To all my friends, medical & non, and the general public,
I am a junior doctor. Currently at FY2 level I have been working in the NHS for about 15 months. To get here I have done a 3 year undergraduate degree, a 5 year medical degree and now a year and a bit of qualified work. Throughout that time I was also working 2 part time jobs at a time to try and fund the copious quantity of debt that I was racking up to support myself through. As it stands I still have 10s of thousands left to pay off this debt and this will take 20+ years on my current wage, because honestly I don't earn as much as you might think. And I'm fine with that because I love my job. I currently work in a Neonatal medicine unit, helping the team look after the very sick babies. We cover this 24/7 365 days a year, and that includes the "juniors" the FY2s up to the ST8s (10 years out of medical school) and the consultants. For this I get a basic wage which also has a supplement called a banding, for this job I get 50% banding because of the high level of out of hours - late evenings, nights and weekends, involved in this role. At the end of the month I come home with about £2,000, which equates to around £9-10 per hour based on the hours I actually work. I am writing this letter as I have come off night shifts after an 80 hour week, before starting my next stretch of working 12 days and approximately 100 hours before I get a day off. On my next job I'll come home with about £1500 a month for working 8-6 seeing patients at a GP practice.
Take heed, the government are trying to attack the medical profession, they would have you believe we are lazy, money grabbing, and have no sense of vocation. As a whole we vehemently disagree! The vast majority of us entered the profession with a genuine desire to make a difference, from healing that little wound to saving the life of the person coming in through A&E with a massive heart attack, or holding your hand at the end if there's no medical avenue left to pursue. We work outside our rota'd hours regularly to do this without complaint or desire of recognition for this, and we do it because we care.
You may or may not be aware of the changes coming into effect with the junior doctor contracts. To give you an idea of the back ground, contract negotiations were ongoing last year, the BMA our union walked away from these when the government bodies declined to negotiate, they were forcing through main points and refusing to negotiate them to a place of mutual agreement. The BMA stated they would not return to negotiations unless the talks were a discussion and not an enforcement. The government declined to do this and have since decided to enforce these contract changes without our input. These changes are dangerous, they will have a significant impact on patient safety, recruitment and retention of medical staff and are seemingly the first steps to privatising the NHS completely which will result in many patients being forced away from seeking medical attention. Now let me also say that we have been aware of this situation for months and the BMA have actively been seeking solutions to get the government back into talks, as they will not drop the absolutes and negotiate we will not come back to the table either leading us to give serious consideration to industrial action.
The first many people heard about this was the trickle into the media that consultants were option out of weekend work and as such death rates sky rocket during this period. Media propaganda stating we are not covering hospitals with enough staff at the weekend is significantly affecting patient safety. Many patients are delaying seeking help at the weekends as they think they are u safe to be in hospital at this time, which is just an outright lie being pumped through the media from the government press machine. It has been shown many a time that more unwell patients are admitted at the weekends which directly affects mortality rates. Studies during strikes also show that death rates massively decrease when elective procedures stop. The government would like to introduce a 7 day NHS. They are using this term misleadingly as this 7 day service exists. What does not exist on a 7 day basis is routine scanning, clinics and surgeries or diagnostic procedures. Studies have also shown that well planned surgeries result in better outcomes, and that extending these services has no real effect. If you have a surgery you will need recovery time off from work following this, so does it matter if that surgery is done on a Saturday rather than an alternative week day? What we do know is that if this service is to be fully extended then a significant amount of funding will have to be found, what we don't know is where this will come from, it seems that we are being expected to deliver an extended service at the same cost.
Furthermore, emergency services are ALL fully covered at the weekend with similar amounts of staff of the weekday level, this is because MORE patients come through the A&E doors on a weekend. So if you need to come to A&E you WILL be seen, and quickly if your life is at significant risk just like through the week. It is the less urgent cases I.e. cuts, scrapes, minor burns, coughs & colds that will take longer to be seen, because frankly they shouldn't be in an A&E department in the first place. Pharmacies, over the counter preparations and walk in centres are more than adequate to treat these symptoms. All hospitals have consultant cover on the weekend, A&E has full cover, scanning is available, and medical and surgical consultants are present and ready to spring into action when needed, and continue to review unwell patients over the weekend on the wards. It is only the most stable of patients, such as those waiting for social care for discharge, who would wait until Monday for a further review, or be reviewed by the extensive team of juniors that are in the hospitals 24/7, and should they become ill again, guess what, here's that reliable consultant staying late to make sure that patient is cared for. Less than 0.1% of consultants have opted out of weekend working, those that have done so are due to health concerns that would make it unsafe for them to be working extra hours. Even those specialties that only have rare emergencies so do not require the most senior medical cover to be resident on site out of hours, that specialties consultant will be on the end of the phone supporting the "juniors" that are on the shop floor. It is worth noting that the term "junior" covers any doctor from the newly qualified FY1 up to the ST doctor who is just completing their competencies to gain a consultancy post.
