The junior doctor contract: we now need strong leadership at all levels

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This article covers the author’s personal views of where the medical profession stands following the outcome of the junior doctor contract referendum. It builds on a previous post to this blog, and was adapted for publication in The BMJ. The text below is the unedited version.


 

Kaanthan Jawahar says that junior doctors, having voted to reject the proposed new contract, now need to work with another and with senior colleagues to tackle the problems that lie ahead.

The EU referendum result has set a mandate to split the UK from the EU. An uneasy feeling followed, where those voting to remain bemoaned the far right and older electorates for dictating their future.

Yet it was the disenfranchised working-classes hedging their bets on uncertainty by voting to leave that influenced the outcome. In their eyes, anything was better than preserving the status quo that austerity had given them.

I see parallels in this group when I consider my junior doctor colleagues. Years of discontent, increasing workloads, decreasing training opportunities, bureaucratic e-portfolios, and worsening work-life balances are why morale is rock bottom. The contract dispute is simply the latest in a long series of changes that have worsened junior doctors’ working lives. It’s no wonder the contract was rejected, though in this context the Government is pressing ahead with introducing the new contract despite the outcome of the vote.[1,2]

I voted to accept the new contract. I believed it offered a chance for the medical profession to take back control. Through exception reporting, barriers between frontline junior doctors, guardians of safe working, directors of medical education, and educational supervisors would be broken down. This could be a powerful workforce planning tool to quantify rota gaps, forcing employers to act via contractual board and national-level accountability frameworks. Our supervisors would be performance managed by new and pre-existing junior doctor fora bolstered with contractual remits and powers.

I believe that the proposed payment structure, though complicated, is fairer than what we have now and that the contract goes as far as it can on whistle blowing, with the ultimate endgame being legislative change. I’ve even reconciled that the removal of automatic pay progression will adversely affect some less than full time trainees (LTFTs). Many disagree with me on this, but I worry that ‘paying off’ LTFTs detracts from the underlying problem – that society and medicine discriminates against those needing to work less than full time. We should re-focus our efforts into supporting these LTFTs into full-time work where possible.

I may be overly optimistic. Many colleagues cannot fathom a world where exception reporting works, where relationships with our senior colleagues improve, where employers act to fill rota gaps, or where medical staffing pay us for all work done. They view me as deluded or as an apologist.

This divisive feeling could be the downfall of junior doctors. We are not each other’s enemy, but we risk becoming exactly that. No one comes to work to do harm. There are good senior colleagues out there and employers rarely, if ever, set out to do the wrong thing.

A leap of faith is required now with strong leadership, both from the BMA nationally, but also the very junior doctors that were on the picket lines locally. I see a world where the leaders are those on the junior doctor fora, who hold employers to account, who show their colleagues that it is ‘ok’ to exception report, who flatten the hierarchies between junior and senior colleagues and fight for equality in the workplace. We must approach the unknown with a plan. Grass roots activists, shop floor junior doctors and national BMA leadership must roll their sleeves up. We need it all if we are to get through this.

  1. Rimmer A. Junior contract will be imposed, Hunt says. BMJ Careers 6 Jul 2016http://careers.bmj.com/careers/advice/Junior_contract_will_be_imposed%2C_Hunt_says
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