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Striking anomalies

Still practising

Chris Preece

Tuesday, 06 October 2015

strike_shutterstock_321324746.jpgI’ve been deliberately putting off writing about the Junior Doctors contract in the naïve hope that the whole mess would somehow be resolved. Even now, as I type these words, some part of me is running a narrative in which Jeremy Hunt agrees he’s been terribly silly, and the whole problem disappears somewhere between my sending this off to the editor, and publication.

Ever the optimist; and it’s optimism I suppose which has always fuelled my stance on doctors striking, which is simple, unimaginative, and seemingly easy to follow:

Doctors don’t strike.

It seemed an obvious unassailable position, with so many reasons to support it. After all, fundamentally, our job and our responsibility, is towards our patients. Pretty much the first line of the GMC’s “Duties of a Doctor” is “Make the care of your patient your first concern”. Striking, no matter how convincing the argument, feels immediately and instinctively contrary to that.

No matter how careful we are, it will result in delayed operations, extended stays, reduced access, and by extension greater suffering. Make no mistake, there will be a human cost to any industrial action – otherwise how would it be effective?

It’s also politically incredibly dangerous. Doctors continue to enjoy considerably more trust and respect than almost any other profession (though it’s hard to remember that when perusing the comments section of pretty much any news story about medicine.)  Striking has the potential to seriously undermine that, in the short term at least. 

Whilst some news outlets will come out in support, I predict others gleefully falling back on the clichés of greedy, lazy incompetent doctors – individuals that seem to exist primarily in the imaginations of certain journalists – followed by a whole raft of articles on how doctors’ strikes invariably result in reduced mortality. (Which is, of course, completely true; because any remotely challenging surgery is immediately delayed until after a strike.)

Meanwhile, if discussing a strike is an elaborate game of chicken, actually continuing one is even harder; and if you lose, you lose everything. How long could it be sustained if the Government saw fit to do so? For how long would the public remain supportive? For how long could doctors’ consciences handle it?  And what possible leverage would remain, if we blink first?

So. Doctors don’t strike. And yet…

The situation for Junior Doctors is utterly perverse. Here we have a group of individuals whose skills are, or at least were, highly valued. Not only valued – but scarce – 1 in 3 GP training posts are unfilled, whilst 50% of Specialist Emergency Training posts remain empty. That means that both of the traditional front lines of medicine in this country will face huge shortages of adequately trained staff in the very near future.

Now if we were to apply principles of “the market” to this scenario (something this Government has always been keen to do with the NHS) one would expect doctors to be anticipating huge pay increases, or other perks, in a desperate attempt to generate more of this essential resource.

Which makes it truly extraordinary that they are, instead, looking at pay cuts of 15-30%, and significantly worse hours. 

Of course, once you start to scratch the surface, the situation only becomes more unpleasant. Standard working hours will now become 7am – 10pm Monday to Saturday.  What’s more they’ve lifted safeguards on doctors working hours (developed to protect patients), and removed any financial penalty for trusts that fail to enforce the few that remain.

The traditional incremental pay increase will also be going the way of the Dodo, so anyone working part time, or deigning to take time off to have a family – you know, the sorts of well rounded people we really need in the profession - will take a substantial financial hit.

Of course, there’s a perfectly reasonable argument that we’re in a time of austerity, and as such the NHS simply can’t afford to pay its doctors their current rates. So what are those rates of pay? Basic pay is around £23,000, though they get a bit more depending on how many unsociable hours they have to work. (Remember, anti-social hours will now only be 10pm – 7am or Sundays.)  For comparison, according to the University of Birmingham all of their graduate Physician’s Associates - a role seemingly created to fill the gap in the medical workforce – earn at least £30,000 a year, and you don’t have to look too far to find jobs offered in the £50,000 pa range. These are people (undeniably hard working, smart and dedicated) who don’t have a medical degree, have to work under the direct supervision of a doctor, and who can’t prescribe. It seems peculiar, at the very least, that the NHS can afford one, but not the other.

(For the uninitiated it may be worth noting here that a “junior” doctor is any doctor that isn’t a consultant or a GP. It’s not unusual to remain a junior for 10 years or more.)

Still – think of the patients. Remember, “Make the care of your patient your first concern.”  Except, of course, there’s a lot more to the GMC guidance on the duties of a doctor. For instance: “Take prompt action if you think that patient safety, dignity or comfort is being compromised.” I can’t help the suspicion that patient safety is certainly compromised by deliberately changing a doctors’ contract to remove safeguards against them overworking. It’s also undoubtedly going to be harmed if we continue to have a brain drain as more and more doctors abandon the UK for pastures new. (Actually, not the UK, England, and possibly Northern Ireland; Wales and Scotland have already said they’re not adopting the new contract.) Which leaves you wondering precisely what “prompt action” the GMC advises in such a scenario.

So, in truth, I’m torn. I still fervently believe on principle that doctors shouldn’t strike, but really, what else can they do? Get everyone else to strike for them?

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Chris Preece

Chris has worked as a GP Partner in North Yorkshire since 2004, and still relishes the peculiar challenge of never quite knowing what the next person through the door is going to present with. He was the chair of his local Practice Based Commissioning Group, and when this evolved into a CCG he joined the Governing Body, ultimately leaving in April 2015. He continues to work with the CCG in an advisory capacity. When not being consumed by all things medical, Chris occupies himself by writing, gaming, and indulging the whims of his children. He has previously written and performed in a number of pantomimes and occupied the fourth plinth in Trafalgar Square. Tragically, his patients no longer tell him he looks too young to be a doctor.
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