The Battle For Our NHS Is Nearly Over. And We Are Losing.

Posted on March 8th by Junior Doctor Blog.

Be kind, for everyone you meet is fighting a battle you know nothing about.
Wendy Mass, The Candymakers

There are secret battles going on all over the country right now: battles to keep teachers, fire fighters, police officers in work, to protect the rights of disabled people, and save children from poverty. The NHS is quietly becoming a war zone all by itself; there are battles to stop stripping student nurses of their bursaries, to stop A&E and maternity closures, to keep community pharmacies open, to challenge consultant contracts, to keep GP practices open, and the most publicly of all; to halt the imposition of the junior doctors contract.

These battles are secret not by our choosing- I have colleagues who have done nothing but work themselves to the bone for the last eight months to try to get the word to you- I hope you were listening. Many mainstream media outlets were not. The uphill struggle to even dent the public perception from the governments spin machine has been titanic. I still think we haven’t got even halfway there.

This isn’t about weekend pay or hours, it’s a little about unsafe staffing and a lot about dangerous underfunding of the national health service. What it’s mostly about is challenging a government set on dismantling the free at the point of use service of the NHS.

Since 2010, on every recordable measure the NHS is failing: waiting times, staff retention and recruitment, funding ‘deficits’. If you want to get really simple: death rates are up. Let me reiterate that- since 2010/12, after fifty years of steady decline, death rates in the UK have started to rise. More people are dying. THIS is the result of a financial crash and a Tory government ‘not letting a good crisis go to waste‘- pushing an ideology of public sector sell off and shrinking of government that is the core of conservatism.

You might think they’ve gone too far- I do. So does Prof Don Berwick, the Nuffield Trust, the Financial Times and the Kings Fund to  name a few. The deficit is £97 billion, the national debt is £1.6 trillion– there is no ‘balancing of the books’. Austerity was a great lie. This is a government of PR, not policy.

Now circle around to the junior doctors’ contract dispute. The contract is a means to provide lucrative cheap elective weekend work at the cost of safety to patients during the week. There are no more doctors to provide these services. The National Audit Office and Cass Business school said these changes ‘posed a genuine risk’ and may ‘breach employer duty of care’.

Why would David Cameron do this then? Because for twenty or thirty years successive governments have tried to privatise health in the UK: the head of the NHS is an ex-US health care executive, Virgin own many NHS community services ALREADY in the UK, the former Health secretary now works for a private health consultancy, £1.5 billion pounds of private contracts linked to companies of sitting MPs. Still don’t believe me? Here is the plan- from 1988 Britains Biggest Enterprise by Oliver Letwin, current Tory advisor and strategist. Here is the plan revisited in 2005- Direct Democracy, co-written by current health secretary Jeremy Hunt.

The plan is to drive down terms and condition, create an unworkable and unsafe NHS, and then in a crisis- roll in private companies. As they say- ‘never let a good crisis go to waste’. While people, other normal human beings will suffer; your families, grandparents, uncles and aunts.

That is what this fight is about. The battle for the NHS has raged for thirty years, and you mostly had no idea about it.

I have colleagues who spend all their own time organising, campaigning, giving interviews, challenging the government to show us we are wrong; and thus far all we are met with is lies and spin. Colleagues who have taught themselves law, economics, public relations, journalism, song-writing. These men and women are all working doctors, nurses, physios and AHPs- saving your life as a day job, trying to save your health service from home.

We are doctors who want to do our jobs; to protect the health of our patients. We are fighting because banging our heads against the wall just isn’t enough anymore.

We will fight them in the courts.  The BMA is launching a legal challenge to the contract. It will force the government to legally show us that they will not harm patients, that they will not create further crisis in the NHS, that they are doing as they say, and acting in the best interests of patients. We know they are not.

We will fight them on the streets. Join us on the picket line on March 9th and 10th March. Show them you value the service and staff of the NHS. Come and talk to us at Meet The Doctors events. Find out more here.

We will fight them in Parliament. The NHS reinstatement bill has its second reading on the 11th March- it challenges the legality of privatising the NHS and the market that encourages private takeover, at huge public cost. Write to your MP and tell them you support this bill. https://speakout.38degrees.org.uk/campaigns/685

The fiercest battle is sometimes one you never heard of. Don’t let this one be – join us in our fight to save our NHS. To paraphrase a superb junior doctor on social media; “in two decades time you can tell your kids the reason there’s still an NHS is because twenty years ago you stood up for it”.

