For the last few weeks I have been giving daily thanks for the combination of fate, circumstance, and medical school admissions committee that led to me moving to and falling in love with Glasgow eight years ago.
Because I live in Scotland, I have not been forced into seriously thinking about taking industrial action as the only viable way to save my profession. Because I live in Scotland, I do not wake up every morning feeling sick at the prospect of not being able to pay my rent come next August. Because I live in Scotland, I have dodged the bullet of the imposition of the new junior doctor contract by the Health Secretary in Westminster.
In England, my colleagues have had an exhausting couple of months. They have been devalued and demoralised. They have been accused of lacking professionalism and vocation. They have been threatened and lied to and bullied and abused. They have fought back against their bullies. And they have done it while routinely working more than twelve hours a day and working twelve days in a row, and at a time of year when most of them have been rotated into new jobs in unfamiliar hospitals in areas that will not have been entirely of their choosing.
Last night in London there was a peaceful protest by thousands of junior doctors marching on Whitehall. It was the biggest march by junior doctors in history.
They were protesting the imposition of a contract that will result in the following:
- A pay cut to all doctors below consultant grade of anywhere between 10 and 40%.
- An end to the safeguards in place to prevent Trusts from forcing their doctors to work what are considered unsafe hours.
- An increase (from 60 hours to 90 hours) in the hours worked that are considered “social”, so that in effect working at 9pm on a Saturday would be the same as working at 2pm on a Tuesday.
- A financial penalty to people who have children (thus increasing gender pay disparity), to people who change specialities, to people who choose to take time out of programme to do research, to teach, or to further their own medical education, to people who change specialties.
In July, the British Medical Association left talks about the proposed contract after it was made clear to them that they were not allowed to negotiate unless they accepted certain preconditions of it including that pay cut of an unspecified amount. We are now nearly three months away from that and still NHS Employers in England have refused to withdraw their preconditions for negotiation, have been unable or unwilling to put a number on what people can expect their salary to be in August, and today cancelled with five hours notice a series of meetings that were being held for junior doctors to ask questions about this contract after it became clear to them that junior doctors were going to protest and were going to ask questions — questions, one can only assume, that will be awkward and embarrassing to these agents of our anti-NHS government.
I am now into my fourth year of postgraduate working and my third year of postgraduate training. I spent last year employed not in a training programme. I spent a year being a doctor in the job for which I was contracted and then in my evenings and weekends running around various hospitals in the west of Scotland being a locum to plug rota gaps, keep up my acute medical experience, and make up for the fact that I would not have been able to pay my bills on my basic salary. I got a lot of experience last year. I took that year because of a commitment to both my specialty and my region, a commitment for which under the proposed new contract I would have been penalised.
I am still considered a junior doctor and still will be for at least another eight years, providing I don’t extend my training to do anything like teaching, researching, or having children, all things which under the new contract are considered mere frivolities of no value.
My current rota has had me working one in two weekends since I started this job in August, which is legal because I’m not on the rota to do more than twelve days in a row. I finish a run of night shifts at 9.30am and am expected back at work at 9am the following day, which is legal because I’m getting the mandatory eleven hours of rest between shifts. I have been working a 59 hour week on average, although often running straight into another week without any days off, which is legal because I get a few weeks now where I’m not on call at all and so over the course of sixteen weeks it will (presumably, although I haven’t actually done the maths) average out to 48 hours. My colleagues and I come in early and stay late and, no, despite the hilarious conversation I had with the rota monitoring department last week, never go to lunch, on the days when that actually happens, without taking our pagers, and wouldn’t want to. Any reading or exam studying or teaching preparation has to be done in my own time. I am paid a £32,000 basic salary for this (before tax, pension contributions, National Insurance, or student loan repayment) and then an additional 50% banding supplement (on which I pay National Insurance, tax, and student loan repayments, but not pension contributions) for the extra 10 hours per week (the basic salary is for a 38 hour week) and the fact that a percentage of my hours are worked at night and at weekends (these are “antisocial”, partly because they are antisocial and partly because work intensity is higher at those times).
All this under the current contract. My rota is within legal limits and probably not even the worst I’ve ever had and I am renumerated well for my work. I am not looking to work less. I am not looking for a pay rise. I tell you this all to illustrate why my colleagues in England are fighting so hard against a contract that will make it worse, for less pay, and with no repercussions for any of the safeguards being violated anyway.
It is insulting and demoralising, yes, but it is also not safe. It is not safe for doctors, but it will not be safe for the patients either.
To read some of the papers and even to read some of the documents from NHS Employers themselves, you’d be forgiven for thinking that people who aren’t consultants are just playing at it. No. I remember primary school, and playing was never this exhausting and never with this much riding on it. No, no junior doctor is playing at it, and the majority of us aren’t fresh-faced dew-eyed just-finished-medical-school 23 year olds with not a care in the world either. The few who are don’t stay that way for long. You don’t, not after you’ve run an overnight surgical take by yourself in an inner city hospital or been part of a team that was unable to resuscitate someone or been the person to give another person the worst news they will ever have. This is a difficult and demanding job, and we do it proudly and we do it well and we do not stand quietly by while our work is devalued and our patients’ care is compromised by making them be cared for by doctors who are being forced to work unsafely.
I know — oh, believe me, I know — that we have not yet returned to the bad old days of hundred hour weeks and thirty-six hour shifts, but remember, if that’s going to be your argument, just remember that doctors campaigned to get that changed. It was done then, and it can be done again. I have never known the medical world be so united — senior colleagues, the BMA, the Royal Colleges, all of them standing up and agreeing with us that this contract will be bad for doctors and bad for patients, and if enough of us keep talking then eventually someone will have to listen.
Yes, junior doctors in Scotland and in Wales too have got a lot to be relieved about right now, but from our safe havens we have a responsibility to stand up for our colleagues in England and we will do so.