Jeremy Hunt’s decision to impose an unfair and unjustified contract on junior doctors will have serious and long-term repercussions for patient care throughout the NHS and the current, as well as the next, generation of trainee GPs.
There is little doubt that junior doctors will be demoralised by Hunt’s decision this week. The imposed contract will strip away the current reasonable pay system that compensates them for working unsociable hours deep into the night on weekends because of the ludicrous suggestion that it somehow prevents the government’s much eulogised 'seven-day service'.
Leaving aside the fact that ministers are still to define what this totemic policy actually means practically or that doctors already work around the clock in key services, the government is also ignoring the fact that its contract will make any delivery of new services more difficult to achieve. In short, it is likely to drive more junior doctors out of the NHS.
Already, one in two foundation doctors are choosing not to apply for further training in this country. A poll for the Independent on the day of the strike showed that close to nine in 10 junior doctors were considering walking away from the NHS because of what was then a threatened imposition. There are added specific problems for general practice. We consistently see posts being left unfilled: one in 10 GP trainee posts remained vacant after three rounds of recruitment in 2015.
Year on year we have seen application rates drop for GP training. The reasons for this were made clear at the recent special LMC conference, where speaker after speaker highlighted the monumental evidence that workload in GP services is becoming unmanageable, with more older patients with complex conditions arriving each day at GP practices that are underfunded and understaffed.
We have increased numbers of housebound patients, those requiring dementia care and other specialist services in the community. At the moment general practice doesn’t have the tools to effectively meet this enormous challenges: it doesn’t have the funding, staff, premises or infrastructure. I know many of my colleagues will look at the combination of this imposition, the terms of the contract and the general state of general practice and question whether its where they want to spend their career.
In this environment, even if the health secretary had a magical blueprint for seven-day services, he simply will not have the doctors to make it a reality. The NHS is already creaking at the seams to provide enough care under current conditions: how on earth is it expected to do more or even maintain itself into the future?
This week, with a heavy heart we have seen our doctors, our professionals, demoralised, devalued, attacked and vilified by a government who does not understand patients, does not understand our vocation and does not understand how you deliver a safe NHS.
In the weeks to come, we will see the logical result of this approach: an increasing risk of doctors leaving the profession permanently in the middle of a staffing crisis. The BMA will stand strong and united to fight this imposition: the government must be made to realise that its plans will damage the very fabric of our health service.