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by Virginia C Patania
22 April 2016

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Pantomime fighting

The junior doctors’ fight against the government doesn’t seem to be going away anytime soon. Both sides have made valid points but until there is any concrete evidence to go off it is impossible to say who is right?

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It’s the end of March, and headlines around the junior doctor dispute continue to multiply. Rather unusually, this is one problem the British Medical Association (BMA) and the Department of Health (DoH) won’t be able to resolve by chatting at a table. Experience tells me the government would normally bend over backwards and put the right people at the table to avoid bad NHS press. So the DoH’s entrenched insistence that their contract proposal is fair gets me thinking. Assuming Jeremy Hunt, secretary state for health, still has a full plate of sandwiches at this picnic, he seems to have run out of other options, and to have concluded that the only way to bring a seven-day service to the NHS (and consequently the 21st century) is to batter it into submission.
So what really drives the dispute? Is it really about pay or about patient safety? Cases on both have been vehemently argued. Now here comes the science bit. Pay: The government is making a case to increase basic pay, but also the number of hours worked at this basic pay. This kind of makes sense, and as a patient, and as a worker, I very much want NHS services to be available at the weekend. Safety: Junior doctors, make the point that stretching the number of doctors currently available over five days to cover seven is unsafe. In response, Hunt states that current arrangements allow for 91 hours of work per week, which under the new contract would fall to a maximum of 72. Above both of these caps sits the European Working Time Directive, which ensures that no-one works more than 48 hours per week on average. Among the loudly shouted views I find it hard to place my hat on a specific hook. The reason is as important as it is frustrating – neither side is producing evidence I can understand. And while they pantomime fight, the streets fill with doctors on strike and the credibility of the NHS suffers.
I have no issue with campaigning. I’ve done quite a lot of it myself, marching patients and doctors around East London, fighting to get back our Minimum Practice Income Guarantee (MPIG) payments. What I do have an issue with is allowing deeply emotional arguments to run without reference to hard evidence.
When we campaigned to get back our MPIG payments, our message was clear: this is how much money we are losing, this is where the government says it’s going, this is the equivalent in services that we would need to lose to compensate for this loss. We took it one step further: we demonstrated the cost of a consultation for wealthier and more deprived populations, analysed the gap in resource this left us with (about 33% within the old Carr Hill formula), and translated this into pounds. No-one – not even the department of health – could or did challenge us on our evidence.
In the junior doctor dispute evidence is not being articulated in a way that makes it clear either what this fight is about or how to resolve it. Is it about loss of pay for doctors who want weekends to be acknowledged at a premium rate? Is it about safety – not enough doctors for two ‘extra’ days’ work? Is it the slap of being told seven-day working starts now, when many doctors feel they have been doing it forever? Or is this really a more symbolic battle around NHS resourcing, and the growing gap between policy and clinical delivery?
If this was it, I would gladly hang my hat on the hook of rebellion. But the case would then need to be made more articulately. I would need to better understand the resources needed to provide not only safe, but also convenient care, and I would really need to understand how and why our current number of doctors could not deliver this. I am not standing up for the government’s stance – but I do feel that this is an argument that can only be credible and resolvable with solid evidence from both sides. Unless and until that point, this remains to me a case of poor communication and expectation management. With better energy, articulation and reasoning, the discussion can still be harnessed to make the real point. Whatever that may be.

Virginia Patania, practice manager, Jubilee Street Practice, London.

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