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Contract imposition 'unworkable'

Juniors industrial action protest at Whitehall outside the Department of Health. Dagan Lonsdale and Rachel Clarke participants

Senior hospital leaders have revealed they fear an unprecedented crisis of morale and recruitment if they are forced to bring in the new junior doctors’ contract.

The medical directors and other leading clinicians — without whose support, the contract could become unworkable — have issued a bleak assessment of unfilled rotas and a disenfranchised generation of doctors.

One described it as a ‘disaster waiting to happen’. Umesh Prabhu, a medical director and expert on patient safety, said ‘morale has taken a huge hit’.

He said it was imperative that health secretary Jeremy Hunt, who has resisted calls for further talks, met with doctors.

‘I think [Mr Hunt] should invite senior medical leaders to speak to him — these are good people. We all need to sit round a table and make the best of this contract and work out how to inspire juniors and make sure they are the future of this NHS.’

Dr Prabhu, medical director at Wrightington, Wigan and Leigh NHS Foundation Trust, said: ‘We need to put the juniors at the heart of everything we do. That needs to be the attitude. It’s about inspiring and motivating not bullying.

‘Our HR director thinks we could sort it all out by speaking with the doctors. That’s how we should have done it. To be honest, morale has taken a huge hit. It’s going to be very challenging.’


Rota gaps

A senior consultant at one of the largest hospitals in the country expressed grave concerns that rotas would be nowhere near full by August.

He said: ‘We have concerns about the potential impact on junior doctor recruitment over the next six months.

'We’ve had contact from the local training organisation to say they have only filled around half of training places for doctors to start in August. It’s an absolute disaster waiting to happen.’

Alistair Flowerdew, who served for nine years as a medical director at an NHS foundation trust, said introducing the contract would damage the attitudes and culture the health service needed to uphold patient safety.

He said: ‘In my experience one of the most notable features during the last few years and in particular following the publication of the Francis report has the engagement and leadership demonstrated by training doctors in improving safety and effectiveness in providing hospital care to patients.

'The NHS cannot afford to lose this attitude in those who will become the medical leaders of tomorrow.’


Militant trainees

Dr Flowerdew said there would be a long-term negative impact on staff relations.

‘I think the knock-on effect of disenfranchisement that young developing doctors may acquire as a result of the contact imposition will make it more difficult for medical directors and managers.

‘The consequences could be quite serious in that it may make the training medical workforce more militant and less engaged with improvement from a medical manager's point of view.

'Undoubtedly, graduates coming out of medical school will still be looking for jobs but there will be an underlying unhappiness if the matter is not resolved expeditiously.

‘Medical directors in the health service will carry the responsibility to atone for the fallout that will inevitably fester unless the dispute is not addressed.’

He said the imposition of a new contract could affect how junior doctors view the NHS.

‘For these doctors to have a sense that ultimately their employers and the political forces are not part of a caring NHS has potential to cause long-term harm.’


No room for manoeuvre

Meanwhile, foundation trusts have found that their much-vaunted ‘freedom’ to introduce their own terms and conditions has been severely restricted when they have considered alternatives to the imposed contract.

HEE (Health Education England) has told trusts they are likely to lose out on training funds if they introduce a different contract.

A letter from chief executive Ian Cumming in February said: ‘A single, national approach is essential to safeguard the organisation and delivery of postgraduate medical training to ensure all doctors can secure the professional development they require to complete their training programmes…

‘Therefore implementation of the national contract will be a key criterion for HEE in making its decisions on our investment in training posts.’

A spokesperson for Mid Cheshire Hospitals NHS Foundation Trust said, despite discussing an alternative contract, it had been left with few options following HEE’s move.

He said: ‘HEE has stated it will withhold trainee monies if we do not and it is part of the agreement around accepting transformation funding. Therefore there is little choice.’

It follows reports that senior staff at Addenbrooke’s Hospital in Cambridge, including the medical director, had emailed staff to say their trust shared the local negotiating committee’s concerns about the impact on patient care, training and work-life balance of junior doctors, but that it was under ‘considerable pressure’ from the Department of Health and HEE.

BMA junior doctors committee Johann Malawana said: ‘The collective voice speaking out against this contract has grown too strong for Mr Hunt to ignore.

'This process has been clumsy at best and the resulting contract is flawed and inspires no confidence in a workforce under increasing pressure.’

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