Why are junior doctors in the UK so pissed off?

What are the proposed changes that junior doctors are unhappy about?
The government has been in discussions with the British Medical Association (BMA) Junior doctors committee for around 2 years around imposing a new contract on junior doctors. The government had 23 positions it wanted to change, and it has said it would only negotiate on one of them. The BMA had to agree to all the others to continue to negotiate. It therefore walked away from negotiations as it could not accept that stipulation.

There are many bones of contention, but these are the main ones:

• Switching our ‘plain time’ contractual hours from 0700-1900 Mon-Fri to 0700-2200 Mon-Sat: How would you feel if your boss suddenly told you you now work 1400-2200 Tuesday to Saturday? How would you get childcare? How would you socialise with other people?

  This is pretty self-explanatory, but a further consequence is a paycut as we get paid more based on the proportion of our work that falls into antisocial hours. This will have a disproportionate effect on those specialities that do most out-of-hours work - like A+E, anaesthetics, intensive care, obstetrics etc. Half of all A+E posts are already unfilled as it is so onerous- what do you think will happen if those posts are made even less attractive?

• Removing annual pay increment: Thereby disadvantaging those who train less than full time for childcare or health reasons and those who take time out to do research. This is also a pay-cut, as we’d watch inflation eating away at static pay while waiting 3 years to get to the next level of training (or 5-6 years if you are part time). We’ve already had a 14% paycut since 2007 due to a pay freeze. This will disincentivise research, which we need to improve care, and is directly discriminatory against women (the largest component of the less-than-full-time workforce).
• The new contract will remove the financial penalties that hospitals face if they impose unsafe rotas. We are bound currently by the New Deal and European Working Time Directive, that means that our hours are capped at 48 hours averaged over 13 weeks (although we can work much higher than that in any one month as long as they rota days off afterwards- it is normal to do 12 straight days with 4-6 of those being 13 hours). This is unsafe for us and patients, as there is a clear incentive for hospitals to impose more hours and harsher rotas.

But who are junior doctors, and what you do?
The label “junior” doctor applies to all doctors between first year out of medical school and consultant level (or GP if they leave hospital medicine). That can take anywhere from 5 years for GP training to up to a decade for a hospital-based speciality. That doesn’t include any time taken out for research, which delays the completion date (2 years for an MD or 3-4 for a PhD).

So the label is a bit of a misnomer really. There are around 50,000 of us in the UK. I’m 35, with 3 kids. I look in the mirror at my receding hairline and the bags under my eyes and don’t feel very junior!

What is the background to the changes?
The government want to bring in “7-day services” in the NHS - which we doctors also want. What happens now - if you are admitted to hospital - is that only emergency work is done at the weekend. The routine scans, blood tests and reviews don’t happen at the weekend, which slows down your progress through the hospital stay. Doctors staff hospitals at the weekend to cover these emergencies, but the routine work happens during normal hours. The government want to bring this routine work to the whole week, but don’t want to pay any extra money for it. This means they are going to have to get an extra 40% more work out of the staff to have similar staffing at weekends compared to the week.

They aren’t aiming to recruit 40% more staff, so this can only come about by either increasing antisocial hours and reducing weektime working (depleting already risky weekday staffing), or by plain increasing hours for the same pay (making even more tired doctors and thus mistakes). This new contract is bad for patients and staff.

The plan can only work if the doctors are supported by radiographers, technicians, pharmacists, nurses, physiotherapists, social workers etc - which means that if they succeed with us they will be coming after everyone else next. This is crucial - there is simply no point having a hospital full of doctors doing routine work if there is no one to process the blood tests, rehab the patients, dispense the drugs etc.

Doctors in privatised health services earn much more money and work less. Already Australia and New Zealand are very popular destinations for doctors (roughly 1500 junior doctors head there a year). We worry that this is the subtext here - impose a contract that makes lots of juniors leave for better conditions elsewhere and make already stretched services fail. Then make the case for a publicly funded NHS being unworkable and then privatise it.

I've never heard about the British Medical Association talking about industrial action before. What is different this time?
The BMA last went on strike in 1975, suspending all non-emergency hospital work for 3 months in protest at at a contract that would force them to drop private practice. Later that year in November the juniors also walked out over a pay and conditions dispute.

Since then there have been several one day strikes by nurses and some other hospital workers, but nothing sustained or particularly disruptive.

