The new health secretary must tackle junior doctors’ dissatisfaction before winterBMJ 2023; 383 doi: https://doi.org/10.1136/bmj.p2888 (Published 06 December 2023) Cite this as: BMJ 2023;383:p2888
Despite the announcement of new strike dates, the recent offer by the government to NHS consultants and progress in conversations between the Department of Health and junior doctor representatives provide hope for resolution of industrial action. Negotiations, and any subsequent offers, represent an important opportunity to consider and tackle all the root causes of junior doctors’ discontent.
The new health secretary Victoria Atkins took office with a long to-do list. At the top of this list sat the need to urgently resolve junior doctor and consultant industrial action, tackle long NHS waiting lists, and manage the increasing clinical pressures anticipated this winter. Junior doctors' dissatisfaction in particular remains at the forefront of the minds of doctors, patients, and hospital trusts. The last round of industrial action led to 130 000 appointments being rescheduled and doctors losing further pay and valuable training opportunities.1 As seasonal pressures begin to strain NHS services, an open minded and considered examination of junior doctors’ disillusionment is particularly vital.
Fifteen years of pay erosion and salaries that fail to reflect not only the nature of the work, but also training length and associated student debt, demand that pay remains a dominant focus of current negotiations and offers. But scrutiny of why junior doctors are leaving the profession indicates that their motivations for quitting clinical practice don’t entirely centre around salary. Surveys of doctors and medical students highlight that quality of life, NHS culture, challenges around training opportunities, and a desire to be close to family all represent important motivators for quitting doctors.234 Although a subjective term, “quality of life” typically requires good physical and mental wellbeing, work-life balance, and professional satisfaction, as well as stable and proportionate income. Importantly, junior doctors are motivated to create sustainable working conditions for the future of the profession and also for the welfare of current and future patients.
Substantial gains could therefore be made by extending consideration to other factors that would positively impact on junior doctor wellbeing, health, and quality of life. Areas for improvement could include free hospital accommodation for on-calls, sufficient and designated space for junior doctors in hospitals, reduced administrative burden, staff centred rotas, support and space for pursuing non-clinical career opportunities, adequate educational and mental health support at work, and increased flexibility and reduced bottlenecks within training programmes. Similarly, initiatives to deal with wider workforce challenges such as bullying and harassment, burnout, and lack of support during investigations and complaints procedures are essential to improve and protect the psychological, social, and professional wellbeing of doctors at work.
Although none of these suggestions represents a sufficient solution on its own, in combination they could offer a powerful revamp of current working conditions. Salary uplifts are also not the only way to put much needed money back into the pockets of junior doctors. Australia and Canada provide notable examples of tax relief for healthcare workers, student loan forgiveness, and reimbursing expenses for essential professional exams, indemnity, and revalidation.56 The Nuffield Trust has provided recommendations that outline feasible strategies to write off doctors’ debts to tackle current rates of staff dropout. Smaller changes such as timely, transparent, and reliable mechanisms for reimbursing study budgets and travel expenses offer other simple fixes to reduce the psychological and financial stress routinely felt by doctors.
The ongoing workforce crisis in the NHS is a concern for patients, trusts, and squeezed junior doctors alike. Creating sustainable working conditions for junior doctors and dealing with all the causative factors of our current disillusionment must remain a priority.
Competing interests: None declared.
Provenance: Not commissioned; not externally peer reviewed.