I started my medical career in 2015. Looking back on that first year as a doctor, I remember a few things incredibly clearly. I remember the pride of being able to help and care for the fine people of Leeds (my home city); I remember the faces of my colleagues during our busy shifts, faces which spoke silently of the anxieties associated with trying to provide care in an understaffed and under resourced NHS; and I remember standing on the picket lines with my colleagues, fighting for better conditions during the strikes of 2016 so that we could tackle those problems that were driving our colleagues from the profession.
Eight years later and I find myself standing again with my colleagues, about to pick up those placards once more and strike against a government that still fails to value the hard work of our committed and passionate junior doctors.
Real-terms pay cuts
The recent BMA junior doctor ballot has delivered an unquestionable mandate from junior doctors to tackle the issue that has so insidiously plagued our profession since 2008 – real-terms pay cuts. Pay cuts, which now total 26% and are climbing.
Since 2008, successive junior doctor pay awards have failed to ensure that our pay has kept up with rising inflation. This isn’t an acute problem that has developed due to international conflict or rising energy prices. This is successive, repeated failures of government to value junior doctors since 2008. Failure to ensure that our pay can keep up with the rising costs of goods and services. Failure to ensure that a doctor today can provide for their family, to the same standard as a doctor 15 years ago.
Junior doctors have seen more than a quarter of their real-terms wages disappear since 2008 and the trend is only getting worse. Now 77% of eligible junior doctors have used their voice to send a message to the government on how they feel about this. And 98% of those doctors have clearly stated that enough is enough. We are prepared to take industrial action to fight these chronic issues of falling levels of pay.
GP trainees taking action
Since my first days as a doctor, I have progressed in my training. I am still a junior doctor but I am now training to be a GP. GP trainees (or GP registrars) make up 15% of all junior doctors in England. A call for junior doctors to take industrial action is a call for GP trainees to take action too. The industrial action planned by the BMA will not be limited to the hospital wards and A&E departments; GP practices will also see disruption to services on days of strike action.
I am incredibly proud to be a part of the GP workforce. I get to work in a fantastic profession, where we make a difference to patients’ lives every day. Despite all the negative press GPs have experienced recently, it is still a hugely rewarding job and one that I hope to work in for many years to come. It is also, sadly, a job that is becoming ever harder.
The UK population is becoming older and sicker. This means more work for GPs in an already overstretched NHS. Against this background of increasing demand, we find significant issues with retention in the GP workforce.
GP trainees enter training, find that they are poorly valued by the NHS leaders, and are ultimately lured away by other countries and professions who are willing to appropriately remunerate our skills and expertise. Issues with retaining GPs in primary care makes delivering care for patients ever harder. Fifteen years of real-terms pay cuts for doctors in England have led to this unsustainable situation.
Industrial action and general practice
The commitment from the Conservative government to grow the GP workforce by 5,000 more GPs was never matched by the actions needed to ensure that that commitment could be delivered. The government that made those promises to deliver those additional doctors in primary care is the same government that has slashed the real-terms wages of GP trainees.
Instead of encouraging more doctors to have careers in general practice, this government has created an environment that clearly states that junior doctors are simply not valued. A cut to our wages of more than 26% in real-terms since 2008 does not make me, as a GP trainee, feel valued.
GP trainees are key members of the GP workforce. According to figures from NHS England, we make up almost 25% of the entire full-time equivalent GP workforce in England.
On days of industrial action, we too will be leaving our posts and stand side-by-side with our hospital colleagues in calling for the government to address pay erosion and deliver pay restoration. For the first wave of industrial action, where the BMA has called for 72-hours of strikes, we will not be in our GP practices.
This will mean that appointments booked with GP trainees will be rearranged and clinics may be cancelled. Our GP colleagues who have completed their training will ensure that those who are in acute need of medical attention will be seen.
Resolving the crisis
We don’t want to take this action. Patients don’t want any staff walking out of their practice. On Wednesday 22 February we met with the health secretary’s officials, but there was no offer on the table and the DHSC made clear they are not ready to enter negotiations.
There is still time, however, to avoid industrial action. We have written to Steve Barclay asking to meet with him within the next 24-hours so that we can work together to tackle these issues and reverse the real-terms pay cuts experienced by junior doctors, including GP trainees, since 2008.
The friends I made in those first days of being a doctor are lifelong colleagues that I speak with often. We look back over our medical careers to date and we agree that working conditions have never been so bad.
Chronic undervaluing of junior doctors and real-terms pay cuts have triggered a retention crisis in the NHS on a scale never seen before. Working in understaffed hospitals and GP practices, burnout and frustration are feelings that all junior doctors now routinely experience. This situation cannot continue, and we have had enough.
We are calling for change. We are calling for this government to deliver pay restoration to tackle the chronic erosion in our pay, and junior doctors – GP and hospital trainees together – are ready to fight to achieve it.
- Dr David Smith is chair of the BMA GP trainee committee