Tom Goodfellow

If the new contract is dangerous, monitor and gather the evidence

The news that the BMA has suspended (sic) the proposed series of five day strikes is to be welcomed unreservedly.

These would undoubtedly have caused real harm to patients as opposed to mere inconvenience and I am sure that, despite the frustration of their situation, many junior doctors will be quietly relieved.

The volte face is due, it seems, to the fact that they have been listening to their members who had contacted the BMA in their hundreds expressing concerns over patient safety.

Dr Ellen McCourt, Chair of the Junior Doctors Committee, stated that the BMA had called off next week’s strikes to protect patient safety because “for the first time in this dispute, NHS England have told us that a service under such pressure cannot cope with the [12-day] notice period for industrial action given. We have to listen to our colleagues when they tell us that they need more time to keep patients safe.”

Hmm! This is a disingenuous statement to say the least and it raises more questions than it answers. First it remains unclear as to whether or not the threat of strike action has been abandoned completely or merely suspended as the press release states. Will the strikes in November and December go ahead or will they resume one or two day strikes.

The next blindingly obvious question is how the BMA council managed to close its collective eyes to the clear responsibility, “to make the care of your patient your first concern”, a principle which should be written into the DNA of every doctor. In my view (and I suspect many of the juniors) the proposed strikes were ethically and morally irresponsible.

With respect to Dr McCourt if she and her committee needed to be “told” of the need to keep patients safe then she should give up now.

Unfortunately the Government still plan to go ahead with implementing the contract, so where next for the juniors who will be given no choice but to accept? I would like to make a few basic comments.

First you must realise that in general hospital managers and are not your enemies. They are stuck with implementing the contract and it is in everyone’s interests to ensure the delivery of safe patient services; indeed the Trust executives are legally responsible for this. If a service can be shown to be unsafe due to imposition of the contract then they have a legal duty to act.

The most important thing, therefore, is to keep careful records, both individually and as teams. If the new contract is unfair, unsafe and unworkable as suggested then this must be clearly demonstrated; simply moaning about it will not do.

Rota gaps and inappropriate cross-cover should be carefully documented and must include any breaches of contract by the Trust. Consultants being required cover gaps in junior rotas is also an issue; they have their own responsibilities and their work should not be compromised. Incidences of managers putting inappropriate pressure on doctors to fill the gaps should also be carefully noted.

Adverse effects on social life should also be recorded – doctors have as much right to a family life as anyone else.

If any doctor or team has clear, robust evidence of risk to patients then they need to follow to the letter the GMC guidance, “Raising and Acting on Concerns about Patient Safety”. Indeed you have a duty to do so. But it is better to act as a team rather than on an individual basis because this will carry more weight. If all else fails then, and only then, you have the right to whistle blow.

In a previous posting I stated that in my view the BMA, like the “Grand Old Duke” had marched the troops to the top of the hill, but seem unclear as to where to go next, and would have no alternative but to march them down again.

This now exactly reflects the situation, and I doubt the troops will be too keen to be marched off again in any direction, at least not under the current BMA leadership.

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One Response to “If the new contract is dangerous, monitor and gather the evidence”

  1. Worried Doc says:

    How right you are Tom!
    It is vital that accurate records are kept of any incidents affecting patient safety. Indeed, it is best that these are logged on the Trusts’ Clinical Incident Systems. Many Trusts have electronic systems such as Datix. All staff can log incidents, and generally doctors do so less often than other staff, but can and should log any incidents that occur.

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