For two days the junior doctor strike extended into the emergency department. British emergency physician Paul Jarvis explains what’s happening, and what will likely come next.
The UK Government and junior doctors are still in a deadlock over the introduction of a new pay and working conditions contract. The government has described the current national arrangements as “outdated.” The junior doctors (any grade of medic below the level of an attending physician and those doctors not in training) feel that the government’s proposal will mean that they will work more hours per week and be paid less for working unsociable hours.
Negotiations between the government and the British Medical Association (the Doctor’s Union in the UK) broke down in February 2016. Currently, the government has decided to impose the new contract from August 2016 despite protests from the doctors.
In response to the government’s threat of imposition of the new contract, there have been national strikes organized by the British Medical Association, which saw junior doctors standing on picket lines protesting at the contract changes. This is the first time that British doctors have gone on strike in the history of the National Health Service. However, junior doctors felt it was necessary as the government refuses to return to the negotiating table saying it is too late for discussions, and the contract will be implemented. Obviously, this has major issues for all people employed in the public sector in the United Kingdom and not just junior doctors.
The strikes consisted of the cancellation of all non-emergency care performed by junior doctors. This has caused a lot of disruption to elective services throughout the health service with attending physicians carrying out the majority of the day to day running of the service, supported by those junior doctors involved in delivering emergency care. So for the rest of the hospital, there was essentially a skeleton service firefighting until the strike was over. As a consequence, large numbers of operating lists and outpatient clinics had to be cancelled. However, last month saw an escalation in the nature and magnitude of the industrial action. For two days the strike now extended to emergency care as well. Consequently, attending physicians had to provide all care at all times apart from the small number of junior doctors who felt that industrial action of this nature was unethical.
Thankfully, the strike days went without a hitch in the emergency department where I work. All leave was cancelled, and all non-clinical work was postponed. To ensure that the service ran as normally as possible we distributed our entire senior medical workforce over the forty-eight hour strike period. In addition, there had been a lot of coverage of the strikes in the national and local media and as a result, the number of patient attendances during that forty-eight hour period was considerably lower than one would expect.
Working in an emergency department without junior doctors was actually quite enjoyable. It fostered a strong feeling of camaraderie amongst the attending physicians, and there was no one asking for advice, although the burden of work was much higher.
There continues to be great public support for the junior doctors, but the brunt of the industrial action is felt by the patients and the longer it continues, the more the junior doctors will lose public support. Irrespective of who is right or wrong in this stalemate, there is an old maxim in medicine that we should bear in mind. ‘First, do no harm,’ should be a salient reminder to those on both sides of this argument. My personal concern is that the longer industrial action goes on, the more patients will suffer. Whether that is because surgeries are delayed or waiting times lengthen; patients will come to harm. It is clear that a service without junior doctors is not sustainable in the long term, and a solution will have to be found soon.