Intended for healthcare professionals

Feature Doctors for the NHS Essay Competition

Why junior doctors need more autonomy

BMJ 2018; 363 doi: (Published 01 November 2018) Cite this as: BMJ 2018;363:k4525
  1. Rose Penfold, junior doctor
  1. London
  1. rose.s.penfold{at}

To tackle low morale, strategies to reduce workload are only partly feasible or desirable, writes Rose Penfold: we must also empower doctors in training to give them more control over tasks and working environment. Her essay was the winning entry in a competition run by Doctors for the NHS and The BMJ

Junior doctors are discontented. Our professional bodies acknowledge low morale and high stress, but key concerns remain.

In a national BMA survey conducted in 2017, 61% of 422 English doctors in training said that their stress levels had increased in the past year,1 and 44% of respondents described their morale as low or very low. Only 19% reported high or very high morale. These worrying statistics seem consistent over the past few years, as 41% of respondents reported low or very low morale in the corresponding survey in 2014.2

An unprecedented strike

Junior doctors took industrial action in 2016, with a nationwide withdrawal of routine and emergency care after negotiations broke down over the terms of the new junior doctor contract.

In a ballot by the BMA some 98% of doctors voted to strike. The media focused on pay: the abolition of automatic progression and the introduction of an NHS providing consistent care seven days a week, meaning longer working hours for similar or lower remuneration.

But this unprecedented protest was not just about hours and pay. It reflected deeper rooted dissatisfaction among a group of professionals who felt “devalued and denigrated,” wrote Johann Malawana, former chair of the BMA’s Junior Doctors Committee, and they had no apparent way to communicate this other than by withdrawing labour.

The crisis in morale has created another in retention and recruitment, with many medical and nursing vacancies affecting NHS hospital and mental health trusts.3 A ripple effect can be seen …

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