A single pay rise won't fix our NHS, but as a doctor I know what will
I was working a long shift and I had to be on the ward by 8am.
After going round the ward with the consultant, listening to the needs of patients and families, the sounds of random alarms, the horns I carry and people throwing up, it's 1pm by the time I have to do my morning tasks.
The screen in front of me reads that the patient has acute kidney injury, and at the same time I realize that I haven't had a sip of water all day. My kidneys could not be far from a similar function.
I'm exhausted and the day isn't over yet. It feels like most junior doctors have several times during a typical week. I can't help but feel that the strikes are what we are waiting for.
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During the 28 days of strike action, the British Medical Association (BMA) took a very draconian stance. Most of his arguments are based on the restoration of wages, with only a few whispers about working conditions.
The net result of this? Almost zero. And while yes, significant pay increases are warranted for doctors across the country — the same can and should be said for the rest of the public sector across the country over the past decade. I was disgusted to read over and over again that, while trying to justify my own salary increase, I saw doctors patronizing the pay of others.
The strikes failed for a variety of reasons. Partly due to the incompetence and ignorance of the Department of Health and Social Protection. There is no doubt that his failure to negotiate while repeating the same rhetoric about how much they really value doctors and other medical staff has done irreparable damage.
After the trauma of Covid-19 and what staff have suffered in the name of public service, there is a sense, perhaps naively, that the NHS will no longer be taken for granted and that reward will be given. This was not the case.
Likewise, the impasse was also caused by strikes, which ironically created a vacuum of temporary staff shortages that are filled by deputizing staff at extortionate rates. The staff in these positions are the youngest doctors on strike. This means that continuity of care is virtually unaffected and that strikes – which are carried out in the interests of patient care – cause less disruption than is necessary to force the government to make the offer doctors need.
But even if by some miracle the strikes were successful and the deserved money was paid, I imagine that the mass exodus of doctors from the country or changing professions would not stop. Many doctors I've talked to, myself included, value the time we (rarely) have and want better working conditions.
After speaking to my colleagues, I have five proposals that I believe will make life much better for doctors in this country and make the NHS an attractive place to work again.
- Fixation of the mouth system
As a junior doctor, most trusts across the country say you can only take annual leave on a normal working day (NWD). In practice this sounds good, but on average rotation half of your shifts over four months will not be NWD. This means you are not entitled to annual leave for these changes, unless you find yourself covered. And as professionals who often work more than 60 hours a week, you just can't find the time to cover for your co-workers. An alternative system should be implemented that allows annual leave to be taken for any shift – and doctors should not have to look for alternative cover.
- Changing the amount of mandatory out-of-hours (OOH) shifts
Working after hours is something that is inevitable for a doctor, you need to put everything else going on in your life aside and spend a week or so going nightlife. Now, while these changes may be nice to many employees, they are not being paid for properly. The rate of pay for these shifts should be brought closer to the pay of a deputy, which will make working these shifts more attractive for staff. This would mean that the government would not have to focus so much on raising the basic salary and have another way of raising the salaries of doctors. It should also be more flexible as to whether or not the doctor should work these shifts.
The strikes have proven that with proper pay these gaps will be filled. Flexibility is the one thing that keeps many doctors in the profession long-term, and it needs to be increased, not decreased as it is now.
- Remove the bottleneck for training opportunities and training programs
Despite what the government says, with more doctors graduating from the UK and migrating to the UK, there are fewer training opportunities than ever. The competition is growing every year, and if we want to have a medical service with highly qualified doctors specializing in therapists or consultants, then we need to increase the number of training places. It is unwise to increase the number of junior doctors and not allow them to train.
- Allow doctors to work privately early in their careers
Another way to increase the pay of doctors in the UK is to increase the amount of private work they can do. This will require a fundamental change in UK policy, but if doctors really want to get the pay they deserve, it needs to be considered. The unspoken truth at the moment is that a lot more doctors than you might think want to work privately on the grounds that the NHS is overworked and grossly underpaid.
- Create a vision for the NHS that is hopeful and innovative – not toxic and jaded
The NHS was at one point the wonder of the world – and is still one of the things this country is most proud of. After all, it was used as a showcase at the opening ceremony of the 2012 Olympics.
But now it seems that this moment has passed a lifetime. The Department of Health and Social Care needs to realize that staff are leaving in droves and a career that was once prestigious and rewarding is now a laughing stock.
Opportunities, rewards and respect must be key messages in shaping the NHS for the future. Despite the negatives of working in the NHS at the moment, there's no reason why it can't change and become the envy of the world again. To achieve this, you only need reason and faith.
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