‘We are just regular doctors.’
Vivek Trivedi is keen to stress this point throughout an interview with The Doctor in which he and fellow BMA junior doctors committee co-chair Rob Laurenson reflect on the challenges and achievements of the last year.
It’s been quite the year. The BMA – driven in no small part by the actions of its junior doctors committee – has reached record levels of membership, organised the biggest coordinated strike action in NHS history and set huge policy decisions on touchstone issues.
The importance of the JDC co-chairs being representative of working doctors is not lost on the pair, who have been thrust into the spotlight through live TV appearances, social-media fame, and being the subject of special attention from certain newspapers.
Balancing the workload that comes with the co-chair positions while in specialty training (Laurenson GP; Trivedi, anaesthesia), is not without its logistical challenges.
Doctors are willing to stand up for ourselves. That can only be a good thingDr Trivedi
As Dr Laurenson explains: ‘We’re in touch with 40,000-odd doctors at the end of our phones. We communicate daily, responding within hours.’
Noting the importance of organisation in effective trade unionism, he adds: ‘Members can feel that. Their union is incredibly responsive now, which gives them faith and trust in the function of the institution.’
Dr Trivedi recalls how, early in the pay restoration campaign, a major challenge was getting doctors – especially those on rotations – to update their details with the BMA so their votes could be counted (a successful ballot requires a majority to vote in favour from a minimum turnout of 50 per cent of eligible voters).
This was of course comfortably achieved in February, with 98 per cent in favour from a turnout of 77 per cent and followed up with 98 per cent voting in favour from a turnout of 71 per cent in a summer re-ballot which extended the JDC’s strike mandate beyond Christmas.
The long-term effect of the initial engagement drive was a sense of empowerment and camaraderie among doctors, not just in the fight for pay restoration but a range of issues.
‘Doctors are not being taken for a ride any more,’ says Dr Trivedi. ‘We are willing to stand up for ourselves. That can only be a good thing. It will hopefully help them seek out more training opportunities or prevent them from feeling burnt out and victimised – things which might push people out of the profession.’
Pay has been central, however. Dr Laurenson says it has been crucial to ‘destigmatise’ conversations about remuneration, which can ‘often feel uncomfortable’.
‘One of the prominent underlying stresses that anyone feels stems from financial pressures,’ he explains. ‘If you turn a blind eye to that you’re going to leave thousands of people feeling a bit lost, rudderless and disenfranchised.’
Dr Laurenson adds that doctors can feel ‘disempowered, disrespected and devalued’ working in an NHS which now ‘looks very different to how it did when you signed up’.
A ‘cultural shift’ over the past year has seen doctors across the board become more confident to talk about pay and working conditions, and to identify the underlying problems, he says. ‘It’s OK to talk about these issues, and then you can present solutions which people can get on board with.’
The co-chairs say a renewed energy, momentum and confidence has manifested itself in a groundswell of BMA members getting involved at a grassroots level, creating a ‘positive feedback cycle’ that helps effect change in all manner of ways.
Their plan, from the outset, was ‘flattening the hierarchy’ of the BMA, so that members and elected representatives felt a common sense of purpose and importance.
Harnessing social media has been key in driving engagement. So has setting clear objectives.
The media is used as a weapon rather than a tool for disseminating factsDr Laurenson
Reflecting on the 2016 strikes, Dr Laurenson says arguments were lost in the nuance of contract renegotiations. By contrast, the ‘big idea’ of pay restoration this time round is more tangible.
The JDC co-chairs don’t elaborate on the potential outcome of talks, which were ongoing at the time of interview and with agreements to keep details in the negotiation room (further strike dates have since been announced). But assessing the virtue in long-term promises against concrete changes to remuneration, Dr Trivedi says the experience of 2016 taught doctors ‘you need things written down’.
‘There’s an age-old adage that “if it’s not documented, it didn’t happen”, so doctors want to make sure that whatever is dangled in front of them is robust because ultimately if that slips through the net then we’re letting slip the ability to retain our colleagues in the future – which will only go to harm everyone in our healthcare system,’ he says.
Becoming the faces of the campaign has unavoidably raised both co-chairs’ profiles, and while they appreciate kind words from BMA members thanking them for their efforts, they are at pains to point out the hard work of many other representatives in less public positions.
‘We’re not doing anything more than pulling the legal levers that allow members to defend the profession,’ says Dr Laurenson. ‘I don’t think many people will ever understand just how important the people behind the scenes have been.’
Dr Trivedi agrees and describes the co-chair roles as being ‘a conduit’, ‘channelling a collective voice, that many people probably didn’t know they had’.
He adds: ‘We wouldn’t be in this position if the profession wasn’t in the position it is in now. If doctors weren’t willing to stand up and speak up for themselves at local levels, which gives us strength at a national level, we wouldn’t be here.’
‘I didn’t get into this from a profile point of view,’ Dr Laurenson stresses. ‘I saw this movement growing and I thought, “I can’t go out without a fight. I need to do something”.’
But putting himself forward as a spokesperson has led to media ‘hit jobs’ from the right-wing press and even death threats.
While he shrugs off some of the stories written about him as ‘amusing’, Dr Laurenson says his views on how some parts of the media operate have been affected by his experiences: ‘I always used to have a lot of hope and thought negative views of the mainstream media were conspiratorial, but when vested interests are involved it feels quite obvious how the media is used as a weapon rather than a tool for disseminating facts and information.’
Doctors are going to get trained and they’re just going to leaveDr Laurenson
Dr Trivedi has faced fewer personal attacks but praises his co-chair’s handling of the situation as ‘admirable’.
For his part, Dr Trivedi has appeared on political talk shows and prime-time news programmes answering sometimes politically loaded questions from journalists and facing down MPs in debate.
