plans for a “seven-day NHS”. The calls for charging, co-payment and alternative funding models are already coming from the right. Expect those calls to get louder and more frequent as the winter kicks in.
Dr Clive Peedell
Co-leader of the National Health Action Party, Consultant clinical oncologist
• The National Institute for Health and Care Excellence (Nice) blames doctors and patients for the overuse of antibiotics but the problem goes much deeper (Resist patient pressure on antibiotics, GPs urged, 18 August). As a patient I’ve been prescribed 11 antibiotics in the last nine years. One of them saved my life, two allowed me to have an operation, but the others did me more harm than good.
Because I know about the issues, having researched and written about them for many years as they relate to antibiotic overuse in farming, I’ve asked my doctor each time if they were really necessary.
The problem, I believe, is two-fold. Medical and veterinary schools teach little but drug-based medicine and, as a result, doctors and vets have little to offer except antibiotics. And in the pursuit of ever-cheaper milk, meat and eggs, intensive farmers are driven by economics to use antibiotics to increase productivity.
So put some of the blame on the universities and some on the government, which is hand in glove with the drug companies that want to sell as many antibiotics as they can. But at a more immediate level, why doesn’t Nice prepare a range of leaflets for non-urgent conditions, which doctors could hand to patients instead of prescriptions? I’ve learned the hard way that there are often better alternatives and also that pharmacists are often better at giving good advice than doctors.
Richard Young
Policy director, Sustainable Food Trust
• The announcement by Diabetes UK that an increase in the number of diabetes cases threatens to bankrupt the NHS (Report, theguardian.com, 17 August) has reignited discussions about a sugar tax. Remembering that 90% of diabetes cases in the UK are type 2, this may be worth pursuing, but there is a much more fundamental cause from which most of the risk factors emerge, which is not being discussed.
That is our relentless full-time work culture, which sees many of us sitting at desks for eight hours a day, five days a week, if not more, bookended of course by a sit-down commute morning and night. This work culture, which is so normal to us that it seems almost ordained is in fact extremely unnatural and is the reason that many of us are sleep-deprived, don’t eat well and lack exercise – three known causes of type 2 diabetes. It is hard, though, for any one person to drop out of the dominant work culture, especially if they have family responsibilities. Either one drops out and is underemployed, or gets used to an expanding waistline.
It doesn’t have to be this way. A shorter working week, shorter working days and more work flexibility would allow us more time to pursue active hobbies and leave us less tired. This would go a long way towards reducing the number of people who develop diabetes and would probably do a lot for preventing cancer and heart disease too. It is all well and good for the government to tell us to exercise more and eat healthily, but at the same time, it encourages an ethos of long and hard work. For our own health, as scandalous as it sounds, we need to work less.
Angela Dennis
London
