Traditionally, medicine is not a particularly militant profession. However, last Saturday, hundreds of doctors and their supporters were angry enough to congregate outside Belfast City Hall, to protest against a new contract for junior doctors, proposed by the government.
The health secretary, Jeremy Hunt, is determined to drive through changes he claims are necessary to deliver the ‘seven day NHS’ that Conservatives pledged in their general election manifesto. The British Medical Association (BMA), which represents doctors across the UK, opposes the new contract, on the grounds that it will compromise patient safety and force its members to work exhaustingly long hours.
Currently junior doctors are paid at a standard rate for working between 7am and 7pm, on weekdays. They receive a higher rate of pay, or ‘banding’, when they work nights, weekends or beyond 7pm in the evening.
Legally, junior doctors can be asked to work up to 91 hours per week, under their current contract, although the average workload over a six month period should comply with the European Working Time Directive, unless they sign an ‘opt out clause’, exempting them from its conditions. Health trusts, which are responsible for employing doctors and running NHS hospitals, can be penalised if they infringe the rules.
The contract Hunt is proposing would extend basic working hours from 7am to 10pm and add Saturdays. It would also remove penalties which health trusts face for forcing doctors to work outside their contracted hours. In addition, a requirement for junior doctors to get a break every four hours would be abolished and replaced by a mandatory twenty minute break every eleven hours.
The government claims that its proposals won’t cut pay or increase hours. The health secretary points out that the new contract will decrease the maximum number of hours a junior doctor can work during the week from 91 to 72. However, doctors counter that they often work beyond the terms of their current contract and ask how maximum hours will be enforced, if Trusts don’t face any type of penalty.
Many medical professionals think hospitals are already operating at the limit. Frequently there are gaps in rotas, which are filled by asking staff to do extra shifts, or bringing in locum doctors, paid at expensive rates. Juniors doubt the government’s contention that services can be provided over a longer working week, without requiring them to work longer hours.
Jeremy Hunt’s proposals are for the NHS in England. The devolved governments in Wales and Scotland say that junior doctors’ contracts in their jurisdictions will not be changed. However, in Northern Ireland, the situation is much less clear.
Due to ongoing difficulties at Stormont, the DUP health minister, Simon Hamilton, has only just returned to his duties on a permanent basis. He was one of the ministers involved in weekly resignations and reinstatements, while talks took place about IRA violence.
Mr Hamilton has not yet indicated whether he intends to implement the new contract for the NHS in Northern Ireland. In the absence of a clear decision, junior doctors are worried that the health minister will simply follow the example of the Westminster government. There are even indications of disagreement within Mr Hamilton’s party, as some DUP MLAs responded favourably to the BMA’s overtures, while others were less positive.
Few patients would choose to be treated by a demoralised, exhausted, overworked doctor, who may not have eaten or drunk anything for almost eleven hours, if they were seriously ill in hospital. Staff say that the NHS is already getting by only because it draws deeply upon copious reserves of their goodwill, as resources are stretched and trainees head abroad for better terms and conditions. If this contract is imposed it is likely to create a furious reaction, which could result in industrial action and chaos in hospitals.