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Although it doesn’t directly affect us, I’m sure many of you will have been paying attention to the Junior Doctor Contract negotiations in England over the past couple of weeks – after all, who knows where our careers might take us? After the UK government imposed a contract that English Junior Doctors had voted down in 2016, mandatory negotiations were put in place to give Junior Doctors in England a chance to take a second look at that contract to renegotiate parts of it. The product of that negotiation will be voted on in a referendum. If you're going in to a training post in England from August get in touch to update your contact details and register to vote.
With all that going on I've had plenty of people asking me what's going on with Junior Doctors in Scotland. The BMA recognises that differences in Scotland are deeper than contractual given we have our own government, legal system, NHS structure and other things that makes it a bit different here. So, the Scottish Junior Doctors Committee has fully devolved power to represent Junior Doctors here. With that fully devolved power we take forward the views of members to challenge employers, Educational bodies, the GMC and government to do better and rise to the worthy challenge of making Scotland an attractive place to work. They need to do this by valuing junior doctors, supporting them through high standard training and ensuring they are safe to do the work they love – for them and their patients.
I’d like to take the opportunity to update you on where we are with things at the moment – and hopefully answer any questions final year med students about to enter their FY1 year may have…
Nausea, disorientation, forgetfulness. If you've ever done it, you'll recognise the inevitable horrible feeling that comes with it to remind you. Finishing a run of nights only to be back at work first thing the next morning is frankly horrible and simply unsafe. Colleagues and I would nervously laugh about not remembering the journey home from work, some of them having driven 40 minutes. We'd laugh nervously and ask to not have to do “anything complicated.” We were nervous because we knew the effects of fatigue on us, our health, safety and performance and of course on our patients. Would you have wanted to be seen by yourself?
With those memories flooding back to you (or perhaps they're more hazy) I'm really proud that we've made that specific practice a thing of the past. From August this year, the vast majority of Junior Doctors in Scotland will be getting 46 hours post-nights rest after any block of full shift overnight working. This specific target was chosen because of the evidence around safety post-nightshift and we've taken a serious approach to fatigue and patient-doctor safety. Securing this agreement was a major priority for SJDC and I believe it will make a significant difference to the working lives of Scottish junior doctors.
This doesn't fix nightshifts, but alongside campaigns, like those of Michael Farquhar in Guys and St Thomas' and the calls for proper rest facilities that we bring forward and your local reps are taking to hospital managers, we can start to mitigate the dangers to us and patients. It is essential that we recognise the need to limit and manage fatigue and do whatever possible to reduce the risks of fatigue. You can start by making sure you take your natural breaks which aren't just your legal entitlement but an essential for doctor-patient safety. Most things can wait, and you will come back less likely to make an error and serving your patients better than you would if you hadn't.
Additionally, we are continuing to participate in the Expert Working Group (EWG) which is currently considering the Scottish Government’s proposed policy of a maximum 48-hour working week with no averaging for junior doctors in Scotland. We have raised concerns over the impact of any implementation of this policy for junior doctors on health and wellbeing, education and training, salaries, and the continuity of safe and effective patient care and our health service.
I have made it clear to members of the EWG and the Scottish Government that we need to consider not only the total hours of work, but also other more impactful and evidence-based interventions which must be implemented with an aim to minimising the risks of fatigue and overall junior doctor health and wellbeing – including the availability of rest and catering facilities. Any Junior Doctor could tell you what works – we just need to start being listened to. That's why we have to keep shouting loud and clear that the safety of patients and the doctors looking after them must be a number one priority.
We continue to have regular meetings with the Scottish Government and NHS Scotland employers, pursuing issues including ensuring adequate notice of fixed leave, securing enhanced shared parental leave, and resolving issues arising out of the move to single lead employers (such as public holidays and relocation expenses) – and as ever, are working hard to ensure that the 2002 contract, to which we all work, is still fit for purpose as we enter another decade.
48 hour maximum working week with no averaging would be a disaster. Where did that idiotic idea come from?
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