We are used to the idea of doctors as carers, not fighters. Yet on Monday evening, thousands of junior doctors called for a fight, as they marched into Parliament Square. Waving signs and placards, the crowd yelled “when they say privatise, we say organise! When they say cut back, we say fight back!” Was this the ‘frontline’ David Cameron was referring to back in the nearly-forgotten days of election promises – the one he vowed his party would protect?
The protest comes after a long stand-off over contracts. Talks between the doctors’ union, The British Medical Association (BMA), and the Department of Health (DH) broke down last year, and last month the BMA refused to re-enter negotiation, accusing the government of a “heavy-handed” approach. Never a government to let accusations stand in their way, ministers then said they would impose a new contract in England, starting in August 2016. This contract would extend ‘ordinary hours’ from the current 7am – 7pm Monday to Friday to 7am – 10pm Monday to Saturday and remove overtime pay for evening and weekend work.
To an outsider, the minutiae of pay differences in different settings, at different times can be difficult to grasp – the vociferous reaction perhaps even more so. We’re all in Cameron austerity together, right, doctors, teachers and train-drivers alike?
However, despite the Conservative’s rhetoric, this change is more than an austerity-era update – a slight tightening of the belt and rolling up of the sleeves, in the interest of ‘fairness’ and ‘just rewards’. What is at stake in this change is the future of healthcare in England. The changes to what counts as ‘social’ hours would increase the standard working week for junior doctors from 60 to 90 hours. Not being paid for the dramatically reduced number of ‘antisocial’ hours imposes what would amount to a 30% salary cut. It imposes a 40% reduction to GP trainees’ salaries. Pay protection for women who choose to have children is being removed. Welcome back, gender barriers to the medical profession.
In the words of the trainee doctors group (ATDG) of the Academy of Medical Royal Colleges (which represents the professional interests of all the UK’s 240,000 doctors, including 53,000 junior doctors) “the proposed contracts fail to offer safeguards on hours and working conditions necessary to ensure the safety of all the patients treated within the NHS, and risk a return of exhausted doctors and rise in medical errors”. The government is creating a tired, overworked, underpaid, frustrated health service, and the ones who will suffer will be the sick and the elderly – the most vulnerable in society, the ones the National Health Service was introduced to protect.
The 2016 contract is an open declaration of warfare on the NHS. Shortages are already noticeable in key areas like A&E units, children’s services, acute medicine and general practice, due to their necessary reliance on out of hours work. This contract weakens already stretched young people, most saddled with years of training debts. It will, without doubt, deter young doctors from staying in the NHS, make vacancies even harder to fill and endanger the safety of patients. Latest figures from the General Medical Counsel show that almost 3,5000 NHS doctors applied for certificates allowing professional work abroad in the 10 days following the confirmation of the contracts. The general public is told repeatedly that the bailout of the banks was to prevent bankers going abroad – their contribution to the country too vital to be lost overseas. It is a pity medical care is not viewed as equally vital.