Saturday, 14 November 2015


Junior doctors are deciding on whether to strike for three days. This is the final attempt to kickstart fair negotiations between the BMA and NHS Employers over a new junior doctor’s contract. Although we would all prefer that a strike did not happen, I will be supporting my juniors for the following reasons:

1.     Junior doctors form a vital part of the NHS. They are a dedicated, hardworking and vital part of the NHS family and MUST MUST be valued and respected. They also happen to be the hospital consultants and GPs of tomorrow. Changes to their contract are being imposed on them with a refusal by NHS Employers to negotiate on vital points. Proper negotiations with NO pre-conditions must start immediately. Let's not forget that Jeremy Hunt has also threatened to impose new working arrangements on consultants.

2.     We must attract the best students to medicine and the best doctors to frontline medicine. Recent data shows that Britain needs 26,500 more doctors to match the OECD average. The NHS is already the most cost effective universal healthcare system in the world and existing resources are being stretched to breaking point. The new contract is one step too far. A flow of junior doctors away from the UK or frontline medicine has already begun. Let’s not make that problem worse.

3.     The new contract imposes a new definition of ‘normal working hours’ on junior doctors, and penalises those working in specialities with a greater ‘out of hours’ commitment (such as emergency medicine, cardiology, paediatrics etc). This sort of work needs to be recognised and paid appropriately. Removing safeguards that prevent doctors from working even harder exposes them to abuse and may harm patients. Women in medicine must not be penalised for taking maternity leave. We should be working harder to help all doctors achieve a good work life balance.

4.     Clinical scientists are vital to good healthcare research. The new contract penalises junior doctors doing clinical research.

5.     The NHS already delivers 7 day urgent care. So when Jeremy Hunt, David Cameron and the media say that these contract changes are necessary to turn the NHS into a 7 day service, nobody really understands what they are saying. Can we assume that they are talking about elective or non-urgent care? If the government wants to create a 7 day non-urgent service, a 30% increase in resources and funding (and not just doctors) may be required and we all know that that won’t happen. Imposing contract changes on junior doctors, then consultants, GPs, nurses and everyone else in the NHS is not the answer.

6.     The assumption that ‘excess weekend deaths’ are avoidable by making doctors work harder and longer is rash and misleading. Even the authors of the cited papers make this clear. Patients admitted on the weekends were more sick, almost twice as likely to be an emergency admission (than on a weekday), were at NO extra risk of dying during their hospital stay and had a small increase in mortality 30 days after admission (as would be expected). So when politicians and the media say that a ‘7 day NHS’ made possible by changes to doctors’ contracts will ‘save 6000 lives’, they are not being truthful. At best they don’t understand the data, at worst they are deliberately misleading the public.

7.     We have had enough of political spin. Talk of militant doctors, danger money, doctors being misled by the BMA, doctors lacking a sense of vocation and worse is starting to make negotiations with the present government impossible.

8.     This is only one of many spanners. Disruption of the NHS by refusing to negotiate fairly with junior doctors is just one of many spanners being thrown at the wheel of the NHS. See my pre-election blogs for a summary of how the Health and Social Care Act of 2012 and now TTIP will conspire to break the NHS. We only have to look at Jeremy Hunt’s predecessor to see where this might be going.

Vinod Achan

Vinod Achan is a Consultant Cardiologist at Frimley Park Hospital, Surrey