Britain simply can’t afford to treat doctors like this

by Nitin Shrotri

Predicament of health service has led to break down of industrial relations 

Location: England
Published: Monday 6 March 2023
nitin shrotri

The junior doctor strike ballot result ought to have the Government quaking in its boots. A resounding 98 per cent of junior doctors in England have voted in favour of industrial action.

The launch by the Government last year of a consultation on changes to NHS pension arrangements, which aimed to encourage doctors in their 50s or 60s to remain in or return to work was deemed to be ‘too little, too late’.

For doctors, in terms of ‘early retirement’ and the situation with NHS pensions, is there actually a better alternative? There really isn’t. The profession is stuck between a rock and a hard place due to a decade of neglect. That is what has led to the resounding ballot result. Junior doctors are saying ‘enough is enough’.

We all know that the NHS pension scheme at present disincentivises those whose pension pot is full by taxing them exorbitantly. Returning after retirement is also difficult because, under certain circumstances, if we have taken early retirement, we lose some of our pension. We also pay a large amount of tax on the remaining earnings, which stops any incentive from being effective.

But what are the alternatives? As someone who retired from the NHS three years ago and about to leave private practice very soon, I believe the alternatives are not as rosy as some may think.

The ‘easy’ option of course is for those that wish, to go to Australia, New Zealand or Canada in the hope of finding a better job that pays well in return for a better quality of life. But that is mostly feasible for those that are young, and recently qualified with minimal responsibilities as yet.

Perhaps it could be done by those in their 50s too, but leaving behind your extended family, and uprooting yourself to go abroad is not an easy task. So what is a realistic option? I believe there really is none. 

I was running on empty when I retired from the NHS, and was looking for work-life balance. The poorly rewarded 100,000-plus hours devoted to the NHS had taken their toll, and it was time to look for something easier. I was willing to adjust my lifestyle to the amount of money from a reasonable pension pot plus a few other savings.

I also found alternative areas of interest that still allowed me to remain in touch with medicine and my colleagues, giving me a lot of work satisfaction. But for those retiring over the next decade, things may not be easy, due to the combination of pension tax issues and present-day workforce pressures.

Last summer I met a senior consultant colleague who is now 81. He told me his story which made me feel very sad. He had retired at 60. One day he was a highly respected senior consultant surgeon in his department, the very next day he felt that he was reduced to nothing, a nobody.

He had an immense feeling of emptiness! Being labelled as ‘retired’ can be a very difficult transition and perhaps this group is a yet another lost tribe, that can be rescued, for the benefit of us all. In countries like the USA and India, doctors don’t really retire till much later.

This is not something that many will understand. I certainly didn’t, 20 years ago. I did not remain in touch with my older colleagues who had retired before me for a number of reasons. But now that I am at that point in life myself, I realise I could have behaved better, and perhaps asked after their welfare. But I was too busy living my own life. That too, is perfectly understandable.

A lot of colleagues are leaving the NHS, or threatening to. With increasing longevity, I believe that those in their mid-50s and over could be offered attractive alternatives where they can be useful to society, not just for its benefit, but for themselves too.

I'm coming up to complete retirement myself and to be honest it fills me with a slight degree of trepidation. We need to find something useful and meaningful to do for ourselves.

I have seen colleagues clinging on to practice for as long as possible and when I was younger, I used to wonder why so many couldn't retire and walk away, but now I understand. That is because having worked at a highly intellectual and functional level, useful to society, respected by many, to end up as someone that doesn't matter and being given the fairly useless label of ‘retired’ is not really nice at all.

Having had a very fruitful, busy, interactive career, boredom, especially intellectual boredom sets in easily and that can be very difficult to manage.

Not just for the benefit to society but also therefore for benefit to the individual we must make things easier and find options to offer. Those of us who are lucky to survive to this age and have enjoyed reasonable health, will no doubt end up at this point, some of us very soon.

We are becoming yet another member of this lost tribe, which the NHS, society and the country can ill afford at present.

One suggestion I would make is that senior colleagues (over 55s) be allowed to come off the ‘on call’ or allowed to work part time at a level that may be acceptable to everyone, but mainly to them. This will help us retain a highly trained and highly useful workforce and deal with the problems at hand.

I discussed this with the eminent public health physician, Professor Mala Rao, and she mentioned that another option could be that consultants can go to working at a different level, with less responsibility and less stress which would be in accordance with the desire for quality of life for doctors that age. Employers need to facilitate this.

Changes should also be made to pensions because this group of doctors do not have a decent alternative. Going to Australia may be easy for those who are young and the beginning of their career.

A few go into aesthetics, some areas of which outside medicine are poorly regulated, but pays well, while completely leaving medicine may be also possible for a small number of people. But to the majority of those who have had a very busy and fruitful career there are not many options and this lost tribe could do with some help.

The reason for my concern is not just personal, or about the people I know, but an entire generation which is highly intelligent and functional but is being lost to society.

When this continues to happen, and it’s bound to happen to many of us, eventually, we won’t have any young doctors because they will have left the country, or even more likely, the profession, due to workforce pressures. The most able young people will stop going into the profession.

As we become a poorer nation, we will also not be an attractive option to come to, for doctors from other countries and our national health will suffer. We should also consider that the impact that recent high-profile cases of racial discrimination towards NHS workers has had on the international reputation of the UK and its attractiveness as a place to work.

The 24/7 society and culture is also affecting the mental health and well-being of many. We have realised, not completely yet, that mental health and resilience are as important as physical health, if not more. We will continue to haemorrhage staff from all around the profession.

There are a few senior consultants who have left or are leaving the health service out of sheer frustration. They do maintain a bravado, and a facade of success, but the grass may not be greener on the other side. I know from my own experience that working alone in private practice can be a very lonely ask.

Not having the soothing (or sometimes even the cantankerous) interaction with colleagues makes a positive and helpful difference. The comfort and support of our work colleagues is vital. The actual fabric of the health service is therefore important to the profession and the impending breakup of the NHS, will not be fun for anyone – not for the doctors, not for the country, not for the politicians. As John Donne said, ‘No man is an island’.

It is therefore important that we see the health service maintained by giving it what it needs and I hope the politicians get round to doing something. Everyone needs to make a compromise; the profession, the politicians, society, but it is vital that our once great NHS, now decimated over the last decade, continues to function as the nation needs. Rishi Sunak, Jeremy Hunt, Stephen Barclay, are you listening?

BMA council chair Phil Banfield was recently quoted as saying the prime minister and health secretary were ‘standing on the precipice of an historic mistake’ if it did not listen to junior doctors’ concerns and take appropriate action.

Wellcome chief executive and incoming WHO chief scientist Jeremy Farrar described morale and resilience in UK healthcare as ‘very thin’. And now 98 per cent of junior doctors have voted to strike.

There truly will be no one around when we need them. Even the rich with their private insurance schemes will eventually suffer, believe you me. We must, urgently, address the pension taxation issue, review salaries, retain the young, and lure the retirees and ‘near retirement’ staff back into light but useful duties.


Nitin Shrotri is a consultant urologist from Kent, and a member of the GMC BME forum