Junior Doctors: What's all the fuss about?

If you're even remotely active on social media or keep half an eye on the television, chances are that the uproar from junior doctors over Jeremy Cu Hunt's new proposed contract won't have passed you by.

However what with everyone on twitter thinking they're a cyber-activist (... guilty) and even politicians themselves throwing supposed 'facts' around like they're gospel, it's difficult to wade through all the emotionally fuelled arguments and work out what is really going on here. So what better to do on a drizzly Saturday afternoon than try and break it down for you....

** if you have expertise in this area and I get something wrong, please tell me so I can edit it!**

The current situation

A junior doctor is any medic who has graduated from medical school, but is not yet a GP or a consultant. Junior doctors therefore can be doing foundation training, GP training or hospital specialist training, some of which can last up to 10 years. There are approximately 53,000 junior doctors in England currently. Their basic annual pay is about £23,000, working 40 hours a week between 'sociable hours' of 7am to 7pm Monday to Friday. For those who work 'unsociable hours' in overtime (as many have to), pay is increased.

The government's position and the 'weekend death' debate

In the 2015 general election, David Cameron promised to expand emergency and urgent care in the NHS on weekends by 2020. This promise was made in light of research that seemed to suggest patients were on average, 15% more likely to die if they were admitted to hospital on a weekend than if they were admitted on a weekday. Whilst it may seem an alarming statistic, as with many data reported by politicians, there is more than meets the eye.

By looking at the studies frequently spoken about by Hunt and his colleagues, it appears the statistics have been dangerously misinterpreted and damagingly misrepresented. This British Medical Journal article found no significant difference between patient deaths who were admitted mid-week compared with weekends, suggesting Hunt's reporting of this is just plain false. The second measurement of this study looked at the likelihood of dying within 30 days of being admitted to hospital on a specific day. This found that patient deaths were significantly higher when admitted on a Friday, Saturday, Sunday and Monday, compared with Wednesday. So whilst Hunt may be right in claiming that you are more likely to die within 30 days if you are admitted on a Saturday or Sunday than a Wednesday, by the study's data, he must also acknowledge that this risk is no higher than if you are admitted on a Friday and Monday too. (For whatever reason, Tuesday seems like a lucky day ...)

Jeremy Hunt's new proposed contract

In order to attempt to improve 24/7 emergency patient care, and deal with issues over pay, Jeremy Hunt's new proposed contract aims to reduce compulsory hours for doctors and increase basic rates of pay, which appears positive right? Below are just some of the changes that the new contract would bring about.

Why junior doctors (and many others) are opposed to it

However, whilst the contract changes appear to ensure more pay for junior doctors and better working hours, there is much contention as to whether this is actually going to happen. Considering the uproar it has caused from junior doctors themselves, many MPs, the BMA and hospitals across England, there must be reasons why so many doubt this contract's ability to deliver positive changes to the NHS. So what is causing the uproar?

1. The increase in standard 'sociable' hours

The 7am to 7pm Monday to Friday sociable hours are being extended to 10pm each evening, with the added inclusion of Saturday. This increases the sociable hours from 60 hours a week to 90 hours a week. Despite the 11% increase in basic pay, many are concerned that the reduction of 'unsociable hours' for which doctors are paid overtime, will result in an overall decrease in their 

salaries, some estimates reaching 30%. One junior doctor from the Intensive Care Unit at the Royal London Hospital said "I don’t particularly want to live in a society where a Tuesday morning is counted the same as a Saturday night, I think home life is really important". The current contract means that working weekends results in extra pay, but the new contract transforms Saturdays into just another weekday as far as pay is concerned.

2. The replacement of pay-increases according to time with a system based on progression through training stages

Whereas before, the longer you are a junior doctor, the more you were able to get paid, the new contract proposes that those who have higher responsibility and more training will get paid more. This will disproportionately affect doctors who choose to take leave to look after children, as their pay won't be protected. This builds on issue number 1 regarding the consideration of unsociable work hours and their effect on home life. Furthermore, this new policy in the contract means that it is much more difficult to switch speciality during your time as a junior doctor. Under the new contract, your pay is not protected if you switch specialities, meaning you have to start again from the bottom of the pay ladder which could mean a significant reduction in pay whilst you retrain. It is these elements of the contract, making being a junior doctor in England that much more tough, which are causing concerns that many may consider leaving to work in other countries, and make it less attractive for international junior doctors to come and work in England. If these concerns turned into a reality, England could suffer a real shortage of junior doctors in the future, undermining Hunt's efforts to increase patient care throughout the week.

3. The inflexibility of the government negotiations

A large part of the battle against government from the BMA and junior doctors comes from the fact that Jeremy Hunt is refusing to negotiate on 22/23 of the points on the contract, threatening to impose it anyway. There is a widespread plea for Hunt to resume meaningful contract negotiations with the BMA in order to come to a solution that the junior doctors are happy with in regards to working hours and pay. A junior doctor from Homerton hospital said "you can't negotiate a contract at gunpoint", displaying just how threatened junior doctors feel by what is, in their opinion, this unsafe and unfair contract. Hunt's plans to bring about a 7 days a week service, on what is essentially a 5 days a week fund, is unrealistic and is going to negatively impact not only the working lives of junior doctors, but their home lives and morale too. 

What needs to be done

By so adamantly ploughing ahead with a contract that has clearly been met with such fervent disagreement and contention, on such an important profession literally dealing with life and death decisions, Hunt has the potential to undermine healthcare for a generation. He needs to put aside his pride, recognise the issues at hand, and re-enter meaningful negotiations with the BMA.

There is something to be said for the fact that so much of the public has rallied behind the junior doctors in their plans to strike. Despite the plain facts on the contract that seem to imply better working hours and increased pay, it would seem that the public's trust lies in the junior doctors themselves, whether they be boyfriends, girlfriends, siblings, cousins or friends. Their alliances lie with the doctors themselves who are on the front line, and who can foresee the damage that Hunt's contract will cause. We should stand by the junior doctors, whether its demonstrating, signing petitions or writing to MPs.

They save the public's lives daily. It's about time we did something to repay them.

Finally, watch this video. Cause it's great: 

"Everybody look to the left, cause you won't get much help from the right, could you save a life if you'd been up all night?"