Not safe, not fair…
Todays decision by the Health Secretary Jeremy Hunt to impose the junior doctors‘ contract has sent ripples through the department where I work.
There has been a range of responses, from furious to despairing and apathetic – often depending on the grade of the doctor. The more junior, the more hopeful: its early enough to leave, change careers or emigrate to Australia.
Its not just about the pay. There’s one aspect of the new contract that particularly alarms me: “permission to undertake work in spare time.”
The digital health industry survives and thrives on the evening and weekend work that junior doctors do advising start ups, taking up Chief Medical Officer roles, or building new technologies themselves.
The new contract – or at least one of the aspects that couldn’t be agreed in the most recent negotiations – states that trusts will have ‘right of first refusal’ over any work done in a doctor’s spare time.
With the current 48 hour working time directive, junior doctors have some time to engage in other activities – professional development like wilderness medicine, working for a medical charity, or prototyping a medical device.
These activities – bear in mind – are on top of the half, or a day a week that doctors spend documenting evidence of clinical competencies in their online portfolios, authoring academic papers and conducting quality improvement studies. All of which are essential for their career progression, and all of which are done for free.
Doctors provide an important input into other industries, contributing expertise where it is needed. These are not doctors running private practices on the side, but doctors whose out of hours work is essential to the improvement of our public health system.
With the new contract, any work outside of contracted clinical hours must be approved by the Trust. In other words, our employers will have control over what we do with our free time.
This will clearly be damaging for doctors, limiting their ability gain wider clinical experience beyond the work they routinely do, or supplement their income to support their children for example.
But beyond that it will damage our burgeoning digital health industry, which relies on the input of practicing clinicians to develop, test and trial innovations.
Without doctors forming part of the health technology workforce the industry will be innovating blind and could fall behind other digital health economies around the world.
Or maybe the new contract will have the opposite effect. Perhaps, Jeremy, we’ll find a sudden rise in clinicians looking for full time Chief Medical Officer roles.