Hugh Byrne is an NHS hospital consultant in London.
The title ‘junior doctor’ is a misnomer, but the approach to their contract negotiations has been juvenile.
Junior doctors are those who have graduated from medical school and who are now working in a series of rotational hospital jobs in order to qualify as consultants. This usually takes between seven to 12 years, depending on the speciality, but shorter periods are required in order to enter the community as a GP.
The section of the doctors’ trade union, the BMA, which represents these junior doctors have recently decided not to re-enter negotiations with the Review Body on Doctors’ and Dentists’ Remuneration (DDRB). The DDRB is an ‘arm’s length’ advisory function of the DoH. This impasse follows a previous walk out in October 2014. The purpose of negotiation is not to do as one likes, as Napoleon said – and now walking away again has simply meant that the DDRB can impose their review instead from 2016.
I’ve written here before about my own profession’s behaviour when discussing its working conditions in the context of ensuring an effective NHS in the future. Having a sense of our own importance, which is rightly earned, we tend to assume that we are the expert in every room and not just the consulting room.
About two thirds of doctors are represented by the BMA (150,000 out of 250,000). One of their ten reasons cited for leaving the talks is that there will finally be a serious review of how those in less busy specialities who are on call from home out of hours will be paid compared to those resident at work in high-intensity specialities – and it is hard to see how they could possibly be united on this issue, which is a long-standing cause of argument between doctors themselves. Annual pay progression is another issue for junior doctors, but they’ll face a wake-up call in this regard when they become consultants, because there are very few salary increments once that rank is obtained.
Even Heidi Alexander, Labour’s Shadow Health Secretary, has said that “it is not the time for high-handed demands”, but the junior doctors have read this to mean Labour’s unequivocal support for them rather than a call to both sides. Unfortunately, such anti-Conservative bias spills over into the junior doctor’s arguments at frequent intervals, which greatly weakens their position and distracts from the issue at hand.
As with their opposition to NHS seven day services provision, they seem to hold Jeremy Hunt personally responsible for the deal. Rachel Clarke, who has worked for Channel 4 and the BBC before becoming a doctor, said recently on Channel 4 news: “…this contract, which Jeremy Hunt wants to impose…” The junior doctors need to realise that it’s not all about them, or their political views, no more than it is about him and his. One of the last medical Royal Colleges to come out behind the juniors, the Royal College of Obstetricians and Gynaecologists, also couldn’t resist a pop at the Government in a letter to their members, which includes the line “those at the coalface keeping the NHS afloat with little Government support”. If little means £120 billion, then they should see the education budget.
The walkout aside, the junior doctors are not helping themselves in other ways. There are the rather idle and repetitive threats to emigrate and the warnings about recruitment and retention, but the public knows that there is no shortage of applicants to medical school and that there are only a finite number of jobs abroad. There is also the air of the perpetual student about some juniors – a sense of entitlement that they should be carried along through the ranks without any competition, meaningful performance reviews or a healthy fear of unemployment.
This failure to see themselves as employees in a competitive marketplace is commonplace. The Guardian quotes a junior who says that the new contract “would change everything that (she) signed up for” – but this is not the fault of her contract, it is because all the career eggs are in the rather creaky basket of the NHS which cannot and will not stay as it is for forever.
Other mistakes in their campaign include the tendency to preach only into the already converted vacuum of the social media bubble – a lesson the Labour party should have learned after the general election. Writing long winded ‘open letters’ to all and sundry is masturbatory in terms of political action, but doctors’ groups seem to like to this form of communication. Being emotive about what you do at work all day is also futile – the public expect and pay you to do this difficult work and it would be akin to an RMT tube driver (they were roundly criticized by the nurses on social media during the tube strikes, by the way) saying “Look at me! I get 600 people to work every morning!” and expecting sympathy for it.
Me, I’m expecting the usual time-delayed online abuse following publication of this, which is another problem with a Twitter-based campaign – anyone can join in and speak rashly on your ‘behalf’, which damages your cause. The Left always get personal, but online slander is libel and although few people have the time or energy to challenge it someday somebody will. If and when the strike occurs, public support will wane rapidly, only elective work will actually stop…and eventually one goes back to the negotiating table in a weaker position than when one Twitter-stormed out.