John Puntis on why Junior Doctors deserve full support
Only after a lengthy period of training (5-9 years) following five years at medical school do doctors move from the ranks of junior doctor to a senior role. Junior doctors have been among many sections of the NHS workforce to take strike action in the past year, during a time described by Jeremy Hunt as ‘the greatest staffing crisis in the history of the NHS’. The dispute is ongoing, but so far has involved 34 days of action with an unprecedented consecutive six days in January 2024. More are planned.
Of 75,000 whole time equivalent junior doctors, around 50,000 are members of the British Medical Association (BMA). Smaller numbers are found in the TUC affiliated Hospital Consultants and Specialist Association and Doctors in Unite. Of those eligible to participate in the February 2023 BMA ballot, 77% did so, with 98% voting for strike action. In a second ballot six months later, the figures had barely changed (71% and 98%). Public support has been strong, but given the BMA does not have a strike fund some doctors may find ongoing commitment increasingly testing.
What is the dispute about? The BMA is asking for a 35% rise (over several years) to restore pay to where it was in 2008. The figure was derived using the Retail Prices Index (RPI), showing that there had been a 26.1% loss of earnings. While there was some criticism of this methodology, the Royal Statistical Society confirmed that RPI is the better indicator of change in cost of living. Additional aims were for the Review Body on Doctors’ and Dentists’ Remuneration to be independent of government, and a mechanism for preventing such a disastrous wage decline in the future.
Junior doctors have appeared solid and well organised, sharing a wealth of useful information to guide union members on effective strike action. This has enraged right wing commentators such as Policy Exchange who claim that a small group of radical activists have taken over the BMA and advanced revolutionary demands. These include calling for an NHS Staff Charter, a fund to cover examination costs and improvement in representation of junior doctors in deliberations about rota and service design!
Not just about pay
Forty per cent of junior doctors have said they are thinking of leaving the NHS. Reasons include short staffing (1,400 doctor posts unfilled on any given day), burnout from the Covid pandemic, feeling undervalued by government, and “moral injury” through being prevented from providing the highest standards of care to patients. In addition, the old close-knit hospital teams offering mutual support have long since disappeared.
Other grievances include lack of a quiet space to write up notes and order tests, outdated and slow IT systems, no provision for a restorative nap at night when quiet, no food available on night shift, car parking costs that have risen to around £1000/year, and child nursery care averaging £1000/month. Of course, other less well-paid staff also feel these pressures and many have come to regard the NHS as a bad employer. For junior doctors, the average student debt at the start of their working life is £71,000. Additional recuring mandatory costs include Royal College membership subscriptions, General Medical Council (GMC) fees and medical indemnity. Fees for college exams and during specialty training can add up to thousands of pounds.
With nearly 9,000 vacancies across the medical workforce, the planned increase in Medical Associate Professionals (MAPs) from 3,500 to 12,000 raises concerns that, rather than appointing more doctors, workforce gaps will be filled by these non-medical science graduates. It is also irksome to junior doctors that they are initially paid below MAPs who have much less training and responsibility. The development of medical apprenticeships as an alternative way into medicine piles on further worries.
Value staff
To provide good care for patients we must value and support staff to keep them in the NHS.
The GMC found an increasing number of medical trainees experiencing burnout (emotional, physical and mental exhaustion), with 1 in 5 junior doctors at high risk in 2022, compared to 1 in 7 in the previous year. This means they are more likely to leave the profession. Problems retaining junior doctors have knock-on effects on senior vacancies. In the year to December 2021, 1 in 12 GPs left; around 140,000 staff (1 in 9) gave up NHS work in the year to September 2021; this included 1 in 10 nurses and 1 in 18 consultants. Meanwhile, around 1 in 4 junior doctors leave within two years of finishing medical school, increasing to nearly two in five over a five-year period.
The most common reasons given for leaving are stress, shortage of staff/resources, and low pay. It makes no sense to drive staff away given the huge and increasing waiting lists. While there is now a workforce plan of sorts, throwing more staff into a veritable mincer while not addressing retention is untenable. Replacing doctors with less skilled MAP is a risk to patient safety. Pay restoration should be an immediate priority, but there are many other things the NHS could do to show proper concern for staff and their wellbeing.