How do British junior doctors help ensure their voices are heard regarding working conditions that are optimal for patient care? Aspiring physician, Beverly Kyalwazi (’17), recently traveled to London to learn more and found the process can be challenging when trade unions, medicine, and governments intersect.
Industrial action taken by junior doctors in London brought substantial attention to the negotiations taking place between the NHS and British Medical Association (BMA) over the 2016 NHS contract. Beverly Kyalwazi (’17) investigates the perspective of junior doctors in London on the negotiations carried out by the British Medical Association (BMA) and the outcome of the NHS contract.
The reformation of healthcare systems has significant implications for not only patients, but medical professionals. An NHS contract affecting work hours and pay of junior doctors in the United Kingdom was recently implemented. Where does the physicians’ voice materialize when it comes to discussions surrounding healthcare reform? What actions have and are physicians taking to gain agency when it comes to healthcare reform? How is the efficacy of the physician work environment preserved given the governing political factions?
“As things stand, we’ve failed dismally.” This was junior doctor Rachel Clarke’s response to the outcome of the NHS contract negotiation. With junior doctors throughout the United Kingdom uniting to prevent the NHS from imposing an unwanted contract, the outcome of the negotiations from the junior doctor perspective remains uncertain.
The BMA is a trade union for doctors in the United Kingdom. Throughout the negotiations between the NHS and BMA, the junior doctor’s committee met monthly at the BMA headquarters in London to discuss the contract and meetings held with health secretary of state, Jeremy Hunt. Additionally, BMA junior doctor representatives would meet with their respective hospital boards to discuss the progression of the negotiations. I asked several junior doctors, some who are representatives of the BMA junior doctor’s committee, for their perspective on the negotiations and strikes leading up to the contract implementation. Many junior doctors believe that the strikes were necessary to raise awareness of their working conditions and the adverse pressure the new contract would place on their unstable emergency health and critical care units. Additionally, junior doctors who were not representatives of the BMA expressed the belief that the BMA representatives were distracted with other responsibilities and did not take a strong enough stance against government health care officials. As a result, they turned to industrial action in order to unite junior doctors and gain additional support from the public. However, all of the junior doctors interviewed shared the belief that what started out as a motivated, united front with junior doctors going on strike, ended in political fatigue and low morale. Some junior doctors believe that ultimately the voice and agenda of junior doctors was lost following numerous strikes. Consequently, this weakened their stance against the health secretary of state. Members of the junior doctor’s committee contributed the unexpected change in leadership in the BMA to low morale expressed by junior doctors.
These findings prompted me to ask junior doctors in London what other means could they use to advocate for themselves in addition to representation from the BMA. The junior doctors I interviewed served as deputy chairs of training committees, members of the Royal College of Physicians, and hospital board executives. Many reported they engage in leadership positions in attempts to contribute to improving work conditions for junior doctors. However, they also expressed the tradeoffs incurred by engaging in these leadership roles. Serving in these roles limits the amount of time they can devote to patient care. One junior doctor stated, “we can’t have the best of both worlds.” He perceived the only option of junior doctors in effectively advocating for themselves to be focusing on political career and taking time off medical practice. Some junior doctors are currently pursuing this route as they believe that future NHS reform will have even more significant implications for their role as physicians.
Several junior doctors echoed the following sentiment: “We fear the NHS is becoming more privatized, and we are losing the system we were once proud to serve.” This is one thing both the junior doctors who were representatives of the BMA and junior doctors not involved with the trade union agreed on. Though many junior doctors in London are feeling at a loss when it comes to establishing autonomy over their work environment and patient care, there has been some offer of reassurance to junior doctors with new safeguarding mechanisms, most notably exception reporting, which provides junior doctors an avenue to more effectively report malpractices as defined in the new contract. Prior to the implementation of exception reporting, junior doctors were required to report overtime work through a monitoring system. The monitoring system presented obstacles for many junior doctors because of the difficulty in communicating with a liaison and the excessive administrative work involved. With exception reporting junior doctors now have a more accessible online platform through which their concerns can be streamlined. In addition to exception reporting, another aspect of the contract junior doctors believe is promising is the implementation of junior doctor forums. Hospitals under the new contract are required to hold junior doctor forums where junior doctors have the opportunity to express concerns that may arise due to the new contract, work hours, or patient safety. In attending a junior doctor forum at the Guy’s and St. Thomas’ Hospital, I observed some of the reports made as well as the hierarchy that addressed concerns raised by junior doctors. An appointed Guardian of Safe Working Chair and a member of the Local Negotiating Committee were present at the forum. Their role was to preside over the forum and serve as liaisons between junior doctors at their respective hospital and all NHS hospital trusts. Overall, junior doctors in London perceive their autonomy is limited when it comes to their work conditions under the NHS. However, there is also a sense of stability given these safeguarding measures that have been implemented as a result of the contract. As discussions emerge on the reform of the NHS, this sense of stability perceived by junior doctors will be important to build on in the future.
Next fall, I will begin medical school. As an aspiring physician I hope to not only provide medical care to my patients, but also elucidate challenges in improving quality of life. With the understanding that the provision and management of healthcare involves the collaboration of several working groups, I sought to better understand how these groups, government workers and medical professionals, engage with one another. Having the opportunity to conduct this research allowed me to do so through analysis of the perspective of junior doctors working under the National Health Services. This experience provided an invaluable opportunity to explore a universal challenge experienced by medical professionals and gain insight on a different health care system. I look forward to building on this experience in my discernment of how I can implement research into a career as a physician.