One year after the end of a long and bitter dispute over the
junior doctors’ contract, the final batch of staff are about to
be moved on to it. But those who battled against it are still
pushing for change in the NHS.
Posted on July 13, 2017, 12:23 GMT
2016 was a historic year
in the NHS. For the first time since 1974, junior doctors
poured out of the wards and on to the streets
to strike over a contract that would radically reshape
the way they worked.
Health secretary Jeremy Hunt had pledged to create a “truly
seven-day NHS” by altering doctors’ working structures. It
was an attempt to prevent an excess number of deaths in
hospitals, which he attributed to not enough doctors working
But doctors were quick to point out that most of them were
already working weekends. Many argued that if they were
to work more Saturdays and Sundays without more staff being
recruited, their services would be spread too thinly, risking
Nonetheless, after months of protests, strikes, a court case,
and stop-start discussions between the government and the
doctors’ union the British Medical Association (BMA),
Hunt imposed the contract on the 54,000 doctors, despite
them rejecting it in a ballot.
Last autumn, thousands of junior doctors started working on
the new contract. This August, every remaining doctor in the
country will be moved to it. Many have already left the NHS
But a year later, some of the doctors who fought the hardest
to stop it in the first place have said that the fight isn’t
Dr Rachel Clarke, Oxford-based palliative care specialist
and author of the new memoir
Your Life in my Hands – A Junior Doctor’s
Dr Rachel Clarke is not a woman to be messed with. When Hunt
shied away from engaging one-on-one during the dispute, she
upped her game as one of the contract’s most vocal critics
and camped outside the Department of Health. On behalf of
54,000 junior doctors, she demanded to be listened to.
Hunt, however, made it no further than his office window at
Richmond House, where Clarke said Department of Health staff
told her he would stand, absolutely fuming, and watch her
Throughout the contract dispute, junior doctors warned that
increasing the number of hours doctors worked over the
weekend without employing more doctors overall would leave
huge holes in hospital rotas during the week.
“That’s exactly what seems to be happening,” Clarke said when
we met in London recently. “It’s an absolute nightmare.”
Clarke has not yet been moved on to the new contract, but she
knows plenty of people who have. “It’s so depressing because
we’re looking at these rotas and thinking, There is no way
I could work that,” she continued. “They’re so different
to what they used to be, and people are already saying ‘I’m
Since the start of the contract dispute, the number of junior
doctors leaving the profession before reaching consultant
stage, the next level up from a junior doctor,
has risen significantly. It
increased still further after the contract was imposed:
Just half of those who finished their first two years in 2016
decided to continue their training.
“That’s telling you something very, very bad is going on,”
“[Junior doctors have] dedicated six years of their life to
the most brutal exams imaginable, and committed to a career
that they know is going to be arduous.
“They’ve got a whopping great student loan of tens of
thousands of pounds and in spite of all of that they’re
walking away from the NHS.”
Clarke was among the doctors who initially stepped back from
the ward – “to lick my wounds more than anything” – after the
dispute ended, choosing to postpone continuing with her next
stage of training and eventually returning to a palliative
care post this year.
“I’d been through this awful experience,” she said.
“A lot of us who’d been activists felt broken. We were tired,
demoralised, and completely pessimistic about the future of
In the final months of 2016 Clarke began work on a memoir,
Your Life in my Hands. It’s a powerful account that
intermingles emotional recollections of saving lives and
stomach-churning experiences of when medicine could no longer
help someone, mixed with the tense NHS politics that have
dominated news headlines.
But above all, it’s a book about hope, and writing it
rekindled Clarke’s bruised love for medicine.
“I thought about medical school, my early days… and all of
these amazing experiences which are the everyday warp and
weft of being a doctor, and everything I love about it,” she
She hopes that it will help to keep alive the message that
doctors fought to get across during the dispute: “I’m
desperate for people to know what’s really happening because
I think if they knew how fragile the NHS is at the moment and
how real the fears are that it won’t survive the next five
years, they would be up in arms.”
