Saturday, June 25, 2016

2 words...

So we are here. One referendum done, another crucial vote around the corner. I will be clear about it- I voted "Remain" not based on any economic issues but one and one thing only- the importance of a multicultural, all togetherness that the present world needed. To assume all those who voted Leave are bigots is silly and crass but for sure, it gives the minority the belief that their view is supported now by more than half of the country. Racism has always been a part of Britain- its got a bit more polished as time has progressed. As uncomfortable as it sounds- let me be blunt about it- when you are still doing Equality workshops in 2016, when you look at all the NHS arms length bodies and who leads them,..well…bias comes in different shapes. What you certainly didn't want is all of it to come creeping back into the open..back to the days when no one would sit next to my mum in Dudley on a bus in the 1970s.
Looking at whats happening today all over social media, welcome to a new world where the Trumps, Hopkins, Farage et al of the world are seen as voices of the "suppressed". No, they aren't- they are just an eloquent face of the ugliness which has always brimmed under the surface.

Lots in the Leave side voted for that due to the need for individual identity- not be part of a bigger mass- controlled by "others". I get that. We see that in the NHS don't we? A fierce passion in individual identity- whether it be their own GP surgery, their department, specialty, hospital- but a lesser drive when asked to sacrifice their individuality for the need of the NHS. So why surprised to see that in the wider world- we all love our own islands, don't we?

Which brings me to the next upcoming vote- one on the junior contract. We live in a strange climate- where the ferocity of negativity prevents many from giving a contrary view. I also appreciate that what I say next will bring forth some anger, some sniping about my background- perhaps even how because I work for NHS England I am some sort of government stooge. It will be forgotten very quickly how vocal I have been in support, written blogs, argued on their behalf on social media,railed against HSJ about their "leaks", how I went and stood with them front of Richmond house inspire of my national role….I have seen what reaction Jane Dacre has got from some- the same Dacre who has been simply outstanding in her support. But frankly, I couldn't care less. If you want to say something to me, grow a pair, come out from behind the keyboards and debate it with me- face to face. If you can't, thats your problem, not mine.

So I will come straight to the point- Vote Yes. Is it perfect? No. Is it better? Yes, I think it is- and I have read through it- just like I have read the previous ones. The imperfections need to be ironed out behind the scenes- working within the process. The ground gained compared to the first offered version is vast- and there is much to be proud off what has been achieved- as a collective. Does it tackle the issues of equality and patient safety better than the previous versions? Yes in my opinion. Again, its my opinion- none of which is binding or worth listening to if you don't want to, but that indeed is my view. I have also seen the heat Johann has taken on social media- here's my tip- if you fancy doing his role, go do it- but don't slight him-it takes a brave man to stand up and take all the heat he has to negotiate what he has.Arm chair leadership is only that, nothing more.

So is it a safer contract? Yes- key does sit with the Guardians- and it is up to as seniors to play our part. Is it a contract which is more fair? Yes - definitely in my view compared to previous. As the saying goes, you don't get what you always want, you get what you negotiate.
A"No" vote opens up further uncertainty and I can't quite see what exactly the play is after that. Will the EWTD go- perhaps so- would that make future contracts any more palatable? Rebellion is great-as long as its to an end- and I am not sure what that is. The system needs to heal, it needs to move on- careful that by creating or encouraging more anarchy, you don't hasten the demise of what has been the main issue, at least from my perspective- ensuring patient safety.

If it indeed is a No vote, I hope there is a plan…because if,as champions of the No vote. by whipping up frenzy, you end up compromising the careers of many bright young folks as well as patients….look no further about the situation the Leave campaign leaders find themselves in today. History will be the judge…and happy to be proven wrong. 

So if you are a junior doctor- and read this blog- take your time, think for yourself…and then I have 2 words for you- simply as a suggestion.

Vote Yes.


  1. Hi Partha, I am a consultant in anaesthetics and read your piece with interest. One question, what was wrong with the old junior doctor contract ? Was it not safe for patients ?

  2. Partha. As a relatively young Consultant I am inclined to agree with you as 'we' survived worse conditions(on better OOH pay) and managed to come out this end so why can't they? many bloggers have pointed out it was a totally different NHS even 10yrs ago! The demands have shot up in the last 5yrs, the expectations are greater, there is more frailty, we've had the Financial Crash and crippling austerity in adult social care. Budgets are being squeezed, tariffs are reducing and now HMG want 7-day services...? When I was an SHO and you were an SpR, the Consultant was seen 2-3 times in the week and did 1PA (<half a day)seeing patients on call. Now we are almost ever present daily and can spend an entire 12hrs on call in Acute Medicine. So one would think that juniors have almost nothing to complain about as they are so much better supported?! Well, it's not so rosy in the real World. The increasing complexity of frailer patients, the deficiencies in IT infrastructure(in stark contrast to our smartphones & tablets), the loss of continuity of care, the non-existent firm structure, the fragmented supervision, the nonsensical shift patterns, the 'gaming' of EWTD with consequent unfilled rotas have made the lives of trainee doctors miserable. I had not mentioned the rigidly fixed annual leave; the NROC scams; the delayed release of on call rotas blocking reasonable attempts at covering for important study leave or College exams; the ambivalence of HEE towards whistle blowing protection. Okay, hear me out.
    Contract v2 is clearly an improvement and all the JDC negotiators(including the HSJ WhatsApp leakers) should be applauded for their hard work. However, to say that 'juniors' should now accept it with the caveat that the unresolved concerns about equality, LTFT, Guardianship etc have been noted is to ask them to display a very, very high degree of trust. Politicians are felt by the general public to be untrustworthy so why should 'young' doctors who have plenty of evidence of crass, underhanded, insensitive and hypocritical behaviour from many politicians trust them? To accept "v2" because we have had Brexit and people everywhere are panicking is to capitulate. Even the senior Brexiters acknowledge that immigration would not alter radically with a Leave win. So do we now believe that if there is a NO vote that junior doctors employment will collapse overnight?! They would not be breaking away from the NHS with a NO vote. But they will disappear if a poor quality contract is imposed!
    Apologies for not having read through every paragraph of the contracts- v1 and v2: So a few Qs. Why can't there be rota pilot schemes within Trusts and particular specialisms? Why not wait for 2 yrs before invoking NHSE's version of article 50? Do we really need to rush into this?
    Ultimately this new contract is not even about current trainees as they are already in the system and will be seniors soon enough. Like the EU debate, thus dispute is about the future and the children who come after us. It is therefore existential and not just technical. If I were a trainee - junior or senior, I would VOTE NO.