Contract wars: what's next for doctors?

October - not a great month for doctors, so far.

This week a survey of more than 6,000 doctors in training found that:

• 97% were in favour of industrial action

• 75% say they will leave their jobs if the new contract is brought in

• 42% say they will leave to work abroad

• 15% say they will change career.

They are obviously upset and angry. The anger has been rumbling for many months but now, in the media, seems centred on changes to the payment system. Currently, normal working hours are 7 am to 7 pm Monday to Fridays with pay supplements for hours worked beyond such times, according to the levels of work done. The new system will 'rebrand' normal hours as 7 am to 10 pm, Monday to Saturday.

Further supplements are also being cut, including "out-of-hours" payments doctors can earn for extra work.

The RCGP has already petitioned the government over the proposals. The College claims that if the contract goes ahead, it will deter graduates from training as GPs, making it impossible for the Government to achieve its target of recruiting 5,000 extra GPs by 2020, and that patients will ultimately bear the brunt.

Other specialities are also feeling the strain; the head of the Royal College of Emergency Medicine said we have already lost one third of our A&E doctors in the last five years, most of whom have taken work in Australia and New Zealand.

A further blow to GP recruitment this week was the long-expected seven-day working week announcement, which finally came at the Conservative party conference in Manchester. Seven-day care from 8 am to 8 pm will be included in a new "voluntary" GP contract that will be developed by April 2017.

One aim of the contract is "making sure that people in our country can get access to a GP on a seven day a week basis, 8 am to 8 pm". The new directive to NHS England will require that they and clinical commissioning groups should ensure that every patient has access to seven-day services by 2020. This seems a noble aim, but most of us have already heard that some pilot scheme CCGs have abandoned the system either because of poor appointment uptake, or because of lack of impact on emergency department waiting times.

The Department of Health (DH) plans to publish a new GP contract ("to get rid of the box-ticking and the form filling") by 2017, which would mean that QOF and other sorts of bureaucracy will be removed. I'm sure we all recognise a carrot (or a stick) when we see one. There is little yet in the way of fleshing out these proposals although the DH says it will set out clear milestones for delivery in the coming months. How do you stretch the resources we already have, even further? Surely something will break?

There will be gnashing of teeth and threats of action. People will talk - we're good at that. But few will do anything. Most will feel powerless to do anything without unthinkable repercussions.

We have been here before. Threats to strike come around on a regular basis. No one does. And the politicians know that.

So - what do we do? Buckle down and find a way to work through it? Stand up for ourselves and take the consequences?

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