A letter

I'm still angry at the government.

But at least one MP understands what I mean: Famous Green Caroline Lucas has sponsored a sympathetic early day motion http://www.parliament.uk/edm/2015-16/539, so I wrote a letter to my MP at www.theyworkforyou.com to bring it to his attention.

                              


                                        Tuesday 20 October 2015

Dear My Local MP,

I have recently moved to constituency to begin work as a junior doctor
at hospital, and so have become one of your constituents. I am writing to
ask for your support in opposing recent changes to doctors' working
conditions and further to express my disappointment in the current
government's handling of the NHS.

I am sure you are well aware of the collective anger felt by doctors at
prospective contract changes. Much opinion and analysis has been
published in the national press, as well as on social media. I expect
many doctors will have written to you before now and you will have no
doubt seen coverage of the large demonstration in London last weekend.

I speak for many of my colleagues in stating that I believe the imposed
changes are damaging for a great number of reasons. The proposed
contract devalues doctors, patients and the NHS. 

The contract fundamentally changes the way doctors get paid, such that
they would expect no increased pay for working evenings or Saturdays.
This  allow rota managers to significantly worsen the working
conditions of all doctors, and will result in a significant pay cut for
doctors already working difficult rotas.

The contract would remove safeguards against doctors working long
hours. Doctors could be coerced into routinely working longer than
their contracted hours, further demoralising and fatiguing those in the
profession.

The reason for this change appears to be to work towards a 7 day health
service. The benefits of a full 7 day (elective, as emergency cover is
already 7 day) NHS has been grossly overstated by the government. Many
people would welcome the huge increase in staff (and funding) required
to achieve a full 7 day service, but unfortunately there has been no
suggestion of this.

Without extra funding and extra staff the alternative solutions would
be either pulling doctors out of their weekday jobs to cover the
weekends - and the NHS is already straining to operate Monday to Friday
- or increasing the working week of doctors by approximately 40% more
hours. Both are directly harmful to doctors and patients. The contract
would also pave the way for other healthcare professionals to be
expected to work at the weekend and/or face (further) pay cuts
themselves so these concerns will be soon also directly felt by nurses,
consultants, porters, radiographers, ward clerks, physiotherapists and
so on, and on, and on.

There is already a large retention and recruitment crisis in the NHS.
Training positions in many specialities remain unfilled and demands of
patient care are only barely met with expensive and less efficient
locum staff. As doctors decide that the working conditions are no
longer tolerable then the working conditions for those remaining get
worse still as they must shoulder the annually increasing burden.
Obviously this situation is already bad for patient care, and the
problem will only be exacerbated as this contract will force many
doctors out of the NHS to better jobs in the UK or abroad.  I am very
concerned that an understaffed NHS will not survive much longer.

It is painful to watch as my profession and the NHS continue to be
undervalued, misunderstood and mismanaged. I do not have confidence in
the Secretary of State for Health's ability to protect the nations
health. I urge the Secretary of State to listen to his workforce and to
engage in meaningful talks. Unfortunately this has not occurred as yet
and many doctors feel forced to take the uneasy decision to vote for
industrial action in the coming ballot. I sincerely hope there can be a
strike-free resolution that allows doctors to feel valued, patients to
receive excellent care and shows investment in the future of the
National Health Service.

I strongly believe that the NHS is worth fighting for and so I would
like to ask your support for Early Day Motion 539: Junior Doctors (tabled
19/10/15), and also to ask what you and the Labour Party will do to protect
doctors, patients and the NHS.
Many thanks for listening to my concerns. I look forward to your reply.

Yours sincerely,

Dr O
MA MBChB 





On the 5th of November I got a fairly supportive copy paste reply, albeit vague and without reference to the Early Day Motion I asked support for.
 (re-copied and pasted here with names removed) 

Dear Dr 

Thank you for your recent email regarding junior doctor contracts.