Stand up.

Juniordoctorblog.com

73% Of Junior Doctor’s Want Full Walkout, after Jeremy Hunt Imposes Contract!

Posted on February 22nd by What The Bleep

73% Of Junior Doctor’s Want Full Walkout, after Jeremy Hunt Imposes Contract!

In a recent poll of junior doctors 73% of doctors want the next strikes to include a full walkout as the government continue to impose an unsafe contract.

Jeremy Hunt responded to the last junior doctor strike by stating imposition of the contract for August, and now with time running out and the BMA planning the next strikes, junior doctors have voted in a recent poll of over 504 doctors across Facebook and Twitter and online poll, with almost three quarters voting in favour of a full walkout. 

Whatthebleep‏@whatthebleepdoc

Should our next set of #juniordoctors strikes include a full walkout? #juniorcontract

73%

Yes - 369

19%

No - 96

08%

Not Sure - 39

(votes collated across social media and online poll)

There is overwhelming public support for the junior doctors who put the blame at Jeremy Hunt’s door, and comments from those doctors voting No/Not Sure raised concern that they may lose public support if there is a full walkout, however what the public need to know is that junior doctors have support from their senior colleagues who will stand in on the emergency cover during a full walkout, and although a full walkout will cause disruption it will not effect patient safety. Well known evidence has famously shown that mortality actually drops when doctors strike.

Overall this is not a decision taken lightly by doctors, but with a government not listening and not responding to the last strikes junior doctors need to turn up the pressure on the government if striking is going to be successful.

Exhausted? Of Course I Am.

Posted on February 3rd by Junior Doctor Blog.

“Jeremy Hunt’s strategy now is to exhaust the junior doctors.” Guardian 1/2/16

I am, like many of my colleagues, indeed, exhausted.

I’m exhausted of going to work to find huge gaps in the rota where doctors used to be, where nurses used to be, where physiotherapists and OTs used to be. I’m tired of never seeing a contract, never being able to plan to see my family. I’m exhausted by the deaf ears of faceless administrators.

I’m tired of endless top-down reorganisation, target-chasing and publicity managing. I miss looking after patients. I miss training to be a better doctor.

I’m exhausted by the media. I was on BBC radio during the last strike, and a rather hostile presenter asked me “Why are you on strike? Why aren’t your doing your job”. I gave a PC, measured answered. But what I wanted to say was this ; “I’m striking today to protect the long-term health of patients. That’s my job. But what about you and your fellow ‘journalists’? Are you doing ‘your job’? When a Secretary of State and Prime Minister can say anything and it is reported verbatim; unscrutinised,unchallenged and uninvestigated? When they can lie about stroke care, perinatal care, weekend hospital care, consultant cover, NHS funding, NHS safety and privatisation and not a single journalist will take the time to report the utter lack of credibility on any health issue in any way? I’m doing my job to the best of my ability- are you doing yours?”

Sigh.

I’m exhausted by the politics and the endless endless lies and spin. I’m tired of having to counter the same propaganda ad nauseum. A ‘seven-day NHS’ sounds great- but what is it? Is it urgent emergency care? We already have that. Is it routine care? We don’t need and can’t afford that- not when the NHS has never been poorer. Can we make it better? Of course- but we need investment, policy based on evidence not sentiments. Should I go to hospital at the weekend? Emphatically, categorically and unreservedly YES.

I’m sick of noxious columnists pumping out toxic nonsense; d’Ancona, Baxter, Lawson, Vine…the cogs of the Tory spin machine are many, and they are all dirty.

Most of all I’m exhausted by fighting for an NHS on the brink of destruction- and the public remains wholly unmoved. When you go to the doctor and she tells you something is seriously wrong- how do you respond? Do you then go to the Daily Mail to fact check it? Do you ask for a balanced opinion from a government think tank, deeply invested in privitization? I’ll declare my vested interest right here; I’m a junior doctor and I think the NHS is the best healthcare system for my patients- in equity, in outcomes, in value for money. Now the junior doctors are striking, the GPs are resigning, the consultants are halfway between both. The student nurses are striking, the staff nurses are planning, and pharmacies are closing. Meanwhile NHS services are already being sold- to Virgin, Circle, TDL. Domestic and domiciliary have been private for years already. PFI hospitals are £80 billion in debt for £10 billion of services – does that sound efficient to you?

