Since the new junior doctor contract hit the headlines about 6 months ago, I've been asked my opinion by medical and non medical friends alike. Most have been supportive, some confused, a few not supportive. I thought I'd direct them to a FAQ so I didn't have to keep repeating myself.
Why do you want to strike?
Like a good politician I will not actually answer the question, I will answer the opposite of the question to appease people who think I'm greedy.
I DO NOT WANT A PAY RISE.
OK, now I've cleared that up, I'll answer the actual question.
I can see why the BMA wants to keep the narrative about patient safety, inability to cover rotas (seeing as we can't already) and discrimination to women and part timers. However for me when it comes down to it, I do not want a pay cut. As a trainee who has changed career I have benefited from pay progression in my years as a surgeon. With pay progression scrapped for career changes and academic trainees will doubly affect me. My argument for keeping pay progression is that my experience in surgery has positively affected my work in this post pretty much everyday. The pregnant lady who I knew had appendicitis from her walk across the waiting room probably agrees.
Seeing as my rota is not changing my previous post explained how I might get a pay cut. As a single income household with 2 kids and a mortgage I really don't fancy losing nearly £5k a year. I actually think a pay cut should be enough of a justification for industrial action but there we go. Entitled doctor opinion or not. Vocation is a wonderful thing which I have in spades, but unfortunately it isn't legal tender.
As I need to break even to pay my mortgage, my solution to the pay cut would be to work more locum shifts. This sort of shoots any "I'm really worried about the amount of hours I work" argument out of the water. However caps to locum pay would mean almost a 50% cut in take home locum pay. The free market should be allowed to be free, except for public sector workers.
The other thing is that would sort of go against having another agenda for wanting to strike is a hypothetical situation where we were given the current contract and complete loss of hours safeguards but we'd all be paid 80 grand a year. Do you think we would all be out on the streets? I wouldn't be.
As it happens I agree with the wider argument from the BMA that the junior doctor contract is one facet of a wider campaign to undermine the staff in the NHS in an attempt to open it up to private investment. Others including getting rid of bursaries for student nurses and the health & social care act. This happens to be a convenient vehicle to voice concerns in general.
So you agree with the strike action, Why are you scabbing then?
Almost exactly the same answer. MONEY
I'd love to say my intense desire to keep my patients safe compelled me to cross the picket line. That was not really the case as at no point were any inpatients in any danger during any of the strikes.
It is the fact that I would lose £200 a day for each strike day that is what compelled me. When you are borrowing money from your Dad to pay your MOT and spending every other "rest day" in A&E locumming, losing £400 a month is quite a hit.
I was quite happy to work and let my colleagues strike, ones with no kids or money worries. You could say it is short sighted to not strike when you stand to lose out in the long run. That is what the government wants unfortunately, and my bank manager won't accept late payments because of my staunch principles. I can't afford jam today, so I'll worry about today now and worry about later, later.
What would it take to get me to be happy with the contract?
Well, I'm not really sure, which is why I've put my faith in JDC to negotiate for me. Probably a complete reversal and no change would satisfy me, but that isn't going to happen.
The problem with the old contract is that banding payments only have a few levels (50% 40% 20% 5% and nil) and this meant that people working wildly different hours could be paid the same. For example as a surgical registrar I worked a partial shift pattern with overnight on calls. The urology registrar worked every other Saturday and no nights. We were on the same salary. The new contract won't address this issue as the pay cuts will mostly affect those that work the most unsociable hours, making people like myself in Obstetrics worse off and people in day time "office" specialities better off.
So essentially, I'll be happy if the BMA are.
I don't know, and that is the problem. There have been no sample rotas, no plans to open clinics or theatres at weekend, no plans from our trust about how we will provide this "Truly 7 day NHS". What is the point of introducing a new contract if we don't change our working patterns. When I'm operating an elective list on Saturdays have the trust got plans to pay for ODPs, porters, scrub nurses, support workers who also need to be there? I don't think so.
Salford has managed to provide excellent 7 day emergency access to MRI etc. and have a Standardised Mortality ratio of 88 (This is good). They have done this with current staffing and contracts.
Didn't we pay for your training?
Yes, you did, and bloody good value for money as well. I'm old and lucky enough to only have £25k of student debt and the taxpayer put up about £175k over 5 years. That's quite an investment. One solution would be a golden handcuff to keep us in an NHS post for 5-10 years post qualification. That will only reduce numbers coming in the door or poor students attending. The thing is where would such a policy end? Teachers? Nurses? Police? Anyone who works in the public sector should pay back all their education fees? What about those working in private sector, they are using taxpayer education to profit someone else, is that right? Does this mean that nobody should get state funded education? Having a well trained workforce is good for the country but there needs to be good enough jobs to keep people there.
Here I will put paid to the myth that your taxes pay for all my post graduate training is not good value for money. Whilst HEE pay some of my salary I can guarantee you that the time I spend in post graduate "training" is actually spent providing a service at a cut price. All the discharge paperwork, cannulas, radiology forms, coding paperwork actually contributes to the running of the service, not just my "training". So beware people who quote £500k as a training figure as that includes my salary for all my years in training. Of course, my post graduate "training" isn't passively looking over a consultants shoulder and absorbing knowledge. A lot of service work goes into it as well. If I do an appendicectomy at 2am on my own, am gobbling up your money being trained? Or am I actually providing a service within the remit of my current skills?
What is your solution?
Unless enforced ill health, misadventure or a better long term alternative comes along, I won't give up my National Training Number. This puts me in somewhat weak position with regards to the new contract. Now I have a family and a mortgage and am not yet a consultant so I can't just up sticks and leave for Oz like last time. So whatever happens I'll be at work in August. I can't say the same for my colleagues. In my department alone we have 1 going to Scotland, 1 moving abroad and 1 leaving medicine all together. I know the plural of anecdote isn't evidence but I did a teaching session for our 14 FY2 doctors last week. More of them were moving away, locumming or taking time out than staying for a specialty post. Maybe a zero hour, poorly trained cohort of juniors is what the government want?
Next BMA action could be to not sign any one up to a new post in August and instead form a locum agency to outsource trusts own doctors back to them at locum rates. Then nobody has to strike and it will show you how much a medical workforce could cost. Indefinite emergency only care is an option but suffers the same problems that caused me to scab this time. We could work with the deaneries to give all trainees 3 months "out of program experience" so nobody had to lose their training numbers and nobody starts work on August 5th. This is difficult to achieve seeing as HEE is a government agency.
The NHS is a monopoly employer so I can't just go and work and train at the hospital down the road.
Do you want to bring down the government?
Well, Yes. I'm a member of a political party which isn't the conservative party, so seeing the government brought down would be great. Just not over the JD contract dispute. There are lots of reasons not to like what is going on in the current government, but it's not out of character is it? People knew what they were voting for and they're getting it.