The need for change
The junior doctors’ contract dispute has shown the need for major and sustained changes in education, training, and policy. The contract, and its imposition, may have been the catalyst for the junior doctors’ dispute but it is clear that a broad range of issues have fuelled doctors’ anger.
This is evident from both social and broadcast media and the picket lines. Indeed, health secretary Jeremy Hunt said that he “fully accepts that the . . . frustrations of many junior doctors are about more than just their contract.” These “frustrations” are varied and extensive but there are common themes.
Education & training
Many junior doctors raised a number of issues relating to their education and training. They are concerned by training quality, access to training opportunities, and the ethos of modern medical training—which some have described as “little more than a box ticking exercise.”Many are worried about the increasing costs of medical education, both at undergraduate and postgraduate levels. Still more are dismayed by an inflexible and impersonal national recruitment system, which pays no regard to the personal lives of doctors in training.
Employment & working
Many junior doctors raised issues relating to basic employment, equality, and their working conditions. Doctors have often complained about inflexible HR practices—which have seen them unable to take leave for significant personal events. Others take issue with poor facilities for doctors working out-of-hours. Still more have reported an absence of meaningful support and a “loss of a sense of belonging.”
Questions of healthcare policy
Beyond these issues, many junior doctors are concerned about broader questions of healthcare policy. Many are troubled by the broader vision for the future of our NHS, and whether universal healthcare is sustainable—or even a policy priority—in an age of austerity. Regular chants of “save our NHS” were unmissable on the picket lines.
The dangers of disillusionment
Cumulatively, these issues have resulted in junior doctors feeling demoralised, disillusioned, and disengaged. Although industrial action is currently suspended and Justice for Health’s judicial review has concluded, a failure to tackle these problems means that a return to “business as usual” seems unlikely.
This carries real danger to the NHS: Mark Britnell, a former NHS director general, has warned that a demoralised junior medical workforce “could really set the NHS back,” as it struggles to cope with current and future challenges. More immediately, there is a risk of further attrition from medical training programmes—with the number of doctors choosing to continue with specialty training falling year on year.
The need for a national response
Many of these issues fall outside the remit of any single organisation. This was recognised by David Dalton, who recommended an urgent review into trainee morale by the Academy of Medical Royal Colleges before concerns about timing, governance, and terms of reference led to a trainee boycott.
Although the BMA’s junior doctors’ committee, NHS Employers, and Health Education England subsequently agreed to comparatively narrow reviews, and individual medical royal colleges have sought to engage with their trainees, there has been no coordinated effort to understand or tackle the causes of poor morale among junior doctors.
A lost generation
The absence of a comprehensive, system wide, national response to the problems cited over the course of this dispute risks becoming a missed opportunity for medical education and training, medical employment, and the wider profession as a whole. A generation of junior doctors have stood together—with the support of many of their senior colleagues—and called for meaningful and enduring change.
If these voices are heard it would represent an unprecedented opportunity for the medical and political establishment to collaborate and engage with a body of committed and compassionate agents for change. If these voices are ignored then a “lost generation” of disengaged junior doctors may come to threaten any hope of delivering a world class healthcare service in the UK—today or tomorrow. Urgent and coordinated action is required by medical leaders across our NHS. The status quo is no longer an option.
S Alderson, P Dacombe, M Dias, T Duncan, T Foley, S Gauher, G Hill-Cawthorne, W K Wong, S Mehta, S Mukhtar, K Patel, S Panchal, I Rodrigues, H Ryland, F Taylor, S J Wang, K Whitfield, M Wittenberg, W Wynn-Jones
This article originally appeared in BMJ.