The medical director of NHS England, Bruce Keogh, accuses striking junior doctors of crossing an ethical and professional line (Withdrawing emergency cover crosses a line, Opinion, 9 April). Many in the medical profession think that Keogh himself crossed a line by presenting politically motivated and commissioned work on weekend mortality as independent science. His paper, published in the BMJ, has since been used by his political masters as a key justification for imposing a new contract on junior doctors. In this, and by failing to acknowledge his conflicted involvement in the contract dispute, he undermines his position as leader of all NHS doctors.
Idris Harding
Cardiology registrar, St George’s Hospital, London
• Bruce Keogh should be aware that studies of the effects of doctors’ strikes have shown that they can be made safe with appropriate safeguards (A report on this was published in the British Medical Journal with 40 years of evidence in November 2015). When the juniors, who are less experienced, strike for nine hours, their roles will be taken over by consultants, fully trained and the most experienced doctors. If he is saying that the consultant workforce is not up to the task, then he should, as an urgent priority, make sure we have enough safe consultants.
He should refrain from scaremongering about the effects of a major disaster as experience shows that off duty doctors will spontaneously come in to help. I know this from working with the disasters at Ibrox stadium and Battersea funfair in 1972
Eric Watts
Chair, Doctors for the NHS
• How many members of the public, never mind doctors, support the chair of the General Medical Council, Terence Stephenson, in his statement that “strikes are increasingly hard to justify” (Report, 11 April)? The GMC’s chief responsibility is “to protect, promote and maintain the health and safety of the public”, and the main complaint of the junior doctors and all other professional associations in the NHS is that overwork is preventing them from being able to do this. If the GMC disagrees with the entire medical profession on this point, it should say so; and if it thinks strikes are wrong, then it should make clear what alternative courses of action it would approve of, given that it is responsible for licensing all doctors. Otherwise it should keep out of medical politics altogether given its privileged position.
Dr Richard Turner
Secretary, BMA Harrogate division
• We are deeply concerned about the impact of the new junior doctors’ contract on the dying. We already have a national shortage of palliative medicine consultants, with one in three posts vacant; a recent survey suggests the imposed contract would further deter 25% of prospective candidates. In our specialism, 88% of trainees and 73% of consultants are women, of which one-third and 60% respectively work part-time, so the new contract would hit us disproportionately. It is also completely incompatible with aims to encourage females to enter and remain in medicine. Our survey also found 68% of our trainees would not engage in research under the new contract’s terms.
The Care Quality Commission reports that care for the dying is indifferent or poor in over 40% of hospitals and the National Audit of End of Life Care 2016 confirms only 37% of participating hospitals provide seven-day specialist palliative care. We cannot deliver seven-day services now and the attrition caused by this contract will threaten existing services. As usual in this NHS, it is the dying who end up disadvantaged.
Professor Rob George President, Association for Palliative Medicine
Dr Amy Proffitt Chair, trainees’ committee, Association for Palliative Medicine
• Your report that Health Education England is seeking to recruit GPs trained in India (NHS plans to hire Indian GPs to plug gaps in services, 8 April) is frightening. But it would be against the explicit policies of the NHS. The NHS Employers website lists under its code of practice for international recruitment a number of best-practice benchmarks which it expects will be applied. One of these states: “There is no active recruitment of healthcare professionals from developing countries.” Please can we train our own?
Richard Wakeford
Cambridge
• Does Professor Keogh realise that for the new contracts to be imposed in August, the NHS will have to terminate all existing contracts, effectively dismissing all junior doctors? There is no requirement for junior doctors to work under the new contract. Once they have all been dismissed, how many operations will need to be cancelled and how many lives put at risk?
Alan Neil
Stockport
• As Jeremy Hunt is still refusing to change his stance and negotiate fairly with the junior doctors, far from being “increasingly hard to justify”, surely strikes are easier to justify; it is Hunt’s intransigence that is causing suffering for patients.
Pete Lavender
Nottingham
• Join the debate – email guardian.letters@theguardian.com
