Back in June of this year, I wrote about the Conservative Government’s plans for a “7 day NHS” and the impact that this could have on patient safety.
I raised questions about how this would be funded especially as the NHS is currently in financial crisis with hospital trusts looking at a budget deficit of over £1 billion.
Over the last month, we have seen that the government intends to put its plans in place by making cuts to the funding of frontline medical staff. Health secretary Jeremy Hunt has proposed changes to contracts for junior doctors which essentially mean that they could be forced to work longer hours for less pay. The term “junior doctor” actually encompasses all those doctors who are not at consultant level and therefore affects thousands of doctors across England (Scotland, Wales and Northern Ireland are not yet facing the same changes).
Junior doctors have branded the proposed changes unfair and unsafe and have said that patient safety will suffer if the changes are implemented. The proposals include cutting the number of hours that are classed as unsociable and which therefore attract additional pay. This corresponds with the government’s plans to make staffing levels the same at weekends as they are in the week, i.e. a “7 day NHS”. Junior doctors already provide the vast majority of staffing in hospitals at the weekend and therefore these cuts in pay could result in them working the same number of hours they do currently, but for 30% less pay. There are also concerns that the new contracts do not have adequate safeguards on the number of hours which junior doctors can be asked to work with the result that average working hours could rise from 60 hours per week to 87 hours.
Clearly, this must impact on patient care and safety. If doctors are forced to work longer hours, it is more likely that mistakes will occur as a result of tiredness and a lack of breaks. Shifts worked by junior doctors can already be gruelling owing to pre-existing staff shortages and adding more hours over the course of a week is likely to reduce the quality of care that patients receive. This will then leave the NHS open to negligence claims as being tired is obviously not an acceptable excuse for providing substandard care.
Last month saw thousands of junior doctors march in protest against the changes. In response, Jeremy Hunt has offered what is termed as an 11% pay rise in order to ward off further protests. However, the British Medical Association has now voted to ballot its junior members as to whether they move forward to strike action. The BMA has stated that its junior members need further assurances in respect of recognition of unsociable working hours and safeguards on total hours worked before it can agree to re-enter negotiations.
Another concern is that these proposed changes could result in thousands of doctors deciding to leave the NHS. Since the proposals were announced, the General Medical Council has received over 5,000 requests from doctors for the necessary paperwork to enable them to practise medicine outside the UK. The number of requests of this nature received by the end of 2015 is expected to be double that of 2014 as junior doctors seek to access better working conditions abroad.
The impact of this on patient care cannot be underestimated. As I have stated above, the NHS relies upon junior doctors to provide frontline care, especially at weekends. If the NHS loses thousands of junior doctors to other countries, this will have a huge effect on the provision of care and services to patients with the inevitable result that patients will suffer. In addition, the NHS would then be forced to buy in locum care at significant cost which would negate the proposed savings.
It is clear that the government has much work to do if it is going to successfully implement a “7 day NHS”. In addition to the changes to junior doctors’ contracts, it is also seeking to re-negotiate consultant contracts, a move which is also raising concerns about patient safety. Unless the government can provide concrete assurances that patient care will not suffer, then these significant concerns will remain.