An idiot’s guide to the junior doctor dispute

The junior doctor contract dispute is really hard to understand. Especially if you work for the Government. So here are some easy-to-read answers to common questions on the topic.

Who cares about junior doctors anyway? Bloody kids.

You should care. ‘Junior doctor’ is a huge misnomer, referring to every doctor who hasn’t finished their training to be a consultant yet. Seeing as this training lasts around a decade after medical school, many ‘junior’ doctors are over 30 years old, and quite a few are over 40. They’re so experienced they can do complex operations, take care of the sickest of ITU patients, and run whole departments at certain times. This is on top of doing a lot of legwork like blood tests, ordering scans, being the first to respond to ward emergencies and writing discharge letters, making them integral to the whole NHS. So when 98% of a 76% turnout of them vote to go on strike, you should switch your ears on.

But isn’t their new contract vital for a ‘7 days NHS’, which sounds lovely, whatever it is?

No. The new contract aims to make us work more weekends (for the same money), but junior doctors already work them frequently. We usually do the routine work (clinics, elective operations..) from Monday to Friday and only provide urgent care on the weekends, because the NHS isn’t well enough staffed or resourced to do routine work on all 7 days. Hunt’s idea of a ‘7 day NHS’ seems to be to expand routine work into the weekend, but the new contract won’t help with that, because there will still be the same number of us working the same number of hours (apparently) across the week. If we do more weekends it’ll mean the weekdays are less well staffed, and services aren’t geared to do routine stuff on the weekends anyway. This infographic explains it well.

The only real way towards a ‘7 day NHS’ is to hire more staff, but staff cost money and the NHS is meant to be saving £22bn over 5 years (LOL).

Jeremy Hunt likes to say that more weekend cover is needed because the death rate goes up on the weekend, but the editor of the medical journal that he stole his stats from, and the author of the actual research itself, have called him out for misunderstanding it. (You’re more likely to die if you’re admitted to hospital on the weekend because you’re more likely to be sicker to start with, not because there are less staff around).

My Tory MP says this is ‘effectively a pay dispute’. Are you calling them stupid?

Kind of. It’s likely to be quite hard for them to imagine that people could kick up a fuss about anything other than money. Yes, the imposed contract does suggest that after a few years of suspiciously labelled ‘pay protection’ (protection against what, if not an eventual pay cut?), many of us might end up being paid much less on our new rotas, but we’re more concerned about other aspects.

By the way, junior doctors aren’t the Porsche-driving, champagne-bathing millionaires that some think they are. Our starting salary is in the £20,000s and our student loans now top £50,000. But even so, we’d never call ourselves hard off, or go on strike just over money.

So why are you standing out in the rain holding signs?

Many reasons. Here are just a few:

  1. The new contract is brazenly sexist. The hours we’ll be asked to work include more evenings and weekends, which disadvantages women, especially single parents, as finding childcare at those times is near impossible. The Government’s own Equality Impact Assessment (produced in a flash after the BMA resorted to threats of legal action) contains choice cuts like “some aspects of the new contract have certain adverse impacts regarding maternity” and “any indirect adverse effect on women is a proportionate means of achieving a legitimate aim”. Not okay in 2016 (or ever, actually).
  2. Currently, if a junior doctor wants to retrain in another specialty halfway through their career, for example if they have a baby (are you sensing a pattern here?), they continue up the payscale because the NHS appreciates their loyalty and experience. Under the new contract, this would only happen if they switch to a ‘shortage’ speciality that needs the staff. Apart from being a crap way to tackle recruitment problems in ‘shortage’ specialties, this severely restricts doctor’s ambitions. Imagine realising at the late age of 27 that you want to be a surgeon, not a GP. That’ll be a pay cut of about £10,000.
  3. Saturday 9am-5pm being ‘normal working hours’ and paid at the same rate as Monday to Friday working. Give Jeremy Hunt’s office a ring on Saturday to discuss this further.
  4. The safeguards against being overworked are weaker than your gran (no offence). On the current contract, our hours are monitored regularly on a group basis. If a group of doctors are working too long and hard, their ‘banding’ payment goes up. No one is singled out. On the new contract, if you think you’re being worked too hard, you have to (personally) report to the ‘Guardian of Safe Working’ who (the Government think) will be delighted to meet you, won’t mention to anyone how troublesome you’re being and will sort the problem straight away in a blame-free and paperwork-light manner, resulting in a fine imposed on the Trust by itself. Welcome back, 100 hour weeks.
  5. Pay for being on a non-residential on call rota (where you’re based at home and are called out to a potential multitude of locations) is being cut from 20-40% extra on top of our basic salary to 5-10%, because Jeremy Hunt thinks we spend that time sleeping. Tell that to my 18 hour shift last week. You’ll be paid for each hour you’re called in, but that’s just going to be an incentive for you to become a ‘last resort’.
  6. Not letting junior doctors work for anyone else in their time off unless their own Trust has turned down an offer of locum work from them first. Freedom of trade isn’t always a virtue, it seems.

Why can’t you all just talk like grown ups?

Good question. Being mature adults has been a consistent challenge for the people in charge of negotiating the contract. For a while, the BMA threw their toys out of the pram and decided that refusing to talk to Jeremy Hunt was the best option. Presumably the only person in their office with a GCSE in political strategy was on holiday. Of course, they got shafted for being intransigent. Now it’s Hunt’s turn to be all bulshy and refuse to talk it out like a big boy. He recently responded to an urgent parliamentary question by facetiously asking how long he should have been expected to talk to the BMA for without reaching an agreement. [The correct answer is “as long as it takes to avoid alienating and demoralising* an entire generation of doctors and driving their hospitals further into abject desperation as a result”].

