If you want an NHS, save it yourself

It was July last year that something changed- Jeremy Hunt took to the podium and started a fight, claiming doctors had a 9-5 attitude, attacking our professionalism. But that fight was just a scuffle in a longer battle for a free at the point of access healthcare system, and it’s a battle that’s over. We lost.

This time last year I was on the street, on my own, staging a one man protest against a government dismantling the NHS and getting away with it. On my birthday a month later I organised a group protest, a Crash Call for the NHS, to raise awareness. Since then we’ve been on the streets, on your televisions, in your newspapers. The NHS is going under, we said, it isn’t safe, we said, people are dying. 

But the government spin machine is immense, and effective, and perceptions have barely changed. 

I was going to write a blog about this suspicious article in the BBC, claiming consultants are overpaid, right as consultants went back to contract negotiations of their own. I was going to point out the average overtime payment is just each consultant doing 6 hours a week more, compared with their basic salary. I was going to point out aberrant arrangements like the one in the article were locally agreed, to save struggling hospitals from huge government fines for waiting lists, despite their underfunding and understaffing. I was going to point out that huge numbers of consultant posts are unfilled, nearly 40% in medicine alone, and that unspent salary cost far outweighs the cost of any ‘overtime’ consultants earn for covering those same gaps. I was going to point out yet again how the government is spinning and dog-whistling and smearing while the NHS goes under.
But I’m not going to. I tried to write a blog full of facts and hope and fight, but I find facts are useless, my hope is gone, and the fight has left.
I wrote before how exhausted we are of all of this, but it’s only got worse and it’s about to get catastrophic

If you read this and think “well the NHS is a lazy, inefficient and rubbish health system, that should be replaced”, then good for you- it’s exactly what will happen. Just check you can afford the co-payments, or insurance premiums, or whatever comes next.
If you read this and think “this can’t happen, but what can I do?” Then think harder. 

Because whatever you do next will have to come from you. This doesn’t have to happen, but sitting at home doing nothing will definitely let it. 

If you want an NHS, save it yourself. 

My name is Dr Dominic Pimenta, GMC 7304248. 

And I quit.
Juniordoctorblog.com

The Choice Part 2: No

In another two part post, juniordoctorblog and guest writer Dr Hugo Farne look into the futures of a ‘Yes’ or ‘No’ vote on the junior doctors contract. 

Read Part I- ‘Yes’ here.
We don’t know yet what a ‘No’ vote for members will mean, or even what a referendum result will have to be to be truly accepted as a No by JDC and government. Let’s assume for this psychic exercise that it’s overwhelming. 

Here’s what might happen; 
– the JDC exec will resign- new representatives will have to come forth and a new negotiation team and strategy formed

– The government may impose the contract

– Justice 4 Health may proceed with a legal challenge to imposition. It’s uncertain if the BMA will proceed with their legal action

Here’s what definitely will happen; 

– Everyone will be angry
So what next?

We can model a No vote into five scenarios; 

1. Accept an imposed contract

2. Call for a delay while new negotiations and JDC committees are chosen

3. Campaign for a better contract from the May starting point

4. Campaign for a complete withdrawal

5. +\- Campaign for specialised contracts 

1. Accept an imposed contract 

This obviously is the worst outcome of a No vote. There were significant changes in the ‘imposed’ contract from the terms discussed in February, terms such as the Locum fidelity clause and the ‘we can change anything anytime’ clause. However, there wasn’t a full terms and conditions published at that point which we do have now. How the government would justify republishing terms and conditions without looking as if they are taking advantage would be tricky. It would also give ammo for further protests if the government were to backtrack on what was agreed with the BMA.

2. Call for a delay while a new negotiations committee is chosen

Slim chance of government listening if they think they can impose without a publicity storm. But if they do the BMA can have time to rebuild and reconsider their position and the ongoing strategy, realistically delaying events for six months. A long time in politics and also a cooling off period. Negotiations could start afresh- the govt may have more PR room to manoeuvre, concessions and changes more accepting to junior doctors could happen. 


3. Campaign for a better contract from the May starting point

This would be the single most difficult option of all. For the simple reason that justifying increasing protest for what would be small incremental changes from what the BMA accepted would be very difficult. Public support would be stretched, especially given the whatsapp leaks story, which has yet to be definitively addressed by the BMA. 

4. Campaign for a complete withdrawal; the ‘leave us alone’ option. 

A campaign predicated on this would bullet point to;

– the new contract is less safe and no better than what we have now. (This really comes down to the implementation) 

– The toxic contract has damaged morale and retention- the longer it is threatened the worse it will get

– The reasons for original imposition have been since found to be invalid: no link between junior doctors and weekends, no money for seven day services.

– If the new contract is cost neutral then why is it necessary given the above?

– The new contract is still discriminatory against women

But also remember that the public didn’t really get our message the first time. They supported us yes, but the safety message did not register in the polls: most of the public thought it was about pay and conditions. The real question is will they continue to support us?
This argument is particularly hamstrung by the fact that the BMA has accepted and promoted this contract. 

The counter message here would be;

– we didn’t accept it- the grassroots said No

– The BMA has to respond to the membership

– It was the best deal from a bad one- but why did it have to be a bad one to start with?
5. +\- Campaign for specialised contracts 

The difficulty with much of this dispute is in the increasing specialisation of medicine and consequent variability in working practices. What is right for A&E and ITU, providing essentially 24/7 services already, won’t suit GPs or clinic-based specialties (e.g. dermatology), with relatively little overnight work. Maybe it is time to move away from a one-size-fits-all contract, and from a single negotiating team. Let experts from each area design their own working patterns and contracts, within the same cost neutral envelope (Foundation doctors will need a separate deal). Invite BMA representatives with an appropriate background and/or representatives from the relevant Royal College, who set the training curriculum. Empower them to come up with the solution to their own speciality; how to remunerate the different duties of the week that is deemed fair and provide appropriate incentives to encourage retention. At the very least they will have no one else to blame, and in all likelihood they will find a better answer.

So that’s what ‘No’ might look like. If you haven’t read Part 1- ‘Yes‘ yet, go and do so here.


Summary

All of these scenarios will require work and time and support. If you want to vote no, be prepared to fight a very uphill battle. If you vote yes, be prepared to fight to make the contract function as it should in your hospital. This is your 99% perspiration- whatever you choose, it will require your blood, sweat and tears to make it work. 

Choose wisely.
Juniordoctorblog.com 
with guest writer Dr Hugo Farne