Open letter to Jeremy Hunt from the Society for Acute Medicine

Thursday, 15 October 2015
Dear Secretary of State,
As we head into what promises to be another difficult winter for the NHS, especially acute services, the Society for Acute Medicine wishes to express its grave concern regarding the ongoing dispute between NHS Employers and our junior doctor colleagues. We strongly believe that attempts to impose a new contract on junior doctors will have a catastrophic effect on the NHS, of which the long term consequences will dwarf any short-term fallout.
We recommend that you listen to our voice because a failure to do so will potentially jeopardise the very existence of the NHS. Initially we would like to dispel some common myths. Firstly, junior doctors are not really that junior. Whilst some have just left university, the majority are more senior and all of them are highly trained. They deserve to be treated with respect. We believe that you have described junior doctors as the backbone of the NHS and on this point we wholeheartedly agree.
Secondly, the call for 7-day working fails to acknowledge that doctors of all seniorities are currently working out-of-hours and at weekends. In acute and emergency specialties we already have significant service provision over 7-days. The paradox that our government fails to mention is that it is the doctors working in acute specialties who want to improve care at weekends. In our specialty, acute internal medicine, 90% of senior doctors support weekend services. However, to make this commitment work in a sustainable way we need a workforce which feels appreciated and properly rewarded.
Junior doctors still feel that a new contract is being imposed on them. We note the reassurances you made in your letter to Dr Johann Malawana, the BMA’s junior doctors leader, of October 8th 2015. However it is clear to everyone that your letter did not deliver the intended reassurances. We certainly support junior doctors when they argue that evening and Saturday working must not be seen as routine time. We are also concerned that doctors who wish to take time out of clinical training, for example to do research, or who wish to start a family, will be prejudiced by the new contract. We know that women outnumber men graduating with a medical degree. Yet the new contract will be less favourable for the majority of women doctors.
Discouraging our brightest young doctors from undertaking research is simply wrong.
Why are NHS Employers imposing a contract that will ultimately drive doctors away from medicine, especially acute specialities? Have the consequences not been considered? If junior doctors do not work in acute specialities we face an immediate recruitment and workforce crisis filling junior doctor posts and a longer-term shortage of consultants. Surely NHS Employers are aware that even under the current contract we are struggling to recruit to registrar level posts in many acute specialties, including our own. Ironically, Health Education England is funding a project to drive-up recruitment in acute internal medicine, which we call TakeAIM, and yet another NHS body is imposing a contract that could spark the biggest recruitment crisis ever seen in the NHS.
Sadly there will ultimately be one loser, patients. No staff means no service. No staff and we forget about 7-day services. No staff and the NHS collapses. Last winter the NHS reached breaking point; there is no luxury provision to allow the changes being imposed in the junior doctors’ contract. The NHS is a complex social model, with every area interdependent. Watching junior doctors driven away from their chosen vocation would be truly catastrophic.
The NHS, and hospitals in particular are a sanctuary not only for sick people but also those members of our society who are disadvantaged. Without junior doctors and acute services where will our old people, our homeless and patients with mental health illnesses go when no one else has a solution? In an imperfect world the UK boasts an institution that simply says ‘we care’.
Without junior doctors, without the consultants of tomorrow, that all disappears. People need to know that junior doctors are not asking for massive pay rises or the life-styles of premier league footballers; you know that. They deserve a fairer deal than that which is currently on the table. For the sake of every one of us who might be a patient tomorrow we politely ask you to do what doctors do every day, work for patients.
Yours Sincerely,
Dr Mark Holland
President, Society for Acute Medicine
Dr Nicholas Scriven,
President Elect, Society for Acute Medicine
Dr Alistair Douglas,
Immediate Past President, Society for Acute Medicine
Dr Hannah Skene,
Secretary, Society for Acute Medicine
Dr Susan Crossland
Treasurer, Society for Acute Medicine

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