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
