I love being a consultant in the NHS. Many years ago, I loved being a junior doctor. Even when I was working a 120-hour week, undeniably exhausted and a long way from what is now called work-life balance, I was sustained by a metaphorical – and occasionally real – mentor’s arm around my shoulder telling me that one day, all this could be mine.
Medical apprenticeships now are no easier than they were: weekends on call have been replaced by punishing 12-hour shifts. A doctor coming on shift is handed a long list of tasks: when they eventually hand over to the next team, they pass on a similar one. Many teams are understaffed, there is not much continuity of care, often not much feedback on performance and, increasingly, not much thanks and appreciation.
On top of working conditions that are far less attractive compared with those that juniors can find in Australia, New Zealand or India, real pay has been so eroded that some doctors starting a career with more than £50k debt find it genuinely difficult to pay for public transport to get to work and eat on the same day. It’s hardly surprising that given this backdrop, doctors below consultant level are demanding higher hourly rates.
But is a 35% rise realistic? The British Medical Association is pushing hard for this with no visible evidence of compromise, but it may find it difficult to persuade the million or so healthcare workers who have settled for 5%. There appears to be a standoff between the BMA and government officials, with little understanding on either side of the other’s position. But with a few changes, this could be addressed quite simply.
First, pay properly for overtime. Junior doctors who currently work beyond the hours of their shift report this via a written system of exception reporting. This does little to benefit individuals but often engenders significant ill-will among senior doctors, many of whom maintain that professionalism in almost every field involves working extra hours. Junior doctors know this and are usually reluctant to fill in the forms.
In Australia and New Zealand, doctors clock in and out electronically and are automatically paid for overtime, with much publicised results on UK doctor recruitment. Why not just pay our doctors for what they do at a reasonable rate? Time and a half, say three hours per week. Cost: about £130 per doctor per week.
Second, pay for the training courses needed to become a consultant. It costs upwards of £1,000 to sit professional exams, but attendance at courses required for higher training can be even higher and is often compulsory. If a doctor is going to work for an organisation at consultant level, surely there’s a case to be made for that organisation to pay for essential courses.
Third, hot food at night, which is not available in most hospitals. If a lawyer or a banker pulls an all-nighter to meet a deadline, they get fed, usually for free. This would be easy to provide in hospitals. And for goodness sake, abolish car parking charges for those who have to drive to work.
These steps to improve working conditions don’t address the pay gap that has widened so much over the past 15 years, but would begin to show that the NHS values junior doctors, which could make a big difference.
What else can the NHS do to value the junior doctors who are so important to it? Well for one thing, it could do something about the ludicrous system of recruiting trainees and then sending them to remote parts of the country, often away from family and even partners. A little consideration here would go a long way.
We could also do something about the enormous debt that newly qualified doctors accumulate before they start earning. They are medical students for six years while their peers have three- or four-year courses. Subsidising tuition fees for the last two years (rather than one year as at present) would make a big difference to finances in the early years after qualification.
But what about salary, the main advertised cause of this dispute? The BMA leadership have been bullish about demanding a 35% increase, although they say it is pay restoration to 2008 levels rather than a pay rise. At the very least this is an ambitious target– but this dispute is not simply about money. The junior doctors I have spoken to could be reconciled to a pay rise more in line with other groups, given some of the steps I have outlined here, accompanied by a review of the doctors’ and dentists’ pay review board and perhaps a commitment to address this pay erosion over five years.
One thing is certain: unless we realise that this dispute centres around a young, talented and committed workforce who are genuinely demoralised and fed up with current working practices, large numbers will leave, with unpleasant consequences for their colleagues – and most importantly of all, for patients.
Stuart Bloom is a consultant physician and gastroenterologist at University College Hospital London
