Tag Archives: junior doctor pay

Junior doctor dispute: The politicisation of a generation

24900_701854411339_8280213_nThuvaraka Ware is a GP Registrar working in Camden. She tutors medical students at UCL in community medicine and believes primary care research will shape clinical and public health policy over the coming years.

I am a junior doctor. I went through medical school, foundation and speciality programmes with relative ease and multiple accolades.  I married a guitar playing, Aston Villa supporting historian I met at university who entered policy work.  I would scoff at his insistence that politics was important – I truly believed that I was doing the only true and noble job in the world. Politics was beneath me.

Experiencing the furore of our contracts dispute I now realise how completely and naively politically illiterate I was.  To disengage with this process and say it does not concern us for we are public servants has proved detrimental.  If the health secretary has done nothing else, he has at least caused a political awakening amongst our generation and I am not ashamed to say that at times this has been thrilling.  I have attended marches, canvased local support, given interviews, written and appeared in newspapers and journals and signed numerous group letters to various news outlets.

Social media has played a central role in this. Facebook groups have allowed us to feel connected to almost every other junior doctor in the country in some way, answer queries, debate responses and celebrate victories. The twittersphere, has enabled rapid dispersal of information and opinion.   Both these have helped nurture and spread the message of an essentially grass roots campaign, like #meetthedoctors, to fight the imposition of a contract that is unsafe for patients and unfair to us.

The unravelling of this dispute in the media has strengthened the resolve of many of my peers to become more politically active.  Many believe that the media have to take responsibility for their role in exacerbating this dispute – you may recall the now retracted 1998 Wakefield study and subsequent rise in incidence of measles as an example.  Indeed the online national survey by Gan et al1 to explore the ‘Hunt effect’ suggested that in the months after reporting of Jeremy Hunt’s irresponsible interpretation of the Freemantle epidemiological study2, there were patients presenting later than they would have to emergency services, afraid the weekend care would be suboptimal.  Patient care was potentially compromised as a consequence.

By engaging with the press, we are able to project our concerns whilst also being able to hold them accountable to what they write – my peers have written letters to the Independent Press Standards Organisation (IPSO) and a complaint about a report on our pay was recently upheld by the BBC.  This increased engagement between our media and the scientific community can only be a good thing, hopefully leading to an improved relationship long term.

As we enter the next chapter of this dispute with a clear mandate for industrial action it is life affirming to realise that we are not alone.   Many patients, allied health professionals and other emergency staff understand the nature of this fight and stand with us.  Becoming politically aware does not have to mean just engaging with politicians and the status quo.  It is also the way we connect on a meaningful level with those around us to make our immediate and extended social, cultural and economic environment relevant and bearable.

Although I am yet like a child taking my first steps in this new landscape, my feelings of political apathy are diminishing and I sense that change is possible.  I’m aware that our contracts debate will take many months to resolve.  But I am hopeful that our political awareness and social responsibility will survive the crest of this campaign post crisis, whatever the outcome.

 

References

1. Gan HW in response to BMJ 2015;35:h4596. Available online:  http://www.bmj.com/content/351/bmj.h4596/rr-52
2. Freemantle et al., Increased mortality associated with weekend hospital admission: a case for expanded seven day services? BMJ 2015;351:h4596

Junior doctor pay changes will damage general practice: the trainee view

Picture 030(1)Ravi Parekh is an academic clinical fellow in General Practice in North-West London with an interest in Medical Education.

I am a GP registrar working in London and over the past few months I have felt increasingly apprehensive about the future of general practice training in the UK. The latest blow to our training comes in the form of the recommendations from the DDRB report on the future of doctor’s pay.1

This independent report states the GP trainee supplement should be removed (currently 45% supplement) and replaced with “a flexible pay premium” known as a RRP (recruitment and retention premium), with trainees paid for the amount of unsociable work that is carried out, and a possible flexible pay premium adjusted locally, to help target problems with recruitment.

Firstly, in the majority of cases, this change will mean a substantial pay cut as trainees progress from a SHO (ST1 and 2) to a registrar (ST3). A large number of hospital rotations will include a substantial amount of unsociable work, which currently is remunerated with normally between 40-50% banding on top of the basic salary. However, the new proposals will mean despite career progression, increased responsibility within a higher risk setting, and working far more independently in the registrar year, there will be a significant pay cut. This would equate to a substantial penalty for choosing general practice as a career.

