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We must fight - and the time is now

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I don’t remember much about being a junior doctor in the 1990s, other than long hours on call for half my hourly rate. Who else remembers the gross sense of injustice and exploitation? This is exactly what the Department of Health is trying to bring back with its threat to impose a new junior doctors’ contract, which will result in a pay cut for working the same hours. 

The reason is obvious: the ministers want to introduce routine seven-day working without a significant increase in expenditure.

Core hours are to be expanded from 8am to 7pm Monday to Friday, to 7am to 10pm Monday to Saturday, resulting in a lower banding for the same hours. The theory is this money will be recycled to pay more for Sundays and nights, but we all know how recycled money works: we’re all pulled down to the lowest common denominator, as has happened with the PMS reviews.

For GP trainees, the situation could be even worse.

The banding that equalises pay between hospital and GP training posts will go, which could result in a GP trainee pay cut of £15,000 per year. These massive losses may be offset in other ways, but with all this uncertainty, why would anyone want to join the profession?

We are no longer in this alone. Juniors, consultants, GPs – we need to fight for our profession, which is becoming a laughing stock in the developed world. The only body that can unite us is the BMA and I am sure many, like me, would reinstate their membership if decisive action were proposed. We need to stop feeling emotionally blackmailed and devise creative ways to take industrial action without significant damage to patient care.

This will differ for all specialties, but here is my 10-point proposal for general practice:

• Stop all home visits except for palliative care patients. We are one of the few countries where patients can get to hospital appointments and the hairdressers, but not to their GP.

• Stop prescribing all OTC medications. This will inconvenience, but not harm, patients.

• Prescribe the most expensive option in each family of drugs. Let’s start dishing out rosuvastatin and esomeprazole.

• Stop engaging with the CQC. If we do so en masse, what can they do – close us all down?

• Stop engaging with revalidation and appraisal. As above – we can all be referred to the GMC. 
I don’t care that I will be out of a job as an appraiser.

• Stop signing sick notes. Let’s face it, we hate policing the system anyway.

• Stop writing reports for the Department for Work and Pensions. We aren’t paid for most of them anyway.

• Stop attending CCG meetings. It’s a good excuse to be rid of the poisoned chalice.

• Stop providing any out-of-hours service. When A&E is on its knees, ministers might realise we already provide a 24/7 service.

• Stop signing cremation forms. Granted, this will be the least popular but it’s not risking any lives.

How much more will it take before we stand together, shoulder to shoulder, and fight our corner? For how much longer will we accept these contract impositions? We cannot allow this to continue. We must act… and the time is NOW.

Dr Shaba Nabi is a GP trainer in Bristol

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Readers' comments (49)

  • Peter Swinyard

    Remember the pensions "fight"? No use leading your troops if they don't follow.
    What will it take to unite a formerly proud profession?
    8 annual pay cuts? No
    Cuts to pension rights? No
    Lifetime earnings cap? No
    Loss of "in perpetuity" MPIG? No
    Outrageous increases in indemnity costs? No

    Just tell me!!!

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  • This is about leadership, if the leaders could not mobilise grassroot GPs, then it is obvious you do not have the right leadership capabilities or the appropriate level of engagement with grassroot doctors !! GPs are tired, stretched and ready to strike !! we need the right coordinated approach that reaches every city and every locality !!! get your act together BMA

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  • Hunt will win

    1. He will train up a load of cheap alternatives to GPs so patients can still see someone free at point of need
    2. Or GPs will cave in and do what he wants.
    3. Or GPs quit en masse and take the blame.

    The only way his strategy can fail is if the profession dont allow him the time to implement 1. This means all GPs agreeing on a strategy that means patients turn up at practices and there is noone there to see them. There would then be calls for his head on a platter

    JH is sensibly betting that GPs cant organise their way out of a paper bag.

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  • GPs as a group are just wet and have the business sense of a potatoe...a wet one at that. The NHS survival group has a grand total of £1400 of donations. If each GP just gave a pound that should be £46,000. Stop blaming the BMA and RCGP and get off your own collective arses and do something positive.

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  • Great suggestions Shaba. If only we could implement them. GPs are sadly incapable of uniting and that's what @unt and his mandate are using against us.
    Sigh :(

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  • Well said Shaba. The fight needs to be taken to the politicians and also some of the public. Just being defensive may not get us far. Fight hard. Fight long. Fight dirty. If not prepared to deliver the knockout punch, theer is no point in geting in the ring and go a few rounds

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  • Well said and well written . We GPS are so fragmented within ourselves that it is no wonder that the government is playing around with us and until such time we will continue to suffer . it is a disgrace that we have put up with such contempt from the government . The NHS is on the brink of collapse and we can all do ourselves a favour by resigning on masse so that the power that be can realize how valuable we are

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  • Count me in. Anyone else?

    I didn't join the toothless, let's-not-actually-inconvenience-anyone "strike" over pensions and haven't been a BMA member for many years, but I'll do whatever I can to make sure that today's junior doctors don't have to experience the brutal hours and low pay that those of us who trained in the 1980s and 1990s suffered.

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  • Hope Maureen reads this and finally gets her act together and step up, otherwise, resign, resign, resign.

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  • Hunt will win.patients are the first priority.
    Therr is no pint striking.this is bound to happen.this is becoming evident now.

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