Is pay really the issue for striking doctors?

With junior doctors striking again, Dr Katie Musgrave explores whether the real crisis lies not in pay negotiations, but in the very foundations of the NHS

Everyone’s talking about the junior doctor strikes. Aren’t doctors already well paid? How can the health service afford to pay them more? Isn’t the NHS becoming a black hole that will subsume the whole economy? Whilst not directly relevant to GPs, I find it interesting to reflect on these strikes – especially while GPs have their own ongoing contract dispute.

Junior (sorry, resident) doctors voted again to take strike action from July 25 for five days, so we are currently bang slap in the middle of it. But just last September, the same group of doctors accepted a government pay deal of 22.3% on average over two years. So what’s changed? And will pay increases fix the problems? 

With the UK public finances appearing highly vulnerable and the NHS in a poor state, the public mood now seems increasingly unsympathetic to medics’ demands. With the NHS clearly floundering and the whole country feeling the pinch, people are wondering why should doctors be paid more. Recent polling found that 49% of respondents were opposed to the doctors’ strikes, with only 36% in support.

Of course I am extremely biased – but I cannot help reflecting on the working conditions I experienced as a junior doctor, and feeling sympathetic. Qualifying in 2010, my pay did not feel excessively generous. I was able to cover my half of the living costs on the small two bed house I shared with my husband in the Midlands, we lived frugally, and I started paying back my student loan. There were no designer handbags! The BMA state they wish to restore doctors’ pay in real terms to 2008 levels. There is dispute over whether pay demands might reasonably follow increases in RPI or CPI. Yet pay demands aside, I find myself wondering if remuneration is the fundamental issue here.

Upon qualifying as a doctor, I was shocked to discover the widespread shortage of staff that seemed ubiquitous in NHS hospitals. This experience must surely have been the same for every UK based junior doctor, for decades before and after me. Yet over time, you begin to accept failings and dysfunction as normal. This is just what working in a hospital is like. Things will never change. This sense of powerlessness, and one’s inability to make positive changes in an overwhelmed system, leads to frustration and disillusionment. 

We covered vast numbers of patients: finding ourselves racing from ward to ward, playing Russian Roulette with treatment decisions, and lacking the senior support needed. Colleagues worked through significant illness, close family bereavements; we missed weddings, funerals; social lives and hobbies were set aside. We fell asleep at the wheel driving home from arduous night shifts. Some grew fat and unfit. Others turned to alcohol. Working in the NHS takes its toll in myriad ways: and among medics at least, junior doctors often bear the brunt of the most short-staffed and dangerous shifts, the longest, most antisocial hours, and the most job- and location-insecurity.

Doctors commonly start their careers with a reverence for the NHS; nurtured by medical lecturers, academics, and peer-to-peer student interactions. But if junior doctors have been brainwashed to believe the NHS is above reproach, then what are they to think if they find it doesn’t work? Who can they blame?

So they argue the NHS is underfunded and demand more investment into the system. But perhaps the deeper issue lies with the health service itself and the way it’s funded. The ever-expanding range of drugs, tests and treatments, combined with an ageing and increasingly unhealthy population, places unsustainable pressure on a purely state-funded model. As costs spiral and outcomes worsen, the NHS appears to be steadily falling apart; demanding more from the economy, while delivering less in return.

I do wonder if repeated votes to strike by doctors belies a deeper dissatisfaction: with unsafe working conditions, substandard hospitals, and permanently understaffed rotas. But it may also be the case that no amount of public money will be able to fix this, because the NHS is failing, and is possibly broken beyond repair. The BMA would never admit this though – so we should expect these disputes to continue.

Dr Katie Musgrave is a GP in Devon