As Talks Between the Government and the BMA Briefly Resume A Survey of Junior Doctor Parents Shows More Than 50% Considering Leaving NHS England if the Contract is Imposed.
This week a five-day truce in the embittered junior contract dispute between the British Medical Association (BMA) and the Government was announced. The new contract proposes, among other things, an increase in weekend working. The dispute is not merely about Saturday pay, there are more complex issues at hand. Recently, the Equality and Human Rights Commission (EHRC) has reviewed the contract and is concerned enough to ask the United Nations for a review of the contract with regard to its legality and potential effects on women in particular. It is worth noting the results of a recent survey of more than 1000 junior doctor parents. They have spoken up voicing grave concerns about the new contract, set to be imposed this August. The proposed contract threatens a mass exodus of doctors with families. This exodus in light of recent reports of 300 unfilled foundation programme posts and unprecedented levels of specialty training posts also vacant could add a further serious insult with serious concerns for patient care.
In an online survey conducted in April 2016, 99.4% consider the contract will have a detrimental effect on their family life and less than 5% of respondents plan to continue their career as it currently is. 93% consider the proposed contract will have a detrimental effect on their relationship with spouse or partner. More than 25% are considering leaving the profession altogether, with a further 26% considering a move to another country. Respondents to the survey were predominantly female (82%) highlighting concerns that women medics (and male counterparts) face working for the NHS today.
There are around 54,000 junior doctors. A junior doctor is anyone graduated from medical school up to consultant or GP level. Most are of child rearing ages and many have children. Junior doctors can be aged up to their mid-40s and older. This survey should serve as a stark warning to Jeremy Hunt to consider during this five-day hiatus. When doctor recruitment is already in crisis and only 5% of junior doctor parents plan to continue as is, imposition of this contract could throw the entire doctor workforce into disarray. This contract threatens both lives of medic children and, with a potentially reduced workforce, the lives of patients too. As one respondent stated, “we are not prepared have Jeremy Hunt wreck their childhood”.
Junior doctor parents already face significantly stressful work-life balance demands. Respondents described marital breakdown, decisions to terminate pregnancy, elderly parents struggling to babysit, living apart from family and commutes of up to 4 hours a day. They describe already not seeing children for days at a time due to shift work and having only one family weekend in months when both parents are at home. Further stories of children suffering emotional harm and family members flying in from as far as America to cover night shift childcare. The survey comments make for bleak and depressing reading. This is before the potential contract is implemented, some leaked proposed staffing rotas suggest working as much as every other weekend which would have a huge, untenable impact on family life.
“Children need their parents, it doesn’t matter what other childcare the government thinks we could or should arrange, this remains a fact and has a significant impact on wider issues of public health (through breastfeeding) and social and emotional development,” says Dr Amber Holmes, a GP trainee.
“For the hassle and stress the small amount of pay I’d have left after childcare at the end of the month it just wouldn’t be worth it. I could be slightly poorer but see my family every day and be valued – as opposed to working myself physically and emotionally into the ground for no respect from the government. It’s not what I signed up for when I started med school,” stated one anaesthetist.
Of particular concern are the doctor and doctor couples that comprise nearly 40% of those who responded. “I cannot imagine how it would be tolerable if the frequency of our weekend working were to increase; I could easily imagine this causing marital and family breakdown,” said one married male doctor.
The 2016 proposed Junior Doctor Contract equality analysis openly states that it disadvantages women but that this ‘indirect adverse effect on women is a proportionate means of achieving a legitimate aim’. The legitimate aim claims to be a “7-day NHS”, an electoral promise which the government intends to provide with no additional funding. Women, men and their children make for serious collateral damage in this, as yet, un-costed and un-modelled plan. Currently, nurseries and schools provide Monday to Friday services, leaving weekends as essential family time.
“It’s the toughest job in the world, being a mother. I would quit medicine for my child in a heartbeat, but it would be heart breaking to have worked so hard for 15 years for nothing. This government should be ashamed of their blatant sexism against working mothers,” stated one respondent.
The equality analysis goes as far as to suggest that some may find it easier to arrange informal, unpaid childcare in the evenings and weekends. The survey results showed that nearly 60% of respondents do not have access to such childcare. Of those who do, 86% believe it will be unreliable for ensuring attendance at work. 93% state that finding any childcare with the new contract will be more difficult.
With rota gaps already threatening safe delivery of care, being unable to attend work at short notice will only exacerbate already stretched departmental rotas. NHS Trust staffing departments may find workforce planning even more challenging, especially if they are implementing drastically reduced staffing rotas. Survey findings also suggest a highly stressed workforce, with more than 77% citing emotional strain and stress influencing their decision to leave medicine with implications that more doctors may take sick leave. Those left in the workforce will be left under further pressures to deliver safe patient care, especially if extended to 7-day elective care. NHS Trusts and all parties involved in the dispute should consider the implication of this survey findings in their decision on implementing the new contract and welfare of the NHS workforce.
To state that the contract is merely about Saturday pay is a naïve over simplification of a complex situation. This survey turns any assertion that work-life balance will be improved for junior doctors under the new contract on its head. Jeremy Hunt’s rush to impose the contract threatens to create a potential time bomb that could explode as early as August as thousands of junior doctor parents struggle to find childcare or quit their jobs. The legacy could harm generations of children and lead to a loss of thousands of years of medical training from the workforce.
For further survey results visit this
Survey creator, Dr Sethina Watson, is a junior doctor training in anaesthetics and a mother of four @morefluids