The End Of the NHS? Junior Contracts – A Medical Student’s Perspective


What do you think of when you hear NHS? Long waits in A&E? MRSA infections and green scrubs?

For some of us, the NHS represents our sole future employer (until we have the medical experience required to work privately, if that’s what we wanted to do and if our specialty allows it). It is the only company we can work for in the UK with our qualifications. The only route to training, practising medicine and ‘helping people’ which we all eagerly scribbled on our personal statements as our main drive for choosing this career.

That puts us in a pretty unique situation. Not many career paths are so monopolised when it comes to job prospects. In many or most other jobs, if you don’t like your payment scheme or your working hours there is the opportunity to apply to move to another company.

So what happens when that sole employer decides to force through a contract its employees don’t agree with? Protests and a ballot to strike.


As a medical student, I signed up to do medicine out of a genuine desire to come home at the end of every day and be able to say ‘today I helped someone’ or ‘today I made a difference to someone’s life’. We are very privileged in medicine to be trusted with the most intimate, painful and scariest moments of patients’ lives and doctors work hard to maintain that trust. We would never take that for granted. Day to day we will also witness suffering, pain and death, and have a great deal of responsibility on our shoulders. This is what we signed up for and what we train so long and so hard for.16255176372_ab221a5c52_b

However, the goalposts have now changed. There is not enough money to support the NHS as it currently is, and so the government looked into ways of saving money using an independent review board (The Review Body on Doctors’ and Dentists’ Remuneration – none of whom are in fact doctors). This board came up with a list of suggestions of alterations to junior doctor contracts. NHS Employers then entered negotiations with our union, the British Medical Association (BMA). These ‘negotiations‘ broke down because NHS Employers would not in fact negotiate on the terms of the contract until the BMA accepted several of the DDRB’s recommendations. The BMA walked away as these prerequisites to negotiation put both patient and doctor safety at risk and extended doctors’ hours while reducing their pay.

In brief, here is a summary of the new contract which has caused so much outrage:


Currently, junior doctors (that is any doctor below consultant level – which could include anyone from a foundation year doctor in their first year of training to a 35 year old specialist registrar with a family) can be scheduled to work at any time of day or night, 7 days a week. If your hours fall outside of 7am-7pm Monday to Friday, you will be paid more per hour to recompense you working these ‘unsocial hours’. In the new contract, the basic hours will be extended from 7am – 10pm, Monday to Saturday. This means working at 9pm on a Saturday will be regarded and paid the same as working 9am on a Tuesday. Doctors working in the specialties or departments which have a lot of unsociable hours, such as in the emergency department, will be working the same hours but being paid up to 40% less than on the current contract. Working on a Saturday for no extra money has knock on effects on childcare, family life and outside hobbies. Junior doctors already do work all hours of the day and night and at weekends, but are rewarded for working at antisocial hours with extra pay – which can then be used to cover late night transport costs or childcare . What does Jeremy Hunt suggest two married doctors do with their children on a Saturday if they aren’t lucky enough to have other support around at home?

Training Level 

Currently if a doctor trains in one specialty, such as respiratory medicine, their pay will increase over time with the amount of time and experience they have gained in that specialty. If they decide to move specialties and re train – for example as a GP – their previous experience will count in their favour and they will remain on the same pay grade as the one they left. The new contract demands that all doctors start back at the basic level of pay if they change specialties.


All hospitals currently face financial implications if their juniors are working too many hours a week. This provides a safeguarding system so that juniors are protected as their hospital does not want to lose out financially if they are working for too long. The new contract advises removing these safeguards meaning we won’t be as protected and are more vulnerable to working longer hours. Exhausted doctors make mistakes. Patients and doctors alike will be put at risk.

These are just some of the changes and the British Medical Association (BMA) has provided an excellent summary of the full guidelines here.

As it stands these contract changes will be forced through in August 2016. The BMA is currently balloting its members over whether or not to strike, and demonstrations are being held all across the country protesting against these changes.

On a personal level, these changes will mean that I will have less flexibility in my job and if I take time out to have children and come back to a more ‘child-friendly’ specialty such as general practice I will be penalised. I will also be paid less for working evenings and weekends. Working longer hours without safeguards will put both my life and my future patients’ lives at risk. I want kids and I want a career and I have been lucky enough to have been brought up in a generation and an environment of equality which has proven to me that this is possible. How dare Jeremy Hunt take that away from me and my colleagues? How dare he make doctors feel so desperate that the only option they can see is to leave medicine entirely?eye-766166_640

A recent survey of medical students at the University of Southampton by our BMA student reps revealed that if this contract goes through, over half are thinking about moving abroad or changing career. The rest of the country paints a similar picture. The lifestyle of a doctor is simply going to be better in Australia, New Zealand, Canada… anywhere but England. Elsewhere our pay will reflect the hours we put in and the safety of our patients will not be compromised. We will have a better quality of life. So why are we bothering to protest? Why don’t we all just up sticks and leave? Or wait for the NHS to fall apart, become privatised, and earn twice as much for doing the same job for a private medical company? Because that is not why we went into medicine. The NHS is unique and we are so lucky to have a free healthcare system for anyone who needs it. We love the NHS and we want to keep it going. That’s why doctors put in so many extra hours every week. That’s why we study for at least five years, take on huge amounts of student debt and offer ourselves up to being shipped anywhere in the country to work. That’s why we will stay on after a shift to explain to a family exactly what is going on with their elderly mother’s healthcare. That’s why we will stop at the side of the road after a 12 hour shift to help someone in an accident. For our patients and for our NHS. If we were in this for the money, we would have used our handful of As and A*s from school to go into the city where we could earn three times as much.

So what will happen? If the new contract goes through, juniors will move abroad or leave medicine and the government will face an even bigger recruitment crisis. They will have to fork out more money to get last minute cover for their rotas. They will spend even more and eventually the NHS as we know it will collapse.

The sad truth is that if this does happen and our health system becomes privatised, we doctors would actually be better off. We would be paid more, have better control over our holidays and work friendlier hours. So why don’t we just keep quiet and let the contract go through?

Because in a private healthcare system, no one is a winner. If you can’t afford treatment, you won’t get any treatment. Have a quick look at how much it costs in America simply to be transported to hospital in an ambulance. It can range from $200 to $2000 and that is before you get through the door of the hospital. And that’s if you have insurance.

We don’t want this for our patients!

We want to protect our NHS which we are lucky to still have. This contract is aimed at driving doctors and the public apart and demoralising a health service which is already on its knees.

So what can we do? As medical students we are not allowed to take part in industrial action, leaving us feeling helpless. Which is why we are reaching out to you to help us spread the word. It’s not just about the money. It is about our National Health Service which is being slowly dismantled.

Please spread the word, join our cause and help us to help you!



Final year medical student.

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