Intended for healthcare professionals

Rapid response to:


Wider political context underlying the NHS junior doctors’ dispute

BMJ 2015; 351 doi: (Published 24 November 2015) Cite this as: BMJ 2015;351:h6317

Rapid Response:

Low morale and future brain drain of the NHS

Dear Editor,

We are writing in response to David J Hunter’s article on the junior doctors’ dispute, which highlighted the resurfacing of the “unhappy doctors” syndrome, as a manifest of the dispute over the proposed Junior Doctors Contract. At our busy district general hospital in England, we were interested in how junior doctors viewed the proposed contract changes, and the effect on staff morale.

Among the junior doctor respondents at our hospital, 85% strongly agreed that the proposed Junior Doctors Contracts will harm the long term future of all medical professionals (from juniors to consultants), and indeed 85% also strongly agreed that the proposed contracts will harm the long-term future of the NHS. This echoed the thoughts of the author - ‘no matter what the rights and wrongs of the dispute, the ramifications will be felt throughout the NHS for some time to come’.

The current Conservative government has stated repeatedly that the new contract would improve patient safety; 92% of our respondents disagreed with this. What is more unsettling for the future of the NHS is that 61.6% of those surveyed said the proposed contract had made them think about leaving medicine, and a greater number (69.2%) were now thinking of working abroad. Only 23.1% could see themselves working in the NHS for the foreseeable future. This combined loss of expertise and front-line staff would be detrimental to the NHS, and contribute to the UK ‘brain drain’.

Hunter highlighted three areas that led to the ‘unhappy doctor’ syndrome- pressures on staff, the need for a better work-life balance, and concerns over patient safety. This was strongly echoed in our questionnaire; 88.5% thought that staffing levels were inadequate, and 96.2% agreed that a lack of permanent staff affects patient care. Pressures on staff was highlighted by 73% who thought that there was insufficient time to provide the care that they would like to, and 69.2% felt they were tired all the time due to long working hours. 88.5% disagreed that doctors are well remunerated for their hours. These figures are not surprising given the recent outcome of the BMA ballot, which voted overwhelmingly for strike action (27,741 doctors).

Our questionnaire findings resonate Hunter’s views. Staff morale among junior doctors at the moment is at an all-time low, and many consider the proposed Junior Doctors Contract to be a threat to the long term future of the NHS.

1) 'Staff Morale Questionnaire' Adapted by Dr Ramesh Mehay (2010) from 'The Assessment of Work Environment Schedule' (AWES) developed originally by Nolan (1998) at Sheffield University
2) 'Wider political context underlying the NHS junior doctors’ dispute' David J Hunter BMJ 2015;351:h6317

Competing interests: No competing interests

26 November 2015
Sirke L Rinkoff
FY1 Doctor
Dr Fiona J Tsang, Specialist Registrar in General Surgery
London, England