On the whole we all support the idea of extended services. What we can't support is the lack of safety for patients and staff in the current proposals, and the pay cut we would have to take to allow this to happen. In real terms we will see between a 12-30% cut depending on how heavily your wage was subsidised by banding. As my job is fairly heavily affected by this my cut would likely be closer to the 30%, and as I've already said with the sheer amount of debt I have I would no longer be able to make repayments and meet my living costs. Ask yourself this. Could you afford that kind of real term cut to your wage? Could you meet your mortgage payments, buy your kids school uniforms etc? This will occur due to the redefinition of sociable hours. The government state that they are bringing our sociable hours in line with other healthcare professionals, yet the hardworking nurses and porters etc who help run the system efficiently and deliver excellent care have sociable hours of 7am to 8pm Monday to Friday, ours would be 7am to 10pm Monday to Saturday. Families will be hit hardest by this, they will lose time with their children, and inevitably miss more events than we already do. I've seen the struggles of my colleagues trying to ensure they get leave for their own wedding let alone those of friends and family. The government spins that our basic wage will increase and out of hours pay will be higher and as such our pay will rise, but this is a smokescreen as the redefinition of hours means a real cut to most. In the same sentence the same politicians will say that we will get a pay rise, yet we are told that these changes will be 'cost-neutral' but if this is the case then who stands to gain? It's not us on the shop floor given the financial projections that have been released for us, it seems to be the government from the higher levels of tax and national insurance which will be paid by us with the new contract.
Not only are we facing a real time cut we are also having our benefits of pay progression take away. In the current system our pay year on year is frozen. We do not get the 1% pay rise that the public sector do, and this has been the case for years. What we do get is pay progression. This is a small increase in basic pay each year according to the level of responsibility increase seen with each advancing year of our jobs. In the new system there would be only 3 progression points and still no yearly wage rise in line with inflation. This equates to an ST3 doctor being paid the equivalent rate of a doctor 5 years their senior, and all of us taking a real term pay cut year on year. Not only that but if we change our minds about career direction, and let's face it - we're human our situations and decisions change, we would be penalised with a pay cut as the pay protection we enjoy now is abolished.
The NHS system of 20 years ago has been vastly improved upon. We now deliver world class healthcare at an extremely efficient cost based on GDP and per head spend, better than most European countries and about 5x cheaper than in America without us having to pay at point of contact. If the system continues changing as it is we will have an NHS that is more like Americas private health care. Do you want to lay £200 for that X-ray when you've fallen? Or £85 to see your GP? £1000 or more for that overnight stay in hospital? 20 years ago the doctors were working 100 hour weeks as standard. This was abolished due to the safety implications for the patients. The simple fact is, humans when tired make mistakes. Under the new contract while our hours would be capped at a measly 72 hours per week, their is no way to penalise the hospitals for extending our hours more than this as there is now through the banding system. This will only get worse if the European working time directive is successfully scrapped. And not only will our hours extend, but our leave will be reduced from the 27 days and bank holidays now, to 25 days inclusive.
Whatever your view on doctors I'm sure we can all agree that a private healthcare system is not the way forward for the NHS. It is our institution, a stronghold of the nation and should be treated with respect and funded adequately to maintain it. Particularly given that our population is ageing, becoming more unwell, facing more cases of cancer and dementia than ever before. Would you want your family member to have to sell their house if they develop dementia to pay for their care? This is already happening and will get worse if the system becomes private. We don't want to strike, we want to carry on working with a little respect and dignity in an extremely tough environment and we will strike if necessary to get our message across. The protests are happening, the media is not covering them as they are peaceful, we're not looking to create headlines we're standing up for our NHS, our careers and the safety of our patients and families. You can slander us in the media, ignore our pleas, but we'll still be there fighting for the NHS and providing the best care to you up In the hospitals across the country.
To the rest of the junior doctors struggling with the uncertainty, stay strong! The government doubts our resolve over the strikes, we must stand firm. To the other healthcare professionals, bear with us while we strike, we know your work load will be increased and we appreciate the support. To those that didn't know what was happening or on some level don't agree, get informed and join the cause, it might be your profession next. To those that stand by us, thank you. To those that agree but haven't gotten involved yet, join us in standing up for the best worldwide health care system there is! And to the government of our supposedly democratic nation, please listen to the masses, drop your pre-conditions and go back into negotiations with the BMA.
Thank you for reading.
Dr Hayley King,
A tired, disgruntled but hopeful NHS doctor.