The BMA have suggested that the recommendations would mean an average pay cut of 30% to GP registrars.2 In real numbers, this is equivalent to a £15,000 pay cut, with virtually no consultation with the GP community or GP trainees, and now with the BMA leaving contract negations, we have no voice to express our concerns.

Secondly, a number of trainees within my own scheme have significant financial commitments, including families, mortgages and other dependants. With the potential of these changes being imposed onto us in the very near future, this will have a considerable impact on our take home pay, with many of us having to think about whether the job remains sustainable. I fail to understand how this fits into the “drive in recruitment” the government wants to achieve, with the goal of 50% of medical graduates entering general practice by 2016.3

Thirdly, there is a need to examine closer the “flexible pay premium” the recommendations suggest can help replace the supplement and solve the problem with GP recruitment. They state these can be implemented in “some parts of the UK”, with no specifics on how much this would equate to, who would be eligible to receive this, who decides whether this should be provided and what protection would we have for this premium. As a London trainee, I have little hope that this will be provided to London trainees or any other trainees who live in an area of the UK where the recruitment for GPs still remains competitive, and given the increase cost of living in these inner city areas, the impact on us will be increased.

Finally, what message does this send to medical students and junior doctors thinking of general practice as a career? With constant negative press in the media, proposals for seven day working, increased pressures to stop A&E admissions and transferring more services from the acute sector to us in the community, it appears to be that general practice is being treated on one hand as the saviour for all the problems in the NHS with no real increased funding to match these expectations.

Interestingly one of the solutions from the government to reduce pressure on us appears to be hiring physician assistants in general practice. These are people with a health related degree who complete two additional years in University. They can take histories, examine patients, diagnose conditions and propose management plans.  These jobs are being advertised with a salary of £50,000 very similar to the current pay we receive as a GP registrar. These physician assistants need to be under the direct supervision of a GP, who it appears will still hold ultimate responsibility for the patient.4,5

So it appears the public are going to be seen in the future by staff who are not doctors, who have not gone through the rigorous GP training schemes, who have not sat the AKT or CSA exams and are likely to be paid significantly more that those about to become fully trained GPs. I hope my fellow GP trainees, qualified GPs and ultimately our patients are aware of what is being proposed for the future of primary care in the UK.

 

References

1.     Department of Health. Review Body on Doctors’ and Dentists’ Remuneration (DDRB) review for 2015: written evidence from the Department of Health. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/382236/DDRB_2015_-_written_evidence_from_DH.pdf

2.     British Medical Association. Contract proposals for junior doctors. http://bma.org.uk/working-for-change/in-depth-junior-and-consultant-contract/ddrb-recommendations-analysis-for-juniors/junior-doctors-contract-negotiations-faq#5

3.     GP Taskforce Initial Report: Securing the Future GP Workforce Delivering the Mandate on GP Expansion. http://hee.nhs.uk/wp-content/uploads/sites/321/2014/07/GP-Taskforce-report.pdf

4.     NHS Careers. Physician Associate. http://www.nhscareers.nhs.uk/explore-by-career/wider-healthcare-team/careers-in-the-wider-healthcare-team/clinical-support-staff/physician-associate/

5.     BMJ Careers. Physician assistants: friends or foes to doctors. http://careers.bmj.com/careers/advice/view-article.html?id=20008022

BJGP Letter: A bleak future for future GPs in England

IMG_0976 (2)Guy Rughani is a Foundation Year 2 doctor working in North London. He wrote this short letter to the BJGP.

Contribute to the BJGP at http://bjgp.org/letters.

I want to be a GP, but the government is doing everything it can to stop me.

Mr Hunt’s brilliant answer to the crisis in GP recruitment is to slash trainee pay by 30%, penalise doctors taking maternity leave or extra degrees and extend normal working hours.1 Morale amongst my peers about to apply for specialty training is catastrophically low. As a result, the majority of my friends are looking to move from the NHS and take a ‘Foundation Year 3: FY3’ because they perceive that their immediate future here is bleak.  At a time in our careers when we should be optimistic and enthusiastic, it’s tragic that the state of the English NHS is leaving us so disillusioned. Scotland has dismissed the new junior contract, making a move North ever more tempting.

We need a strong positive message from senior doctors that there is a bright future in English General Practice, and a commitment from government that our incomes will be protected and our efforts valued.

1: BMA Junior and Consultant contract negotiations explained: http://bma.org.uk/working-for-change/in-depth-junior-and-consultant-contract/ddrb-recommendations-analysis-for-juniors#trainee