Junior doctors: This dispute is not about money, it's about the future of the NHS

The government wants to characterise the junior doctor dispute as being about pay, but the contract changes were the last straw for an already demoralised workforce, writes GP trainee Dr Rob Eastham.

Isn't it all a bit dramatic? Doctors striking, carrying placards predicting the demise of the NHS as we know it? After all, isn't it essentially just an argument about hours worked and pay on a Saturday?

It would be reasonable to reach this conclusion given the government's attempt to characterise the junior doctor contract dispute as being mainly about pay. The truth, however, is that this dispute was the last straw for a workforce that has over a number of years become increasingly demoralised, disillusioned, depressed. It is a systemic problem that, unless we acknowledge and address it, threatens the very fabric of the health service we depend on and treasure. 

Demoralised, disillusioned, depressed

When I decided on a career change and started medical school at the age of 30, I had a pretty diverse range of work and life experience. I had spent time stacking warehouse shelves, working as a pizza chef, teaching English and later writing about finance issues as a trainee journalist. I hoped this life experience would be useful preparation for life as a junior doctor. But nothing I did anticipated the intensity of work and the level of responsibility that I would take on.

I am now in my final year of GP training working at a surgery in Leeds, having recently completed my hospital jobs. The rota for my last surgical hospital job is fairly typical of the rotas worked by junior doctors up and down the country. It was a seven-week rolling rota, which involved working a mixture of 12-hour on-call day and night shifts, as well as regular day shifts.

An on-call shift can be very busy, particularly during the day. I have been so busy seeing patients in A&E that I have gone the whole day without going to the loo. This level of intensity has become the norm up and down the country. I freely admit to being so tired during a night shift that I had to re-check a basic drug calculation, that I would normally do in my head, four times using a calculator. I suspect many people would not have had the same problem after a night at the pub.

There have been tragic cases of doctors dying while driving home exhausted after night shift work. Relentless changing of shifts from days to nights and back again can potentially affect both patient and doctor safety. And that is under the current contract, before we are stretched even further.

Some people suggest that the current generation of doctors have it easier. To some degree this is true, doctors used to work much longer on-calls. But most agree this was unsafe for patients. And a busy on-call week today could easily stretch beyond the current contractual limit of 91 hours.

Today's health service is barely recognisable to the one my father worked in years ago. Improved treatments and longevity have led to an exponential rise in demand on the system. In general practice alone the number of consultations has risen by 19% to 361m in only five years between 2008/9 to 2013/14.

The truth about staffing levels

A lot of debate has focused on the issue of weekend staffing. Junior doctors have been incensed by Jeremy Hunt and the DH's misrepresentation of evidence to back up their claims that staffing levels are directly related to an increase in weekend mortality.

Doctors get rightly very angry when evidence is wilfully misrepresented, as this can lead to harm to patients. The fact Mr Hunt persists in repeating claims unsupported by the evidence and despite the lead authors of several studies publicly stating Hunt's claims are rash and misleading is irksome to put it mildly.

So is weekend staffing a safety issue? The evidence currently does not support a causal relationship between junior doctor staffing levels and weekend mortality. But the truth is staffing levels can be an issue throughout the week, not just at the weekend.

Elderly medicine, for example, has a high number of in-patients being treated compared to specialties such as obstetrics. When I did my elderly medicine rotation there were five wards with between 20-30 elderly patients at any one time.

During a weekday each ward would have, at worst, one junior doctor on the ward, and at best three or four. At night time during the week and at weekends this dropped to one junior doctor covering all five wards (up to 150 patients) with the help only of a registrar (also a junior doctor) who could be contacted for support with the sickest patients.

So what is the answer? Great staffing at weekends? A seven-day NHS? Every doctor in the country wants more staff at night time and at the weekend. But we are stretched to near breaking point as it is under the current contract.

Shifting some staff from an already skeleton service on weekdays to weekend days is not the answer. Junior doctors already work regular nights and weekends, and we all work to the absolute legal limit of hours possible, and often way beyond and for no extra pay. We do it because patient safety is our number one concern.

What does a seven-day NHS involve?

Mr Hunt is also still yet to tell us what he means by a seven-day NHS. The idea that simply providing additional junior doctors at the weekend will improve patient safety alone is absurd. Yes we need more doctors, but doctors can achieve very little without the rest of the team. We also need more nurses, healthcare assistants, ward clerks, laboratory and diagnostic staff, the list goes on. It is not that we need to work differently, it is that we need more people to work.

I never imagined there could ever be a situation in which I felt justified in striking as a doctor. The sad truth is that like 98% of those balloted, I could see no alternative in defending our patients from a contract that was unfair and unsafe.

My father was a GP and a lifelong Tory. But I feel confident that if he were alive today he would have been appalled by what the current government are doing to our health service. Junior doctors have very different political views, but we are united in our abhorrence of the government's seeming desire to dismantle our NHS.

As a nation we need to have an urgent cross-party debate about what kind of healthcare system we want and what we are prepared to pay for it. Don't be fooled by the government's soundbites about money being pumped into the NHS. As a recent King's Fund report illustrated, this decade is 'likely to see the largest sustained fall in NHS spending as a share of GDP in any period since 1951'.

Being a doctor is a privilege because in the main our patients trust us to act with honesty and integrity. Acting with integrity is at the core of everything we do, as without their trust we are nothing. So we ask our patients to trust us now, when we shout from the rooftops to declare that our beloved NHS is in crisis. Just as we are privileged to support patients in their hour of need, we ask them now to support us in our defence of the NHS.

  • Dr Eastham is a GP trainee in Leeds

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