Royal College of Physicians president Professor Jane Dacre comments on the junior doctor contract referendum and possible long-term solutions.
The junior doctor contract negotiations and ongoing dispute have been a long journey. But, as a profession, we have come a long way over the past 10 months. The agreement brokered by Acas has provided a welcome opportunity for reflection on the situation. It was really good news that the Academy of Medical Royal Colleges’ suggestion to have a pause led to renewed negotiations and then an agreement.
The dispute has certainly raised awareness of the discontent that is felt by many of the trainees working in the NHS. The British Medical Association (BMA) has done a fantastic job of highlighting junior doctors’ hard work and dedication to patient care every day when they are working in the NHS. Dr Johann Malawana, chair of the BMA Junior Doctors Committee (JDC), has demonstrated true leadership qualities during this difficult time to highlight this discontent.
The need to value, support and motivate trainees has never been clearer, and the problems caused by rota gaps and staff shortages are well recognised. We must now move on to the next stage of the journey and start the process of resolving these problems to build an NHS that supports junior doctors to deliver the best care for patients.
Among the trainees that I speak to, there is still a lot of concern about the new contract and whether it adequately addresses the problems highlighted. No contract is perfect, so I am sure that it will have its challenges and problems. There are bound to be a number of issues that will need further discussion and modification in both the short and long term. This is not surprising, given the complexity of the deal to be done and the emotion surrounding it.
I know that all trainees will be thinking carefully about how to respond to the referendum and I trust them in this process. I am clearly not a trainee, but I have been trying to think through the possible outcomes and what I would do if I was in their position. It seems to me that the option I would take is to vote ‘Yes ... but’. That is, a qualified yes to the contract but with a strong commitment to resolving the challenges. A complete rejection would undermine that commitment to addressing the concerns. The uncertainties about the future, the unrest among junior doctors and the lack of clarity surrounding the contract all have a negative impact on the delivery of patient care and the morale of the profession. I am sure that all of us would like to see these challenges resolved.
This contract is not the final point in the journey, but the new contract can provide a starting position to build from. The prospect of the complete rejection of the contract and ongoing industrial action is increasingly worrying for patients, the public and doctors.
The JDC has achieved a huge amount over the past months. The Medical Royal Colleges, Health Education England and NHS England are now really focusing on how to improve things by recognising the need to work more effectively together. We must all work together to better support trainees to balance clinical responsibility with education and training, to resolve the significant rota gaps that are present in wards and hospitals across the country, and to provide the entire health and care system with sufficient resources to meet the needs of patients.
I know that trust has been seriously affected by the dispute, but I now see a genuine desire from all those involved to work collaboratively to sort it out.
So I know that opinion is likely to be split but, after a lot of thought about what I would do if I were a trainee doctor now, I would vote ‘yes’ in the junior doctor referendum but with a strong commitment to sorting out the challenges and issues highlighted during the dispute. This will not be easy, but we need to be able to move to the next stage. You have my commitment to work together, to make things better.
Professor Jane Dacre, president, Royal College of Physicians
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