Members of the trainee committees that sit on the Academy of Medical Royal Colleges Trainee Doctors Group (ATDG) have written an open letter to Jeremy Hunt, Secretary of State for Health, to express their concerns with proposals to impose a new employment contract on all doctors in training in England in 2016.
The signatories to the letter represent the vast majority of Royal Medical Colleges across the UK and their associated faculties, and they represent the voice for training and standards for doctors in training in the UK.
The group states that the imposition of the contract presents an immediate risk to the provision of healthcare throughout the UK, and an ongoing threat to healthcare for generations to come.
The letter informs the Secretary of State that the failure to provide safeguards in terms of hours and working conditions will detrimentally impact upon the safe treatment of patients. The training of doctors would also be compromised and the contract would negatively impact the recruitment and retention of doctors in the UK, where there is already a shortfall.
Dr Gethin Pugh, Chair of the Academy Trainee Doctors Group, said:
"The doctors in training that we represent have significant concerns regarding the potential impact on patient care as a result of imposing these changes.
"At a time when we are already facing significant problems in the recruitment and retention of doctors in the UK, any contract must ensure it supports education and training as well as service provision across all specialties, to maintain safe and effective care for patients.
"We must value and support the doctors that deliver this care.
"The possible implications for the future sustainability of the NHS should not be underestimated."
Dr Rosemary Hollick, Vice-Chair of Academy Trainee Doctors Group, said:
"Morale is at an all-time low and we are facing a crisis in the recruitment and retention of doctors. Imposing contractual changes upon junior doctors will only serve to exacerbate this.
"By removing the safeguards that facilitate a safe and supportive environment in which to train, these changes will further devalue the role of doctors in training and directly compromise patient safety and quality of care."
The full text of the letter is below.
23 September 2015
Dear Mr Hunt,
We write as members of trainee committees who sit on the Academy of Medical Royal Colleges Trainee Doctors Group (ATDG). We represent doctors in training from a broad range of medical specialties and provide a coherent, informed and balanced view on issues such as education, promoting excellence in training and high quality patient care relevant to all doctors in training.
We have significant concerns arising from the proposals for the new employment contract to be imposed on all doctors in training in England and its implications for patient safety and maintenance of a sustainable medical workforce.
The proposals are directly at odds with the stated priorities of the NHS, and the stated aims of the Review Body on Doctors’ and Dentists Remuneration (DDRB). The Scottish and Welsh governments have already declared that they do not intend to impose the proposed contract changes. Imposition of the contract presents an immediate risk to the provision of healthcare throughout the UK, and an ongoing threat to healthcare for generations to come.
Impact on patient safety
Doctors in training already work extensively out of hours, but benefit from some key employment safeguards that penalise trusts from forcing excessive and dangerous hours from their medical workforce. Despite this, specialities with the highest out of hours commitment such as Emergency Medicine, Acute Medicine, Paediatrics and General Practice already show deficits in recruitment. The proposed contracts fail to offer safeguards on hours and working conditions necessary to ensure the safety of all the patients treated within the NHS, and risk a return of exhausted doctors and rise in medical errors inherently linked to clinicians forced to work under such unsafe conditions.
Impact on Training
Excellent training ensures excellent patient care, and is reliant upon a safe and supportive environment in which to train. The proposals would see an increase in the amount of work provided out of hours, and risk a reduction in the amount of supervision and training provided. Training is already significantly eroded by the demands of service provision, but the proposed changes risk further compromise of the quality of doctors patients rely upon to provide healthcare and medical leadership in years to come.
Impact on recruitment and retention
The NHS currently has shortfalls in both recruitment and retention of medical staff in front line services. The proposed new contract regards most evening and weekend work as normal time, which is a further disincentive to recruitment into posts that involve substantial evening and weekend commitment. The Shape of Training review specifically aims to introduce greater flexibility in training, yet the proposed changes risk directly penalising doctors who choose a more flexible career path. This risks compromising the numbers of doctors with formal training and experience in medical education, management or academic research, and disadvantages those training less than full time.
Failure to promote these additional abilities within medicine may lead to a loss of the diversity and skill mix within the profession that is essential for the continued delivery and development of high quality patient care; the foundation for innovation that allows us to remain at the forefront of healthcare in an increasingly competitive international market is at risk.
Whilst we understand the financial pressures on the NHS, we are extremely concerned that the proposed new contract will damage the standard of care available to future patients. We would urge NHS Employers to reconsider any imposition so that all sides together can work out the best approach for a sustainable medical workforce and to ensure we deliver the best care to patients both now and in the future.
Dr Gethin Pugh, Chair of the Academy Trainee Doctors Group
Dr Rosemary Hollick, Vice-Chair of the Academy Trainee Doctors Group and Chair of the Royal College of Physicians of Edinburgh Trainee & Members’ Committee
Dr Judith Harrison, Vice-Chair of the Academy Trainee Doctors Group
Signed on behalf of:
- Associate in Training (AiT) Committee, Royal College of General Practitioners – Dr Laura Armitage, Chair
- Association of Surgeons in Training – Miss Rhiannon Harries, President
- British Orthopaedic Trainees Association – Mr Mustafa S. Rashid, President
- Faculty of Intensive Care Medicine – Dr David Garry, Trainee Representative & Dr Ian Kerslake, Trainee Representative Elect
- Faculty of Sexual & Reproductive Health – Dr Laura Percy
- Foundation Trainee Representative – Dr Charlie Williams
- Ophthalmologists in Training Group – Dr Oliver Bowes, Chair, Dr Richard Lee, ATDG Representative
- Royal College of Anaesthetists Trainee Committee – Dr Peeyush Kumar, Chair; Dr JP Lomas, Deputy Chair
- Emergency Medicine Trainees Association – Dr Jon Bailey, President
- Royal College of Obstetricians & Gynaecologists Trainees Committee – Dr Matthew Prior, Chair & Dr Jonathan Frost, ATDG Representative
- Royal College of Paediatrics & Child Health Trainees Committee – Dr David James, Chair
- Royal College of Physicians (London) Trainees Committee – Dr Ruth Dobson, Chair & Dr Giles Major, Vice-Chair
- Royal College of Physicians of Edinburgh Trainee & Members’ Committee – Dr Rosemary Hollick, Chair
- Royal College of Physicians and Surgeons of Glasgow Trainees’ Committee – Mr Alex Vesey, Chair, & Dr Stacy Smith, Vice Chair
- Royal College of Psychiatrists Trainees Committee – Dr Matthew Tovey, Chair
- Royal College of Radiologists Junior Radiologists Forum – Dr David Little, Chair
- Royal College of Radiologists Oncology Registrars Forum – Dr. Michael Kosmin, Chair, & Dr Saif Ahmad, Vice-Chair
- Royal College of Surgeons of Edinburgh Trainees’ Committee – Mr Richard McGregor, Chair, Mr Michael Kipling, Ms Alice Hartley, Mr Alex Arvold, Mr Peter Coyne, Mr Junaid Sultan, Ms Victoria Wilson, Mr George Markides, Members
- Scottish Academy Trainee Doctors’ Group – Members
- Mr Mark McGivern, Specialty Registrar Public Health – ATDG Representative