Junior doctor: The NHS is already a 24/7 service

Junior doctors have voted to go on strike over the changes being made to their contracts.

Here, anaesthetist Rachel Freedman tells ITV News the contract is "not fair and not safe".

I am a junior doctor. I am an anaesthetist. I put in your epidural to ease your labour. I put you to sleep for your life saving surgery then monitor you throughout. Afterwards I care for you on the intensive care unit. I work weekdays, weekends and night shifts, all surrounded by a brilliant team of consultants, nurses, operating department practitioners, surgeons, obstetrician. This is my response to Jeremy Hunt.

Seven day NHS

The whole premise to Jeremy Hunt’s reform of the junior doctor contract is flawed. The NHS is already a 24/7 service. While there are some elements that we agree could be improved out of hours, there needs to be a clear distinction between improving 7-day emergency care, and providing excellent 5-day elective care.

Elective care is all the planned operations and clinics that happen Monday to Friday. These do not happen at the weekend and that is why there are 3x less doctors rostered at the weekend.

If Mr Hunt wants to make the NHS exactly the same each day of the week, he will need to find thousands more doctors, nurses, physiotherapists, radiographers, receptionists, cleaners, canteen staff, social workers, pharmacists, and so on.

He does not have the money for this, and recent seven day GP pilot schemes have shown that the demand from patients is not there either.

The public understand the difference between being seen in A+E with crushing chest pain at 2am on a Sunday morning, and having their keyhole knee surgery. One needs to happen 24/7, one can be scheduled for a weekday.

So, whatever the Conservative Party’s election manifesto mandate, they need to recognise that this does not give them a mandate to bulldoze through changes to doctors’ contracts. Without more doctors in total, if you have more of us working on a Saturday and Sunday, there will be less of us during the weekdays.

Pay

Despite Jeremy Hunt’s 11% basic pay rise announcement, junior doctors can see the new contract represents a significant pay cut. One third of my pay is for the antisocial hours that I work. If you cut our antisocial pay by such a huge amount, an 11% basic pay rise will still leave us worse off in total.

I am an ST6 doctor. This means that I am in my sixth year of anaesthetics training, and have been a doctor for over eight years. Today the Department of Health’s pay calculator showed that because I am in an established training post, my personal pay will be protected until 2019. But, what about those anaesthetists I work with daily who are still earlier in their training. I don’t think they deserve a pay cut either.

I will continue to fight for a fair contract that does not disadvantage those that come after us. As Johann Malawana said, we will not pull the ladder up behind us. Not one single junior doctor deserves a pay cut (now or in the future) for the valuable, irreplaceable work that we put into patient care.

Safe Hours

We work longer hours than our rota because patients need us. We don't get overtime pay for this. However, to protect our patients from overtired doctors, we can challenge our employers using a formal process of hours monitoring.

A new contract will not change the need to work over our rostered hours but removes this safeguarding process. Today, Jeremy Hunt announced that in the future the CQC will be responsible for ensuring that our hours are not higher than they should be.

A CQC visit every 4 years will not help doctors who rotate around hospitals every 3 to 6 months to challenge their rostered hours. The only thing that will bring junior doctors’ hours down is increasing the numbers of doctors, every single day of the week, but Jeremy Hunt’s plans risk that being an impossibility with school leavers choosing not to study medicine and existing doctors leaving the profession or the country.

The Future

I like working shifts, in fact I actually love being able to run errands midweek post night shifts while the rest of the world is at work. But there is a limit.

If the new contract removes or lessens the financial consequences to my employers for me to work late evenings and Saturdays, rotas will be written so that though I may not work more hours than I currently do, those hours could be shifted in such a way that they no longer allow me the same quality time with those I care for.

Should I lose out on Saturdays with my husband and family just to allow Jeremy Hunt to fulfill an ill-thought out election pledge for seven day elective NHS services? No thank you.

When patient care needs my hours to change, I will change them, when political spin demands it, I will fight with all my might. This imposed contract is not fair and not safe and we must all stand firm against it.