Emergency physicians from the United Kingdom have made headlines recently for taking to the picket lines in the hopes of securing a better government contract. British emergency physician Paul Jarvis explains the current state of affairs.
In the UK, our Secretary of State for Health, Jeremy Hunt, has tried to enforce a new junior doctor contract onto everyone who is not a consultant. Junior doctors in the UK are the equivalent of residents in the US.
The terms of the contract are as follows: Everyone gets an 11% pay rise, but the pay for so-called “unsocial hours” would be reduced by 40%. Unsocial hours are overtime hours that are currently defined as Monday through Friday 7 p.m. to 7 a.m. and weekends; in the proposed contract, those overtime hours would be changed to 10 p.m. to 7 a.m. Monday through Saturday and Saturday after 10 p.m. All day Sunday would remain unsocial. The reduction in pay and in amount of the unsocial hours essentially means a 30% pay cut.
In addition, Secretary Hunt wants to remove the safeguards that make sure hospitals do not have doctors working too many hours – in other words, hospitals can insist doctors work up to 90 hours a week. Currently they are limited to 72 hours.
The government has said the contract is not negotiable.
Understandably, the junior doctors are upset by this and they have full support of the consultants.
The government is saying that doctors are striking because they don’t want to work 7 days a week, but in reality, most of them do already.
The British Medical Association (BMA), our union, has essentially said that the government representatives are not to be trusted. As a result, the BMA is reluctant to go back into negotiations.
January 12 saw the first industrial action by doctors in over 40 years and the first ever strike. All elective work across England was canceled. However, all emergency care (including the ED) were fully staffed. So patients were inconvenienced, but not put at risk. There is a full strike planned for February which will have no junior doctors working at all.
Neither the government or the BMA are bathing themselves in glory currently. Hopefully there will be a negotiated, reasonable solution soon. Currently, the public seem to be supporting the government but I cannot see this lasting too long.
Ask Me Anything: Junior doctor Jon Hilton took to Reddit to answer questions about the UK physician strike
Q: Are junior doctors unionized in the UK? Are doctors unionized as well? How does this work in the UK?
Hilton: All doctors in the UK can be members of the British Medical Association (BMA). The BMA is the largest medical uvnion in the UK and negotiates our employment contracts at a national level. They also settle local disputes and give advice on working conditions.
Q: Are you considering relocating to a different country to practice medicine?
Hilton: I am. Scotland, Wales and Northern Ireland currently have no plans to impose a contract.
Q: Do you feel the NHS may be both more effective and more reasonable on its staff if it were run by a doctor, rather than an individual with a solely political background?
Hilton: I do. I fully support Norman Lamb’s recent proposal of a cross party independent NHS governing body. I imagine it would be a bit like the Bank of England, but for healthcare matters.
Q: How engaged and organized do you feel the junior doctors are towards this entire effort? Has this really mobilized your community?
Hilton: It has, all junior doctors and many consultants and GPs are concerned about the contract.
Q: What band are junior doctors on?
Hilton: Doctors are on a separate contract, we’re not on Agenda for Change. A brand new junior doctor starts on £22,636 plus their antisocial hours pay, which can be up to an additional 50% depending on how many antisocial hours they do.
Q: If 98% of the doctors don’t sign the contract won’t that have the same effect [as the strike]?
Hilton: It would, but it’d also leave hospitals without any doctors. Today’s strike action is to protect future patients and future doctors.
Q: You’ve said that “the government have no plans to recruit extra doctors so I can only assume they intend to spread us out thinner.” Can you go into a bit more detail concerning this?
Hilton: The government keep saying that to provide a “truly 7-day NHS” a new junior doctor contract is required. The government have never defined what they mean by that statement. The NHS currently provides urgent and emergency care 7-days a week. We currently only have the staff to cover urgent and emergency care on weekends. If you want more services provided, you need more staff. If the government want more staff working at weekends (which, I must say, would be nice to have) then they need more total staff. If more staff are not recruited (and retained) then staff will be taken off weekday shifts in order to cover the weekend.
Q: This is the first time in 40 years that junior doctors have gone on strike. Have you spoken to any more senior consultants who were junior doctors during that time to get their view on the proposed changes? What kind of solidarity are you finding from the older guard so to speak, who have completed all their training long ago and earned their full pay?
Hilton: Consultants are some of the most supportive people. One of our A&E consultants visited the picket line on her day off and another brought us snacks. Consultants know that their jobs would be a lot harder without good quality junior doctors working for them. We are the consultants of the future.
Q: Why do you think junior doctors have mobilised so quickly and easily in comparison to nurses and admin staff who have had similar or often far worse changes imposed on them? Is it simply that these changes have been doled out on a trust-by-trust basis so it’s more difficult to organise resistance or is there another problem. Similarly why have junior doctors not raised concerns about the problems faced by their fellow works in other professions in the NHS?
Hilton: I don’t think this has been quick. The contract negotiations have been going on for a couple of years. It probably helps that there is only one major doctor union. I think it is also the result of years of slow chipping away at our collective good will and tolerance. Junior doctors are very supportive of our colleagues. I am disgusted that the government wants to remove the student nurse bursary which is so important for so many student nurses.
Q: On average, how many hours a week do you work? I’m a US resident and work approx 60-80 depending on the week. No extra pay on weekends or overnight shifts. On average, we get paid about $50-60k USD per year, but haven’t heard any rumblings about striking.
Hilton: I do anywhere between 48 and 56 hours a week on average. One week in 6 I am rostered to work 87.5 hours. I earn around £40,000, which after tax and other deductions is about £2,000 a month. We’re not striking for a pay rise. We are striking to show how strongly we feel about the unsafe, unfair contract proposed by the government.
Q: What would you say to one of your patients who is missing their appointment today?
Hilton: I would say, I’m sorry your outpatient appointment has been re-scheduled so that senior clinicians can cover the inpatient wards. I’m on strike today to protect future patients and future doctors. The current system isn’t perfect, but neither is the contract proposed by the government.
Photo by Roger Blackwell