She thinks that after the contract dispute galvanised the
workforce, there’s no chance her colleagues will keep quiet
about their concerns in future.
“Ironically for Jeremy Hunt, he has created a force to be
reckoned with,” she said. “Junior doctors will speak out,
will tell the truth, and are not going to let him get away
Leon Neal / AFP / Getty Images
Dr Roshana Mehdian, London. Surgeon and orthopaedics
registrar and cofounder of the Healthcare Leadership Academy.
Currently based in Washington, DC.
“I’ve never been a campaigner,” Dr Roshana Mehdian told
BuzzFeed News over the phone recently.
when she led a crowd of thousands of junior doctors along
Whitehall early last year, during what turned out to be one
of many protests against the contract, it didn’t quite look
“I just wanted people to understand our point of view, and I
started speaking out because I feel passionately about the
NHS, it’s as simple as that,” she said.
“For me this was never about winning some sort of battle. It
was about trying to explain, without exaggeration or being
overly emotional, what the problems are. And I hope that’s
what I did.”
While the dispute itself is over, and Mehdian has laid her
role as a temporary activist to rest, she is keen to find new
ways to effect change within the health service.
During a break from training, she has been working in health
technology in Washington, DC, where she hopes to gain
insights she can use to help improve services in the NHS when
she returns to the UK and her role as a junior doctor.
“The challenges of the past two years made me ask big
questions about the future of healthcare, and I wanted to
develop skills that might help address those challenges,” she
Mehdian said that she feels proud to represent the NHS within
the US medical sector, but that working in a nonclinical
role, while also hearing tales of astonishingly low morale
from doctors back in the UK, has been something of an
“At the moment, the nature of the work I do in the US means I
get to have a life and I feel valued,” she said.
“I’ve got lots of friends who have [transitioned on to the
new contract in the UK] and I think morale is really poor. If
anything it’s gotten even worse, which is what we were saying
would happen. That’s really sad.”
She believes many more doctors are likely to leave medicine
and may reconsider her own future too, “if I go back and
people are as stressed and as downtrodden as they have been”.
“Of course I understand that we have to do all of the
on-calls, and the night shifts, and the long hours, but
unless the balance is found where the wellbeing and whole
life of doctors and nurses is valued, then people will not be
satisfied with working in the NHS,” she said. “To keep
themselves sane, they will consider leaving, and that is
what’s happening at the moment.”
Another way Mehdian hopes to challenge obstacles doctors face
is through the Healthcare Leadership Academy, an independent
training programme that she cofounded with the former chair
of the BMA’s junior doctors committee Dr Johann Malawana. It
teaches doctors to negotiate and talk to leaders in NHS.
“We need to continue to highlight the issues and hope the
right people listen,” she said. “I think some people within
the establishment do listen when you talk about it sensibly.”
In today’s tumultuous political landscape, Mehdian believes
doctors may now be more able to sway the establishment. “All
political parties coming to a consensus about the challenges
faced by the NHS is quite something,” she said. “Where I can
engage to make change, I will.”
Dr Nadia Masood, London. Anaesthetist and member of
campaign group Justice for Health.
Dr Nadia Masood is excited but nervous to return to working
as a junior doctor this August, after taking nine months out
following the contract dispute.
“There were lots of reasons why I felt the need to take a
break, but I think nearly every junior doctor had their
morale affected by the dispute,” she told BuzzFeed News. “I
wasn’t feeling very good about being a doctor, to put it
very, very simply.”
While she’s taken a breather from the intense combination of
working and training that characterises at least the first
decade of a doctor’s career, Masood, an anaesthetist, has
instead worked ad-hoc “locum” shifts.
Temporary doctors on these shifts have become more crucial
than ever, as trusts struggle to fill gaps left in hospital
rotas, which many doctors believe are an effect of the new
“I’ve been offered many, many more locum shifts than I’ve
taken and I’m definitely seeing the effects of worsening rota
gaps,” Masood said.
