Rejecting the contract offer - our duty as doctors

Having declared 'victory' over the doctors, it must have been a shock to Jeremy Hunt that his contract was just voted down 58% to 42%. It probably isn't that surprising, when you consider his year spent dragging a respected profession through the mud on the basis of empty promises, politically-driven threats and scaring patients. A resounding 'No!' is a stand for the NHS, and one that we can be proud of. Patients over politics, we did this for you.

This last year has been a theatre. The junior doctor strikes polarised the nation and pit doctors against politicians. In return for standing up for our patients, we were labelled 'militant' and 'greedy'. It was a cynical attempt to turn patients against us. Despite the Whitehall rhetoric and media mutterings, this dispute was about 'safety', not pay. Rejection of a contract unsafe for patients was inevitable, and a mark of our integrity. It was our duty to protect our patients. Trust me, we took an oath.

The original justification for the new contract was to provide a 'seven-day NHS' in line with Conservative Party election promises. Jeremy Hunt proclaimed a higher risk of death at weekends due to a lack of doctors. A 'new contract' would save lives and provide seven-day care for the same price. Hunt was to be saviour of the patients and the king of the NHS. It all sounded so glamorous and progressive. But like any fairy tale, it was just good storytelling.

It quickly became evident that Hunt's claims didn't add up and that his solutions fell short. The 'weekend effect' was shown to be a myth. Hours safeguards were judged unreliable, the pay structure sexist and rota plans untenable. Whistleblowing was demonised and became a career killer. It became the case that speaking out was a recipe for unemployment. Even the medical students wanted to quit.

It became clear to us that a 'seven-day NHS' required more money, more staff, honesty and better integration of existing systems. A new contract wasn't enough, we needed a new approach. We needed dialogue and a workable plan. Stretching the system further risked breaking.

Hunt needed to work with us, not against us. No matter what evidence we produced, the government would not listen. It seemed that being 'strong' was more important than being right. How dare a union oppose the government? The negotiations were just like a hunter toying with prey. It became clear that the government saw this dispute not as an effort to improve patient safety, but a challenge to its superiority. We were seen as 'militant'; words usually used to describe terrorists. Johann Malawana, the Chair of the Junior Doctors Committee of the BMA, was painted as a despot, and the BMA as his army. Sensationalism at its best.

Our strikes were about preventing a situation where the NHS would fail, nothing more. No radical coups here. The contract presented a terrifying reality, where this was not just possible, but inevitable. Pay reduction risked forcing those doctors with families to resign, with longer hours spent covering the gaps exhausting the rest. Reduced staff cover threatened patient health. 'Hours safeguards' were as reliable as a house of cards, built on sand during a hurricane. The NHS seemed in danger of collapse as more and more doctors chose to resign or leave. We saw a storm on the horizon.

The media became polarised, and the dispute became political. Patient safety became a buzzword and not a priority. Finally, the government grew weary of challenge and threatened imposition. The king became a tyrant. Time wore on, and finally the BMA conceded to an 'agreement'. Bullying seemed to have paid off. Except that the agreement was still unsafe, unfair, and unwanted. It seemed only a matter of time until the government's bubble burst.

The only solution available was to reject the contract and hope that the government takes the opportunity to work with us, to adjust the very real issues highlighted over the past year. We mean funding, staff numbers and system integration. We need to talk to find new ways to reduce waste in the NHS, incentivise workers and industry, to invest in our nation's health. We need to work together to design rotas that are robust and resistant to failure, to design pay structures that support our working mothers and researchers for their time. We need a government who supports our public services, not goes to war with it. We need an honest whistleblowing system which rewards those who speak out, not punishes them. We need progression and we need help.

We are not militant or mercenaries. We simply ask to be able to do our job with the support and resources necessary. All we ask is a contract that protects us and our patients, and perhaps it's time that Whitehall listens to the frontline. This is likely to be a long battle, but if there is one person you want in your corner it's a grizzled doctor, not a politician who has shuffled where he doesn't belong. This was not a 'No' to the NHS; it was a 'Yes' to patient safety. We have had enough of politicians making empty promises at the risk of our livelihood and our patients.

Stand with us, we stand for you.

Any opinions above are the author's alone and may not reflect those of the NHS and affiliated parties.

Ben is a young NHS doctor in the Southwest. His interests include neurology, health communication, and medical ethics. He is also an avid advocate of compassionate care and quality improvement, running a project in the Southwest around medical humanities. Please follow and support: Dr Janaway on Facebook Dr Janaway on Twitter


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