It would not be an understatement to say that doctors this week feel as if the government has waged war on them.
It would not be an understatement to say that because that is what Jeremy Hunt actually said this week, as if there were no better rhetoric to use in a speech about public servants whose job involves the actual saving of peoples’ lives. From accusing us of being unprofessional, to trying to impose upon us an unsafe training pathway, to threatening us with having new contracts forced upon us if we don’t stop pointing out minor technicalities like that we already work weekends and that healthcare does not run on doctors alone. Oh, we are furious, and righteously so.
A lot of the proposals that the Health Secretary puts forward are great soundbites.
5000 new GPs, 15% fewer deaths, and a seven day NHS.
As I listened to the Radio 4 coverage of Mr Hunt’s speech at the King’s Fund on Thursday, I heard in my head the voice of Jed Bartlet, my memory dredging up a twelve-year-old line from in a fictional debate speech that finally articulated what I’ve been thinking since before the election:
There it is. That’s the ten word answer my staff’s been looking for for two weeks. There it is. Ten word answers can kill you in political campaigns. They’re the tip of the sword. Here’s my question: what are the next ten words of your answer. Give me the next ten words. How are we going to do it? Give me ten after that, I’ll drop out of the race right now.
You can’t. You can’t get 5000 new GPs when you’ve insulted and browbeaten them so much that no one wants to be a GP, and you can’t run a hospital on the weekend the same way that you do during the week unless you can also get us weekday levels of staffing from support staff and allied health professionals and you’re prepared to make social services run the same service.
So, tell us, Mr Hunt; tell us how you’re going to do it.
And then he refused to commit to the continuing of an NHS that is free at the point of need. I still don’t understand how that part wasn’t on the front page of all the papers.
But while we were all incensed by that speech, what slipped in almost under the radar was an announcement that the Doctors and Dentists Review Board had made proposals regarding changing the pay structure for both consultants and trainees.
The important things for you to know are that training grade doctors are currently paid a basic salary with a percentage increase based on how many hours over 38 per week and how many unsociable hours we are contracted to work, and that if implemented these proposals would amount to a real-terms pay cut of a lot.
Now, to be clear: I am paid a professional salary for doing a professional job, and I am wary when I talk about money of coming across like I’m whining.
But it is also important that you know that I do not live what I consider to be a life of objective luxury or excess or waste. I don’t drink alcohol or smoke, and the most exotic drug I’ve ever taken without prescription is Naproxen. The last time I left the UK for a holiday was two years ago. I have cats to feed, which I am given to understand is less expensive than having children to feed. My biggest expense after rent is paying off the debt incurred in the course of getting the degree that I had to get in order to do the job that I do. It occasionally occurs to me, usually as I’m feeling guilty about them, that my theatre tickets and bookshelves and cleaner and the fact that I haven’t got a flatmate aren’t things that I should have to make excuses for having, and yet I feel guilty about them anyway.
In the last year I have spent £420 on being registered with the GMC, £220 on being a member of my trade union, £40 to be insured to do my job, and £1670 on postgraduate exams with £400 in associated study costs. No, that zero isn’t a typo. I am about to be charged £338 for the privilege of having my indentured servitude to the NHS for the next two years recognised as a training post and being required to sit and pass further exams involving enormous amounts of study time for which I will not be renumerated.
No, I am not badly off. I couldn’t book a flight to New York or afford for my car to break down right now, but I manage just fine. In four years time when I have fulfilled my current obligations to my bank (see above re: debt incurred in the course of getting my degree) I will manage better than fine. I am well aware of my financial privilege.
The truth though is that as a well trained, highly educated, skilled professional who does a difficult job under often impossible circumstances and works evenings and nights and twelve days in a row and unacknowledged overtime and, yes, weekends, largely without complaint, if the DDRB proposals for training grade doctors are implemented then I will not manage fine. I will, under those circumstances, struggle to pay rent. That is the bottom line. In a week when we have delivered world class healthcare while trying to protect our healthcare system from a man who is doing his level best to implode it, that is the situation that is faced by doctors in this country.
It’s okay, though, because I hear there’s work to be had. I hear Jeremy Hunt could do with a new communications director.