For the last 9 years Clare Gerada has been the medical director of an NHS service providing confidential help to doctors and dentists with mental health problems. Here she outlines how she has seen a rising number of doctors week on week, including more and more junior colleagues. For this reason she argues that striking doctors are not ‘unpatriotic militants’, and should be supported. Being a doctor – or any public sector worker – shouldn’t be such a battle.

In our early days the ‘typical’ patient was an older male (GP or psychiatrist) with alcohol problems. But our patients have changed. Now nearly half of all new patients are under 30 years old. They come to us with depression, anxiety and symptoms akin to post-traumatic stress disorder. Many have worked in the NHS only a few years. They started out bushy tailed and bright eyed, but end up ‘burnt-out’ (a polite euphemism for depression) after only a few years working. Our youngest patients are only a few months qualified and many are in their Foundation years.

Image: Junior doctor protests. Flickr/Garry Knight

Patient after patient talks of feeling betrayed and bewildered by their loss of enthusiasm about a profession that they had strived to enter (often since their early teens). How their desire to care for patients is sapped by every working day. The language they use to describe their work is that of the battlefield. Being on the ‘front-line’, of ‘surviving’ another shift, being ‘at war’ with management. They talk of feeling abandoned by the NHS. Of working intolerable shifts that appear to have been designed by robots with no concept that humans will need to work them. Of having no sustenance – literally and metaphorically – as they try their best to deliver care to patients.

They talk of working in an unforgiving environment – where every error will lead to punishment and where every move is watched and recorded. They describe the fun having gone out of their profession. They say that they cannot see a future any more in medicine.

Hardly surprising therefore that the numbers progressing through training (from the early Foundation Years to the start of specialty training) is reducing. That now nearly half of doctors are not progressing. And that this is against a background of fewer of our brightest entering medicine in the first place.

Our junior doctors are striking for more than pay and conditions – important though these are. Their planned strike is consciously or unconsciously action to shine a light on what is going on within the NHS – to shine a light on the conflict between idealism and industrialization.

Increasing privatisation has changed the relationship doctors have with their patients. Constant reorganisation has fragmented services, and shattered long-standing teams. At a series of NHS listening events I held in 2014, the overwhelming term used by all NHS staff to describe their working environment was ‘Fear’.

The pay of junior doctors has never been good – not when calculated across the hours worked, the responsibilities they have and when compared to their non-medical peers. But this was part of the compact we all had – we gave our all for our patients and the organisation we worked in gave their all to us – cared for us, nurtured us, trained us.  We also knew that the intolerable hours would end as we climbed the medical career ladder. Now all of this has been fractured. Instilling ‘fear’ in doctors, teachers, nurses and other public sector workers is deliberate government policy – as explicitly set out by Cameron’s policy guru, Oliver Letwin, in 2011.

The new junior doctor contract will erode not just pay but also the current safety net against exploitative hours of work. Saturdays will be counted the same as week-days (tell their children that when they are off school and wanting to see Mum or Dad). Women and others who take career breaks will be discriminated against. Junior doctors have been forced to look into the abyss and chose between pain today (strike action) or pain tomorrow (agreeing to an unfair and unsafe contract). They are being treated as children rather than the committed adults they are – their pleas ignored, instead accused by Jeremy Hunt of being ‘extreme’, ‘militants’, and even unpatriotic.

The junior doctors are not alone in their discontent. The nurses who are marching this Saturday, the teachers and social workers, in fact most public sector workers have seen insecurity, exploitation, fear, and subtle discrimination as the backdrop to their working lives.

The junior doctors are fighting for fairness for all of these workers.  They are leading the charge for a restoration of the values that should drive our public services. For a change by those who employ them – ultimately our Government – who have a moral duty to protect those who care for some of the most vulnerable in society. Without this change, goodwill will disappear forever and with it the glue that binds our public services together. The government must now stop their bullying tactics and accept that something is profoundly wrong the NHS today and act before it is too late.


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About the Author

Dr Clare Gerada was chair of the Royal College of GPs.

(Feature imaged: Dylan Harris CC BY 2.0)

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