Do No Harm, Jeremy.

Junior doctors rarely take industrial action. What pushed them to the limit with the new contract, will it work, and is it ever right for doctors to strike?


The last time doctors went on strike was in 1975 (Photo: AFP/Getty Images)

The last time doctors went on strike was in 1975 (Photo: AFP/Getty Images)

What is the new contract?

The BMA and the government are at loggerheads over a new contract for junior doctors, resulting in strikes that caused almost 3,000 routine operations to be cancelled. David Cameron’s idea of a ‘truly seven-day NHS’ has been ridiculed and protested against. Imposing the resulting contract will demoralise the workforce that has a responsibility for many lives. The Secretary of State for Health, Jeremy Hunt, and his affection for statistics and evidence on the ‘weekend effect’ does not seem to be followed up with evidence-based policies. A profession that rarely takes industrial action has now had enough. How do we make sense of it all?

It all started when negotiations over a new junior doctors’ contract that was drawn up by MPs in 2012 (alongside less controversial reforms surrounding the contracts of consultants) broke down in 2014.

But first of all, who is a ‘junior doctor’? The term itself is vague, covering both those fresh out of medical school and those with years of experience.

The term ‘junior doctor’ covers those with varying degrees of experience. (Source: BBC/BMA)

The term ‘junior doctor’ covers those with varying degrees of experience. (Source: BBC/BMA)

Those at the bottom of the career ladder (Foundation Year 1/2 doctors) have a starting salary of £23,000, although with extra hours this can increase to £30,000. At the top end, the salaries of junior doctors who are senior specialty trainees, and a few years’ away from becoming consultants, can be around £70,000.

The new contract, however, will lengthen the times during which the basic pay rate applies, and shorten the definition of ‘antisocial hours’, meaning that it will become cheaper to roster doctors at the weekends, reducing the cost of the NHS – or so the government hopes.

But what is the purpose of all this? The government claims that deaths are more likely on the weekends and so there should be a ‘truly seven-day NHS’. The solution to higher weekend mortality, according to the powers that be, is to make junior doctors work longer hours, increasing physician fatigue, and harming patient safety. What Mr Hunt seems to be ignoring is the fact that junior doctors already work on weekends, providing the bulk of essential medical care. Most countries have a 24/7 emergency care service and a non-24/7 non-emergency care service, including the NHS. Claiming that the NHS needs reform in terms of weekend service is a diversion from the greater problems faced by this institution.

Why would you impose a hated contract?

The reality is that the NHS does not have enough money. With an ageing population and wastage on bureaucracy, the NHS cannot survive without more money. Trying to slash spending by cutting junior doctors’ pay indirectly is not the solution. Neither is imposing a contract that is near-universally hated by the medical profession. Prof Sir Bruce Keogh, medical director of the NHS Commissioning Board, has warned that if sustainable action is not taken, the NHS could see its ‘taxpayer-funded status challenged’.

Professor Sir Bruce Keogh has warned about the unsustainable model of the NHS. (Photo: The Guardian/Rex)

Professor Sir Bruce Keogh has warned about the unsustainable model of the NHS. (Photo: The Guardian/Rex)

The NHS will require more doctors in the future (as well as other allied healthcare professionals of course). Making that career less attractive will not only harm the current workforce, but the future ability of our health service to deliver. In the first quarter of 2015, foundation trusts admitted 2.3 million non-emergency patients, an increase of seven per cent from the same period the year before. And the numbers will continue rising.

By imposing a contract, Mr Hunt is letting the medical profession know that he does not care. No wonder we hear about so many doctors applying for work overseas. No wonder a profession that has not taken industrial action for over 40 years for the sake of patient safety is now forced to do so. But without sufficient manpower, the health system of this country is certainly on a collision course.

Instead, the government needs to increase the protected NHS budget, and reduce bureaucracy by introducing efficient technologies. Perhaps the £640 million spent on management consultants who have never been inside a hospital ward even could be better allocated – this was not done by the previous Coalition government despite promises to do so.

A key element of the solution is increased taxation. Many people are, for obvious reasons, opposed to increased taxes, but without clamping down on offshore tax havens, increasing the additional fiscal rate, and ensuring corporations pay what they ought to, it will be difficult to procure the funding necessary. This is something that only the Labour leader, Jeremy Corbyn seems to understand; otherwise, ‘the principle of universal healthcare which is free at the point of use’ will be under attack.

Understandably, though, the government opts for the easier, more saleable option: make doctors work longer hours, and pay less, under an unfair and unsafe contract.

Is it ever right for doctors to strike?

Doctors have been criticised by the government, as well as the public, for taking industrial action. The Daily Mail even published a laughable article criticising the photography business of Johann Malawana, the chair of the BMA Junior Doctors Committee. On a serious note, is a strike against Mr Hunt the correct course of action? Can striking ever be reconciled with the duty of the healthcare profession?

With a previous 98 per cent vote for industrial action, it is clear that the doctors are undeterred. But is care not the first duty of a doctor towards his patients?

Primum non nocere – first, do no harm, a key principle of medical ethics and the covenant of the medical profession. (Photo: Craig Yoshihara)

Primum non nocere – first, do no harm, a key principle of medical ethics and the covenant of the medical profession. (Photo: Craig Yoshihara)

Niall Dickson, chief executive of the General Medical Council, issued the following advice: “any doctor contemplating industrial action must follow GMC guidance”, and that they must “take reasonable steps to satisfy themselves that arrangements are in place to care for their patients”. Indeed, consultants supported and covered junior doctors during the emergency services walk-out. But 4000 operations were still cancelled, inevitably causing some harm to patients and possibly contradicting the primary medical duty of non-maleficence. However, during a time of threats and forced contracts on the medical profession by the government, when negotiations and other difficult – but better – options for reforming the NHS exist, doctors have been pushed to the limit. They have made their voices heard. It would do well for the government to listen.

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