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This week sees the publication in JAMA by Andrew Goddard entitled 

Lessons to Be Learned From the UK Junior Doctors’ Strike.

The paper eloquently explains how we arrived at an impasse resulting in the first ever all out strikes by 'junior' doctors in the history of the national health service. 

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Dr Orford summarises the paper in our journal club as:

This viewpoint describes the demoralising 2-year dispute between the UK government and medical profession, culminating in a workforce at the nadir of poor morale, and the UK Junior Doctors strike.

How did it come to this? In brief the government push to increase weekend cover in the face of increased demand and mortality on weekends, without increasing pay, in the setting of a reduced workforce compared to other OECD countries, a 48-hour work week, and flat health funding since 2008 in the face of increased workload, has resulted in;
(1) substantial and often unmanageable workloads
(2) loss of team structure
(3) poor quality of training
(4) lack of flexibility in working patterns.

With this background, what happened when the NHS pushed for a contract with increased weekend working and no significant increase in pay for junior doctors? A push characterised by brinkmanship, media manipulation, and attempts to sway public opinion ; 

(1) Increased sickness rates among physicians
(2) High dropout rates of physicians from medicine throughout different career stages
(3) Migration of UK physicians abroad
(4) Disengagement with professional development
(5) Strikes - By the end of 2015 a junior doctor strike was looming, as the Health Minister threatened to impose a new contract. Despite the promise of a 13% basic pay increase, 98% of junior doctors voted to strike, and an escalating strike action occurred from Jan to Apr 2016.

Resolution appeared possible by May 2016, with the Junior Doctor Committee accepting a revised government contract. However the junior doctor workforce was not convinced, voting against this in a ballot. The impasse continued, and the debate was sidelined by Brexit. It will re-emerge, and the prospect of further strikes, an unwanted contract, a further demoralised medical profession, and an ongoing breakdown of the trust between doctors and government seem likely.

What can we learn from this? A desire to improve patient outcomes on weekend is reasonable. To try and achieve it through a campaign that demoralises and damages a workforce, fractures the relationship between physicians and the state, leads to poorer patient outcomes every day, and will take a generation to repair, is not. The message is clear. When the relationship between the health profession and government breakdown, everyone suffers.

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I would add to this more recent events such as the campaign by justice for health, notably one of the most successful and expediated crowd funding events in history. A group of 4 NHS junior doctors were able to take the secretary of state (sos) to court with the ultimate findings being clarity on the sos decision making and legal powers. In short he can not impose a contract.

Their lawyer Saimo Chahal QC (Hons) summarises the court case as:

The judgment in brief

This case is all about what happens when loose language is used and meanings imperfectly conveyed and the very serious consequences which can flow from those words. The words used have led to Junior doctors striking and serious consequences for patients. That is why I want to use by and large the language of the judgment to convey what the court has decided rather than to interpret it. Before that:

The key message from the judgment is this:

1. Mr Hunt (sos) is not imposing a contract on Junior Doctor

He never was
He did not suggest he was
He never thought anyone thought otherwise

2. The Justice for Health junior doctors are thrilled to announce that they have succeeded in establishing beyond doubt that the Secretary of State for Health is not imposing the latest ie July 2016 contract on junior doctors. Further that employers of junior doctors are not legally compelled to adopt the contract, and that they can continue to negotiate on terms until agreement is reached.

3. Without the courage and determination of the Justice for Health doctors, Dr White, Dr McVeigh, Dr Masood, Dr Silman and Dr Mashru in taking this legal challenge this position would not have been established or publicly available today.

4. The doctors have established that the statement made on the subject of the new contract by the Secretary of State for Health on 6th July to Parliament did not make this position clear. The position only became clear following documents and statements filed in this litigation. As result the Defendant avoided the Declaration requested in this litigation but the doctor’s position is entirely vindicated.

Conclusion

Justice for Health are satisfied that they were performing a public service in pursuing this litigation and that most importantly their doctor colleagues as well as employers now understand the true legal position – there is no contract which has been imposed on them. Employees and employers can discuss and negotiate terms.

They have established importantly that the principles of transparency and clarity apply and also as to the limits of parliamentary privilege. This will help others in the future.

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If your a UK 'junior' doctor how do we move contract negotiation forward whilst ensuring continued public support?

If your a non-UK 'junior' doctor what is your take on the situation? Do you face similar challenges in your country?