There is only one thing more damaging than junior doctor strikes: abandonment of the NHS
Edmund Stubbs, 18 February 2016
The number of Certificates of Good Standing (CGSs) issued to Junior doctors rose by 1,000 per cent on the day Jeremy Hunt announced that he would impose the new contract on them despite the British Medical Association’s (BMA) refusal to accept its clauses. When British doctors seek to work abroad they usually have to present a CGS to the regulating body of that country. This proves their registration status, fitness to practice, and ensures they are of ‘good character’.
Applying for a CGS does not necessarily mean that a medic will leave this country. It could be a part of applying for many possible opportunities or even part of a sophisticated protest. However, it does suggest that a doctor has made contact with overseas employers. Normally, applications for GCSs stand at an average of around 26 per day. On the day the Health Secretary announced that the new contract would be enforced, this rose to 300, 109 on the following day and double the average number that weekend; a clear indication that dissatisfied doctors might well vote with their feet and leave the country.
When a medical student graduates they will have had well over a quarter of a million pounds of taxpayer’s money spent on their training. By the time they reach senior registrar level (still a junior doctor grade) they will have added around another £100,000 to their training costs. Shadow Secretary of State for Health, Heidi Alexander claims that by enforcing the new contract, and thereby falling out with almost his entire junior doctor workforce Mr Hunt is ‘behaving like a recruiting agent for Australian hospitals’. However emigrating medics could also be seen as abandoning the NHS and the British taxpayer who have provided them with a highly rewarding and lucrative career.
To claim that abandoning the NHS in protest over the new contract is wrong is not automatically to side with the Health Secretary, his department and the new contract. Doctors shape the NHS’s future just as much, if not more, than Mr. Hunt does. Their careers span far longer than the term of a health secretary or any single government. Junior doctors say that they are championing patient safety and wellbeing and are supported in this by one of Britain’s most powerful trade unions ever, the BMA. Much of the media and the general public have also have taken their side. For this reason, junior doctors should stand and fight for what they believe in rather than consider abandoning the NHS. The one thing more damaging to patient safety than the present strikes would be a mass exodus of highly trained UK doctors; doctors specifically trained for the service.
Junior doctors graduate with substantial student debt but their training is heavily subsidised, with placement fees in hospitals alone paid by the state at around £34,000 per year for each undergraduate medic. They also receive bursaries and have their tuition fees paid for their fifth year of study. Medical student loans are paid back very gradually over 30 years so it could be said that medics are getting a good deal compared to many other students. A British medical training is certainly far less costly than one undertaken privately or abroad.
Government training subsidies for medics are reasonable considering the benefit their career will bring to society as a whole, and, as some recompense, for the long hours, even under the BMA’s new contract proposals, they worknow and will work in the future. Such subsidies also seem just with regard to the high level of responsibility they will carry each day of their working lives. However, government funded training subsidies are not fair if medics choose to leave the organisation that has made such a considerable investment in their future.
Before applying to the GMC for a CGS, junior doctors should remember to whom they owe their medical education; namely the working people of Britain through the taxpayer-funded NHS. They should anticipate the damage that their departure might cause to the service, and understand that as doctors, they represent one of the most powerful groups within the NHS, the group with possibly the most power to change the service for the good of its patients. If they are sincere they should stay, and if they truly feel wronged, they should stand and fight.
Edmund Stubbs is Healthcare Researcher at Civitas, @edmundstubbs1