The end of the NHS is here- not in five or ten years, but here, now, collapsing from August. Do you really believe this government is ‘the party of the NHS?’

Did you vote for this? Did you look at the Tory manifesto and read the pledge ‘Seven Day NHS’ and think- “That’s got my vote, now bulldoze the thing and where’s that private health insurance brochure?”

We haven’t explained ourselves properly and for that I wholeheartedly apologise. The junior contract is simply a means to make lucrative weekend work cheaper, and reduce the pay bill and pension bill on hospitals for private takeover. There really is no other reason to do what the government are doing. They don’t care about the safety of patients- they’ve cut hospital budgets in relative terms the deepest in NHS history, we have less doctors and spend less % GDP on healthcare than most of Europe, and they tried to suppress reports on safe staffing levels for nurses. They don’t even care about ‘balancing the books’- the NHS will be £2 billion in debt this year. The national debt in 2007 was £500 billion, now it’s £1.6 trillion. In 2007, the deficit was £41 billion – now it’s £90 billion. I hear your cries of ‘the financial crash’. Exactly- and here is the cost- years of private debt generated by illegal banking practices absorbed into the public purse. Banking and corporate tax evasion remain unchecked. The NHS and every other public service for sale. It’s a crime too huge to see.

I’m exhausted. Yes. And alone, perhaps, defeated. But I’m not alone. 250,000 doctors in this country, 400,000 nurses, 150,000 allied health professionals. 19 million families. 66 million people.

Dear other normal human beings, join us, and help save our NHS, if we can.

Second Junior Doctor’s Protest, Saturday 6th February, 12.00 Waterloo Place, London

Second Junior Doctor’s Strike, Wednesday 10th February, picket lines at every local hospital.

juniordoctorblog.com

Hear Our Nurses Roar

Posted on November 26th 2015 by Gagan Bhatnagar on the clinioncdoc.

I would not be where I am today without the compassion, dedication, and guidance of countless nurses. I am not a patient, I am a junior doctor.

For every heart-wrenching story I have to tell about my own experiences in hospital, there was a nurse stood right beside me. There was a nurse running with me to a cardiac arrest, who despaired with me as we alternated chest compressions to time. There was a nurse next to me who ran to fetch blood products needed to keep someone alive as they bled out because the porters would not have made it in time. There was a nurse with me when I told a patient for the first time that she had lung cancer. It was the nurse that held the patient’s hand, that hugged her, that cried with her. Nurses are the first port of call, they are the personal touch of the NHS that doctors can never be.

I’ve been alerted to a multitude of elderly Mrs. Smiths by nurses who just knew something wasn’t right. It might have been because her vitals were deteriorating or it could have been that she just didn’t mention her late husband that morning as she normally would. Nurses epitomise the good will that the NHS is run on. They laugh and cry with their patients. They will empty bed pans with one hand while fluffing pillows and blankets with the other. They will make their patients a cup of tea with one hand while dispensing life-saving medication with the other.

I am in awe of nurses because I know that I, nor the vast majority of the public, could ever do their job. They do the dirty side of healthcare that we shove out of sight and out mind. The cleaning of bed pans, washing of incontinent patients, and changing clothes soaked with vomit are only a few of the things they do on a daily (if not hourly) basis. They do this through gruelling 12 hour night shifts with no time for breaks, often getting punched, kicked, or spat on by confused or aggressive patients.

How much is their inherent caring worth? By any means – nurses do not earn an astronomical salary. Starting at a £21,692, their salary can go up to £28,180 after many years of working. As a ward nurse, that’s it – that’s your salary. The majority of us would consider that to be a paltry sum for the emotional and physical turmoil which nurses endure. As a society we thanked and encouraged nurses by offering to pay their tuition fees and providing them with a small sum of money to help get through an intense 3 years, knowing full well that what we get in return far outstripped that value.

Removal of nursing student bursaries is the latest in the Government’s string of attacks on the NHS. Nurses are already in a recruitment crisis, most wards are understaffed and overworked. The Government’s proposals will further compound a recruitment crisis. With all the stress associated with the job – is it fair to add in a student debt that they will likely never be able to pay off? How will this encourage more young compassionate people to go into nursing? How does that make nursing an attractive career prospect? A recruitment crisis will only lead to further demise of the NHS.

