With 98% support in a 76% turnout, the decision from the junior doctors to strike is an unprecedented mandate for the BMA negotiators. There is also widespread support from senior doctors, for this is no hierarchical dispute, rather one encapsulating our profession’s collective concerns.
There has been a traditional reluctance amongst doctors to discuss pay, yet this is an issue even if not the key concern. The narrative in the press that doctors are well paid belies the reality that health professionals have borne the brunt of a virtual pay freeze since 2004. Despite the responsibilities of the job, the average medical starting salary is less than the £28,000 average for all graduates. Furthermore, were they to flat-share with any combination of a young barrister, dentist or draftsman, they would see how much faster the others’ pay progresses. Compounding this are high expenses such as student loans, GMC membership, indemnity cover and postgraduate exams.
The practical upshot of this is sobering. Primary care’s workforce has undergone a rapid demographic shift, as retiring full-time partners are replaced by salaried doctors, predominantly part-time and transient appointments – surely the antithesis of what an ageing population requires. GP pay has been hit by phasing out seniority payments, for loyalty has no market value to our elected leaders. The recruitment crisis was once confined to areas deemed unappealing to middle class professionals, but has spread to London, the Home Counties and the Thames Valley, areas now unaffordable even to senior doctors, let alone other NHS staff.
Above all, however, it is Hunt’s belligerent manner, vituperative sniping and failure to engage properly with the profession that has caused a feeling of alienation, unprecedented in history. Playing pop politics, he gives the impression that the wellbeing of patients and that of healthcare workers are mutually exclusive rather than intertwined, potentially poisoning public trust. He has repeatedly quoted the paper by Freemantle et al on the ‘weekend effect’, without appreciating the subtleties of data interpretation evident to the paper’s authors.The overarching issue is that staff shortages, which threaten even current service levels, make any plans for 7-day routine service unworkable.
That is set to worsen with significant numbers of UK medical graduates, seeing their prospects vanish, emigrating early in their careers. The attraction of other English-speaking countries is obvious; furthermore, many are multi-lingual descendants of some of the world’s fastest-developing countries, adding other potential destinations. Is the irony lost on Hunt, Cameron and Osborne – unreconstructed disciples of the free market – of just how freely marketable they are? Yet it is vital that the publicity around this is handled properly. Pictures of expatriate doctors smiling on Australian beaches trivialise the debate, and gives fuel to those who wish to portray our profession as indolent and pleasure-seeking. Truthfully, our climate is no more the reason for doctors leaving than it is the sole attraction for the overseas bankers and oligarchs who flock to London: we must grasp the real issues.
When the least rebellious professionals imaginable become restive, it is surely time to take heed.
Dr Edin Lakasing is a GP, undergraduate tutor and postgraduate trainer in Chorleywood, Hertfordshire and Immediate Past President of the Section of General Practice with Primary Care at the Royal Society of Medicine. The views expressed are personal