This August I moved from being a medical student to become a doctor. After five years of endless exams, coursework and presentations, medical school was finally over. I had often wondered what life would be like. I knew the hours would be long, the on calls arduous and the night shifts terrifying. What I never imagined was that within eight weeks of starting there would be calls to strike, friends from the years above quitting medicine, others leaving for New Zealand (and never coming back) and a new contract being imposed by the government that altered everything I had signed up for. I find myself a junior doctor at one of the most turbulent times the NHS has ever witnessed.



The lines were drawn between the British Medical Association (BMA) and the government last week. The BMA branded the government’s newest junior doctor contract as unsafe and unfair, while the government responded by saying it would enforce the contract from August 2016 anyway.

Coming so soon after the furore over MPs’ 10% pay rise and tube strikes, it seems there is a high risk of the public becoming understandably somewhat apathetic to yet another public sector fight over money. Yet do not be fooled. This contract is not simply about doctors and their pay. The ramifications of the proposed changes will reverberate for doctors and patients alike.

There seemed be universal agreement that it was a good thing when the days of juniors working 80-hour weeks ended. Understandably patient safety was at risk when doctors worked such long hours. Yet there are fresh concerns that with the new contract, those days may be returning – a point that has yet to be clarified.

In recent years banding (a supplement added to your salary for nights, weekends and evening shifts) was used to recompense doctors for gruelling hours and penalise hospitals for making juniors work such long and unsociable hours. The more unsociable the hours, the better the pay. The government wishes to remove the banding system, which will have two very stark consequences.

Firstly, employers will no longer be financially hit by making juniors work longer hours, instead employers are being encouraged to follow working time regulations. Secondly, the government wants to increase standard rate hours from 60 to 90 hours a week. This would mean no differentiation between 9pm on a Saturday and 9am on a Tuesday. What was previously considered unsociable is now “sociable”. So even if the financial penalties still existed (which they won’t) they would be much reduced.

There are other noteworthy changes in the new contract. Pay protection for women who choose to have children is being removed. Just when the barriers for women entering medicine have fallen, in one fell swoop they could be rebuilt. The contract disincentivises women having children and places an unfair choice on those women who choose to enter medicine.

Additionally, we daily hear of complaints about difficulties in seeing a GP. Yet the contract imposes a reduction of 40% in GP trainee salaries (some say they would earn less than their first-year doctor salary). General practice is a hard, gruelling job with many wonderful rewards and a huge amount of responsibility. We need good doctors to enter this profession but the already low numbers are set to fall even further.

Scotland has already said it will not impose the new contract, meaning should the government enforce it in Wales, Northern Ireland and England there will be a huge disparity across the UK.

Too much of the NHS I knew when I started out as a medical student has been chipped away. I fundamentally believe in a service that provides free healthcare at the point of need and we need to collectively stand up for that. The new contract only serves to attack it. I know too many people who are leaving medicine through burn out or emigrating to work as a doctor elsewhere.

In the eight short weeks I have worked as a doctor I have loved it. The doctors, nurses and allied health professionals alike have all been supportive. I have had excellent senior support. It’s hard work. It’s rewarding work. I wouldn’t want to do anything else. Yet the introduction of this contract next year would potentially impact on all of that.



To survive the NHS needs its doctors, but more importantly it needs safe working conditions that put patient safety at the centre. This new contract does not do that. The concerns about working long, unsafe hours are very real and have not been fully addressed by the government. It should never have got this far. What is needed is an opening of renegotiations on sensible terms. I only hope that a way can be found.

Are you a junior doctor? What do you think? Should junior doctors go on strike? How will the changes affect you personally? What impact will they have on the NHS in England?

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