In case you have missed it, a letter from a junior doctor at the Royal Brompton & Harefield NHS Trust to the Prime Minister. Well worth reading.
Dear Mr Cameron,
On Wednesday morning this week I returned to work at 0800. I worked the weekend in Intensive Care as a junior doctor, for your information I was working from 2000 to 0900 on Friday, Saturday and Sunday i.e. I was part of the team that provided a 24 hour, 7 days a week, 365 days a year service. My consultant started his weekend of work at 1700 on the Friday. He finished at 0800 on Monday morning. He didn't go home until well after we had started our night shift and he was in before we went home in the morning. We also disturbed him overnight to tell him about our unstable patients. He didn't grumble once. Our anaesthetic consultant didn't grumble when we took a patient back to theatre for bleeding in the middle of the night, nor did he grumble when he was anaesthetising an emergency case the following night. The consultant surgeon also didn’t grumble. Your irresponsible colleague Jeremy Hunt seems hell bent on suggesting to the public that there is no 7 day a week service and that consultants do not work weekends. I have submitted a request, via the Freedom of Information Act, to the Department of Health last night to quantify how many consultants currently opt out of weekend working. I look forward to finding out.
In the middle of the night my colleagues (doctors AND nurses AND radiographers AND healthcare assistants) and myself were assessing patients with multi-organ failure being supported with complex devices, these patients are teetering on the brink of death all the time. At the end of my 3 night stint, just when I was at my lowest ebb, a patient got really sick. You try managing that after you've been up all night and then tell me the NHS isn't 24 hours 7 days a week 365 days a year. When you have personal experience of that, I would like you to look me, and every other doctor in the NHS, in the eye and tell us that you genuinely believe that we are being adequately paid for all the responsibility that rests on our shoulders.
Let's put things in to context. An Assistant Manager in Pret-a-Manger has a salary of £29,500 and a Manager £40,800. In other roles their starting hourly rate is £7.70/hr everywhere except inside London where they pay £7.90/hr. On the current pay system a doctor has to work for a minimum of 9 years after graduating from their 5 year degree course before they have a basic salary higher than a Manager who works in Pret. How much student debt did people working in these roles accrue?
On Monday night I did something Jeremy Hunt has openly chastised. I worked another night shift as a locum in another hospital. Why did I do this? Because I, 34 years old, did not want to have to borrow money, yet again, from my elderly parents. It's embarrassing but you see I studied medicine as a second degree. I am Scottish but studied in England and therefore was liable for all my tuition fees and did not receive the NHS bursary, unlike my European colleagues. Sadly, during those four years, the student loans did not even cover my rent. I accumulated £20,000 professional studies loan and £7000 of credit card debt. Over £1000/month of my salary is used for debt repayment and I still have 26 more months to pay before I am only left with my student loan repayment. Living in London, my rent is £926/month. How much of my salary do you think I actually get to enjoy? Do you think I will ever be able to afford to buy a one bedroom flat in London? I don't think it's unreasonable to want to own the flat I live in, neither do you apparently but yet you seem hell bent on making it impossible for me.
This month I have to pay £325 upfront in cash for a mandatory course as part of my training in anaesthesia. I will get that money back, eventually, but to be honest it will then be used up as I need to sit an exam, again, mandatory for my training. Those exams are tough and I may not pass it on my first attempt. Surprisingly enough, the NHS doesn't pay for continuing professional development, I will need to study for this in my free time if I want to progress and yet you claim to want a world class service? How do you anticipate that will happen when you and your Health Minister have no idea what life as a doctor is like? I would relish the opportunity to have you shadow us on a night shift, but you won’t.
Has any of the above made you think that it's not quite such a rosy life being a junior doctor?
Do I have to remind you that in order to get a place to study medicine I had to excel academically? I had to be better than all those other applicants who wanted to study medicine. I studied medicine at the University of Cambridge. In many other professions that would have been my ticket to earning mega bucks. As people frequently and correctly point out medicine is a vocation. I truly love my job and my career but I think you have lost sight of the bigger picture. It's all very good claiming you want a world class health service but if you continue to act irresponsibly and vilify doctors by suggesting we don't provide a 7 day a week service you will destroy the NHS.
My basic salary is less than £50,000 after working for almost 4 years since graduation. I studied for 4 years on an accelerated medicine degree while a newly qualified TFL Tube driver earns £49,673. Can you put your hand on your heart and tell me you think this is fair? "Making work pay" is your party's current slogan. Can you explain to me exactly how all my hard work is being rewarded? My reward isn't financial is it?. If you pay peanuts you get monkeys. If you want a world class health service you need to ensure that medicine remains an attractive career and a competitive degree course. The more you continue to vilify doctors and bully us financially the more unattractive you make it. It doesn't take a genius to realise that results in a lower calibre of applicant and a lower calibre of doctor in the long run. Being blunt, to make it through medical school requires an immense capacity for knowledge, problem solving, resilience and good old fashioned intelligence with an enviable work ethic. You and your party have behaved disrespectfully towards my profession and the NHS as a whole. It disgusts me.
Congratulations on your inflation busting pay rise by the way. I believe you think the right thing to do is accept it, despite stating that you think it was the wrong decision to award it. A classic statement from a politician, if ever I heard one.
The sad thing Mr Cameron, when one of your friends or family members or even just someone you pass in the street becomes critically unwell in front of you, you will realise that whether it is the middle of the night or the middle of the day, a massive team will leap into action and that team consists of more than doctors, more than nurses, more than healthcare assistants, more than porters and more than the technicians in the labs running all the tests that we need to manage the patient. That patient will get everything they need. Perhaps then you might actually appreciate all the work we, as a team, do. You might then actually help us become a world class health service instead of working against us.
You need to get real, not doctors. You can't even pay doctors and nurses and all the allied health professionals an adequate salary for their scheduled hours and you certainly don't pay us for all the extra hours that we do outside of what we are supposed to. You do realise that Trusts across England actively discourage us from reporting the actual hours we work because they can't afford for us to breach the European Working Time Directive or actually pay us for the extra hours.
In summary you need to pay doctors, nurses and all the allied health professionals an appropriate salary that reflects the important roles we actually do in providing the 7 day a week service that we currently provide. If you genuinely want to improve patient safety then you just need to provide more staff at every level, patients would be safer if you adopted mandatory minimum safe staffing levels and ensured these were enforced. I realise this simple, yet effective solution, is costly and perhaps that is the reason Jeremy Hunt has chosen to deliberately attack Doctors.
I look forward to your response,