Listening to be heard - junior doctors putting forward the case for change

We live in unsettled times. We have seen the first junior doctors strikes in 40 years. There is palpable disquiet among junior doctors up and down the country. The question I ask myself is why? What is it that is fuelling this discontent? 

Though this may well have been brought to the fore by the contract dispute, the resentment clearly goes much deeper. Junior doctors are unhappy: we’re disheartened, fearful and feel disenfranchised. This is clearly not a good place for us, but neither is it good for our patients or the NHS as a whole. So we need to work out what’s happening and even more importantly what we are going to do about it.

To this end the Faculty of Medical Leadership and Management in collaboration with NHS England (London) held a free listening evening event in June An open discussion with trainees: their present role in the NHS and as the healthcare leaders of tomorrow. This was our opportunity to have an open and candid discussion about the issues affecting us.

More than 35 junior doctors of all grades attended. There to listen were several senior clinicians and medical directors from across the region. The audience was passionate, well informed and willing to share their honest opinions and very personal experiences of working as a junior doctor. The issues raised were not a surprise to most of us in the room. There were consistent themes voiced by junior doctors from different specialties and grades.

The seemingly never ending rotational aspect of training was a key factor impacting on our professional and personal lives. With spiral learning we can expect to change jobs frequently, in some cases every three to six months. Sometimes we find out our new job is in a hospital at the other end of the region, requiring us to move house just weeks before we start. The short time for each rotation makes it difficult to build the professional relationships needed to develop functioning, cohesive teams that we need to feel part of. The shift system further impacts on the team structure so significantly that the support it once offered has been slowly dismantled. It means it is difficult to feel you are part of the organisation or involved in a way that has an impact, making a difference to patients and improving the working lives of junior doctors.

We then have to deal with the competing demands of training, especially given the very admin-heavy nature of our training with the directly observed procedures (DOPS), case based discussions (CBD) and multisource feedbacks (MSF) that need to be completed before each annual review of competence progression (ARCP) and the need for increased service provision to cover frequent gaps on the rota. This has had a huge negative impact on training opportunities available and has damaged morale even further.

We have lost elements of the pastoral care that the team structure once offered. We have increasing pressures in our working environment and on our training so the need to care for each other and have safeguards in place for when things do go wrong has become essential, yet this is still lacking.

Our working lives are further impacted by the continuing difficulties we face in booking leave and taking time off for weddings and other significant events. We have all heard the story of the trainee who had to arrange a swap to attend their own wedding - despite requesting leave months in advance. It feels like the system is just too inflexible.

So now we have the beginnings of a conversation around the issues that are making us unhappy. Our next steps are to work out what we can do about it. A great example given during the evening was of trusts with active junior doctor forums (JDFs). The JDFs that engaged the trust leadership and had active participation from their junior doctors can offer some of the support needed at this time. It was interesting to note that not all trusts had a JDF and those that did felt there was wide variation in their activity.

A useful next step would be to support trusts in establishing JDFs which in turn could support our training needs, pastoral care and help us feel truly valued by the organisation we work for. It would also give us a voice so we can be properly heard.

The key purpose of the evening was to find out the issues that have led to the disconnection and growing divide between junior doctors and those in leadership positions. I feel the event was a solid beginning. But there is still much work to do.

The quote from the evening which I think summed up the general feeling was “We are like migrant workers, we have no home.” This is a damning indictment of the state of junior doctor training in the NHS in 2016.  But if we seize this opportunity to drive through positive change, bring together junior doctors and our royal colleges and faculties so management take us seriously and ultimately train ourselves up into the effective clinician leaders the NHS so desperately needs, we can hopefully make statements like this a thing of the past.

As I post this blog it has been announced by the BMA there will be further strike action.