The drive to reform the NHS must be careful not to alienate the very people who can make it happen, writes Dr Na’eem Ahmed
The British Medical Association has announced further strike action this week. Sir David Dalton states, in his most recent letter, that the main unresolved issue is pay and more specifically pay linked to unsocial hours.
Remuneration and potential issues around safety are important but Sir David’s final paragraph is a welcome observation – the undercurrent to this dispute is that junior doctors have been suffering from low morale for some time. Recent negotiations have piqued these feelings of discontent.
The current impasse needs an urgent, but compassionate, intervention. The drawn out negotiations and counter-arguments are alienating a highly motivated workforce and risk losing the tremendous goodwill that keeps the NHS running.
The strength of opposition to some of the contract changes mean that unilateral imposition could lead to an exodus of doctors and good future candidates choosing alternative careers, limiting our talent pool. And in matters of life and death, we require high-achievers – we should not compromise on this.
Uncertainty and disruption
There are no winners in this dispute. Doctors dislike industrial action and risk deprofessionalisation. Government strategists will be keen to end this feud with a junior doctor collective that are vocal, articulate and continue to dominate headlines, with public support. The public also appear to get little value from these contract changes, facing uncertainty and disruption in their health service in pursuit of a reportedly cost neutral programme.
The longer-term effects of this dispute are already being felt, with a fall in the number of applicants to medical school. The financial uncertainty surrounding junior doctor contract reforms risk exacerbating existing inequalities in selecting our future doctors. The cost of university education is rising; meaning that despite noble intentions, for those that are less affluent, financial security will increasingly become the determining factor in choosing whether to become a doctor.
Junior doctors currently juggle a nomadic lifestyle for up to a decade during training, with making time to achieve their personal milestones
Current consultant contract negotiations may mean that the much feted ‘light at the end of the tunnel’ may not be that bright. Junior doctors currently juggle a nomadic lifestyle for up to a decade during training, with making time to achieve their personal milestones. For those doctors with dependents there is an added complexity of the proposed extension of normal working hours.
Footloose and skilled
Perceived pay cuts, increased antisocial working and feelings of being undervalued mean that bright students with financial constraints or additional responsibilities will choose alternative careers. In a free market, footloose and skilled doctors that are currently working in the NHS may opt to move abroad – taking with them expertise and the taxpayer investment that helped to train them. Our NHS will be worse for it.
Decisions made on the junior doctor contract will inform who we want delivering our health service in the future. A world-leading health system must unashamedly hire top talent to look after our patients. Current determination to pursue reform, although necessary, may preclude this unless we reach an agreement that will not affect the motivation, recruitment, and retention of a high quality frontline workforce.
Dr Na’eem Ahmed is a junior doctor in London (@DrNaeemAhmed).