“I just got an email now, and it’s always ‘urgent shift needs
Masood believes that a shortage of doctors – combined with a
situation where those who are available are often unwilling
to do work that she called “intense” and “demeaning” – is
leaving the open shifts unfilled.
“The environment is really stretched,” she said. “I was
talking to a few of my colleagues about how different the
working environment is now compared to just last year, or the
year before, how quickly and dramatically things have
“Things that used to be rare, unpleasant occurrences have now
just become routine and standard, but it’s really important
that we don’t accept them as normal.”
She said she has heard of patients being left in theatre
recovery bays after overnight operations rather than being
moved to wards, due to a lack of beds, and fewer specialists
than is considered ideal working on shifts.
“Usually there are enough anaesthetists to be able to handle
two life-threatening emergencies and you just have to hope
that there’s not more than that,” she said.
Masood, who was also part of the team of doctors who took
Hunt to court over the contract (Hunt won, but Masood noted
that he was forced to row back on some of its terms), is
eminently employable outside medicine – so why is she going
back to being a full-time junior doctor in what she sees as
such a bleak environment?
“I feel good about going back because there is still
something really beautiful about being a doctor that I miss,”
“I know it’s been the right choice for me to make as a career
despite all of the problems that the NHS has. I’m nervous,
but I’m looking forward to it.”
Dr Jeeves Wijesuriya, London. General practitioner at
Homerton Hospital and chair of the BMA’s junior doctors
As the dispute came to a head at the end of 2015, shortly
after the Paris terrorist attacks that killed 130 people, NHS
Commissioning Board member Sir Bruce Keogh asked what junior
doctors would do if such an atrocity occurred during the
strikes they were proposing at the time.
Outraged, doctors insisted they would return to work. Dr
Jeeves Wijesuriya was unfortunately able to prove that sense
of dedication when a terrorist attack took place in
Westminster this March. He was not on duty at the time but
happened to be nearby,
and ran to the scene to provide emergency care to those
who had been critically injured. “I heard the screaming so
ran to help,” he told BuzzFeed News at the time.
This marked Wijesuriya’s only appearance in the national news
this year, but he was a regular face at the height of the
dispute as part of the BMA’s junior doctors committee who
negotiated the contract with the government.
Wijesuriya remains no less active in his mission to shape
working conditions that he feels are fairer to doctors and
safer for patients. Earlier this year, he took on the role of
committee chair, which became vacant after the doctors’
defeat led Dr Johann Malawana to stand down, and Malawana’s
successor Ellen McCourt lasted just a few months.
“It’s not just continuing to engage with employers
meaningfully, but also challenging them when things go
wrong,” Wijesuriya told BuzzFeed News at the BMA offices
earlier this week.
“It’s about calling trusts out when abuses occur. It’s about
finding your allies and making sure you build bridges with
other groups who have an influence, like the General Medical
Council and Health Education England.”
“We’ve been through a really difficult patch,” he added. “If
you look back to when this dispute started it’s been this
incredibly difficult process that’s still going on.”
His committee is now gathering evidence of what does and
doesn’t work in the contract, ahead of a review in 2018. This
includes monitoring working hours, the gender pay gap, and
training structures that might lead a doctor to have to move
across the country at short notice.
“I’m really proud that as an organisation we continue to do
those things, and I’m proud to be a part of it,” Wijesuriya
Tackling record levels of low morale in the workforce,
however, remains at the top of his agenda, as well as working
to build trust between junior doctors and the senior
“There are a lot of frustrations that we have about the way
that this was handled by the government. I think those scars
remain,” Wijesuriya said.
“A lot of people feel a bit more insecure, and I think the
profession as a whole feels a little bit less respected by a
government that should be listening to it.”
But, he added: “I think that’s bigger than the contract.”
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