Dr Johann Malawana: Why new NHS contracts are unfair for doctors and unsafe for patients

THE outpouring of anger and frustration we have seen from thousands of junior doctors across the UK – and which has prompted the protest in Leeds today – must be a wake-up call for Ministers. If they thought that junior doctors would simply accept their threats to impose a new contract, they have been proven very wrong.

Doctors across Yorkshire believe the proposed contract is unsafe for patients, unfair for doctors and will undermine the future of the NHS. It will remove vital protections on safe working patterns, devalue evening and weekend work, and could have a real impact on the quality of patient care if we return to the days of exhausted junior doctors working dangerously long hours.

Junior doctors working in parts of the NHS that involve lots of evening and weekend work, such as emergency medicine, will be left worse off – disastrous for our A&Es, which are already struggling to recruit and retain enough staff.

Worse still, by making it easier for hospital trusts to return to the days where junior doctors worked dangerously long hours, they risk compromising patient care as well as junior doctors’ health and wellbeing.

The British Medical Assocation has been clear that it wants to deliver a safe and fair contract for junior doctors and patients. Instead of genuine negotiations, the Government has insisted that junior doctors agree without question. This would not have allowed the BMA to negotiate over proposals we believe are unsafe for patients, unfair for doctors and undermine the future of the NHS.

Health Secretary Jeremy Hunt has accused junior doctors of misleading the public, yet at the same time he continues to conflate junior doctors’ concerns and the Government’s rhetoric on seven-day services. The junior doctor contract is in no way a barrier to seven-day services, with the vast majority of junior doctors routinely providing care to patients 24/7.

There are more than 50,000 junior doctors in England alone. They form the backbone of our NHS, working around the clock, seven days a week, and with a starting salary of less than £23,000, earning less than you might expect. Despite improvements in working hours in recent years, more than four in five junior doctors continue to struggle with long hours. Working 12 days in a row and clocking up 90-plus hours in a week are still common. Almost one in three have considered leaving the profession.

As a registrar in obstetrics, my shifts can be anytime 24 hours a day, seven days a week. My job involves making fairly fundamental decisions when babies are in trouble and need to be delivered as an emergency. If I make a mistake, it can have a devastating effect on the baby, the family and on the doctor concerned. No one needs doctors making decisions when they are tired.

Doctors’ training can last up to eight years after medical school – a significant chunk of a doctor’s working life. They remain under the junior doctor contract for that time. The contract determines obvious things like pay and working hours, but also affects the quality of doctors’ working lives and the quality of their training. It also plays an important role in ensuring medicine remains an attractive profession for the brightest school leavers, especially at a time when students undertaking a medical degree face debts of up to £70,000.

Junior doctors work long hours and take high-risk clinical decisions, but in return they need a contract that protects them and the patients they care for, delivers a fair system of pay and ensures they have the opportunity and flexibility to learn as they progress.

These things are vital to delivering high quality care for patients and to ensure doctors are trained to the best possible standards. Instead of working with the BMA to deliver this, the Government want to force though changes that will be bad for patients, bad for junior doctors and, ultimately, bad for the NHS.

In recent weeks the Health Secretary has acknowledged junior doctors play a vital role in the NHS. This is at odds with his relentless and extremely damaging rhetoric attacking doctors, which has led to the anger on display.

We have always stated that without the continued threats of imposition and pre-conditions, the BMA would be happy to enter meaningful negotiations. But, until the Government gives junior doctors the reasonable assurances they are demanding, we will continue with our course of action.

Dr Johann Malawana is chair of the British Medical Association’s junior doctor committee.