Junior doctors’ dispute: pause is welcome but fundamental problems remain

tom_moberlyA five day pause in work to introduce a new contract for junior doctors could be a welcome opportunity for both sides to engage meaningfully on the outstanding issues of disagreement. But it would do little to quell the anger that led junior doctors to the first all out strike in the history of the NHS.

Meaningful talks could undoubtedly go some way to closing the gap between the government and the BMA. The government says that the substantive areas of disagreement relate to pay, the most significant being around pay for Saturdays and antisocial hours. The BMA argues that there are at least seven areas of disagreement, including safeguards and protection against working excessive hours.

The gap between these two positions may not be insurmountable, but both the government and the BMA will have to make significant compromises to reach an agreement. It will need some creative thinking to come up with ways that both sides can do so without losing face. Given the importance of reaching a resolution – for the government, the medical profession, and patients – it would be disappointing if these issues could not be resolved in five days of talks.

But, even if agreement was reached on the specific issues that concern the BMA, it would do little to diminish the strength of junior doctors’ anger and their animosity towards Jeremy Hunt.

For one thing, agreement on these areas would not address the fact that junior doctors believe the new contract is both “not fair” and “not safe”. The contract is seen as “not fair” because it aligns pay rises with training progression and so removes pay progression for those taking breaks from training to pursue research or start a family. It is seen as “not safe” because, although it is designed to support seven day services, it is not linked to any plans to increase junior doctor numbers to allow current staffing levels to be maintained across seven days. It is hard to see how either the “not fair” or the “not safe” argument would be resolved if the BMA and the government agreed on the key remaining matters of dispute.
In a sense, these issues are small compared to one huge and unaddressed problem: that many junior doctors are not really angry about the specific details of the proposed new contract but about far wider issues.

Junior doctors’ frustrations and dissatisfaction with their working lives and careers, and the perceived reduction in “meaning” of the work that they do, have led to a deeply troubling decline in morale among junior doctors. The BMA acknowledges that the issues that it sees as remaining areas of disagreement “sit within the broader context of morale, quality of training, and work-life balance, issues critical to the current and future generations of junior doctors.” The government has also acknowledged the problem. Ministers’ solution, which was to commission the Academy of Medical Royal Colleges to undertake a review of the issues affecting junior doctors’ morale and wellbeing, has been met with scepticism and criticism, and by all accounts has not got off to a strong start.

The low morale of junior doctors is an issue that the whole medical profession needs to face up to and, in part, admit responsibility for. That will require doctors to address the lack of leadership in the medical profession at a local and national level, and begin to work together on ways to support the next generation of doctors.

Tom Moberly is the editor of BMJ Careers. Follow Tom on Twitter @tommoberly