NHSreality offers advice to the threatening junior doctors: “Keep the moral high ground…. Do something but don’t go on strike. It’s the public support which matters..” Juniors make the first diagnosis usually on admission, but this is updated after review by consultants and if necessary corrected. However, many incorrect diagnoses are made, and even in 2008 USA ICUs (Intensive care units) the post mortem showed 40% errors. (Overconfidence as a cause of diagnostic error. Berner & Graber The American Journal of Medicine (2008) Vol 121 (5A), S2–S23)
Litigation often results. If paramedics and Nurse practitioners are asked to make the initial diagnosis it may make no difference, but it may make a whole lot of litigation for the regional health services. It might be cheaper to pay the juniors! We have yet to do the study… Meanwhile Mr Hunt has managed to unite a profession and increase dramatically the membership of the BMA. (Anthony Bond in The Mirror 6th October)
Junior doctors want to go out on strike, according to their leader, who has accused the health secretary of wilfully misleading NHS staff.
The blame for the current stand-off over contract changes lies squarely with Jeremy Hunt, who has cornered doctors and left them with no option but industrial action, Dr Johann Malawana told The Times.
The chairman of the union’s junior doctors committee said: “We have tried our absolute best to work with the Department of Health and go through a consultation process. They have not been serious about that. They have been disingenuous, and when they thought that they could they pushed us into a corner. I’m assuming they thought we would just back down and go with what they wanted to do, but our members aren’t going to do that.”
His comments came as a poll shared exclusively with The Times found that 95 per cent of junior doctors were prepared to vote in favour of strike action. Sarah Eglington, healthcare intelligence director at Binley’s, which conducted the poll via the online community OnMedica, said that the result illustrated a “huge amount of dissatisfaction among junior doctors”.
Dr Malawana said that a speech by Mr Hunt in July in which he threatened to impose the contract if an agreement could not be reached in six weeks had been the starting point for grassroots protest. “To try to shift the blame on to us is disingenuous,” he said. “You can’t just keep attacking frontline NHS staff and not expect them to react.”
The British Medical Association is unhappy with government proposals to extend standard working hours so that overtime rates only apply after 10pm Monday to Saturday, calculating that this could mean pay cuts of up to 40 per cent for some junior doctors.
It says that the proposals remove safeguards that prevent doctors working excessive hours, and that plans to abolish automatic pay increments will put doctors taking time out for reasons such as parental leave or to undertake academic research at a disadvantage.
The Department of Health says that the changes will make it easier for hospitals to staff seven-day services. It insists that the changes are not a cost-cutting measure and that doctors would not work longer hours. Dr Malawana said that the BMA was still deciding what form industrial action could take. Many doctors say that a strike is the only reasonable option open to them, with past forms of industrial action such as work-to-rule having no real impact.
Dr Malawana, an obstetrician at a London hospital, warned that even if the BMA agreed to an “unfair” contract, the NHS could still see an exodus of staff unhappy with the new terms.
“We are talking about talented individuals who have options, in medicine and outside of medicine,” he said. “If we lose even a proportion of the doctors . . . it makes the NHS not safe to deliver.”
A Department of Health spokesman said: “This is deliberate misrepresentation from the BMA. The government has yet to table a formal contract proposal, and we continue to urge the junior doctors’ committee to come back to the table so we can determine the best deal for the profession.
“In the meantime, we have been absolutely clear that we want to see higher basic pay, average earnings maintained, and that we won’t cut the junior doctors’ pay bill by a penny.”
‘Junior doctors believe the proposed contract is unsafe for patients and unfair for doctors’
Sir, Conflating the government’s rhetoric on a seven-day NHS with the BMA’s decision to ballot junior doctors on industrial action is wrong (“Weekend Working,” leading article, Oct 10).
The “weekend effect” on mortality rates is an internationally observed phenomenon, not the fault of already overstretched UK doctors, who have been explicit in their support of high standards of care across the week. Nine out of ten consultants already work weekends; junior doctors work nights and weekends as well as daytime hours; and GPs provide ongoing care. It is under-resourcing that limits quality, not contracts. While consultants have re-entered negotiations, the decision to ballot junior doctors over industrial action reflects their anger at the government’s plan to impose a new contract in the face of the concerns they have been raising.
Junior doctors believe the proposed contract is unsafe for patients and unfair for doctors. It will remove vital protections on safe working patterns, devalue evening and weekend work and could have a real impact on the quality of patient care if we return to the days of exhausted junior doctors working dangerously long hours.
No doctor takes industrial action lightly, but we can only deliver a fair contract if the government negotiates without the threat of imposition.
