Can a junior doctor go on strike?

I never thought that I’d be seriously considering striking.  This isn’t because I have any particular objections to industrial action (I grew up in South Wales in the early ’80s; trade unions are pretty much a way of life for me), but I didn’t think that it was something that doctors did.

There’s a strong cultural imperative against doctors striking: it’s the Cardiac Arrest mentality.  If you’ve never seen the BBC drama, then please seek it out (it’s available on YouTube).  Supposedly, the BBC were persuaded to drop it because it was too realistic… (although my personal life has a long way to go before it gets that exciting)

We are conditioned to think that everything will be OK if we just work a little bit harder; if we stay a bit later; miss a few more loo breaks; come in a bit earlier.  It’s hard to reconcile that training with industrial action.  After all, the patient comes first.  I’ve seen a lot of comments from my colleagues who say that they won’t support industrial action because it will impact patient care.

A few years ago, I don’t know what I would have done.  (I was, and remain, very undecided about the action on pensions for example.)  And clearly, I’m a little bit annoyed about the prospect of a 30% paycut, but would that be enough for me to strike?

In the Cardiac Arrest/House/ER world of medicine, being a doctor is all about doing.  It’s about completing tasks; ticking things off on the jobs list. (That really annoying house-officer with the obsessively completed jobs list; the one that’s organised in time/priority order? That was me – I apologise to all my SHOs and registrars who’ve ever tried to share the jobs list)

Everything is a task:

  1. Take bloods – tick
  2. Re-write drug chart – tick
  3. Update family – tick
  4. Chase results – tick
  5. Prescribe fluids – tick

Everything is a task.

That’s not doctoring.  That’s filling in a jobs list.

Proper doctoring is about listening properly to what patients and families are saying (not just what answers your questions).  It’s about having the emotional energy to do something about what they’ve said.  It’s about really, really being there for your patient.  It’s  resilience and teamwork and thinking time.  It’s staying a bit late to check that the patient you admitted earlier is doing ok.

We cannot provide this care with the new contract.

We cannot work at our best if we are exhausted because the safeguards on our working hours are weakened.

We cannot ensure that we get the best people into medicine if we discriminate against parents, carers, those of us working less-than full time or in research

We cannot be resilient or emotionally available or listen properly if we never see our partners, families, or friends.

We cannot provide ourselves with training courses to ensure that we’re up to date if we also have our pay cut.

So when the ballot comes, I will be voting in support of industrial action.  Because the patient comes first

The real contract

My actual “contract” pays me for 24 hours/week with a 50% unsocial hours supplement.  At least, I think it does. I didn’t see a contract for the first few years that I was working.  When I got a mortgage, I had to download the national terms of service from the internet so that the bank could work out what my contract actually meant.  I didn’t know; most of my colleagues didn’t know; it wasn’t important.

It wasn’t important because we knew that it wasn’t the real contract; it wasn’t the real agreement between patients, doctors, and the NHS.  This paper contract contained things like study leave; training time; advance notice of rotas…. It wasn’t real.  Banding was a kind of compensation for that.

The real contract is unspoken; undefined; yet ingrained into our culture as professionals.

This is our contract

We will not work by the hour – because things don’t start and finish when our shifts finish

We will squeeze in our training around providing a service to the NHS – because the patient in front of you comes first

We will stay late to have a chat and talk to relatives – because families need to know what’s going on

We will jump through the educational hoops; book supervision meetings after night shifts; spend weekends filling in eportfolios; come in on our annual leave to get assessments done – because there isn’t the time to do this in our working day

We will do the audits and re-write protocols and guidelines in our own time – because that isn’t what matters to the patient today, but it makes a difference to the NHS this year or the next.

We will spend thousands of pounds of our own money, every year, on exams and training courses in our own time – because that doesn’t happen in the working day, and because we need to keep getting better to deliver safe care.

We will miss birthdays & Christmas & funerals & weddings, even if we’ve booked them off in advance, because the leave wasn’t approved or the request went unacknowledged, or just because we know it’s busy – because the service still needs to run and patients still need to be cared for.

We will watch our colleagues miss their child’s first steps – because somebody else’s child is sick.

This isn’t an hourly contract.  This is what we signed up for. 

Please. Don’t lose sight of that.

Disconnect in the NHS

My Twitter feed this morning is making my head hurt.

Most of the people I follow are connected to the NHS in someway or another: either because they/we work in it, or because they interact with it on a regular basis. There’s usually a range of views from different perspectives (yes, that is my attempt at being diplomatic), but usually we’re talking about similar things.

But this morning? This morning the Twittersphere is weird.

The “leadership” groups and “innovators” are telling me how important resilience is, and how we all need to be shiny happy people to deliver good quality & compassionate care.

Patients/carers/clients are talking about the importance of patient-centred care; of listening (properly, not just to what we want to hear).

Junior doctors are distressed, scared, and worried about the new contract that is being imposed and what that means for us and our patients.

And NHS employers? They have a new toolkit for how to ensure a happy workforce, and a fascinating discussion about Pumpkin Spice Lattes…

My head hurts

Contracts and the things that go unsaid

So, it’s official.  The new junior Dr contract will be imposed from August of next year.

Trying to work out what that means for us as trainees is complex because there’s been a lot of rhetoric from both sides.  Unfortunately, most of this has focused on the financial implications for junior doctors, rather than working conditions.

Why does this matter? It matters because I see a continual stream of people saying that healthcare professionals need to be resilient; that self-care is important for us to be compassionate; that a happy workforce is one that cares for patients…

It’s hard to see how that is compatible with the new contract.  Reading NHS Employers’ summary of the proposals. it’s hard to see what the fuss is about.  Yes, the “social” hours limit will increase, but basic pay should increase… What’s the problem?

The problem is with all the things that aren’t acknowledged; that we just accept as an extra part of the job.  The things that we’ve just done because that’s how medicine works… And yes, the money does help with that.

If you’re a junior doctor, you know exactly what I mean.  There are the working conditions that are already supposed to be protected and agreed… but that somehow don’t quite work in practice.

It’s the electronic monitoring of hours that’s supposed to make sure that we get breaks & work safe limits… but that doesn’t seem to be monitored itself.

It’s the moving around the region with six weeks notice – not really enough time to sort out a new nursery placement or to find a place to live – that isn’t always six weeks.

It’s the guarantee that your rota will be available six weeks before you start this new rotation, but that somehow isn’t ready until 72 hours before your shift starts.

It’s the knowledge that I have a study budget each year, but that it doesn’t cover the cost of doing one life support course (which, unsurprisingly, is mandatory).

It’s the £7000+ that I ended up spending in one year, just to keep up with all the things that are supposed to be covered in my training. (And I’m not in a craft speciality like surgery – they have really expensive training courses)

It’s the extra hours that we spend at work but never report (see monitoring above); the days that you come in to check your clinic letters are ready; the phone calls to the ward at 3am to make sure things are OK…

It’s the audits and guidelines that don’t really make it into the working day, but still need to get done.

It’s the meetings that we can only arrange after 5pm; the expectation that we will stay late (in complete defiance of Athena SWAN guidance) because there’s no way that we can all get together during the working day…*

It’s hard to see how the new contract is going to address any of this (and yes, some of it is stated in the DDRB recommendations… but as I said, this is the stuff that’s supposed to be happening anyway).

Is it about the money? Kind of. But the money isn’t what’s going to affect patient care. Not having robust safeguards will

  • I do this. But the “why” is probably a whole other blog