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A faulty production line

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)

  • Tell all patients requesting a visit, apart from palliative care ones, to go to the nearest casualty and if needs be they call for an ambulance.
    After taking a careful history that is and documenting it. This could go for anyone after your workable limit, say 30-40 contacts a day, could be told to go to casualty or the nearest walk in centre.
    I suspect this happens in some areas already.
    There's only so much we can safely cope with in a 10 hour day.
    That should soon snarl the system up.

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  • I think we need to stand united as an entire profession - ALL doctors of all grades together. The only task we all do, that we can stop doing, without harm to any patient, is stop signing death certificates.
    "We simply don't have time."
    I would expect it only to be a matter of days before we get some real, sensible negotiation from all parties as the morgues overflow.

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  • Fine words brothers and sisters, but unless and until Maureen and the Cardie Club are willing to come down from their Ivory a Tower, grab a Donkey Jacket and man a brazier, it's all just pith and wind. The time for strikes has passed. The time for mass resignation and emigration is here. Act now. And make some noise on your way out.

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  • The only thing we all ( as doctors) need to do is stop paying GMC fees enmasse. No patients harmed or inconvenienced but a MASSIVE message to government whilst also sorting out the GMC. It's a win win. I have suggested this to the BMA but was told that they don't have a problem with the GMC.

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  • Ildiko Spelt

    Well written, Shaba! I agree with all you say there...

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  • 10 30 --birds of a feather flock together my dear anonymous amigo

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  • Nice article; about 5 years too late but nevertheless good advice;

    There's a feeling of rebellion in the air...

    Its now or never.....

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  • The lack of evidence based, vicious and punitive over regulation of medicine desperately needs 'sorting out'.

    Meanwhile, the GMC advertises £70k plus a year jobs for the non medically qualified with private healthcare, a generous car allowance, working from home and 'a comfortable and relaxed working environment'.

    These are cushy jobs. Meanwhile, the professions is dying on its feet and the likes of this quango fail to have come up with what is a safe patient work load or safe staffing level.

    The non medically qualified ex-journalist chair earns in excess of £500k a year.

    The GMC has nothing to do with patient safety. It cannot provide a shred of evidence that what it does is useful or that it is fit for purpose. Yet it wants to do more and more....

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  • Strewth not another ten point plan.when do any of them make any difference...but if you do want to make one up put something positive in .not just ..stop this; stop that.....

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  • A blanket refusal to do OOH would be effective and would only be needed for a short time . However no one will agree - so we're fucked .

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