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At the heart of general practice since 1960

Junior doctors risk losing public support

From Dr Erl Annesley

As a BMA member since student days and now retired from general practice, I was horrified by the decision of the junior doctors to have a full blown strike.

To give the impression that you are prepared to be seen, standing by, holding placards, refusing to treat seriously injured or ill patients, kills off the most valuable asset any campaign can have: public support. That same support from all sides killed off the proposed welfare cuts in the budget.

Do not ignore the importance of keeping the public on your side

If the junior doctors lose people’s support, they lose the battle.

The public already feels that graduate doctors are well-treated by taxpayers, with their hugely-subsidised degree, guaranteed job prospects on graduation and choice of well-paid part- and full-time jobs when the junior days are over. Their perpetual complaining and ‘Save our NHS’ posters do not go down well, even before any full blown strike.

The public knows many doctors like my stepdaughter, who is a three-day-a-week GP with young family, earns a salary better than many full-time workers and never has to work any unsocial hours. How many other young graduates have that privilege? My son has a well paid job he enjoysas a consultant in emergency medicine. Though he is often tired and works nights and weekends, that is what he expected when he chose to work in that field. It was his choice.

The public does understand the issues. They realise that although junior doctors will get a 13% pay rise, many of them make up their salaries with overtime at special rates and for them a pay cut may result in serious family budget problems. They are happy that anyone who works more hours than they are contracted to do should be paid for those hours, it is only the rate of pay for them that is in dispute. Whether this rate should be higher and how much higher, depends on what any employer can afford. As the NHS budget grows almost as fast as you can print money, the population ages and medical advances race ahead, the extra money will have to come from other areas of big spending like education, welfare, pensions or tax. The last is obviously preferable and the BMA should be playing its part by canvassing politicians of all shades to persuade the public of this and agree a non partisan multi-party approach to raising income tax, specially set aside to cover what is necessary for the NHS to thrive.

The irony of all this is that the BMA made a similar mistake when Kenneth Clarke introduced his new contract in the early 90s. An attacking campaign was launched with big pictures of Kenneth Clarke on roadside hoardings denigrating his attitude to the NHS. It had the reverse effect from that intended. The public did not protest at his proposed changes despite doctor opposition, and the new contract went through, heralding the beginning of targets and later unpopular ideas, like fund holding for GPs.

The lesson learned then should not be ignored and the last thing young doctors need is another own goal. Do not ignore the importance of keeping the public on your side.

Dr Erl Annesley is a retired GP 

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Readers' comments (36)

  • The hospitals, not the juniors, have to treat the seriously ill patients. It is up to management to make sure adequate clinical cover arrangements are in place. The moral responsibility for this does not fall to the JDs.

    Public support is nice but sadly is already largely eroded. More important is to make a stand against government bullying and unsafe expectations.

    You have a different attitude as one who worked in the heyday of GP (and indeed your training posts in hospitals) when you were respected and well paid and trusted. None of these things exist very much any more. Today's doctors are treated only as public staff and as such they have to stick up for themselves because quite frankly nobody else will.

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  • Doctors should not try to be popular, they need to try to survive in this new harsh environment. This is a hugh challenge and if the author of the article wishes to be treated for free by the NHS in his dotage, then he needs to forget the past and look at the present and towards the future.....

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  • I thought Hunt was claiming that his scheme is cost neutral and the rationale (using the term loosely) for change was his misunderstanding of weekend mortality data, thus overall wage bill the same but unhappy doctors and damage to weekday service and paient safety by stretching same number of doctors over 7 days.

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  • I don't even know where to start with this article so......I won't bother.

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  • Bob Hodges

    Retired GPs don't have much of a mandate to analyse the prop/cons of junior doctors' T&C negotiations.

    'In my day anecdotes' don't really hold much water. The 98% of Junior doctors who voted for strike action would probably snap your arm off if offered the T&Cs that you spent your career working for.

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  • you wonder why the f is he posting an article here.... retired, issue doesn't concern him, angling for a political position?

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  • It does seem that all of these articles, rolled out in anticipation of each strike, always come from those who are either retired, or in non-clinical posts.

    Using 2x irrelevant anecdotal examples of your own children, neither of which are even currently junior doctors, isn't convincing evidence. I would assume part of their comfort comes from having a golden era GP as a parent, making it unlikely their finances have ever been as knife edge as, say, an academic SHO in London with a young family, from a non-medical family.

    Unfortunately we have to look at large scale evidence, and not small anecdotal case reports. The sheer number of those involved in this issue (those balloted by the BMA, those petitioning for a vote of no confidence in Hunt) is a more compelling argument for the current state of the NHS than this article.

    Finally, the perception and trust of doctors doesn't really matter - we're still essential to the patient. Also, we're increasingly having the backing of other public sector workers (ie. teachers) who are further proving that this isn't a simple 'doctors not getting paid enough' issue - it's a broad battle against the destruction of our nationalised public services by increasingly corrupt and self-interested politicians.

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  • GPs beware - and learn this lesson well...

    At present we live in the age of the purchaser-provider split. Remember which you are. You are the provider. Your job is to provide ONLY what you are paid to do. Do it as well as you can whilst making a profit. It is the job of the purchaser to get as much bang for their buck as they can out of you. It is your job to deliver the right level of bang for the right level of buck.

    When we loose the split, we can consider being conciliatory again and focus on organising the system to benefit the patient most. While we are merely suppliers to an abusive commissioning system we must mind our own business, and not theirs.

    THIS is the key difference between the deal of fundholding, and the CCG era.

    Dr Annesley - A well reasoned article from the wrong historical perspective. The BMA is impotent at best and complicit at worst.

    That £100k of donors were willing to back an independent legal action tells you all you need to know - we have little faith in the mechanics of the system, and grass roots action is the way to win.

    Need a hint of where we are going? All schools to become academies. The public agrees that the NHS is at risk - we must mobilise them to act on it.

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  • Dr Annesley, I wish you well in your retirement, I really do, but if you retired more than 2 years ago, you will not realise how much things have deteriorated.
    GP partners earnings have gone down by 30%, CQC costs are going to go up by 700%, indemnity costs are reaching 5 figures, patients attending surgeries have nearly doubled in a decade, the proportion of funding for primary care has gone down from 12% to 7.2%. Suppose earnings drop by a further 30% do we still carry on? Suppose , in the future, the governmant says there is no money, do we still carry on working for nothing?
    I know your article is about junior doctors, but most of those will have a pay cut of 30%, they enter the workplace with massive debts, and when they look in to the future this is what they see.
    It`s great that the public are supporting the JDs, and hopefully they will continue to do so, but if they don`t that will be a pity, but it won`t change anything.
    If they become unhappy , they can complain as much as they like , but nobody will be listening. There won`t be anyone there.

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  • Like you I am an outside observer though still working as a GP most of the time. I am more concerned that the "Public risk losing Junior Doctors' support". JDs are brilliant highly educated and capable of tremendous things, but that might not include dedication to a monopoly abusive employer such as the NHS.

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