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Not Safe, Not Fair: The UK Junior Doctor Contract Dispute

Photo taken by Roger Blackwell (https://creativecommons.org/licenses/by/2.0/). No changes were made to the photograph

In the UK, there is currently a dispute over the new junior doctor contract. “Junior doctors” are defined as anyone in training and who is not a consultant. Many have deemed the new contract neither safe nor fair, and despite doctors striking, the Department of Health are intending to impose this contract in August 2016. On April 26, there will be a 48-hour full strike including emergency care — the first of its kind in the history of the National Health Services (NHS) — in the hope that the government will change their mind.

Not about pay, but about doctor and patient safety

The media often misleads the public: they state the contract proposes an increase in basic pay but neglect to mention that proposed cuts in other areas actually cause a decrease in the overall pay for most doctors. Whilst our fight is not about pay, this is still an issue. The decreased income will negatively affect doctors: junior doctors must belong to certain organisations with membership fees, as well as undertake many costly exams to complete their training. Let’s not forget the tuition fees and student loans, which are higher due to the length of a medical degree. When I graduate I will be lucky enough to have not only two degrees, but also a debt of £72,000. It is argued that doctors shouldn’t dispute the contract, but the job entails continuous education, copious stress and emotional and social burden. Is it unjust to be asked for fair compensation?

Still, this fight is not about pay. We chose this profession knowing that our salaries will not reflect the amount of work we do. We are hardworking, educated people. We are all high achievers. If this dispute was about money, many could have chosen to go into higher paying professions such as investment banking. This is not about pay. We chose to become doctors. This fight is about the welfare of the public: patients and doctors included.

We knew that the job came with sacrifices and I will continue to sacrifice my 20s, the supposed fun years of my life, to become a doctor. I am not alone. We do this to improve our education and be the best doctors we can be, as patient safety is paramount to us. From day one of medical school, we put our future patients ahead of ourselves as we have a duty of care. For articles to even insinuate that patient care is not our foremost concern is grossly insulting.

The proposed normal working hours are also a joke. Yes, health care needs to be 24/7, but working unsocial hours have consequences and this should be reflected in the contract. We sacrifice so much already, yet the government wish to deem us the martyrs of society, expecting us to continually keep giving more. The welfare of doctors needs to be accounted for. The profession is on the verge of burnout and yet safeguards, such as penalizing trusts for overworking doctors, are to be removed. This proposal of spreading the workforce thinly in order to achieve the so-called “7-day NHS” is simply illogical. Tired doctors do not make safe decisions. The contract will cause exhaustion and will inadvertently affect the care of patients, which is not something doctors wish to do.

Moreover, there is discrepancy over what a 7-day NHS really is. Is it really more beneficial to have non-essential services on weekends? Perhaps it would be better to invest whatever money is available into hiring more health care staff or into services such as mental health, which is constantly flagged as being underfunded. In addition, how does the government propose to achieve a fully functional 7-day NHS by changing only the junior doctor contract? A fully functioning NHS also requires, nurses, health care assistants, physiotherapists, caterers, paramedics, allied health professionals, midwives, pharmacists, cleaners, health care scientists and … need I say more?

The new contract discriminates against women

The new contract has been labelled as “regressive politics” and contradictory to the UN women’s rights. It is shocking to see something so discriminatory in an age where feminism is at large. A little over 50 percent of doctors are female, thus it seems bizarre that the contract would devalue half of its workforce. Here’s a thought experiment: what if we replace the word “women” in the following sentence with a race, religion or disability — would the “indirect adverse effect on women” be so “comfortably justified,” as the Equality Analysis so eloquently phrases it?

Why the strikes should be supported

No doctor wants to strike, but our voice is not being heard.  The contract is continually being called “Not Safe, Not Fair” and surely we can’t all be wrong? Doctors have a unique insight into health care, as this is their daily environment. I find it a little ironic that the very authoritative and condescending nature our Health Secretary adopts is the exact personality medical education is trying to obliterate. We are taught to adopt a “patient-centered” approach by learning how to effectively listen to patients in order to provide holistic care and fully meet our patients’ needs. Unfortunately, the Health Secretary fails to listen and thus, won’t effectively meet the public’s needs.

While the NHS is by no means perfect, it is often described as one of the best health care systems in the world. The NHS is something the public is proud of, which was highlighted in the London Olympics. The very principles it was built on are the reasons I want to work for the NHS. However, I fear this new contract will be its downfall. There will certainly be long-term consequences to the contract. It will no doubt worsen the shortage of doctors — it has been a motivating factor for people to practice elsewhere and even medical school applicants are down by 11 percent.

How does this affect me (and possibly you)? 

To provide a personal example: the contract will no doubt influence my career choices. At the moment, I want to specialize in emergency medicine; this specialty is one of the worse affected. I am also a woman and wish to do further studies, so I will be even more disadvantaged.  I have always been taught to aim high, yet the government wants to restrict my potential. The new contract discourages me from pursuing opportunities and makes me rethink whether to have a family: I shouldn’t have to make these choices. My gender should not affect my work life. I should not be described as a “woman doctor” but a “doctor,” full stop. The consequence of my anatomy means I, and not my partner, will have to take time out if I choose to have children. However, inherent gender is not a choice and I should not be penalized for this.

I am incredibly excited to start my clinical years in September, but this contract makes me dread what’s to become of my life in three years time. I do not want my career choices to be limited, by my gender or otherwise. I do not want to face burnout. I do not want to be in a profession where I feel undervalued. I do not want to work for a government that fails to recognize that I am a fellow member of the public. My welfare needs to be protected. How can the Health Secretary not realize that an exhausted and unmotivated workforce will inadvertently result in decreased patient care and safety?

Image credit: Photo courtesy of Roger Blackwell, used with permission under Creative Commons.

Alisha Burman Alisha Burman (1 Posts)

Contributing Writer

University of Cambridge

Alisha is a medical student at the University of Cambridge and is currently doing her intercalated degree in Genetics. When not in the library, she can be found putting on events as Welfare Officer for her MedVetSoc, raising awareness about mental health and fixing the "broken bones" of soft toys in Teddy Bear Hospital.