As junior doctors react angrily to changes in their working conditions, should patients be concerned?

The Government recently pledged to deliver the world's first seven-day-a week health service, providing medical care to patients 'wherever they are and whenever they need it.'  On paper these changes sounds ideal, but at what cost?

In order to implement the plan, changes are being made to the junior doctors' standard contract.

This will result in longer working hours, a pay cut of up to 40% and what are perceived to be more difficult working conditions for many. 

As junior doctors reportedly contemplate strike action and moving to practise abroad, it is important to understand the wider implications that the changes may have for patients, and the care they can expect to receive from the NHS, in the future.

The changes

The proposed changes will extend the 'normal' hours during which doctors can be asked to work, from 7am to 7pm Monday to Friday to 7am-10pm Monday to Saturday. 

Under the existing rules, doctors working during evenings and weekends receive a higher rate of pay to compensate for the antisocial hours. Under the new proposals, however, Monday to Saturday up to 10pm would be considered part of the normal working week and would not attract a higher rate.

Consequently, many will effectively suffer a pay cut, because they will no longer be paid overtime for working during Saturdays or evenings.

Doctors argue that they are being asked to work longer hours against a backdrop of reduced resources and poor staff-to-patient ratios.

With morale among NHS staff at an all-time low, this is perceived in the industry as another blow to the front-line clinicians delivering care.

The effect on the NHS and the implications for patients

Demands on public healthcare have increased dramatically in the last decade, and recent investigations, such as the Care Quality Commission's report into Addenbrooke's Hospital, have already highlighted the dangers of staff shortages on patient safety. The NHS is stretched to breaking point as it is, and the proposed changes seem likely to make existing problems worse.

With conditions changing for junior doctors in the UK, there is growing concern that many may go to work abroad or leave the profession entirely.

In order to deliver good quality health care, the NHS needs to remain competitive, and continue to attract and retain high quality medics; this includes working conditions that remain attractive.

If conditions within the NHS continue be seen as hostile, newly trained medics may be tempted to move elsewhere. Other countries, such as Australia and New Zealand, offer fewer working hours for higher wages. In the aftermath of the announcement of the changes, over just three days 1,644 young doctors began the process of applying for the necessary certification to practise abroad.

This should be of concern to the wider public, as the NHS would be left with a serious shortfall in junior doctors, and patients could be exposed to an increased risk of harm. With the NHS already facing crippling staff shortages, this is a loss that the NHS can ill afford.

The changes are likely to have the biggest effect on those specialties that involve substantial evening and weekend shifts, which already suffer staff shortages. These include Psychiatry, Emergency Medicine, Children's Services and General Practice – areas that arguably deal with the most vulnerable and high risk patients. 

Britain is already facing a shortfall of A&E doctors, because many medical students are choosing to pursue careers in less pressurised specialties. General Practice, in particular, looks set to take a hit as the new contract imposes a reduction of up to 40% on trainee GP salaries. The existing staff shortages in these areas are likely to be exacerbated by the proposed changes, as these specialties become financially unviable for junior doctors.

The future

For those left working in the NHS, as well as for the patients they treat, the future looks uncertain. Concerns about doctors working long, unsafe hours are very real, and have not been fully addressed by the government. This could have worrying implications for patient safety, potentially leading to a fall in standards and more negligence claims. 

To survive, the NHS needs caring and motivated medical professionals who are valued, supported and given the resources necessary to fulfil their duties to patients. Denting the morale of existing clinical staff, and driving junior doctors away from General Practice and Emergency Medicine, can only make the situation worse. 

Organisations like the British Medical Association argue that, as junior doctors become tired and demoralised, there will be a significant impact on the quality of the care that they are able to provide.

Those working on the front line of the NHS do their best under increasingly difficult conditions, struggling to deliver safe care. The fear is that, ultimately, the people who will suffer most from the proposed changes are likely to be the patients.