Junior doctor dispute may have a lasting impact on the NHS, researchers say

The junior doctor contract dispute may have a lasting impact on the NHS because it led many junior doctors to change specialties or defer training, researchers have said.

A survey of junior doctors’ career intentions found that many changed their career plans during the dispute. A report on the findings concluded that decisions made “in the heat of a turbulent time” could turn out to have “significant consequences.”1

Among those applying to train in general practice, 30% said that they had switched choice because of the new contract. In addition, those applying for acute hospital programmes were significantly more likely to defer training than those applying for community posts.

The research was carried out by a team from Manchester University. They said that, if the expressed intentions to quit the NHS, work abroad, defer training, or switch specialty choice were carried out, it could notably alter the balance of the medical workforce.

Sharon Spooner, a GP and co-author of the report, said that there was particular concern over how many juniors planned not to proceed straight to specialist training. “The contract for juniors and all the disruption surrounding it has influenced their career plans,” she said.

The researchers’ findings were based on a survey of junior doctors’ future training intentions carried out at the height of the contract dispute in late 2015 and early 2016. Spooner said that the timing was “serendipitous,” allowing researchers to explore whether contract issues were having an impact.

Some 816 doctors in the second year of foundation school programmes in England (FY2s) took part—about 12.6% of the total cohort. Extensive interviews were also held with a sample of doctors.

The researchers found that there was evidence of “systematic changes” in the training and career plans among FY2s applying for a specialty training programme amid the contract dispute. One in five said that issues related to the contract had prompted them to switch specialty, while a further 20% were uncertain about whether to switch.

The most notable move was away from acute to community based specialties, seen as less likely to be negatively affected by the contract. The survey found that 30% of those applying to train in general practice had switched because of the new contract.

Data also suggested that the dispute left doctors feeling less valued or appreciated in the NHS and by society in general. Some respondents said that contract issues had made them question their career in medicine entirely. One doctor said, “It looks like being a doctor now isn’t quite the job I signed up for.”2

Those applying for acute hospital programmes were significantly more likely to defer training than those applying for community posts. Some said that concerns about working antisocial hours, negative effects on work-life balance, and a different mechanism to calculate pay had reduced their desire to train in acute specialties.

Spooner said, “We got the impression that the reason they weren’t going for certain acute jobs was because they could see that the contract would change things in a negative way—as a working environment and arguably for patient safety.”

Among those applying for training and planning to move overseas afterwards, the vast majority cited contract issues as a reason.

Spooner said that it was troubling that young doctors felt undervalued and lacking in support. “This is a global market, they know they can work wherever they want and they have the ability. It would appear they may have the inclination to do that and that’s not good for the NHS,” she said.