The Labour Party is currently leading on this issue in the House of Commons. Last week, we secured an opposition day debate on the matter where we called for the Government to drop their plans for a new junior doctor contract. We also put forward new proposals which are fair for staff and safe for patients.

Ultimately, the Labour Party believes that it is wrong for the Government to want to pay some junior doctors less to do the work they do now. Labour is concerned that the removal of safeguards which prevent junior doctors having to work excessively hours may leave them too exhausted to provide safe patient care. Jeremy Hunt should recognise the increasing public concern on this issue, stop his high-handed demands and demonstrate a willingness to compromise and prioritise patient safety.

I can assure you that this issue is a priority of the Labour Party’s. In opposition, we will continue to follow this matter closely to hold the Government to account.

I have also offered to meet with a group of constituents and junior doctors who are concerned about this matter.

Please do not hesitate to contact me again if you feel that I can be of any further assistance with this or any other matter.

Yours sincerely

Doctors strike: what's all the fuss about?

From the point of view of an internet-generation junior doctor the level of awareness, anger and coverage of the DDRB contract proposals is overwhelming (DDRB is the Review Body on Doctors' and Dentists' Renumeration, advises the government on rates of pay). Years of frustration are finally being vented across social media sites and articulate and human arguments for fair working conditions and for the survival of the NHS are commonplace.

Until recently the discussion has been largely restricted to junior doctors themselves, various websites and forums becoming an echo chamber for doctors to agree with one another, preaching a familiar message to a choir who are already well aware of the issues and who are more than ready to reply with similar stories and personal perspectives, and occasionally this can breed an element of oversimplification, hysteria, or hyperbole, particularly as the issues are a little too complicated to be adequately summarised in a tweet or hashtag. However this hotpot of energy and anger is spilling over and is now beginning to be reported by the national mainstream media. There have been issues in expressing this anger in an understandable and constructive way but we are beginning to find a common voice. 

Manchester Picadilly Gardens last night- pic by Manchester junior Dr Jeremy Lyen

Last night I attended a march in central Manchester, forming part of a slightly smaller but no less passionate crowd than the 5,000 in London the previous evening. It was moving to see so many doctors and medical students united in the campaign, and it was excellent to see the support from the public. It marks the beginning of a campaign to make doctor’s issues well known, and to highlight the direct threat to patients and the NHS. Some form of industrial action in the next few weeks seems inevitable and it is absolutely essential that the public are aware of why doctors feel this is the only path forward. Without the backing of patients and the public any strike will further alienate and vilify doctors and pave the way for the profession and the NHS to be dismantled.

To that end I feel obligated to highlight some key points that may not be obvious to people outside of medicine. The grievances of doctors are multiple and complex so what follows is merely a heavily simplified personal take on the main issue – the BMA website is a good place to start for more details, or the facebook page of any junior doctor. I want to clarify 1) what a junior doctor is 2) why the contract is unfair for doctors and 3) why it is poisonous for patients and the NHS.

The BMA is the union that represents doctors in the UK, and took the uneasy decision (backed by members) to walk away from junior doctor contract negotiations after several discussions, realising that the proposals were neither safe nor fair, and were not a position from which an acceptable contract could be negotiated from. The government plan to impose this new contract on junior doctors in England (not Scotland or Wales) from August 2016. The current vocabulary is misleading, and poorly understood even by other medical staff including consultants. A “junior” doctor is a qualified graduate from medical school undertaking postgraduate training in hospitals or the community. The term includes the very bottom (yours truly) foundation doctors, but also any doctor in training that is not a consultant or GP. Virtually every doctor under 35-40 will be a junior doctor. The label “junior” sticks even if you are in your ST8 year of surgery training or have taken time out of the training programme for example to do research, change specialty or do voluntary work. It is very likely to be a “junior” doctor that performs your elective surgery or resuscitates you in A+E or sees you in clinic. These doctors, from new “juniors” (F1) to experienced “juniors” (senior registrars), make up about 40% of all doctors working in the country and all stand to suffer at the hand of new contract changes.