Dr Ian Wilson
Chairman, representative body of the British Medical Association
Sir, You have conflated the consultants’ contracts with those of junior doctors: junior doctors can neither work privately nor opt out of weekends. Although consultants do work privately, of the 23 hospital trusts who submitted freedom of information responses, only 35 out of 5,661 consultants opted out of NHS on-call work, less than 1 per cent.
Although junior doctors are supposed to work an average of 48 hours per week, notfairnotsafe.com has nationally logged 17,680 hours of unpaid time in seven days, demonstrating that current assurances, which would be removed by the new contract, are inadequate.
Junior doctor, Epsom, Surrey
Sir, We all support better staffing levels at the weekend, but this cannot be achieved by the health secretary’s plans to reclassify Saturday as a weekday in order to make junior doctors provide the extra cover required for no extra remuneration.
There is already a recruitment crisis. Adding more antisocial hours to junior doctor rotas, rather than employing more medics to split the workload, is destined to drive even more of our number overseas.
Doctors in training are virtually never involved in private practice, and to suggest this shows a lack of understanding of the situation. And, for the record, junior doctors cannot opt out of weekend working. The “overtime hours” for which we receive extra pay are not shifts we choose to work. This is mandatory out-of-hours time over which we have no control, making planning life events reliant on the goodwill of our colleagues. This can result in dangerously long periods of work (my wife gave more than a year’s notice for our wedding, yet was rostered in to work that weekend, so on returning from honeymoon had to work 12 days straight).
The huge locum bill facing the health service is not because doctors refuse to work at the weekend (we can’t), it is because the current terms of employment are so unappealing that 50 per cent of GP training jobs are unfilled in many areas, and most hospital rotas are underfilled. Hospitals are therefore forced to employ locums to fill the gaps.
Update 13th Nov 2015 Letters from The Times:
Sir, Daniel Finkelstein misses the point when he describes the junior doctors’ dispute as a dispute about overtime pay. It’s about an exhausted, demoralised group of professionals who feel neither respected nor valued by their employer.
The BMA’s strike ballot is a step too far for Daniel Finkelstein, and should doctors be allowed to buy as well as sell healthcare?
Sir, That groups of family doctors in clinical commissioning groups (CCG) who control local NHS budgets have handed at least £2.4 billion of taxpayers’ money to organisations that their members own or work for is of little surprise (reports, Nov 11).
This huge conflict of interest was eminently foreseeable when the Health and Social Care Act was going through parliament. Indeed, I moved an amendment which would have made these arrangements much more transparent and prevented CCG board members from directly benefiting from contracts to provide services.
Like much else, this was rejected by the government and we are seeing the results. It’s vital that action is taken at once to stop this potential abuse and ensure GPs do not benefit financially from decisions that are meant to be taken in the public interest.
Lord Hunt of Kings Heath
Shadow health minister,
House of Lords Sir, As one of the senior doctors that Daniel Finkelstein refers to, I also deprecate the thought of strike action (“Moderate doctors must defeat the militants”, Nov 11). And I am sure these young and middle-aged physicians and surgeons will not take such extreme action. But the Department of Health has landed its secretary of state in a real mess by its poor communication and even worse track record. Hence, almost no one believes the assurances that pay will be protected. And as for the independent pay review body: no sign of independent thinking there.
All of us agree that patients require care 24/7 but when the OECD reports that the NHS has one of the lowest ratios of medical staff to population in the developed world, clear thinking is required, not confrontation.
This dispute could be managed by creating a group of honest brokers to mediate — just as happened when Andrew Lansley’s reforms were going badly. David Cameron took a bold decision then and Jeremy Hunt needs to take a similar one now.
Professor Tony Narula, FRCS
President, ENT UK
Sir, If junior doctors have the courage to go on strike (the last time we did was in 1975) it is unlikely to harm a single patient as doctors will make sure that emergencies and unforeseen circumstances are covered. Daniel Finkelstein claims that there is “not a scrap of evidence” that the new contracts will be unsafe for patients because doctors will be exhausted. But if doctors are fatigued day after day there is surely no doubt that their decision-making is blunted, that mistakes are more likely and that people do not perform at their best. I know that fatigue harms patients and that a strike is the last resort to get the government not to impose a contract that will harm patients.
In the past I have worked 120 hours in a week: I know what happens when doctors are tired. Finkelstein doesn’t.
Dr Ron Singer
Junior doctor 1973-81 and GP 1981-2009, London E7
Sir, Daniel Finkelstein asserts that a strike could only ever be justified when “some incredibly extreme government measure . . . might harm medical care”.
The new contract is precisely that. Reducing pay for unsociable hours — which, incidentally, will disproportionately clobber doctors in acute (emergency) specialties who look after the sickest patients at night and weekends — will discourage the brightest and best from becoming tomorrow’s doctors, and risks driving the best of today’s junior doctors into other professions or to other countries.
Dr Oliver Boney
Anaesthetics registrar, London NW5