Jessamy Bagenal: Junior doctors—What are we fighting for?

So what?

There has been a huge increase in the number of junior doctors who have joined the BMA since June when Jeremy Hunt began new tactics with NHS staff. Repeated inflammatory and insulting statements like “when you turn medicine into a Monday to Friday profession” have enraged doctors to an unprecedented state. The strike action has been suspended whilst talks continue. Some are angry and a previously united front has fractionated. But, even if, in some alternate universe the government agreed with all the BMA’s terms for a new contract would it matter?

Political awareness

Junior doctors have become more politically aware, realising too late the importance of changes made in the Health and Social Care Act in 2012. A £2 billion deficit, three years of expensive reforms, and overall reductions in mean earnings has resulted in such dissatisfaction and government mistrust that NHS staff are for the first time united. At the weekend the nurse I worked with in A&E wore an “I support junior doctors” badge. NHS staff feel a sense of community. Something that although common to previous generations has fragmented with the introduction of increasing shift patterns and financial pressures. They have joined in what can only be described as a fight; taking arms through social media and recognising the power of public opinion. The continual undermining force of negative media and savvy politicians seems to have reached a critical mass, NHS staff suddenly standing up for their own professionalism and refusing to be mere employees of a government body and their political agenda.

Mixed messages

But the reasons are unclear. When 20,000 people took to the streets in London in protest many of the signs read “Save our NHS,” “Protect our Doctors: Protect our NHS” “We already work seven days a week.” And songs re-written and sung to famous tunes like “It’s not about the money” all have similar mixed messages. This has for many people become more about the future of the NHS rather than terms and conditions in a contract. The BMA has stayed “on message” but even their well organised and branded paraphernalia “Junior Doctors’ contract, It’s everyone’s fight” seems to suggest we are fighting for more than a contract. This “fight” has been managed well with focused press coverage, and rising stars that have highlighted the issues that the NHS is facing to the public.

Seven Day Working

Of course the junior doctor contract changes started because the DDRB was commissioned to come up with a cost neutral pay envelope that would allow seven day working. The government is so convinced in the need for a routine seven day NHS, a notion of such expense and unknown benefit that NHS staff no longer trust the government with its management.

What now—will there be a Christmas number one NHS staff song?

Although times have been hard for NHS staff, their loyalty to the concept of free healthcare and the NHS as an institution is deep rooted and emotional. For many who voted “yes” to industrial action it was because they felt there was nothing else to do—a last resort. The importance of the result of contract negotiations must not be underestimated. It will have ripple effects for all NHS staff, for the future of recruitment and research, and shape the future of NHS staff professionalism.

But now we’ve drawn our only card, what will happen when a resolution is made? The demoralisation of a workforce and the crisis the NHS faces will not go away, but will staff continue to be united? I cried watching the two NHS staff choir songs; the first “A Bridge over you” a mash up of Simon and Garfunkel’s Bridge over troubled water and Coldplay’s “Fix you.” The second, a more uplifting but equally moving song, “Yours” with lyrics like “The NHS needs saving and they’re not listening but we’ve got something to say.” Will a movement to protect a failing NHS continue? Or will the business of people’s everyday jobs, lack of immediate threat to our livelihoods, and knocks from shrewd political moves make us go back under the covers? I do hope not.

Jessamy Bagenal is a general surgical registrar in North West Thames and currently undertaking a National Medical Directors Clinical Fellow scheme. She is based at The BMJ as an editorial registrar.

Competing interests: None declared.