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Pre-nups won’t save the relationship between doctors and the NHS



I have recently been thinking about the concept of pre-nups and what such a contract implies. Why? It started with Johnny Depp and finished with the Civitas report suggesting that medics should be forced to pay back the alleged £131,000 that it costs to train them – an NHS-medic pre-nup of sorts.

What on Earth has happened to open this chasm between NHS employers and employees?

Of course, we wouldn’t want to overly compare the apparent mid-life crisis of a 40-something-year-old man opting for a younger, fresher, and more exciting partner, only for it to all go horribly wrong in the blink of an eye, with the dissatisfaction that doctors feel with their spouse, the NHS…would we?

But perhaps we should; act in haste, repent at leisure – oft quoted, but does this really apply to the relationship between doctors and Europe’s biggest employer? Doctors don’t act hastily, they plan (usually from a young age) to join the profession. It’s a passion, dictating choices from GCSEs and beyond. We build our CVs over the years, every action planned to secure that prized medical school place. So passionate are doctors to join the NHS ‘family’, that their own family, friends and social life are sacrificed. Thousands of pounds are spent along the way, at university and thereafter, taking courses and exams to be the doctor of that early dream. So is a pre-nup really needed?

Just as every young couple embarking on marriage doesn’t need or doesn’t want to think about a pre-nup, so those dreaming of being a doctor don’t. There is love, neither could survive without the other, the thought of parting too ridiculous to contemplate. So contracting for the parting if this flush of love and devotion doesn’t last is just tacky, unbecoming, and unnecessary. And yet Civitas, from the cold side-lines, feels that it is.

This concerns me on several fronts and most can be drawn back to a comparison with marriage. The relationship between husband and wife is similar to that of employer and employee in many ways. Where there is love and passion at the outset, there is basis for a lifelong, respectful and fulfilling relationship, one that if nurtured will grow and be mutually rewarding.

Of course, there will be potholes and bends in the road which prove difficult to navigate, but if both partners have enough respect for each other they will stop and examine the hurdle and work out a way to traverse it together. What on Earth has happened to open this chasm between NHS employers and employees that is seeing so many newly qualified doctors leaving the profession completely by FY2? Where doctors who have given 15 years to training are uprooting their lives to Australia, New Zealand and Canada, leaving friends and family behind.

How did we reach this point where think-tanks are not considering repairing a once beautiful relationship but instead handcuffing a generation of intelligent dedicated young people to an employer who appears to have lost any interest in understanding why their workforce is so unhappy?

So here’s the crux: no pre-nup, handcuff, or any structured punishment for wanting out will redress the fundamental issue that is driving doctors to make the once unimaginable decision to leave the NHS. Indeed, like a divorce that is too expensive to happen, both parties will be padlocked to each other in unhappiness by such a scheme, trapped in a loveless relationship where with every passing day they hate each other a little more. Is this any way to provide top class patient care? 

It’s time for the NHS to consider going to relationship counsellors, and the springboard should be the understanding that only if you treasure, nurture, respect and care for your spouse will the relationship flourish, bloom and survive.

Dr Renee Hoenderkamp is a first-year qualified GP in north London