Again, being a regular doctor helps, because: ‘It usually just feels like a conversation about a subject I understand.
‘I’m not embarrassed about what we’re trying to say, I’m not trying to hide anything, so I find it easy to answer questions quite directly without trying to remember the perfect way to say it.’
Talking about the level of responsibility on their shoulders in the public eye brings us on to the term ‘junior doctors’. Work on a replacement name for this group of doctors is under way after a motion passed at this year’s BMA annual representative meeting to discontinue its use.
‘It ties into so many aspects of professional life for doctors,’ says Dr Trivedi, who explains how doctors, often on rotation, introduced as a ‘junior’ feel like ‘they are seen as lesser, in some way’.
He blames structural systems for infantilising many experienced doctors in the eyes of their colleagues and patients.
Dr Laurenson believes an attempt to tackle historic elitism in medicine by terming some doctors as junior has ‘gone too far’ and can have a negative effect on outcomes for patients.
Blurred lines of responsibility and scope takes us to the debate about medical associate professions, such as PAs (physician associates).
The BMA is now calling for ‘an immediate halt’ in the employment of MAPs until the Government and NHS put guarantees in place to make sure they are properly regulated and supervised.
‘You can’t just say you’re doing the role of a doctor when you’re not a doctor,’ Dr Laurenson says, pointing out that a ‘manufactured workforce crisis’ through years of austerity has led to the lack of doctors and thus government plans to train and recruit as many as 10,000 PAs.
Lack of retention plan
He said the NHS Long Term Workforce Plan published earlier this year will ‘introduce a new type of professional that is simply there to be able to provide accessibility’ and while he accepts a need to tackle waiting lists, he insists there should not be ‘a race to the bottom’ to do so.
‘This is the direction we're going in,’ adds Dr Laurenson. ‘Why are people not being up skilled up, valued and invested in to become doctors?’
He adds that critics who point out the BMA voted to limit medical school places in 2008 are ‘cherry-picking’ facts and should remember the main argument was that there were not enough clinical academics to teach them due to retention issues.
There is a ‘little bit of a repeat’ with the NHS Long Term Workforce Plan, he says, in that while there is a proposed expansion in medical school placements, ‘there is no retention plan’ to stop the increasing numbers of doctors leaving the NHS.
Dr Laurenson argues: ‘The same thing is going to happen. Doctors are going to get trained and they’re just going to leave.’
Before standing for BMA election, he himself had ‘made a decision to leave the country’, because ‘I couldn’t see anything getting better’.
He describes a sense of ‘civic responsibility’ to prevent ‘a tragedy unfolding’ in the profession.
Involvement with the Doctors Vote slate, which began with frustrated doctors talking on social media and now counts dozens of elected BMA representatives as its backed candidates, was critical to Dr Laurenson’s decision to stay and fight.
He compares Doctors Vote to ‘a trade union within a trade union’ with ‘a coherent strategy, and communication’.
‘It’s all about collective action and power,’ he notes, arguing that having slates within a union can help empower greater democracy in the organisation and encourage more groups to form around specific issues or to champion certain groups of doctors.
Dr Trivedi says: ‘It’s no secret Doctors Vote was a catalyst in getting the profession engaged, because there was a lot of disillusionment before.
‘I’m a prime example of this,’ he adds. ‘I wasn’t a member for a very long time and saw a group of people who thought “let’s see what we can do”.
‘Ultimately, you can sit around and complain about how things are, or you can try to make a difference, and that’s what Doctors Vote is trying to do. A lot of people have resonated with that ethos. Initially it was very much about full pay restoration. Over time, a plethora of other issues have risen to the forefront.
‘That shared feeling helped get members engaged and has kick-started the BMA, which is now keeping members engaged in its own right.’
Thinking forward, Dr Laurenson sees Doctors Vote, and other slates, as offering continuity among junior doctors, whose committee by its nature loses experienced representatives as they progress in their careers and become consultants, GPs or specialists.
‘Grassroots groups are beginning to identify how to influence the institutions of which they are members,’ he adds. ‘And that's not nefarious. That is playing to the rule book as it's written, to pull the levers of power that these institutions have.’
Dr Trivedi says Doctors Vote’s ground-up movement has helped show regular doctors like himself that ‘you don’t have to be president of your medical school society to get involved’. ‘In fact,’ he adds. ‘If you’re not that person then you’re probably a better person to get involved – and please do.’
The co-chairs revealed they only met in person for the first time the day they were elected, and say their shared vision of common goals and championing regular doctors’ concerns has helped them work collaboratively.
Neither of the co-chairs ruled the possibility of standing to extend their terms, but both said the groundswell of engagement means there are more candidates than ever to carry on the committee’s work.
‘You can never say never, but I think it’s beneficial to not always have the same people in all the time,’ says Dr Trivedi. ‘One of the benefits when Rob and I took our positions was that we were fresh faces.’
Dr Laurenson agrees, adding: ‘An industrial dispute is fairly defining and I think it would be difficult to take on another strategic goal and while I feel [the experience] has enhanced me it’s not sustainable to do it forever.’
Again, championing the democracy of the BMA, the co-chairs are aware that – however the negotiations go – they will be ‘held accountable’ by members.
Members will always get the final say on any government deal on pay and conditions in a democratic vote.
But whatever the outcome, as Dr Laurenson points out, a re-energised BMA with record numbers of members will not be sitting still, whoever is pulling the levers of the ‘junior’ doctors committee.
With the wheels in motion on policies covering conditions, rotation, training, regulation and many more issues, Dr Laurenson points out: ‘The conversation will very quickly become “what do we need to fix next?”.’