Intended for healthcare professionals

Rapid response to:

Letters New junior doctor contract

More problems with the new junior doctor contract

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h5409 (Published 14 October 2015) Cite this as: BMJ 2015;351:h5409

Rapid Response:

Junior Doctors Contract – A Medical Student’s Perspective

In 2013, National Health Service Employers (NHSE) began negotiations of the contract for junior doctors. In 2014, the British Medical Association (BMA) stalled talks with the Government due to growing concerns about patient safety and the failure of effective safeguarding measures for junior doctors. As part of those proposals, NHSE’s recommendations were redefining ‘sociable’ hours, and removing the banding system, safeguards protecting working hours and annual pay increments.(1) Junior doctors’ outrage at the proposals has been well documented in both the media and academic fields. What has been overlooked however, is the perspective of medical students - the junior doctors of tomorrow.

The impact of the contracts is great on medical students as it is they who are the sole cohort of people who will undertake all future training under the new contracts in their entirety. Most coverage on junior doctor contracts have failed to consider the disproportionate impact that the junior doctor contract will have on future doctors, failing to encourage those from low socio-economic backgrounds as well as international students. Already students have been placed under massive financial strains due to previous measures such as the tripling of tuition fees in 2012. Current proposals now include the removal of student maintenance grants, burdening those from low-income backgrounds with further debt. Research has already shown that individuals from lower socio-economic backgrounds are underrepresented in medicine with only 6.3% of people coming from deprived areas within the UK.(2,3) What the government currently proposes to do is to widen this gap and reduce the diversity within Medicine by making a historically prestigious profession simply financially unviable.

Students have been further targeted from proposals tightening immigration rules on non-EU students in further education. Foreign students will be forced to leave the country upon finishing their course and will have to reapply for a work visa if they want to return to the United Kingdom. This can have an impact on as much as 15.7% of medical students who are international in the current cohort.(4) With so many international students filling medical schools across the country, these changes could have significant effect on recruitment of the NHS, further destabilising it in a time of drastic change.

Furthermore, new contract changes exhibit further discrimination against women.(5) Under the new contract, trainees who decide to work part-time would see their pay increase at a slower rate than their colleagues. Removing pay protection for women on maternity leave could potentially widen gender inequalities and discourage female students from embarking on a career in medicine, exacerbating staff shortages in the future.(6)

Junior doctor contracts have caused a rise in appeal for students seeking to move outside of the NHS. In recent weeks, there has been a rise in ongoing seminars and talks discussing the options available to new graduates to move outside of the UK. As dissatisfaction over the hours and conditions within the NHS grows, opportunities to move to the US or Australia become more attractive for students where doctors can earn up to 50% more despite generally working less overtime. The UK provided Australia with 13% of its GPs and 22% of its specialists in 2011.(7) Current proposed changes in the contract could see these numbers rise. Reports from the General Medical Council (GMC) have shown that in the 10 days after the Hunt contracts were confirmed, doctors made 3,468 requests for a certificate to practice medicine outside of the UK. The regulator normally gets between 20 and 25 requests a day.(8)

In conclusion, the junior doctor contract in its proposed form has alienated the medical student body and resulted in a disheartening in their future career paths. As the contract proposals progress, a growing long term concern must be the staffing crisis the NHS may potentially face created by the low morale and thus dissuasion of medical students from entering training. Medicine faces its biggest hurdle yet in maintaining its impressive diversity and global nature.

References:
1. Review Body on Doctors’ and Dentists' Remuneration 42nd report: 2014 - Publications - GOV.UK [Internet]. [cited 2016 Jan 12]. Available from: https://www.gov.uk/government/publications/review-body-on-doctors-and-de...
2. How does socioeconomic status affect access to a medical career? General Medical Council; [cited 2016 Jan 12]; Available from: http://www.gmc-uk.org/publications/23538.asp
3. Fair access to professional careers: a progress report - Publications - GOV.UK [Internet]. [cited 2016 Jan 12]. Available from: https://www.gov.uk/government/publications/fair-access-to-professional-c...
4. Free statistics online - HESA - Higher Education Statistics Agency [Internet]. [cited 2016 Jan 12]. Available from: https://www.hesa.ac.uk/free-statistics
5. Harries RL, Mohan H, Sinclair P. New junior doctor contract will negatively affect women in surgery. BMJ [Internet]. 2015 Jan 14 [cited 2016 Jan 12];351(oct14_5):h5410. Available from: http://www.bmj.com/content/351/bmj.h5410?variant=long&hwshib2=authn%3A14...)
6. Ahmed F, Ahmed N, Ellis H, Parry E, Catto G. NHS junior doctor contract proposal: risks and prejudices. Lancet (London, England) [Internet]. Elsevier; 2015 Oct 17 [cited 2016 Jan 12];386(10003):e20. Available from: http://www.thelancet.com/article/S0140673615004511/fulltext
7. c=AU, Australia o=Commonwealth of, Statistics ou=Australian B of. Main Features - Doctors and Nurses. c=AU; o=Commonwealth of Australia; ou=Australian Bureau of Statistics; [cited 2016 Jan 12]; Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features20April+2013
8. Thousands of NHS doctors apply to be able to work abroad amid contract changes | Society | The Guardian [Internet]. [cited 2016 Jan 12]. Available from: http://www.theguardian.com/society/2015/sep/25/nhs-doctors-contract-chan...

Competing interests: No competing interests

12 January 2016
Sarim Siddiqui
Student
Ibtesham Hossain, Samee Siddiqui, Mohammed Muntasir, Mustafa Franka, Umair Mughal, Bashar Atalla
Imperial College London
London