A GP’s Diagnosis: Jeremy Hunt is ‘meddling’ with NHS foundations

Photo: James Bass.

Photo: James Bass. - Credit: Evening News � 2009

What are the Government doing? They want to introduce a seven-day routine service in the NHS, which would be great, only they do not seem to want to pay for it.

We are told that the new contract is not intended to cut costs but to solve various anomalies in the way junior doctors are paid, according to Hugh Pym of the BBC.

At present, junior doctors get a starting salary of £22,636, which can be topped up with a complex system of payments for working “unsociable hours”. The new contract would raise the basic rate of pay, but reduce the hours that qualify as “unsociable”. Standard hours will now be 7am to 10pm every day except Sunday. For many junior doctors, this will result in an effective pay cut of 30%, but this is denied by Jeremy Hunt.

The Government is being “cunning and dishonest” according to the Daily Mail, which does not have a reputation of supporting doctors. It wants to make the NHS a seven-day-a-week operation, but can’t afford to pay the additional staff costs.

So it has simply rewritten the definition of overtime. The tiny hike in the basic salary is designed to make doctors look unreasonable – as if they oppose the plans “despite being offered more money”.

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The BMA intends to ballot for strike action because some doctors will incur 30% income drops and also patient safety will be compromised by removing the guards that limit working hours. There was some movement last week as Jeremy Hunt wrote to the BMA on October 8 promising pay protection for doctors moving to ‘shortage specialties’ like general practice, which is positive.

How does it feel being a junior doctor?

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Money is actually only a part of the issue so, although they start on half the earnings of a tube driver, the career does lead further than Cockfosters. The term “junior doctor” means everyone under a consultant so the youngest ST7 grade would be 33.

Training doctors costs the taxpayer £250,000 but they graduate with a student debt of up to £65,000. Compared to other countries they are underpaid, overworked and subject to constant government interference. British doctors are suffering from a serious crisis of morale that is going to boil over with this new contract. They honestly feel it is going to be disastrous for patient safety, and for the future of the NHS.

The specialities hit the hardest will be those already suffering on the frontline – A&E, acute medicine, elderly care, general practice and obstetrics. The new contract – which removes the extra pay for working antisocial hours and takes away the pay supplement for GP trainees – is going to worsen what is already a serious recruitment crisis.

This means less doctors in A&E – so a longer waiting time. It means less GPs – so less appointments. It follows that there will be even more reliance on agency and bank staff to fill rota gaps which really does cost a fortune that the NHS cannot afford. It is a struggle for junior doctors to convince the public that they are doing this because they want to protect patients and the NHS.

What do the Royal Colleges (groupings that represent different types of doctors professionally) think?

There seems to be consternation among leaders of many medical Royal Colleges about what they see as the DoH’s bullish stance on the new contract which has led to a potential strike. It is a real worry that it will deter recruitment into the medical profession and also prompt young doctors to work abroad instead – more than 3,000 have already started investigating this.

Furthermore, it is bound to stop young doctors going into areas of medicine that are already understaffed, such as A&E and acute care, in which working antisocial shifts is routine.

Is this not just a storm in a teacup?

Absolutely not – could past performance be a guide to the future? Over the last five years the head of the Royal College of Emergency Medicine says that a third of the A&E doctors have already left – mostly to work in Australia and New Zealand.

In a poll of 6,000 trainees 75% said they would leave their jobs if the contract was imposed. 42% said they would go abroad while 15% would change career. Could the last doctor emigrating please put the lights out and lock up the hospital.

And yet Jeremy Hunt says he is going to find 5,000 more GPs to ease the front-line load – is he a magician or a politician?

It is as if he is trying to build a bigger NHS to provide seven-day routine services but, because he cannot afford new bricks, he is removing them from the foundations. You have not got to be a structural engineer to know where this is going.

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