Thankfully, the value of nurses is not measured in money, it is far more intangible. However, this does not give the Government license to force such savage cuts on the NHS. The Government has once again demonstrated that it does not value workers that do not generate profit. The Government continues to promote a false economy while battling against doctors and nurses, the very workforce that keeps the NHS running. For this reason we see the NHS underfunded, understaffed, and on its last legs.

Nurses are our lions, they are the pride of the NHS. Hear them roar.

I thank them whole-heartedly and am eternally grateful to them. They are the NHS. I will stand shoulder to shoulder with my colleagues, for the long-term safety of our patients, and the future of the NHS. Please consider signing this petition:

https://petition.parliament.uk/petitions/113491

The Locum Price Cap is Coming!

Posted on November 10th 2015 by What The Bleep

With the government's plan to cap rates on locum shifts for doctors from the 23rd November 2015, and reducing further the capped rate on two future dates (1st February 2016 and again on 1st April 2016) the prospect of doing locum shifts is becoming less appealing. With the junior doctor contract dominating our attention the government are implementing the locum agency price cap, keeping this under the radar and knowing we can't fight this publicly with the junior doctor contract as it will be hard to gain public support for our fight against this. So we thought it was important for us to make this page to keep you updated with advice on how to fight the locum price cap.
The first thing we all need to do is to register our views and response to the proposals using the government's response form here. Urgent this must be done by the closing date of 5pm 13th November.

It is important to stay together against the cap from the start as otherwise it will gradually drain the NHS of good locums and cripple the NHS. Now some doctors may think that this doesn't concern them as they don't do external locum shifts, and you would be wrong. This will impact everyone, it will affect those who do external locum shifts, those who do locum shifts within your own hospital, and by draining the NHS of locums it will affect doctors on-call who are understaffed when Medical Staffing are unable to find a locum doctor willing to work for peanuts at short notice, and it will also affect doctors during the day when Medical Staffing personnel try rearranging and stretching their own doctors to cover shortages across the rota that they can't fill with locum doctors.

WHAT WILL HAPPEN?

Most trusts have an 'internal'/'bank' locum rate which they offer to their own doctors, and if they fail to fill the shift they will offer it out to locum agencies to fill with an 'external'/'agency' locum. Now unfortunately the difference in pay between internal and external locum can be massive and initially for the first capped rate on 23rd November will most likely affect the external locums worst, bridging the gap between external and internal locum rates, however the further reductions in the capped rate will then affect all doctors.

Below is the new proposed locum pay rate table published by the government's Trust Development Authority.

WHAT WE NEED TO DO

1. AGREE A RATE WITH YOUR HOSPITAL

From the 22nd November if Medical Staffing in your hospital try and alter your rates for internal locum shifts we advise discussing with your colleagues in your hospital and formally agree a rate with Medical Staffing that is reasonable (negotiations should be led by your year rep). For internal rates FY1s should not be getting less than £30-35 per hour, SHOs £35-40 per hour, and Registrars £45-50 per hour (more for A&E), so this may not affect those just doing internal locuming in November, but if you agree this rate in November then Medical Staffing will be the ones facing the problem when the government drops the rate again on the 1st February 2016. If Medical Staffing drop the rate in February then stick to your guns and don't take the shifts, you are stronger united.

Now with the new capped rates we are unsure how the Medical Staffing will react but at the end of the day if the internal doctors don't take the internal locum for less than their agreed rate then Medical Staffing will have to try and fill the gaps in the rotas with external doctors which will be harder for them to get.

2. DON'T GET BULLIED INTO DOING EXTRA SHIFTS

Please be warned with the government's plan it will become harder for Medical Staffing personnel to fill locum shifts and we expect that they may start to take advantage of doctors (especially FY1s) so don't be bullied into doing an extra shift you don't want to do, or into taking a shift for a rate that you don't want. You are not obliged to do additional hours. If you do feel bullied into covering extra shifts then please call BMA for advice. 0300 123 1233.

3. SUBMIT INCIDENT FORMS

If you are understaffed and a locum doctor is not supplied as a result of the locum price cap, submit an incident form as a risk for patient safety, and continually bring it up in junior doctor/departmental forums. For patient safety issues you must also inform the Clinical Director each time this happens. 

