A contract that supports juniors

by Evan Sun

The stress junior doctors are under requires a contract that reflects this — and the efforts they go to, to protect patients

Location: Wales
Published: Tuesday 26 October 2021
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Qualifying as a junior doctor was one of the proudest and most daunting moments of my life. You’ve spent years studying and observing medicine and then suddenly find yourself standing in front of a patient looking at you for help. It’s a huge honour but also the most responsibility you’ve ever had.

Whilst you may have been warned about the pressures no one can prepare you for the levels of stress, scrutiny, and exhaustion but you’re expected to get through, after all this is what we signed up for isn’t it?

Why I joined the junior doctors committee

It took a tough first year to realise that perhaps it didn’t have to be this way and that I could make a difference and start to change things for myself and my hardworking colleagues. That’s why I joined BMA Cymru Wales’ junior doctors committee.

As doctors we take an oath to ‘do no harm’ but we’re also fallible humans often working 80-hour weeks, finishing a series of night shifts only to suddenly shift to daylight hours and no one told our circadian rhythms.

How can we provide the best care possible when we’re exhausted and on the cusp of burnout? It’s unsafe for us and most importantly it’s unsafe for our patients.

Why we need to reform the contract

This is why I feel strongly that the current junior doctor contract, which was last reformed in 2002, is no longer fit for purpose and no longer reflects the way we practise medicine.

For example, the treatments for life-threatening conditions such as heart attacks now require far more interventions which cause doctors physical exhaustion and we’re now much more acutely aware of the devastating impacts of fatigue on doctor’s mental health and crucially patient outcomes.

We also face far more assessments than ever before and yet we have no time built into our working day to train, which impacts on our work-life balance and mental wellbeing. How can we possibly learn and improve treatments when there aren’t enough hours in the day?

The 2016 junior doctor contract established in England enshrined safeguards such as the ‘guardian of safer working’, a person specifically appointed to point out unsafe, fatiguing shifts and rota gaps to protect staff from burnout.

Exception reporting is another area we want to look at and adapt for Wales; this is a contractual mechanism which doctors in training can use to report patient safety, rostering and training concerns

I love being a doctor in Wales, I’ve always enjoyed interactions with the various communities across the country but as we continue to struggle to recruit and retain trainee doctors in Wales, we’re also hugely concerned that we will let them down.

Good will alone cannot possibly meet the rising demand on capacity in the NHS in Wales, particularly as we face record-high waiting lists.

As well as safeguards for fatiguing rotas and reporting unsafe practices, we want to see a change to pay scales so that doctors in Wales are better renumerated for their hard work at the beginning of their careers and, crucially, so that they are on a par with counterparts in other UK nations.

This latter point is particularly salient when you consider that despite geographical variations in the cost of living, all doctors are required to pay certain fees to practise medicine as well as paying back years’ worth of student debt.

So why now?

In 2019 the committee gave us a mandate to change the contract and try to reach a fairer deal for hardworking doctors in Wales.

Despite the unprecedented arrival of a global pandemic this is what I and other members of the committee have been working hard to do by working in social partnership (mostly virtually) with Welsh Government and NHS employer representatives.

We’ve listened to doctors from all over Wales to canvass and represent their views and after much discussion, debate, consultation, and hard work we’re at a place where the Welsh junior doctors committee has given us a mandate to enter formal negotiations with Welsh Government.

There’s also no doubt that the COVID-19 pandemic has brought these issues to the fore, the fact that even when we weren’t working, we were unable to see our family and friends for fear of passing on the deadly virus only helped to highlight the occupational hazards we have just come to accept.

But this is unsustainable, and we want to encourage more doctors to stay and develop their careers in Wales and therefore we must see vast improvements in working conditions for junior doctors throughout Wales.

We also know that we have the backing of our more senior colleagues who want us to stay and continue to carry on their work and we want to stay in Wales to remain under their leadership. It’s not only a great privilege to be a doctor but also to be on the junior doctor’s committee who will be instrumental in making fundamental changes to doctor’s futures in Wales.

Next steps

The formal negotiations which are set to take place this autumn, subject to government agreement, will focus on outstanding areas of the contract as well as a wider plan for investment and implementation.

If formal negotiations result in an agreed deal, this will be put to a ballot of BMA junior doctor members in Wales who will decide whether the new contract should be introduced. Look out for our latest newsletters, emails and social media posts for the latest information.

Evan Sun is BMA Welsh junior doctors committee co-chair