Response to the Proposed New Junior Doctor Contract in England
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The Royal College of Surgeons of Edinburgh (RCSEd) is dedicated to upholding standards of training for surgeons, and standards of practice for patients. Delivering high-quality care is the primary concern of all who work in healthcare but, in order to deliver that care, trainees in all specialties must receive the best possible training, and their health and wellbeing must be protected. We are concerned that the new contract for all junior doctors in England will have significant implications for the profession and will affect both the training and the health and wellbeing of junior doctors.
One of our main concerns relates to the changes around monitoring. Currently, employment safeguards ensure that the medical workforce cannot and does not work excessive hours. This is to be supported, not only because the literature showing the impact of a tired workforce on patient safety is extensive, but because of the risks excessive hours pose to the health and safety of the workforce itself. However, the new contract would replace the current safeguards with a new model of retrospective monitoring of hours. As an unproven, untested, model this could leave the system and staff vulnerable.
Over recent times, the structure and processes of the NHS have been continually changed, yet the service delivery model has not changed at all. The European Working Time regulations, which have been adopted, have not been matched by changes in the way that other aspects of care for patients are delivered. In addition, over the past eight years, doctors in training have had to populate rotas with fewer numbers of colleagues than previously and, as a consequence, there have been many instances of rotas being combined to ensure medical cover for patients. This has increased the workload for doctors in training as a group and has added to the pressures faced by individual trainees. We recognise that change is required in the NHS, but the unintended consequences of that change must be acknowledged and addressed. This is why our College has long maintained that there should be no more top-down reorganisations of the NHS.
We also recognise that the NHS faces a number of financial challenges, and there is a desire to move routine services to a 24/7 model - a desire that is shared by the vast majority of our membership. However, it is critical that service delivery and contractual changes are carefully considered to ensure they provide safe and appropriately remunerated conditions of work. Doctors in training are the backbone of the NHS yet the new contract risks deepening the issues with recruitment and retention we already see within this workforce. As such, we urge all those engaged in the negotiations and decisions relating to such changes to work together constructively and positively.
The RCSEd has also given its support to two letters sent to the Secretary of State for Health by Royal Medical Colleges across the UK:
- Letter from nine Royal College and Faculty Presidents
- Letter from Royal Medical Colleges in Scotland
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