Disconnected from reality the politics of health is in “sound bites”. Universities have perverse incentives to appoint students from overseas. Who will be the first party to address health honestly?

When Mr Hunt promised to have GPs work weekend he did not anticipate that their would not be the demand. GPs have been deskilled in emergency care, and in seeing patients without their notes, so they avoid weekend and evenings with cooperatives if they can afford it. Disconnected from reality the politics of health is in “sound bites”. Universities have perverse incentives to appoint students from overseas. Female doctors excel in General Practice but they are over-represented in the Hospital posts…. Prof Meirion Thomas’ Opinion is interesting… Who will be the first party to address health honestly?

End Game horse cartoon

Sophie Borland in The Mail 29th September reports: Patients shun out-of-hours GP surgeries: Half of sites in flagship scheme cut appointments back because of a lack of demand

The inability to plan longer term is evident in the Express headline (Jon Bachelor 29th September) : Junior Doctors descend on Westminster in protest at ‘unsafe’ working contracts – HUNDREDS of trainee medics gathered in Westminster this evening to demand the Government halt controversial changes being imposed on Junior Doctors’ contracts and Scott Cambell on 23rd September in the same paper: British students BANNED from doing medicine at uni – as NHS forced to hire foreign staff – ONLY foreigners will be allowed to study a certain degree course on medicine at a British university, it has emerged – amid a staffing crisis in NHS hospitals.

Marie-Louise Connolly for BBC News 16th September in N Ireland reports: Northern Ireland GPs say urgent action needed over ‘crisis – The Royal College of GPs (RCGP) says 400 more doctors are needed by 2020 and they must be allowed more time to see patients.

Nick Aresti in The Huffington Post politics blog on 25th September comments on “The Smokescreen of the Junior Doctor Contracts”

British healthcare workers discovered DNA. They designed the first antibiotic. They invented the ophthalmoscope, the thermometer, the CT scanner and the MRI machine. They were the first to stop and start a beating heart and the first to conceive a baby in a test tube. They operated on me within weeks of being born, and recently gave my elderly relative first class health care when she broke her hip.

I am proud to work for the NHS. It’s a wonderful institution that we should all be proud of. I remember I once asked a consultant why he went over and above what was expected of him, in effect doing the job of two consultants. Without a moment’s hesitation, he replied; “the NHS took care of me so well in my training, that I owe it to the NHS”. Echoing his sentiment, other than the well being of my patients, what underpins my dedication to the NHS is that the NHS has looked after me, and so I must look after it. Many of my colleagues have resisted offers to double their salaries in consultancy firms and plenty have refused offers of working abroad, for better working conditions, hours and pay.

I will attempt to explain the injustice surrounding the proposed contracts. You have heard the rhetoric. You have seen the petitions across social media. You have seen the facts and figures demonstrating a 30% cut in the salaries and changes in the working patterns of junior doctors, most of whom in my experience work tirelessly for their patients. If you were faced with a cut in your salary by a third, when you had only ever exceeded your targets, you would probably be left with a distinct feeling of injustice. You would probably consider seeking alternative employment.

What you may not realise, is that the contract changes go further than a simple pay cut. Female doctors will struggle to take maternity leave due to the contract structure, and even the choice of when to take annual leave will become more rigid than optional. The next Francis Crick (co-discovered the structure of DNA) or even Bruce Keogh (National Medical Director) will be denied the necessary support to pursue research degrees and perhaps the expertise it takes to run the only health service in the world that is free at the point of service.

What I find particularly insulting regarding the proposed new contracts is not the pay cut and changes in working patterns, but the government’s smoke screen of patient safety as an excuse to push through the changes. In my opinion, the disharmony amongst the medical profession caused by the threat of the new contracts has caused a far greater risk to patient care than the current working patterns. We all know what the new contracts are about. Money.

For now, our rotas will remain covered. Our patients will still be seen, and the most vulnerable given first class medical treatment. But how long will this last? Junior doctors will begin to leave in droves. Already 40-60% of foundation doctors are choosing not to apply for specialist training. A third of GP training posts are unfilled. So are half of A&E training jobs. We have seen a dramatic rise in the number of applications for ‘certificates of good standing’ – the paperwork required to work abroad. Those who have gone to Australia, New Zealand and North America, are deciding not to come back. We are already facing a recruitment crisis that could alarmingly escalate. The future gaps in workforce will be the greatest risk to patient safety, not the current contracts, as the government is suggesting.

Overwhelming evidence shows that a valued, supported and motivated workforce leads to better health care and productivity (Sears Employee-Customer-Profit chain). Demoralising the junior doctor workforce will be the next great risk to patient safety.

This contract change is not only unjustified, but also plain and simply wrong. Goodwill is the oil that lubricates the NHS machine, and junior doctors its fuel. Both are at risk of quickly becoming in short supply.

Nick Aresti is a junior doctor working in London.

Food for thought from Professor J Meirion Thomas on 2nd Jan 2014 in Mailonline: Why having so many women doctors is hurting the NHS: A provocative but powerful argument from a leading surgeon



This entry was posted in A Personal View, Patient representatives, Perverse Incentives, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

1 thought on “Disconnected from reality the politics of health is in “sound bites”. Universities have perverse incentives to appoint students from overseas. Who will be the first party to address health honestly?

  1. Pingback: Health services are “vacant” – and have many GP vacancies despite oversubscription to Medical School over many years | NHS reality. An NHS soapbox. Speakers' corner for the NHS.

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