4. TAKE YOUR NAME OFF THE INTERNAL REGISTER

If Medical Staffing personnel are not negotiating on the rate then stand your ground and ask to them to take your name/details off their 'internal locum' register. This is a register of doctors in the hospital who have opted out of the European Working Directive and who get emailed about internal locum jobs. This leaves a clear message that you are not interested in the locum shifts for the rates they are offering.

5. JOIN A LOCUM AGENCY

If you do still want to do locum jobs at your hospital then ask to be taken of the hospital internal locum register and join a locum agency (pick one which supplies to your hospital). It is unclear how badly the price cap will impact locum agencies but we would advise joining one, because their interests align with ours they will be an additional defence against the capped rates. Though you may have to take care that some locum agencies don't just follow the government's cap giving you low rates. Let them know early on what set rate you are only willing to take jobs for, then the locum agencies will be forced to fight against the cap to find doctors jobs for these rates otherwise the agency will be out of business. They also have more money, personnel and resources to fight against the price cap.

Registering requires an application form and a CRB, however once done you are sorted and you will get access to the same jobs at your hospital but potentially at a better rate!
It is also worth being aware that if you are in a training post, your contract says you should not take locum work for another employer. This doesn't stop you from working as an external locum through a locum agency in your own hospital.

The Fallacy of Hunt

Posted on October 29th 2015 by Gagan Bhatnagar on the clinioncdoc.

“Sorry, this is quite complex for early in the morning” – Jeremy Hunt

The time: 07.15 on the 29th of October 2015 on the BBC.

What Mr. Hunt was trying to explain was how junior doctors working “within the legal limit” will not see any reduction in their pay.

By comparison, thousands of junior doctors have been up all night caring for patients. They would be expected to make life-saving, high-pressure decisions at 07.15 after being awake for 10 hours without so much as a bathroom break. The kicker – this time is classed as ‘social hours’ or ‘plain time’.

Fallacy 01: If Mr. Hunt can not manage simple arithmetic at 07.15 because it is too early in the morning, should he be peddling ‘sociable’ working hours of 0700-2200 Monday to Saturday for doctors? – Where doctors receive no additional remuneration for working outside of the standard 9-5 time bracket.

Given that Mr. Hunt is not particularly strong in arithmetic, we may want to delve deeper into what he is promising for the hard-working junior doctor workforce. He proposes the following: 

• A reduction in maximum working hours from 91 hours/week to 72 hours/week
• A pay envelope that is cost neutral – that is to say, no money is being put in or taken out from the pot of money used to pay junior doctors.
• Extending services by 40% to  include Saturday and Sunday
• No additional doctors will magically appear to fill in for these extended services.

Let’s provide an example with some estimated rounded figures

• Let’s say, for any given week, a hospital requires 100,000 junior doctor man hours (JDMH).
• Let’s say there are 1000 doctors in the hospital each working 100 hours/week to achieve this.
• By extending services by an extra 2 days – the hospital now needs 140,000 JDMH.
• However, there are still only 1000 doctors (a deficit of 400 doctors).
• The hospital now requires 140 JDMH per week per junior doctor.
• However, there is no additional money being inserted into the system. So, that’s 40% extra for no additional cost.
• But now the maximum number of hours a doctor can legally work is reduced to 50 hours / week so the hospital needs 2800 doctors to cover the 140,000 JDMH.
• Again, there are no more doctors, there is no more money – the solution: to make doctors’ labour cheaper and make them work ‘off the books’.
• Alternatively, this could be done at the expense of closing services on, say, a Wednesday to reduce the number of JDMH required by the trust.

Fallacy 02: If there are no more doctors, and there is no more money, extending services by 40% will mean the same doctors are doing this from the same pay envelope. That is, more work for no extra cost. His intentions were made clear by increasing plain time from 60 hours/week to 90 hours/week.

Mr Hunt has reduced the maximum number of hours that a doctor can ‘legally’ work. Doctors already go far beyond their contracted hours and don’t ask for a penny more. Doctors DO NOT work 91 hour weeks because of perverse monetary gain. They work these hours because there are simply not enough doctors, because there is a NECESSITY to work these hours.

Fallacy 03: By reducing the maximum hours but not increasing the number of doctors in the pool, he is advocating an increase in unpaid ‘off the books’ labour of the current doctor workforce. This is confirmed by the removal of financial penalties to trusts for over working doctors and the removal of regular hours monitoring – both of which acted as safeguards to prevent a fatigued workforce.

