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On Wednesday, the next round of junior doctors in England is facing the imposition of the new contract. We remain strongly opposed to the contract, and believe it could exacerbate the crisis in the NHS in its impact on recruitment and morale.
There is, however a means at our disposal to highlight the many flaws in the system. Exception reporting can be an agent for change, and that’s why I think all of us need to do our part to make it work. Over the next week, the BMA will be publishing information on how the system works, insights from other clinicians, and some news of its early successes.
On the face of it, exception reporting might seem yet another complex beast within the zoo of NHS regulation. In reality, it’s quite simple and powerful: if your work or training varies from what was planned, you should exception report it, no exceptions. This is the only way we can build a true picture of a service in crisis. It is the only way to find solutions.
Your employer must provide an electronic system that you can use to report to your educational supervisor every time you are required to stay late, you miss a training opportunity, or your actual day to day work varies in any way from your work schedule.
They have to respond swiftly, discussing an agreed outcome with you and ensuring you are compensated when you have to work late. This is all overseen by an independent guardian of safe working hours who can step in to support you wherever you need it.
Our day to day lives as NHS doctors has collapsed into a frenzy of firefighting and patient prioritisation. The unity we saw last year has given way to suspicion, division and blame, and despite the recent mass-media awakening, our concerns for the wider NHS remain largely ignored.
Why can’t people see what we see? Why don’t politicians understand that it isn’t safe to cover two bleeps? Why can’t policymakers see that people are coming to harm?
In our own hospitals, why are we always a junior doctor down? How will I ever get that procedure signed off if I’m just a clerking monkey? If my teaching attendance is under 75 per cent at my ARCP, will the panel understand if I explain it was due to service pressures?
In medicine we wear these struggles as a badge of honour. It’s a fun game of one-upmanship with consultants who recall the ‘good old days’, with their 72 hours on call and carrying out midnight appendectomies alone, in the dark, and probably with a plastic spoon.
Whilst such stories are a testament to the teamwork, ability and resilience of our NHS staff, we are supposed to be doctors in a 21st century health service who, as it states in the Hippocratic oath, ‘should observe the core values of the profession which centre on the duty to help sick people and to avoid harm’.
We take this oath seriously. When it comes to our individual practice we will prioritise need and, if that puts another’s above our own, then we have to stay late and we will do so as ‘part of the job’. It’s a vocation after all.
But we find ourselves in the centre of a system failure. A system failure in the fifth largest employer in the world. Whilst our individual standards of practice must remain as high as ever, we must now also turn our attention to a system on its knees.
As NHS staff burn out from service pressures, the sticking plasters we provide will cease to cover the wounds that run so deep because the NHS is unable to cope. It is our patients, and their loved ones, who will bear the brunt of these wounds.
In February 2013, Robert Francis QC wrote to Jeremy Hunt to summarise his findings on the Mid-Staffordshire crisis ending with a final recommendation to ‘develop and share ever improving means of measuring and understanding the performance of individual professionals, teams, units and provider organisations for the patients, the public, and all other stakeholders in the system’.
To deliver such ‘means’ will require a mindset change in junior and senior doctors alike. No longer can we be so British and ‘keep calm and carry on’. The stakes are too high, the potential harm too great.
This will be no mean feat which will require patience, perseverance and a willingness to problem-solve together.
We must educate ourselves, each other and our seniors around exception reporting if we are to see this shift in mindset. Over the next week, read the information that the BMA is publishing, so that you’ll be able to highlight what is going on in your working life – warts and all.
Exception reporting is no silver bullet, and it will undoubtedly need to evolve over time, but it is potentially a silver lining in a grey sky of uncertainty. If it provides a way to avoid patient and doctor safety being put at risk on a national scale, then I will use it without hesitation, and without exception.
Chris James is an ST2 ACCS in anaesthetics in London, and has recently been elected onto the executive subcommittee of the BMA junior doctors committee
If you would like to share your experience of exception reporting, you can leave a comment anonymously below or email [email protected]
Read our guidance for junior doctors on exception reporting
Everything changes in this universe except this principle (Aristotle). "Exception reporting" is emerging in exceptional times when British nation has a financial crisis. While our NHS is a Rolls Royce, Chancellor of Exchequer can only afford a Mini Car. In 1966, I was a Senior House Officer at the Institute of Neurology Hospital, London. I lived free in doctors' quarters, wore a tie and a white coat while walking with my stethoscope. No time off was given to me at all, not even a half day. I lived with a bleep, day and night. My wage was small but there was nothing to spend on. After an year, I got a testimonial from my Consultant without paying him any money and it ensured me another job. Now, I have collected 17 Qualifications, sets of letters, and have everything I could dream off. I am witnessing our junior doctors going for industrial actions and marches. I wonder if they can ever veto an elected British Government' s austerity measures by confronting them through media instead of negotiating behind closed doors. I foresee, exceptional bouncing back. Junior doctors may be replaced by physician assistants, pharmacists and private sector services. This is my exceptional reporting, I am afraid. Dr Bashir Qureshi. FRCGP, FRCPCH, AFOM-RCP, Hon FFSRH-RCOG, Hon MAPHA, Hon FRSPH. Life Member of the BMA.