Who is a junior doctor? How much are they paid? Why do the government want to cut their pay? And are doctors really allowed to strike?
A junior doctor is any doctor who is not a consultant, from the newly qualified foundation year 1 (FY1) to those who are just about to fully complete their training and become qualified as a consultant (although training in the medical field never really finishes). This does not include fully qualified GPs. Thus this workforce amounts to an estimated 30,000 doctors, which is 30% of a hospitals’ medical work force.
How long do they work?
These doctors typically work at least 48h (equivalent of six days from 9am – 5pm), including nights and weekends. Often, the real number of hours worked is actually up to 70h a week which is more than any other set of doctors in medicine. Thus, in reality, junior doctors form a far greater percentage of your hospital work force.
How much are they paid?
Junior Doctors receive a basic pay that is dependent on continual service to the NHS. They then receive a supplement dependant on the amount of ‘unsociable’ hours they work. ‘Unsociable’ hours are currently defined as any time worked outside Monday to Friday between 7am to 7pm. Junior doctors are hence compensated for these hours with a Supplement. The pay starts at £22k basic with a maximum of a 50% supplement. This is following a minimum of a 5-year degree with a minimum debt of £45k upon graduation, top qualifications pre university, and being considered in the top 2% in terms of academia in the UK.
What do the government want?
The government are proposing to re-define ‘unsociable’ hours from outside 7am – 7pm Monday to Friday to outside 7am – 10pm Monday to Saturday (adding three extra hours per day to the ‘sociable’ hours as well as a whole extra day). Thus they will get paid the same for working Saturday evening as they do on a Tuesday afternoon. They will also simultaneously increase the basic pay. There are a number of other changes including removing the safeguards preventing doctors working hours that closely resemble basketball scores and preventing the progression of those who decide to take time out for research (often considered mandatory in today’s demanding environment) and those who take maternity.
The winners and the losers
There are winners and losers with the new proposed contract. It will mean an effective pay cut for the majority of junior doctors and certainly for those who tend to work more unsociable hours, including our already crippled A&E service. The BMA have predicted the pay cut to be by as much as 30%.
Why are the government doing this?
The government say this is to encourage hospitals to employ more doctors out of hours to improve standard of care during the times when there is only a ‘skeleton’ staff. If you make it cheaper to employ the doctors at this time, the idea is that the trusts will therefore be able to employ more doctors during these times. Eventually the idea will re-define normal hours as well, pushing doctors into working the kind of dangerous hours that we used to see a number of decades ago, when it was not uncommon to work 72h straight. This was abolished because it became dangerous for the doctors and for the patients.
But the NHS is unsustainable
In reality, the NHS has overspent by £930m in 3 months of this year alone and is predicted to overspend by £2bn by the end of the financial year. Cuts were inevitable. Conservative governments in the past have always leaned towards privatising the NHS, which could well actually benefit junior doctors pay in the long run. Perhaps the real reason behind the cuts is really to push the NHS to privatisation; push doctors to their limits and when they break, and thus breaking the NHS, the only option left is to privatise.
What do the junior doctors think?
Thousands of junior doctors have requested a certificate of good standing from the GMC, which is essentially an internationally recognised reference in preparation to work abroad. Many leave every year for better working hours and pay in Australia. These recent cuts may just be enough to convince those who still had faith in the NHS to leave.
How devastating would a strike be?
The last time doctors took industrial action was in 2012 regarding the changes to the NHS pension scheme. The BMA are about to ballot their members regarding industrial action. If it is approved, all non-emergency work will be affected. This includes GP appointments, clinic appointments and non-emergency operations will all be delayed. With the NHS already running close to capacity, this will have inevitable consequences for the whole population.
The A&E department is dependent on the flow of patients. That 4h wait is often not because of lack of doctors or nurses, it is due to beds being blocked in the department. Once the decision for a patient to be admitted to the hospital, a cascade begins and at the end of the cascade is a patient being discharged. If that patient is not discharged (not considered emergency work) then the patient cannot be admitted and thus, the next patient waiting to be seen in A&E cannot be seen. All those who could not get GP appointments, will be shifted to A&E.
It is impossible to predict how devastating a strike would be. In the past hospitals have demanded their junior doctors to prepare for such industrial action, working extra hours, preparing discharges early and so on. If it is done efficiently enough, the effects will be limited, which defeats the purpose of industrial action. But this is different, you can never compromise any patient’s well-being and hence any industrial action has the potential to have devastating consequences.
Do the junior doctors want to strike?
Such action will not be taken lightly by any doctor. For when they graduated, they did take the Hippocratic oath, which states first, do no harm. However, on this occasion, almost all the royal colleges from all the different specialities have come out in support of their members.
What is the current state of discussions between the government and the junior doctors?
The government and BMA have reached a deadlock and discussions have broken down. The junior doctors are about to strike. Many will leave for bounties abroad leaving us worse off than we were before. Nevertheless, the NHS is a pillar in our society. It is one of the largest employers in the world and is consistently considered one of the best healthcare providers in the world, all of this comes at no charge at the point of care. Nations across the world are jealous and envious of this model. Is it worth risking such an outstanding service? Surely if one is forced to make cuts, surely it is unfair to penalise those who work the hardest.