What do your colleagues think about it? Do they support a strike, and would they really prepared to walk out?
An ICM poll of junior doctors had us at 95% pro-strike action. I started a national poll that had over 1100 responses, and only 2 were for no strike. We will be balloted over the next few weeks and I expect it to be a solid vote for action. The only worry is that the BMA may sell us out and organise some anaemic work-to-rule or one-day tokenistic strike action.

And what about non-junior doctors?
Consultants and staff-grade doctors also seem to be in overwhelming support. Less polling has been done of them.

Do you think the BMA is serious about actually organising industrial action? If not to you think there is some way you could put pressure on them to act?
There are meetings being called all over the country to put pressure on the BMA (including one tonight in Bristol where I write this). Committees have been formed in every hospital in the country that are independent of the BMA, but comprised of BMA members - all of which appear to be pro-strike. Perhaps I’m naive, but I can’t see how they can forestall action!

That sounds very interesting. Could you tell us more about the committees? Is there any coordination or communication across the country?
There are worker reps in the BMA, but within a week of the decision by the NHS Employers organization to impose the Government’s proposed contract next August ordinary doctors in every region set up committees to work on the issue. There are regional groups everywhere organized via Facebook, with a larger national group that most are also a part of. Both the regional and national groups have offline real-world committees with elected positions. Coordination is fluid between the regional and national groups given many members have dual membership online.

The discussion so far has been split between internal and external work: internal discussions have concerned around what to do about altering the media narrative, liberal political lobbying of politicians, and discussions around what forms of action we will support. The outward-facing work has been around coordinating regional and national demonstrations (Bristol, Manchester, London, Nottingham etc), media liason with TV, online and newspaper journalists and lobbying the BMA to ballot for effective strike action.   Some committees have also set up in individual hospitals. These groups all involve the local hospital worker-reps for the BMA. By now I’d say BMA membership is near-universal.

What kind of impact would a strike of junior doctors have?
It is junior doctors who provide the mainstay of care in hospitals, with supervision by a responsible consultant. The consultants are therefore freed to do outpatient clinic work (if they are medics - e.g. the gastroenterologist investigating your father’s rectal bleeding, or an oncologist looking after your friend with breast cancer) or elective operations (if they are surgeons - the knee operation that your grandmother has waited for for 8 months). It is this elective work that makes most money for the hospitals. By going on strike all this elective work will cease as the consultants will have to man the wards and Emergency departments of the hospitals. Discharges of patients will grind to a halt. The entire system will creak.

To your knowledge, what was the reaction of doctors to other recent industrial action in the NHS, like the November 30 pension strike or 2014 strike over pay?
Doctors are largely from comfortable middle class backgrounds, with little social memory of struggle or solidarity. For the vast majority of the junior doctors, this is their first experience of industrial action, and their first direct contact with it. I doubt that most were aware of either of those. For example, I am the only hospital doctor I know of who came out on strike in support of the public sector pensions dispute in 2011. However, consciousness is formed in struggle, and this dispute has seen an explosion of discussion on other aspects of politics and privatisation plans for the NHS.

What do you think the prospects/possibilities are for bringing together doctors with other NHS workers in fighting together to defend conditions or protect services?
Nurses and other NHS workers have so far been prominent on the front lines of the demonstrations called by doctors on our contract, in a way that doctors have never been on theirs. I think that most people in the service either already see that this dispute is part of a privatisation agenda and will come round to involve them in the future, or are receptive to seeing it that way.

What would you say to other workers, like nurses, who might think that doctors are well-paid, and better off than most so they shouldn't complain?
What they do to the doctors today they do to the nurses and allied health professionals tomorrow. The banding supplements for out of hours work; the nature of what constitutes “antisocial hours”; cheap ways of staffing a 7-day NHS without recruiting 40% more workers.
 
More than that, hospitals already only work due to the good will of the staff. The NHS is essentially staffed just well enough to function with no unpaid work assuming no one is ill. Or on maternity leave. Or quits. By making loads of doctors work more at the weekend, there is likely to be a thinning out of cover during the week - which will make the jobs of nurses much harder. The sick patient they need a doctor to see during the week will have to wait longer - and until that happens they are unsupported.

We firmly see this contract as a way of making the NHS appear to be failing. Doctors will leave. When it does become privatised we will also probably make more money - so a double incentive to join us in fighting against it! Either way, patients, the service and the principle of collectively provided healthcare will suffer. This contract can and must be defeated.

Interview conducted between Steven Johns and pingtiao, both members of the libcom.org group