I am incredibly lucky. Because I have a career that I am passionate about. Because I have had fantastic training. Because after three years of undergraduate study, five years at medical school, two years as a foundation doctor and three years as a hospital doctor training to be a GP, as of two months ago I am no longer a Junior Doctor.
Following the collapse of negotiations between NHS employers and the BMA Junior Doctors representatives in October this year, Ministers now say they will impose a new junior doctors’ contract as of August 2016.
The changes outlined in the contract are complex and relate mainly to a change in regulations regarding shift patterns and progression of pay as well as current safeguards put in place to protect junior doctors from returning to the 100 hour working weeks endured by their predecessors.
Currently the standard working week for doctors is defined as 7am to 7pm Monday to Friday. Any shifts outside of these hours are considered antisocial and a supplementary wage is payable to reflect this.
The new contract defines the standard working week as 7am to 10pm Monday to Friday and includes Saturdays. This extends the average working week from 60 to 90 hours and works on the seemingly rather unfair premise that working at 9am on a Tuesday morning is directly comparable to working 9pm on a Saturday night.
Currently junior doctors are paid a ‘banding’ on top of their basic wage to reflect the amount of antisocial hours they work, including evenings, weekends and nights. Under the new contract this will be scrapped resulting, for some, in a 30% reduction in their pay almost overnight.
On top of this the current pay progression scale used to recognise individual doctor’s skills and training as well as pay protection for those taking time out for maternity leave, retraining in different specialties or academic research, will also be scrapped.
Add to this the removal of the financial penalties payable by employers if their juniors are forced to work hours outside of the recommended safe limits (currently 72 hours per week )and you may start to appreciate why the junior doctors are concerned.
The junior doctor workforce is demoralised, deflated and thanks to the press, now demonised. They have been portrayed as barely-out-of-medical school, layabouts who do not want their patients to receive 24 hour, 7 days per week care. In reality these doctors are already providing 24 hr 7 days per week care. They just want to do it safely.
Press coverage in the last few weeks has worryingly used the term ‘junior doctor’ almost interchangeable with ‘medical student’. This is misleading and wrong. A junior doctor is someone who has not yet completed the training to become a Consultant or GP. In some specialties this can take up to 15 years. Others may take time out of their training to conduct important research projects or to retrain in a different area of medicine, taking their skills and experience with them. Many junior doctors have young families and mortgages to pay. In my first year as junior I was paid just over £23,000 as a basic salary. Since then I have paid thousands of pounds for mandatory training, course fees, exams and indemnity cover, just to be allowed to do my job.
I started as a junior doctor five years ago. On my first day I was on call for twelve hours. Contrary to many beliefs this does not mean sitting at home waiting for the phone to ring . Instead it means being the first point of contact for all of the medical patients in the hospital after everyone else has gone home.
To my horror I learned that people don’t stop being ill after 5pm. I was called to see patients with sudden terrifying chest pain, elderly patients who were confused and aggressive, family member s who wanted to know what was happening to their loved ones, nurses who were tearful because a patient had shouted at them. And on every ward I was called to, at six, seven, eight o clock at night, there was a junior doctor, a doctor who should have gone home hours ago, who wasn’t being paid to be there. Who was missing their child’s bathtime or a night relaxing with friends. A doctor who cared about their patients and knew that the on call doctor would be over-stretched and tired and could be bleeped away to an emergency at any minute.
This is the workforce that keeps the NHS afloat.
Over my next five years in hospitals I have been that doctor. I have held an elderly lady’s hand as she slips away because she has no family and is scared of being alone. I have waited for blood results to come through because I’m worried that if I go home they will be missed by the night doctor who is tied up in A&E and can’t get to my patient in time. I have helped my junior colleagues wade through their on call list because I remember the terror of that first day.
We do this because we care and because it is our job. Let us continue to do it safely.
The BMA were forced to walk away from negotiations in October because the proposals put on the table were simply not safe. Why should a junior doctor’s working day be seven hours longer than everyone else? How can a junior doctor be expected to calculate complex fluid balances, safely prescribe dangerous medications, perform intricate practical procedures and make life or death decisions when they are tired, demoralised and unsupported?
This is why we are fighting.