DEVIL'S ADVOCATE on Junior Doctors' Contracts

With the junior doctors contracts causing such a stir from those in the medical sphere, I played devil’s advocate in an interview with Ben Beska, who openly opposes the governments contract changes. This is what he had to say:

Q. Surely a 11% rise in basic pay for doctors is a good thing as it reduces variable pay and ensures getting paid for every hour worked?

“The contract will remove safeguards that are in place to protect patients and prevent junior doctors from working dangerously long hours. Even if the pay were significantly increased, junior doctors would not be happy with this contract as it has the potential to cause real harm to patients.

From speaking to medical students here at Newcastle and by their vocal support at the recent March and protest -which attracted over 4000 medical students, junior doctors, consultants as well as concerned members of the public – patient safety was deemed the key concern of the profession. This was also evident in the recent statements released by the Royal Colleges expressing their concerns.

This offer is not an actual pay rise. In the initial imposition junior doctors were likely to gain at least a 20-40% pay cut, particularly in specialties that have lots of out-of-hours worked, such as Anaesthetics or Emergency medicine -the latter facing a recruitment crisis in the UK. This pay cut will likely deepen after 2019 when the so-called ‘pay protection clause’ expires and the true cuts finally appear.”

Q. Would the contracts not make the role safer, by creating a better protection for both patients and doctors against long and potentially unsafe work hours?

“The new contracts are actually not any safer. The contracts remove penalties for employers who routinely overwork their doctors by removing compulsory monitoring of doctors’ hours, meaning doctors could end up working for much longer than they are now as there would be no way to track how long the doctors are actually working. Even now, doctors quite often start before their contracted start time and stay for hours afterwards to ensure patients are safely handed over as well as ensuring patient care is the best it can be. This is all voluntarily and out of good faith. Financial penalties that are in place to ensure Trusts do not overwork doctors are being removed.

On a sample rota released by the Government arm-length body NHS Employees, one week had a doctor working 65 hours, with sporadic night shifts and day shifts with little time to recover in between. Indeed, the time needed to sleep between two night shifts was called a “day off” – this is like the employer in any other sector, for an employee working a 9am – 5pm day, calling 5pm – 9am a “day off”. It is not compatible with raising a family or maintaining a work-life balance. The sporadic working reduces continuity of care and increases the chance of error. All in all this affects patient safety. There is inadequate recovery from a long night shift – tired doctors make mistakes. There will be fewer, more tired doctors during the week. It will bring the junior doctors to their knees, and eventually the NHS.”

Q. Most jobs don’t pay for unsociable hours, why should we sympathise in this regard?

“It is important that the contract is fair to doctors and safe for patients. Currently, doctors are paid a premium for working past 7pm and -on weekends – are paid a premium to mirror the additional responsibility.  Under the contract that Hunt is imposing on junior doctors this August, ‘plain time’ – that is, sociable working hours – are classed as from 7am in the morning to 10pm at night Monday to Friday, with 7am to 7pm on Saturday classed as a normal working day. It is not fair that 7pm on a Saturday night is seen as exactly the same as 10am on a Tuesday morning.

Junior doctors who work unsocial hours should not be disadvantaged, and those doctors working the most onerous and most unsocial working hours need to be appropriately reimbursed for the responsibility they are taking and to ensure their specialities do not continue to suffer recruitment problems.”

Q. Do you think that the overall response would be as contested if it were not a Conservative government making the changes?

“Junior doctors and medical students, from all different backgrounds and political affiliations are angry about this imposed contract because it is not fair to them, and not safe for patients. The demands of junior doctors, and the BMA, which is an apolitical organisation, are for the Health Secretary to come back to the negotiating table without forcing preconditions on the discussion and without the threat of imposition of this unsafe contract in August. The NHS is an organisation that is very close to the hearts of everyone in the UK and it transcends any one single political party. The imposition of an unsafe, unfair contract strikes a chord with medical students, junior doctors, consultants and members of the public because it attacks the very sustainability of the health service. This is done by attacking a workforce that willingly gives their working lives to NHS to care for the patients that rely on it.”

(Devil’s Advocate: Dan Robertson)

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