The British Medical Association has asked doctors in training in England to take further industrial action later this month, including the withdrawal of emergency cover. The GMC’s Chair, Professor Terence Stephenson, issued a statement on 11 April setting out the GMC’s position. In this he said: ‘Many doctors in training feel alienated, unvalued and deeply frustrated and this extends far beyond the current contractual dispute. There is a pressing need to address these deep-seated concerns.’
Today we have set out the latest GMC advice for junior doctors. This should be read alongside the advice issued on 4 November 2015 and 5 January 2016. We are also making this advice available to all other doctors in the UK as we recognise that there is interest across the profession.
The GMC recognises that there is anger and frustration among doctors in training following the breakdown of negotiations and the decision of the government to introduce a new contract. We have no role in contract negotiations and it would be inappropriate for us to comment, other than to observe that everyone must regret the current situation.
For every doctor affected these are difficult and worrying times and feelings are understandably running high. This advice, which sets out doctors’ continuing professional obligations, is intended to be helpful and sets out the various challenges facing doctors with leadership responsibilities, employers, doctors in training and senior doctors as well as those in non-training roles. We know all doctors will want to do their utmost to reduce the risk of harm to patients and this advice is designed to help them achieve that.
Advice for doctors contemplating industrial action
We ask every doctor contemplating further and escalated industrial action to pause and consider again the possible implications for patients, not only in terms of the immediate action but also in terms of the cumulative impact on patients and the additional risk posed by the withdrawal of emergency cover.
The GMC cannot second guess the situation facing each doctor in training in England – that must be a matter for individual judgement. But given the scale and repeated nature of what is proposed, we believe that, despite everyone’s best efforts, some hospitals may struggle to cope. In these cases where local circumstances are particularly acute, the right option may be not to take action that results in the withdrawal of services for patients.
Any doctor taking action should take reasonable steps to satisfy themselves about the arrangements being made during the period when they are withdrawing their labour. They should engage constructively and at an early stage with those planning for the care of patients during industrial action to make sure that patients are protected. They have a responsibility for continuity and coordination of care, and for the safe transfer of patients between different teams.
If, during the industrial action, it becomes clear that patients are at risk in a local area because of inadequate medical cover, and doctors in training are asked in good faith to return to work by employers, we expect they would fulfil this request. In the event of an emergency, we know doctors in training will always come forward. Where contingency plans are overwhelmed, it is vital that doctors taking action can be contacted and are available to help.
Advice for doctors in leadership roles
Doctors in leadership positions should do everything possible to organise services during the industrial action to make sure that patients are protected, as they have done during the action to date. They should assist employers who will have been preparing for this action and putting in place other options for emergency care.
Although hospitals will inevitably face increased pressure during any period of industrial action, doctors in leadership positions should only call doctors in training back to work where there are genuine and significant concerns about the ability of the hospital to provide safe care to patients.
Doctors who have a management role or responsibility must support their organisations in acting immediately on any patient safety concerns.
Advice for senior doctors and those not in training
Senior doctors and those not involved in the dispute should continue to provide medical care during the industrial action and, as far as is possible, make sure that patients are protected, where necessary providing cover in place of those taking action. They should assist employers and clinical managers who will have been preparing for this action and putting in place other options for emergency care.
Advice for employers
The GMC does not regulate employers but we would expect them to engage with their medical workforce to develop robust plans that protect emergency services and minimise the impact on patients. Where there are concerns about the capacity of the organisation to cope, these concerns should be raised at the earliest opportunity with doctors, including those taking action.
Employers are required to meet our standards in relation to doctors in training. In particular, they should make sure that doctors are supported in the learning environment and given appropriate clinical supervision.
During the industrial action, concerns have been expressed about the design of rotas for doctors in training. We would therefore remind employers, who will be working hard to make sure patients continue to receive safe high quality care during the action, that our new standards for medical education and training – Promoting excellence – require organisations to design rotas that make sure doctors in training have appropriate clinical supervision and minimise the adverse effects of fatigue and workload. Where there are concerns, we expect postgraduate deans to address these with their local NHS Trusts or GP surgeries.