Junior Doctor Contract Dispute/Strike

In terms of it "being about pay", it certainly isn't for most (though as mentioned the 25% pay cut is a bit of a kick in the teeth). It's primarily about working practices. 

At the moment, my wife's department is 50% under-staffed. That means that there are not enough doctors to cover the recommended number of shifts, so as a result those left have longer and more frequent shifts. They all already work every other weekend. Cutting pay will force more people to leave, meaning that her department will be further under-staffed (and don't think for one minute that you can train or hire doctors next week!). Forcing more people to work weekends will put more doctors off working in hospitals (why be a hospital doctor doing 7 days a week when you can be a GP doing 5?)

It's clinically unsafe to be that under-staffed and with doctors who are frequently pulling 80 - 100 hour weeks. They are knackered, they don't see their own families etc etc and that adds to the stress that they are under. 

If you have more doctors on at a weekend will this improve outcomes? Well it might do if you had more nurses, pharmacists, radiographers, ambulance drivers, paramedics etc etc.... but the statistics don't say what the govt says they do (according to the authors of the quoted report). 

If it was just about pay, most wouldn't care - they aren't in this for the money or they'd all be doing private medicine or practising overseas already. Most of them are there because they want to help people. 

No doctor would get a training post if they opted into EWTD. There is a vague rule about "56 hours a week over a 26 week period" ie. your holiday etc is taken into account in that average... rendering it meaningless. Plus, as mentioned, none of them work to roster. (Wife away so can't confirm EWTD point).

And its not a recent thing, been there , done that,  i agree, its hard.. and thats where we went, my wife took 5 yrs off, it was cheaper in the long run.

My default position on this sort of dispute is one of scepticism of the shouting of both sides. The truth almost always lies somewhere in the middle.

While this is from a source that I'm normally EXCEPTIONALLY sceptical of, this seems to be a well-reasoned article, written by a junior doctor who changed his mind completely when he actually saw the first draft of the new contract, which was only released at the end of March - www.telegraph.co.uk/news/2016/04/25/why-i-no-longer-support-the-doctors-strike/

FWIW, I've spent too much time recently getting familiar with one particular corner of the health service - including a couple of hours yesterday in a large hospital. The service was exceptionally good. I wasn't dealing with doctors, but with specialist nurses and radiographers. You could, quite simply, have not asked for more from them.

What you and Xyon have described is the difference between spending 8% (UK) of GDP on healthcare and 10% (belgium). If we matched that we would put an additional 60 billion per year in to healthcare or approx £1000 per person (v.similar to the 1400 euros...).

The accusation of stealth privatisation...The Conservatives were elected in 2010 (albeit in coalition) with a manifesto pledge that there would be 'no top-down reorganisation of the NHS'. They then proceeded to legislate for the biggest top-down reorganisation since its inception with the health and social care act which specifically promotes competition and the compulsory tendering of NHS services. The architect of the act then left the government in 2015 and now works for Bain and company in a consultancy role "In his new role he will support the consulting firm, advise clients on healthcare strategies, and improve its odds of gaining access to some of the £5.8 billion of NHS work that is commissioned to the private sector."

My father was a consultant and became president of the BMA for a while.   He too fell out with the government so was the first one not to be knighted.   However he would surely have been horrified to see what it has become now.   As far as I remember his hospital was run efficiently by the matron with help from a small group of consultants, rather than an army of bureaucrats who make it the shambles it now seems to be.   Typical of public sector management where the failures are never sacked but get promoted instead, or suspended on full pay until their disasters are forgotten.

www.dailymail.co.uk/news/article-3560556/Naked-greed-Former-BMA-chief-explains-fellow-doctors-make-despair-plight-health-service.html

As Belgium has been mentioned

www.theguardian.com/healthcare-network/2011/may/11/european-healthcare-services-belgium-france-germany-sweden

The details that leap out at me in regards to Belgium are repeated references to private & evidence of competition, likely to be considered an anathema in the UK.

Also this for funding source comparisons

www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2015/expenditure-on-health-by-type-of-financing-2013-or-nearest-year_health_glance-2015-graph156-en#page1

On number of doctors, this confused me.

www.telegraph.co.uk/news/health/news/9724532/The-NHS-will-train-fewer-doctors-to-avoid-future-brain-drain-report-warns.html

Comment from BMA to be noted.


Healthcare spending as percentage of GDP has increased since 1997 and was higher in 2013 (8.8%) than at any point under the previous govt except 2008-2009 when the recession led to a massive drop in GDP. The percentage has fallen since due to a faster GDP growth but still remains higher.

www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/expenditureonhealthcareintheuk/2015-03-26

Several companies offer successful healthcare systems based around some public-private co-operation. The key is the provision of comprehensive cover to all that need it.


Unfortunately the drive in this country is towards private companies cherry picking the potentially profitable elements of healthcare and leaving the NHS to pay for the care of emergencies, the elderly and frail. The USA has the most inequitable, expensive healthcare system in the world but there seems to be a push to try and replicate this dysfunctional system rather than (for example) Belgium's.