Dear Mr Hunt & Mr Mortimer
Mr Hunt, I wrote to you last week with respect to my worries surrounding your announced imposition of the new junior doctor contract. I sent it also to the conservative MP in my constituency. I am not sure if you’re read it? To my surprise over 22,000 people did, so perhaps you are in that number. I chose the form of an open letter because I find that sometimes when you find yourself in a difficult situation, knowing that you’re not alone is therapeutic in itself. I have now realised I am not at all alone in my concerns. But I do have some further questions and I thought perhaps it would be useful to copy Mr Mortimer in this time also.
I read with surprise in the DDRB report that NHS employers expressed a concern that doctors would have ‘incentive to work slower’. I don’t believe I have read another piece of information about this entire saga that has shocked or saddened me more. So let me tell you a little bit about how I work:
One day I saw a man on my ward dying, it was early in the morning before ward round. Most junior doctors come into work before their working day begins. This was a natural death, he was more than ninety years old. He needed me and so I sat with him until he died. My preparation was for ward round was delayed, things happened slower than they would have been the day before. I make no apologies for that.
One day I was the house officer on call for surgery. It was a weekend, I did a twelve and a half hour shift. I had more than a hundred patients on my wards. It was busy. So busy that I could not take a break because everywhere I went there were patients who needed me for cannulas, fluid assessments, observation reviews. So I worked quickly and I did not stop.
One day I was intubating somebody for surgery. I knew that they needed me to get it right. I wanted to get it done as quickly as possible, but my consultant told me to work slowly and take my time, because keeping that patient safe was most important.
I think you might be getting my point? Medicine is not a conveyer belt. I am a professional, I am licensed, endorsed by the General Medical Council and I work to the standards of good medical practice. My incentive to work slowly is the patient. My incentive to work quickly is the patient. The prerogative to choose which is mine.
I read with interest the questions the British Medical Association (BMA) had about the potential for discrimination of certain groups; female doctors, disabled doctors, those that become temporality unwell or choose to devote some time to research in medicine. You might also recall that I mentioned them in my last letter too. I found it surprising that the response from NHS employers was not that the BMA were wrong, but that if different groups were affected differently then it was ‘reasonably necessary to achieve business objectives’. I understand that NHS employers even felt it necessary to obtain legal advice on the matter. While it isn’t my aim to confuse ethics with law, I have to say if I needed legal advise on something similar, it would be because I was not actually sure I was doing the right thing at all. I also have some issues with the idea of ‘reasonable necessity’. The current contract does not create these questions of discrimination and so some might say surely it isn’t necessary at all? I will leave this point I think by asking if you might like to contemplate all of the other unjust practices in history that were thought to be ‘reasonably necessary to achieve business objectives’ at that time.
The next question I have is about the ‘cost neutral’ stance of this contract. Using the very best information available to us, most junior doctors are anticipating a pay cut. Additional to this it is clear from the DDRB report that there will be actually be cost savings for NHS employers over time. I have mentioned in my previous letter that there is already a crisis in recruitment to specialties. The example of medical registrar is from my own experience but A&E, psychiatry and GP are also among those worst affected. The term ‘flexible pay premia’ crops up a lot. From what I understand they are to be used to plaster over many of the holes in these proposals. I find it absolutely unfathomable that despite this contract creating savings for NHS employers that those savings will not be recycled back into the pay envelope to help us deal with the recruitment crisis and pay discrimination this contract creates.
I also wanted to discuss with you comments in the DDRB report that highlighted NHS employers desire not to create a system where ‘doctors in training could claim additional money for every extra minute spent carrying out their duties’. The NHS is held up by the good will of its staff, not just doctors but all NHS professionals. If there was a risk of doctors claiming money for ‘every extra minute’ I am fairly certain that the health service would have crumbled long ago. As it is, we are falling to our knees; I should think that you would be better engaged in helping us up not pushing us further into the ground.
I have more questions, but I think that is enough for now. I hope I have now explained to you at least in part why I feel so disrespected and undervalued. I think you will find I am not alone. Someone told me that the key to negotiation is that neither side looses face. I think that perhaps at first, it is reconciliation that should be prioritised here. As Nelson Mandela rightly said ‘only free men can negotiate’. If we wish to say in our homes in England, we as doctors do not have anywhere else to turn, you have the monopoly on our talent and skill. I’m sure you will understand therefore why, with the threat of imposition hanging over our heads, we do not perhaps feel free to negotiate.
Dr Aoife Abbey
PS – If you have not yet had time to read my first letter, I would very much be obliged if you could read it now.