Mr Hunt keeps mentioning patient safety on weekends. The rhetoric of 15% higher mortality at the weekend. The dreaded ‘weekend effect’.

Let us be clear, Mr Hunt keeps quoting a research paper by Freemantle et al (2015). Increased mortality associated with weekend hospital admission: a case for expanded seven day services?

The ‘weekend effect’ describes Friday to Monday (4 days) where a patient is up to 15% more likely to have died 30 days after admission. That’s right…1 month after admission to hospital.

Courtesy of Freemantle et al 2015 – 30 day mortality, relative risk by day compared to wednesday

To simplify this image – if an unwell patient is admitted on a Friday you have a 2% increased chance of not being alive 1 month later compared to a wednesday. Saturday 10%, Sunday 15% and Monday 5%.

The same study showed that an inpatient had a 1% LOWER chance of dying if they were in hospital on a Sunday compared to a Wednesday (although this value was not statistically significant) and a 2% LOWER chance of dying as an inpatient on a Saturday compared to a Wednesday (this was statistically significant).

Courtesy of Freemantle et al 2015 – In hospital mortality in comparison to wednesday

In fact, your risk of dying IN HOSPITAL is LESS on Saturday and Sunday than a Wednesday as Freemantle demonstrated in 2012. Weekend hospitalization and additional risk of death: An analysis of inpatient data.

Courtesy of Freemantle et al 2012 – mortality divided by day

Fallacy 04: Doctors do not deny a ‘weekend effect’. However, the cause of this effect is unknown. It has been observed that globally, more acute / unwell patients are admitted on the weekends and it is speculated that this is a major contributing factor to increased 30-day mortality. It is unlikely to be related to junior doctor staffing on Saturday and Sunday as indeed, mortality on those days actually DECREASES compared to when the hospital is more fully staffed.

The authors of the paper Mr Hunt so readily quotes have stated quite clearly:

“It is not possible to ascertain the extent to which these excess deaths may be preventable; to assume that they are avoidable would be rash and misleading.”

Fallacy 05: So why is Hunt being “rash and misleading”? His motivations are unclear. If this were truly about patient safety, Mr Hunt would promote more research into the actual cause of the weekend effect. Is it that patients are genuinely more unwell towards the latter half of week? Why is this? Is it the lack of social care facilities available at the weekend? Is it our weekend habits of excess alcohol, smoking and generally unhealthy lifestyles? Is it truly the lack of junior doctors or nursing staff? Is the lack of access to community GPs on the weekend? Is there a decrease in compliance when taking medications at the weekend?

There are no answers yet, only questions.

To steamroll through changes to try to fix an unknown is haphazard and foolhardy. Or perhaps he has an ulterior political agenda? Why else would the health secretary ignore the pleas and calls from the ENTIRE health workforce (including all the Royal Colleges) who have unparalleled insight into the workings of the NHS?

I am no politician.

Mr Hunt’s weakness with numbers is apparent. I, however, am trained to interpret scientific research. To analyse and critique data for the sole purpose of improving outcomes for my patients.

Patient safety is my calling. Is it truly yours Mr Hunt?

...................................................................................

See Gagan Bhatnagar's blog on the clinioncdoc.

An Apolitical Creature

Posted on October 27th 2015 by Gagan Bhatnagar on the clinioncdoc.

I am not a political creature.

I’m a doctor. I’ve spent the last 12 years of my life rigorously training to be able to look after the public. My training continues even now, as a clinical oncology specialist registrar (cancer specialist), and I look forward to many more years as a junior doctor. Up until now I did not worry myself with politics, perhaps naively assuming the UK government had the peoples’ best interests at heart. 

Why is this important? Why is this relevant? Because today I am no longer that person. Today I am angry, I am frustrated, I am genuinely worried. 

20,000 doctors turned up in London to protest contract imposition

The NHS is under attack and it WILL NOT survive without public support.

