Dear Mr Hunt
This is not a letter about the ‘7 day service’ shaped political football which seems to be is perpetually in play. This is not a letter about the consultant opt-out clause. It is not a letter about the difference between elective and urgent care. This is a letter about the unjust and unsafe contract which the junior doctors of this country have been threatened with. I am by no means unique or particularly special among my profession, but as I stand aghast at the proposals being thrust upon us, I can only presume that you do not truly understand what they will mean for my colleagues and I. As Atticus Finch told us “You never really understand a person until you consider things from his point of view…until you climb into his skin and walk around in it.” This is a philosophy we often use in medicine, it helps us deliver patient centred care. I thought perhaps a personal story would help you understand why we have come out in force against the proposed junior doctor contract.
I am junior doctor in the West Midlands. I left medical school in 2011 and went straight into training, I worked hard to secure my higher training number and I am now an intensive care trainee at ST3 level. I am a junior doctor that works a minimum of forty eight hours a week. This of course does not include the hours outside of this spent developing my knowledge and skills. I hold myself to high standards. I participate in research and audit. I take exams. I care about patient safety and I try my best to be an agent for change wherever I work. As a junior doctor on an training programme, I work side by side with locum staff who do my work for four times more pay than me.
I am an junior doctor who takes time to hold her patient’s hands. I listen to patient narratives. I reflect on and learn from my mistakes. I support my junior colleagues. I engage in teaching the new generation.
I am an asset to your NHS.
I am a junior doctor who has not been able to plan my life further ahead than four months since I graduated in 2011. I cannot plan to go on holiday next summer or RSVP for my friends wedding in the Spring. I am a junior doctor who has not been on a summer holiday in the past five years. I am a junior doctor who does not yet even know if she will be spending this Christmas with her family or in work.
I am a junior doctor who cannot afford to stand down while your party impose a new contract.
Do you know that you are giving me a pay cut? The new contract will cut my pay by somewhere between 12 and 15%. I cannot understand how any government can look the doctors of this country in the eye and say we deserve this sort of pay cut. I feel this reality has been glossed over and dressed up as something else. Perhaps it is too uncomfortable or impossible for you to defend and so you have chosen to pretend it is not the case. Unless the bank are willing to take the equivalent sum off my student debt and mortgage repayments, I do not have the luxury of pretending anything.
Do you know that we have huge concerns that the new contract deliberately discriminates against women in medicine? That the contract will make it even more difficult for not only women, but those unable to do full time training for any reason to work within the NHS? Have you considered the effects of inhibiting this diversity in medicine? Do you understand that to place the massive burden of financial penalty on any doctor who realises that their skill is best suited to another speciality is not in the best interests of the NHS?
Do you know that the new contract would mean it would be perfectly reasonable for me to do a 12 hour shift with just two twenty minute breaks and if I start a shift at 8am I would not be entitled to any break until after 2pm that day?
Do you know what it is like to work in an understaffed district general hospital? My most recent medical placement had 4 filled slots on a medical registrar rota for 12. Do you think this new contract will attract more doctors into these jobs?
Do you think you could consider what it is like to have the weight of person’s life in your hands? Not in an abstract sense, not from the point of view of having to make decisions that affect a body of people’s lives as I understand you do. I want you to consider what it is like to stand beside a patient and their relatives and tell them that you will do your very best to look after them in hospital. Or tell them that your team has done all they can and you think they won’t survive. To hold their hand while they die or take on the responsibility of letting their family know that they have an incurable disease. To know that if you are too tired or too distracted by personal things you can make a judgement call that brings about a death. Can you picture it? What do you think your emotions might be? I can tell you that contrary to some opinions, I, like most junior doctors happen to be quite good at these things. We have gotten to where we are by displaying both strength and resilience. I am not however a machine and I do require to be well rested, supported, adequately recompensed and valued in my work place. As a doctor, I somehow feel ashamed that I have to say that, yet regrettably this is where I have been pushed.
During the London Olympics we watched the NHS held up as an ideal for the whole world to see; shiny happy doctors, dancing and singing with their colleagues. I am imploring you that if this government impose this unfair contract you will break us. Please understand that broken doctors do not dance, they do not sing and they certainly do not deliver a first class service.
Dr Aoife Abbey