A majority of hospital trust chief executives who responded to an HSJ snap survey believe the government should press on with its bid to change the junior doctor contract.

Twenty-five acute and specialist trust leaders responded to the survey, which was open for 24 hours. It was sent to 144 chief executives, covering nearly all the acute and specialists in England.

Asked whether, in light of the current high profile dispute over the contract, the government should continue seeking changes at the present time, 72 per cent of respondents said “yes”. The remainder said “no”.

Several of the chief executives who said “no” warned of the impact on morale and relationships with trainees.

A number of chief executives expressed concern about the handling of the dispute, pressures on junior doctors, and the lack of accurate information about the proposals.

HSJ asked chief executives whether they supported three individual elements of the government’s contract proposals. All three had the support of the majority of respondents, but the least supported was extending plain time to 10pm on weekdays and to Saturdays, with 65 per cent backing this (see graph below).

When asked about potential outcomes from changes to the contract:

  • 84 per cent said it was unlikely or very unlikely it would result in working arrangements that were unsafe for patients.
  • 73 per cent said it was likely or very likely it would improve care quality outside of normal working hours. Slightly more than half said it was likely or very likely it would improve quality in general.
  • 73 per cent said it was likely or very likely to lead to a worse relationship with the workforce, and 76 per cent said it was likely or very likely to create worse morale among junior doctors.
  • 58 per cent said they did not know if the changes would reduce costs, and 34 per cent said this was unlikely or very unlikely.

Several chief executives, asked for comments on the contract debate, said they believed the dispute could have been better handled.

One said: “The system cannot continue as it is. Medicine is a profession and people need care seven days a week. Extra payments for weekend aren’t sustainable and we can now do most other things seven days a week.

“Doctors have to come to the party or there won’t be an NHS. Unfortunately they can cause chaos with industrial action but a professional wouldn’t strike if they put patient safety first; fair pay for fair work.”

Another said: “I think the current [contract] arrangements are outdated and unhelpful. However, there is so much confusion about what is proposed and how it will affect people that even juniors who will gain perceive that they need to fight to ‘save the NHS’.”

One chief executive called for more information from negotiators about proposed changes, and said they should not be imposed.

Another added: “I feel this is the right direction of travel but done in the wrong way. The junior doctors now feel under siege, undervalued and over worked - morale is low.

“Somehow this has become about money - the patient and care quality should be the discussion point.”

Snap survey: Hospital chiefs back bid to change junior doctor contract