The BMA has repeatedly offered to call off the strike if Hunt agrees not to impose his contract. He has declined this offer because he cares less about NHS staff morale than I care about what homeopathic remedies he recommends (because he does).

Won’t going on strike lead to a Rambo-esque body count?

You’d think so. But no. When we went on strike before, we kept providing emergency cover. It was like a weekend or Bank Holiday; there would be a reduced team of doctors dealing with urgent stuff while the routine stuff waited. This was obviously safe, but annoying.

With the upcoming strikes, we’ll be withdrawing this emergency cover too. Despite the fact that this is another huge PR fail from the BMA, giving the Government a free shot at us as callous and disproportionate for no actual strategic gain, it’s still safe. Consultants can cover junior doctor duties as well as their own by cancelling routine tasks like clinics. In special cases when this isn’t possible, junior doctors won’t go on strike. We aren’t monsters – and we’re vaguely smart – so we’ve planned for this.

So what’s going to happen now?

No one is totally sure how the endgame of this life-size, shitty game of chess is going to play out.

It seems unlikely that Hunt is going to go back on imposing the contract, because his switch is stuck on ‘vile’, so something else will have to happen to shake things up.

It may be that the five junior doctors who crowd-sourced £130,000 to take Hunt to the High Court win their case. The court will decide whether Hunt actually has the right to impose the contract, or has illegally overstated his powers, misled the House of Commons and caused the strike as a result, like a bastard. It wouldn’t be the first time.

Or it may be that Foundation Trusts, who independently decide what contracts to offer their employees, valiantly and rightly decide not to use the new contract. But then Hunt might pull their funding for training, leading to a whole new level of nasty legal disputes.

Or (*prays vigorously*) the public pressure might become too much, and Hunt may be asked to resign by Cameron, or more likely, moved sideways in a face-saving maneuver following the EU referendum. His successor might not be any better but at least they might decide to start afresh and trash the contract.

The final option is that the contract goes through, the Foundation Trusts suck it up, and a large swathe of junior doctors quit medicine or move abroad, stretching the remaining staff thinner than the Tory majority.

This all sounds like an industrial-strength shafting. How can I help?

Good question, and thanks for the offer. You can show your support by writing to your MP, to Hunt or to Cameron, by signing the various petitions going around, or by turning up to pickets to supply us with coffee/umbrellas/flak jackets/antidepressants. Importantly, if possible and safe, you could try to avoid using NHS services on strike days to lighten the workload (but please do use them if you have to), and stick up for us in discussions with people who don’t see things our way.

*To be fair to him, Hunt did call for an inquiry into junior doctor morale. Also to be fair to him, he excluded ‘terms and conditions of labour’ from what could be discussed in the inquiry, and then blamed junior doctors for not engaging with it as a result, which makes him a 24-carat weasel.



About Alex Langford
I am a psychiatrist (now an SpR) based in Oxford after 3 years working in South East London. Before I went into psychiatry, I used to be a general medical doctor, and I also have a BSc in psychology. I'm particularly interested in improving the public face of psychiatry, evidence based medicine, teaching and patient rights. Don't mention cricket unless you've got the next fortnight free to discuss it.

7 Responses to An idiot’s guide to the junior doctor dispute

  1. Reblogged this on Rose Tinted Ramblings and commented:
    Support our junior doctors… sign the online positions, pop down to the picket line for a chat . Take coffee, take doughnut (actually make that bananas, apples or another one of their 5 a day… gotta keep them healthy)
    Maybe write to your MP or Mr cHunt himself (although if you have a Tory Te*t in your constituey you may well feel as I do that its a waste of ink and paper).
    Maybe stick a poster in your car window…
    Read this blog by Alex… it might help…

  2. hiya, good read. Good Luck, we are on your side. Have reblogged , tweeted and posted to my FB page , Lady Lily the Pink

  3. Alexandra says:

    Dear Alex,

    I am also a doctor and I am interested in persuing a career in Psychiatry. Could you tell me what are the main roles of a CT1 in Psychiatry? U mentioned that as CT1 you were taking bloods for example. What else did you do as a CT1?

    • No problem, glad you’re considering it. CT1-3 are the SHO years. It depends on the job but on inpatient wards you’d be doing the usual SHO stuff (bloods, drug charts, writing ward round entries, keeping a list) but also dealing with mental health (and certainly physical health) situations that your seniors aren’t around to help with or delegate to you. The community jobs tend to be more autonomous, you’d have your own clinics and home visits. The on call usually involve A+E assessments and/or clerkings. Trainees get an hour a week of supervision time with their consultant and often get around a day a week of teaching/psychotherapy training, which is generous. Like any speciality there will be good and bad jobs, but I love psych for the variety, the colour and the huge amount we can do for people. I hope you do apply, and good luck with it.

  4. Alexandra says:

    Thank you Alex. Could you give some advice in applying for CT in psychiatry with regards to north west deanery, particularly the greater Manchester scheme?Any particular deanery you recommend? I have some experience in child and adolescent psychiatry which but none in adult psychiatry. Have you ever felt that your safety was put at risk as a CT1 in the adult psychiatry wards/ A&E, particularly with the certain patients? Did you feel you were given enough supervision on the beginning of the program?

  5. I wouldn’t know about Manchester; I trained in South East London (SLAM) which was excellent and I’d recommend it. Lots of specialist services and a big cohort so and excellent training environment. Psychiatry is not really dangerous; most of only adverse events I’ve seen or heard of were as a result of people unthinkingly putting themselves into tricky situations. Our patients are more vulnerable than dangerous. The supervision is always dependent on the individual consultant but I felt adequately supported.

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