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Why junior doctors are striking once again

Low pay, short staffing, burnout and a bullying work environment are adding up to an intolerable situation for medics, explains JOHN PUNTIS of Keep Our NHS Public

JUNIOR doctors are about to begin another round of strike action from February 24 to 28 as part of a long-running dispute with the government over pay and conditions. 

The British Medical Association (BMA) is seeking a 35 per cent rise to restore pay to where it was 15 years ago, recognising implementation may need to be over several years.  

The figure was arrived at by using the retail prices index (RPI) to assess the impact of inflation on salaries, endorsed by the Royal Statistical Society as the best indicator of change in the cost of living. 

Additional demands include that the review body on doctors’ and dentists’ remuneration becomes more independent of government when making recommendations for pay awards, and that once pay has been restored, there should be a mechanism in place to prevent such severe erosion occurring in the future.

Of the 75,000 wholetime equivalent junior doctors in training roles, around 50,000 are members of the BMA, while smaller numbers are members of the TUC-affiliated Hospital Consultants and Specialist Association and Doctors in Unite. 

For the BMA, 77 per cent of those eligible to vote in the February 2023 ballot did so, with 98 pr cent voting in favour of strike action. Six months later the figures had barely changed at 71 per cent and 98 per cent and a third ballot is now in progress. The government has taken the stance that 35 per cent is unreasonable and unaffordable, offering only a figure of around 11 per cent. Junior doctors have pointed out that to accept this would be agreeing to a pay cut in real terms.

It seems that the Prime Minister may have personally blocked a better deal being offered in recent talks. The Conservative think tank Policy Exchange has portrayed junior doctors as a small group of radical activists that has taken over the BMA. Particular cause for vitriol were demands such as calling for an NHS staff charter, a fund to meet postgraduate medical examination costs and improvement in representation of junior doctors in deliberations about rota and service design.

It is far from being just about pay

Among junior doctors, 40 per cent say they are thinking of leaving the NHS to work elsewhere. Reasons include shortstaffing on any given day (1,400 doctor posts) partly fuelled by sickness, a chronic vacancy rate among medics of around 8,500, burnout from working through the Covid pandemic, feeling undervalued by government, and “moral injury” caused by being unable to provide the appropriate standards of care to patients. In addition, the old close-knit hospital teams offering mutual support have long since disappeared.

Persistent grievances involve the weight of bureaucracy, lack of a quiet space to write up notes and order tests, outdated and slow IT systems, no provision for a restorative nap on a quiet night shift and no night time food availability. In addition, there is often nowhere to safely store personal possessions/drinks bottle/packed lunch when at work, shifts are long and involve anti-social hours with no guaranteed breaks for rehydration, eating or toilet access. Complaints also focus on strict training structures, the pressure after graduating to make an immediate career decision and a bullying and sexist culture at work.

Car parking costs for NHS staff have risen to around £1,000 a year, hospitals rarely provide staff nursey facilities and monthly child care now costs on average £1,000. Of course, plenty of other less well-paid staff feel these pressures too, and unsurprisingly, just as with junior doctors, many have come to regard the NHS as a bad employer. 

Note also that the average medical student debt at the start of their working life stands at £71,000. There are then mandatory recurrent costs in the form of medical Royal College membership subscriptions, General Medical Council fees and medical indemnity. Payment for college examinations and during speciality training can also add up to several thousand pounds.

Although medical student places are being increased, retention (as with other staff) is a huge challenge with around a third planning to leave the NHS within two years of graduating. 

Only 56 per cent of those doctors who go on to enter core training remain working in the NHS eight years later. Junior doctors also have worries about being replaced by less qualified medical associate professionals (eg physician associates) who initially even enjoy a higher salary. The imminent development of medical apprenticeships as an alternative way into medicine as well as bottlenecks in training which result in career progression to senior positions being blocked also cause concern.

We must value and support staff to keep them in the NHS

Increasing numbers of junior doctors are experiencing burnout (emotional, physical and mental exhaustion), with one in five junior doctors at high risk in 2022, compared to one in seven in the previous year. For some specialities, such as emergency medicine, this was as high as one in three.

Doctors suffering burnout are more likely to think of leaving the profession; 18 per cent of doctors considered exiting in 2021 — up from 12 per cent in 2019. Problems retaining junior doctors clearly have implications for the number of consultant vacancies.

In total, around 140,000 NHS staff (one in nine/11 per cent) left the NHS in the year to September 2021; this included one in 10 nurses and one in 18 consultants. The most common reasons given for leaving were stress, shortage of staff and resources, and low pay.

Given the huge and increasing waiting lists it makes no sense to drive workers away from the health service. Pay restoration and writing off student loan debt should be immediate priorities, but there are many other things the NHS needs to do to show proper concern for staff and their well-being if it wants to become a good employer. 

A win for junior doctors would strengthen the pay demands and negotiating position of other staff groups. Ultimately, a well-trained workforce that feels supported, adequately remunerated and wants to work long term in the service are prerequisites for providing the best possible patient care.

John Puntis is co-chair of Keep Our NHS Public.

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