The Health Secretary,Jeremy Hunt, and the government are in the process of undermining and attacking doctors throughout the nation with the imposition of an unsafe and unfair contract. The details of this contract have been covered extensively in the media but, put simply, will lead to:

1. The removal of safeguards protecting junior doctors from overworking by removing financial penalties on hospitals for scheduling work-heavy rotas.
2. Removal of pay progression if doctors go into clinical research (yes…including cancer research) or decide to work part time to have a family – essentially penalising doctors for doing research or having a family.
3. Extending ‘plain time’ by 50% from 60 hours/week to 90 hours/week. (By comparison the average 9-5 job has plain time of only 40 hours) 
4. This will lead to a pay cut of up to 30% which will hit the acute specialties who do the most antisocial hours (Accident & Emergency, Intesive Care, Obstetrics, Acute medicine) that are already struggling to recruit doctors.
5. Recommended 20 minute break every 6 hours. That’s right…if I do an 11 hour shift, I am afforded only 20 minutes (including my time for lunch)

These are amongst the few of the recommendations from the Doctors’ and Dentists’ Review Body (DDRB) which, suspiciously, lacks either a doctor or dentist on the panel. In fact, not a single front line health worker was on the panel to provide insight into what happens on the shop floor.

The government are suggesting these proposals are to provide a 7 day NHS while maintaining cost-neutrality. Let’s be very clear about this:

The NHS is a 24 hours/day, 7 days/week, 365 days/year service

 

Proof of a 7 day NHS. Thousands of placards held for doctors unable to attend as working on a saturday.

Distinctions between emergencies and routine care is something our Health Secretary has been unable to do. 

Emergency care is always covered, round the clock. 

However, if you would like that routine operation to remove a bunion, it may not be available on a Saturday or Sunday. The simple reason for this is that there just aren’t enough doctors, nurses, radiographers, healthcare assistants, porters, pharmacists, secretaries, cleaners on the weekend to achieve this. 

Herein lies the problem. The NHS is cash-strapped. Long term underfunding from the government has left the NHS on the brink of collapse. At present it is struggling to hold together a 5 day service and indeed may only be being held up by the good will of the staff who work an insurmountable number of unpaid hours for the benefit of the patient. 

The government are imposing an increase in productivity of 40% (2 extra days) without providing any more money or more staff. It has been suggested that for there to be such an increase, the NHS would need to recruit over 30000 more doctors(currently there are 53000 junior doctors). It does not take an economist to tell you this is fool hardy and short sighted. 

The proposals suggest same number of doctors will cover an additional 40% of the service. This will stretch the regular 5 days in the working week even thinner. At a time when staff are at breaking point, this will be the anvil that breaks the camel’s back.

Surveys have shown, if these contracts are unilaterally imposed by the government, up to 70% of junior doctors would move abroad or give up medicine entirely. Even if only a small fraction of this number leave the workforce due to unreasonable working conditions, this would have catastrophic implications for a stretched service.

So why? Why go against the advice of 53000 junior doctors and all the Royal Colleges who have unparalleled insight into how the NHS functions?

To paraphrase Noam Chomsky: Underfund,  Villify, Demoralise, Privatise.

In the long run, doctors would benefit from a privatised healthcare system (case in point The United States Of America). It will be the patients that suffer. So it should be ringing alarm bells when as a workforce we are fighting desperately to avoid it. The reason is simple…patients will suffer.

From day one, we are indoctrinated with one mantra – Do No Harm. As a workforce we go above and beyond for patients, we dedicate our lives to serve the public.We are not perfect and we make mistakes – we are after all human, but our goal remains singular.

Our previous health secretary, Mr Andrew Lansley, now sits on the board for a firm promoting privatisation of the NHS. There is no reason the current health secretary will not follow suit.

The imposition of these contracts would only be the beginning of the downfall. Nurses would be next, then pharmacists, then radiographers.  Then the reality of paying thousands of pounds for surgery for your burst appendix or for your grandmother’s hip operation, or hundreds of thousands of pounds for your cancer treatment may become a reality. Once the system is broken, there will be no going back. But those that have made the decisions on your behalf will already have lined their pockets.

So what can you do? Write to your MP. Voice your concerns. Join the debate. Support your junior doctors should they reluctantly ballot to strike. Start telling people. If you don’t stick up for the NHS when it needs you, it won’t be here much longer to stick up for you.

While it may not seem it now…this is everyone’s fight. 

I am not a political creature.

 I am a doctor.

#juniorcontract #notsafenotfair #saveourNHS 

...............................................................................

See Gagan Bhatnagar's blog on the clinioncdoc.