Published on October 31st, 2015 |
by Eleanor Newis
Where Will All the Junior Doctors Go?
I recently met up with two friends of mine, and amongst other things, we talked about the future; we all have plans, and we all have decisions to make, like most students moving towards the end of their degrees. But, the future for one of my friends is somewhat different to mine, because she is a medical student. Over coffee, she told us about the recent developments around the contracts of junior doctors, what she thought would happen, and how it would affect her. I know there are plenty of other things to talk about in the news – Jeremy Corbyn (recently uncovered to be fond of making jam and watching the news), tax credits, George Osbourne getting ever closer to the Tory leadership. But, though these stories are all more amusing, the plight of junior doctors, as yet rather unreported, is something we need to talk about. Jeremy Hunt’s new policy is going to affect both the current junior doctors, young medical students approaching their junior doctor years, and on a wider level, the NHS we all rely on, and therefore each and every one of us.
Jeremy Hunt has said his new policy is “about patient care and not saving money”, but many are not so sure – including me. At the moment, junior doctors receive extra payments for work outside the normal hours they are assigned; hours defined under the current system as being 7:00-19:00, Monday to Friday. Hunt’s new contract plans will mean that these ‘normal’ hours will be extended to include 7:00-22:00 on all days apart from Sunday. What this means, is in effect a pay cut. Junior doctors get paid more for hours outside the present 7:00-19:00 band because these hours are classed as overtime, as being unsociable and as also posing a danger to patients if the doctor is not looked after. We all want our doctors to be there – but do we really want to be treated by someone who has been not only awake, but working (often non-stop) for fourteen or fifteen hours? The British Medical Association has claimed that this policy is going to amount to a pay cut of up to 30% for each junior doctor, and subsequently walked out of negotiations with the government about these working hours and rates of pay. This is, incidentally, a choice which my friend disapproves of, and with good reason: the BMA is essentially the only hope for junior doctors wanting this contract proposal altered, and though I can’t begin to imagine the frustration of negotiating with, of all people, Jeremy Hunt, over the NHS, many junior doctors will now wonder how exactly their union is planning to help.
Of course, the next step has been the threats of strike. These are historically unprecedented: public sector workers all know the delicate line they walk when striking, but for the medical sector, this is amplified manifold. The BMA’s strike vote will begin on the 5th November, and though expected for a while, is still rather an extreme result for one policy to have caused. There was, of course, a small strike in 2012 over a pension dispute, but the last time that doctors took industrial action on this scale was in 1975. Blimey, Jeremy, you’ve really done something here. By the 21st September, the petition run by the BMA for junior doctors to strike had hit 50,000 signatures and the number is still climbing. Whilst many will strike, support for the cause actually appears to go far beyond those who will walk out: though my friend will not strike herself, she will support those who will, and I imagine that there are many who take her position. Striking as a doctor raises a whole host of ethical issues, and so many will choose other ways to support the change in contracts. I would say, no matter what your views on the contracts of junior doctors – maybe you think they should work for fifteen hours sans overtime – it must be conceded that no one who has spent five or six years studying to work for the NHS is going to go out striking over trifles. Hunt has called the row “unnecessary anger” and calls the predictions of pay cuts “misinformation”; he has also said that “a seven-day NHS was a manifesto commitment”. Wait one second Jeremy. Your “seven-day” NHS may have been a manifesto commitment, but you had an existing commitment to the welfare of the people who keep that NHS in existence, and the young people who may have put themselves in serious debt (due to your governments’ tuition fees, by the way) in order to train to work for that NHS.
So, I’ve talked about the overtime situation, the likelihood of strike, the unpopularity of the policy – so why has Jeremy Hunt decided this is a good idea? Well, I’m genuinely not sure, and for this reason: this policy will not actually save money. Yes, I know Mr. Hunt would like us all to believe he is somehow doing this out of the goodness of his heart, but even without my usual cynicism, this doesn’t hold up: you simply can’t roll out a policy on the NHS without it being financially viable – right? Well, maybe you can. See, this policy might look like it constitutes a pay cut for junior doctors, and will thus mean the government saves money. But, what the government has obviously forgotten is that the situation for doctors in the UK economically is already worse than many abroad; countries like New Zealand, Malta and Australia offer plans whereby the F1 and F2 (junior doctor) years can be paid much more than in this country. Plus, unlike some countries, including the USA, these countries do not ask candidates to complete their own licensing exam, so the qualifications gained by junior doctors in the UK would be enough for them to gain these jobs and this training.
This means that it is actually more financially viable, in many cases, for medical student to go to university in the UK and then to move to another country, where they will be paid more and often have a higher quality of life long-term than they would here. Added to that, there’s also the government wiping away tuition fee debts if you leave the county for a certain number of years – so they might not even get that money back either. So, Hunt’s new policy will mean that in many cases, the government (i.e. the taxpayer) will spend the estimated £250,000 to train a new doctor, then have to wave a helpless goodbye as they move abroad, whilst our own NHS faces staff shortages. In addition to a new generation of doctors being unconsciously incentivised to go elsewhere, there is another aspect to the new contracts: doctors who wish to change speciality will now have to begin from the bottom, as opposed to going in with a level (and a level of pay) reflecting their experience. Now, this most often comes up as an issue, according to my friend, with consultancy. Many medical students don’t want to go into consultancy: they want to explore other areas; but, when older, and maybe with a young family in tow this changes. So, all of the highly trained and specialised doctors who wish to move into UK consultancy are faced with a pay cut at the time when they will most value their fiscal security. And as with junior doctors, the answer for many may be to move, and to build the life they can’t afford in Britain somewhere else – which is yet another problem for an NHS which has a shortage of GPs.
So, in short, I can’t imagine what Jeremy Hunt is planning. If the policy was somewhat unfair to junior doctors I would understand; I would understand if he wanted them working more hours; I would not be surprised if he asked them to simply move into hospitals and live in NHS compounds, always at his beck and call. But, I don’t understand this. My friend pointed out to me that the best idea would have been to simply lock in junior doctors’ contracts: rather than stretch out the work hours, simply tell them the government trains them and they have to work for the NHS a certain number of years. The problem is not a shortage of medical students, but a shortage of those who actually stay to work in our health service – thus, there aren’t enough doctors, and the government is forced to extend the hours of those left. I think there is a very good argument for locking in contracts. And, if it comes from a medical student, I’m all ears: it’s their contract after all. My friend will stay to do her F1 and F2 in this country, because she can afford to. But, she warms many won’t, and over the coming years we will find out exactly how much this will affect us.