Recent announcements by the British government that a revised contract on junior physicians’ salary and working hours across England will be imposed has come under intense scrutiny. Criticisms from the national workforce to media figures and opposing party politicians have ranged from accusations of compromising patient safety to ensuing longer working hours with reduced pay as compared to the current scheme for around 55,000 affected doctors. But the retaliating strikes on part of the National Health Service (NHS) workforce in protest have certainly proved controversial.
Indeed, doctor’s striking is the result of the changed nature of protest in modern-day Britain: not in the 66-year history of the NHS have doctors taken near-unanimous strike action, with 98 percent of those balloted back in November 2015 voting in favor of country-wide hospital walk-outs. Thus far, two 24-hour strike days have been held in England with cancellation of routine operations and coverage of emergency care only, with a further three planned 48-hour walkouts announced for March and April of this year. However, those working in regions of Scotland, Wales and Northern Ireland in the rest of the UK remain unaffected by the proposed changes, sticking with existing contracts for the foreseeable future.
Striking is ultimately a moderate tactic, which allows the safe public demonstration of grievance by peaceful marchers, rather than by breaking the law. Indeed, considering the contempt for “doctor bashing” evinced during the demonstrations, the restraint shown by the NHS workforce has perhaps been too true to the duty of a democracy to facilitate lawful protest, with many returning to work on strike days despite the initial ballot results. Indeed, as Dr. Hoong-Wei Gan, a clinical research fellow and specialist trainee in pediatric endocrinology at the University College of London (UCL) Institute of Child Health and Great Ormond Street Hospital for Children, states, “Striking is not integral to any doctor’s identity … a doctor pledges, before anything to else, to ‘first do no harm.'” And yet, for many, it remains the only foreseeable option to voice concern and protest proposals to further stretch a system already at breaking point.
Unlike in the United States, health care across England, Wales, Scotland and Northern Ireland is free at the point of use, funded by the taxpayer (for 2015 to 2016, the overall NHS budget was around £116.4 billion — around US $162 billion) and from independent fundraising donations and activities that individual hospitals in charge of their own monetary budgets may receive. Private health care exists, but typically emergency care is still provided for by the NHS. Under the current contract, the average newly qualified junior doctor working within the NHS (equivalent to intern and resident level in the US) receives a salary of just over £22,000 (around US $30,000), and clock in around 91 hours per week (though many doctors nationwide work well in excess of this without additional pay). Weekends are currently considered “unsociable hours,” with an increase in pay by 50 percent above the basic rate. What is proposed in the new contract to be implemented, however, is for Saturdays to be treated as “regular” working days with extra pay provided only after 5 p.m., and a basic pay rise for junior doctors of 13.5 percent.
The British Medical Association (BMA) — the body acting to represent doctors in the UK over current contentions — has spoken out extensively against contract negotiation failures, citing that talks with the UK Health Secretary, Jeremy Hunt, had failed to reach a resolution over proposals by the BMA that pay would be protected for “unsociable” weekend hours and that details would be provided for on-call allowances and policing of working hour limits for junior doctors. The BMA additionally cited that, under the new contract, those regularly exceeding out-of-hours (such as emergency medicine trainees) could lose out on up to 11 percent of their current salary in spite of the proposed basic pay increase, adding the statement: “Imposing this contract will seriously undermine the ability of the NHS to recruit and retain junior doctors in areas of medicine with the most unsocial hours, where there are already staffing shortages.” Hunt retailed by attacking the strike as “wholly unnecessary,” and that “all NHS patients … [should] have the confidence that they will get the same high-quality care every day of the week.”
Yet, embarrassingly for the government, the BMA is also now set to launch a judicial review in an attempt to overturn the decision following the revelation that no Equality Impact Assessment (EIA) — a legal requirement for all working contracts in the UK — was taken prior to the government decision to impose the new contract this coming fall, effectively taking the government to court. Yet the backlash faced by the government is not from the junior doctor workforce and its union alone. The hashtag #IAmTheDoctorWho has been trending widely across social media in support of the physicians, and many of the strike days held across England were bolstered by additional support from public services such as firefighting crews and members of the public alike, with many even holding basic life support teaching sessions outside hospital picket lines.
Indeed, the contract alone is not merely about pay, but about extending junior doctors’ working hours on the basis of tactical rostering, which many believe will compromise the safety of patients and the welfare of the workforce. Dr. Gan claims that “this new contract is not simply about working weekends; it is about working so many weekends and nights that my exhaustion will mean I can no longer safely intubate that 24-week premature infant at 3 a.m. with a 2 mm-wide tube.” Many hospitals across England — including those in the West Midlands, home to my own medical school, the University of Birmingham — have additionally refused to impose the contract come August, on grounds of safety concerns. Current figures from the UK General Medical Council (GMC) which issues certificates for overseas working also indicate that an average of around 5,000 junior doctors in the UK annually are now seeking employment outside of the country, a potential sign of things to come should the contract imposition go ahead.
Image credit: Photo courtesy of Roger Blackwell, used with permission under Creative Commons.