The contract fundamentally changes the way doctors are paid. People may need medical attention at any time of the day and on any day of the week. The NHS is straining but it is providing a 7 day service 24 hours a day. The current government has allowed misinformation to be spread such that patients now fear hospitals at the weekend. At present junior doctors receive a basic salary that rises with experience, and receive a supplement on top of this if their rota involves a lot of night shifts or weekend work. The new contract redefines “social” hours” as 7am-10pm six days a week, so rotas involving working evenings and/or all day Saturday would attract no increase in pay compared to a  9-5. The new contract would increase the basic pay but slash the unsocial work supplement such that doctors working in more acute specialties (already unenvied and overworked doctors such as in A+E, hospital medicine or ITU) may end up with a 15-40% pay cut whilst doctors with more normal hours may have a modest increase - but are at risk of seeing their rotas suddenly becoming much more antisocial without increase in pay. Almost every recommendation of the DDRB contract proposal is worse for junior doctors, and is therefore directly toxic to the NHS as a whole.

It would be dishonest to suggest that a strike is “not about the pay”, because no sane person would be willing to accept such a pay cut – particularly not if they had already been silently suffering a pay freeze/de-facto pay cut for several years (15% less than 2007 in real terms). The current system also does not seem to recognise the increased amount of unpaid overtime (>5hrs/week on average), self funded training, BMA/GMC/royal college membership costs, compulsory medical insurance, spiraling university debt (36K for 4 years tuition alone), or essential, expensive and difficult postgraduate exams. The public perception remains that doctors are well paid, and the well-heeled, golf-playing, Mercedes-driving doctor is a persistent one. This cliche is probably true for a small minority, especially a small number of hard working and very experienced consultants that may supplement their NHS income with private practice. But it is not true of the current generations of doctors in training.  In truth junior doctors at the moment are paid more than the average UK worker, and pay does increase with experience.  There have been several unhelpful comparisons of doctors with the perceived circumstances of other workers. In my opinion it does not help to compare with tube drivers, retail workers, McDonald's managers or physicians associates, as these workers have their own grievances and are of course also entitled to fair pay. Such comparisons serve only to perpetuate the idea that doctors are self-important and entitled: we stand to alienate ourselves from other professionals and the public, many of whom will (unfortunately for us) remain unconvinced that a junior doctor in their 20s or 30s is deserving of a salary that approximates their age in £K, no matter how many bleeding heart "open letter" accounts of their jobs they might read.

The wider issue however is the future of the NHS. In the short term patient safety is likely to be compromised as doctors working longer hours for less pay will be tired and demoralised. There will be more burn out and more mistakes. In the longer term these doctors will continue to leave the NHS in England. There is already a recruitment crisis in several specialties including GP and A+E. 20-50% of training positions in GP and A+E remain unfilled, yet somehow the government expects to attract even more doctors to these careers by making the job less satisfying and reducing the pay. About 60% of FY2s (second year post medical school) last year took a year or more out of training for various reasons and that number is sure to grow as more and more juniors are either forced out of the profession as they can no longer afford childcare or mortgage repayments, or realise that enough is enough; their skills and training are appreciated to a far greater extent outside of the NHS, outside of England or outside of the profession itself. NHS workers have been leaned on already. If the doctors don't stand up to the changes and fold then I am sure the bosses will go for other professionals. The NHS is suffering an insidious end by a  thousand cuts. If the contract is implemented as it is currently I foresee a slow and sad cycle of positive feedback as for each doctor that leaves the NHS leaves a slightly less tolerable atmosphere and workload for those remaining. Morale gets lower and patients are harmed, expensive locum and agency staff are required to fill the gaps and eventually the public will be led to conclude that the NHS has run its course and must be rescued by the private sector. 

I am deeply saddened that this is the situation I have found myself in after years of medical school and only two months in the job. It is a treasured privilege to work as a junior doctor and I am immensely proud to work for the NHS. And because I value both of these things I will be voting alongside thousands of my colleagues in favour of industrial action to protest these contract changes.