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Loyalty to the NHS Won’t Stop an Exodus of Underpaid Junior Doctors

The National Health Service is under threat unless the Government starts properly paying its workforce, reports Michaela Makusha

3 January 2024 – Junior doctors on the picket line outside St Thomas’ Hospital as they began their 6 day strike. Photo: Tayfun Salci/ZUMA Press/Alamy

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The longest strike in NHS history by junior doctors has taken place, with junior doctors in England striking for six days from 7am on Wednesday 3 January until 7am on Tuesday 9 January. The British Medical Association (BMA) are pushing for junior doctors to get a 35% pay rise, which would restore pay to 2008 wages, in line with inflation. There are also concerns over changes to employment contracts which may see extended working hours without compensation which jeopardises both patient safety and the wellbeing of doctors. The strike ended with no progress on pay talks and the junior doctors intending to hold ballots on further strike action.

Junior doctors are qualified medical professionals, working full time while engaged in post-graduate research or further specialist training, and they are crucial in delivering healthcare across the UK – from patient consultations to performing medical procedures and research. They work long hours in demanding conditions, particularly during winter with rising COVID admissions to hospitals across the country, this issue cannot be ignored any longer by the Government.

In the middle of all of this, medical students training to be doctors find themselves uncertain of their future employment. Not only in terms of pay but working conditions, a viable work-life balance, and the impact on mental and physical health.

Last year, it was revealed that some trusts have asked unqualified medical students to step in during strike days, even though their placements in hospitals are meant to be purely educational.

Medical students cannot strike as postgraduate doctors can but are allowed to show support to picket lines, under BMA guidance, and are protected under BMA guidelines if they are asked to do more than is required or to take the place of a junior doctor.

Steve, a final year medical student in Manchester expressed full backing for the strikes: “There is overwhelming support for the strikes – they are fighting for our careers, for better investment in the services and better working conditions.”

Steve explained that the strikes have had an impact on students’ training: “We get more one-on-one with consultants which is great for learning and experience on the wards, but we shouldn’t have to get that because our colleagues are on strike”, he said, arguing that this demonstrates the existing problems in the NHS.

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Around £2 billion was spent last year by the NHS to cover the costs of the strikes, which included paying for consultants to cover. Critics have argued that the strikes cause chaos in an already chaotic system.

“The argument is that the strikes will cause overcrowding and overflows, but that was already happening before the strikes and will be happening after the strikes end. The service has been damaged for years with a lack of investment across so many areas,” Steve told Byline Times. “I recall being in A&E one night and there were three separate overflow areas – that was before any strike action.”

There are concerns about the future workforce of the NHS about whether or not they will remain in the UK and the NHS. Last year, a survey of 10,400 people from the UK’s 44 medical schools found 32% of participants were planning to practise abroad in countries such as Canada, New Zealand and Australia. An exodus of doctors from the service would be dangerous and while there are those that will stay, some would only stay two years (foundational years) before changing careers.

“I completely understand why people want to move abroad. You hear that it is much better in New Zealand, and Australia – from working hours to pay and overall health,” Steve said, “And we’re also probably going to see more people wanting to work in private health rather than public health. We all feel gratitude to the NHS – personally for me, that is why I would still work for them – but gratitude is not enough to sustain a workforce.”

In a written statement sent to Byline Times, Dr Latifa Patel, BMA representative body chair, said: “There have been increasing concerns about doctors, at the start of their careers, deciding to leave the UK and we have seen blatant recruitment campaigns to urge them to do so. However, this survey reveals the very real and worrying trend of doctors making the decision, even before they have qualified, to either practise medicine overseas, leave the NHS or leave the profession altogether. It is disheartening that medical students already recognise the extent to which our profession has been devalued through constant pay erosion and declining working conditions, and have made up their minds, as a result, that the NHS is not the right place for them to work. They are investing seven years of their lives, starting out with the intent to be a doctor in our NHS, only to have that enthusiasm and commitment crushed out of them.  

“The Government cannot continue to turn a blind eye to this increasingly untenable situation. This study clearly shows that increasing medical school places alone is not enough to turn the tide on the growing workforce crisis. It is not too late to fix this, but the power to do so rests with the Government. Retention must be prioritised, and plans must address pay restoration, career progression and working conditions. The Government making a credible offer to our members to reverse 15 years of declining pay must be the starting point.” 

When Steve graduates from his university medical degree, he will enter the UK Foundation Programme as an ‘F1’ – a first year foundation trainee doctor.  “The government says that it costs around £300,000 to train us – so why not pay us properly if we are worth so much?” Steve said, “As a medical student, I am incredibly nervous about next year. I can only imagine how stressful it will be for me and my soon-to-be fellow F1s.”

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