Doctors versus Jeremy Hunt – a liberal cause we should all champion

Ever since Jeremy Hunt spoke to the King’s Fund and Radio 4, when he stated doctors had a “Monday to Friday mentality” and needed “to return to a sense of vocation”, there has been an all-out war between doctors and the health secretary being played out on social media.

His point was that doctors were a roadblock to his plan of 7-day services and they needed to be dealt with; this would save 6000 lives.

The backlash began with #iminworkjeremy campaign, where people took selfies of themselves proving to the health secretary that they were already at work.

This has been followed up by a petition of over 200000 people calling for a vote of no confidence in him, and a follow up campaign #weneedtotalkaboutjeremy which has received little attention.

If this is just a workforce dispute then why would liberals want to get involved especially if 6000 lives a year are saved?

Tim Farron, released a document outlining his liberal values. These values are key to understanding why the Liberal Democrats must be engaged in this debate.

His first three values discuss freedom, fairness and democracy, being “free of a controlling state”, “a spirit of openness, equality and debate” and fairness “in the amount of control employees can exercise over their conditions of work”

Mr Hunt has used his position of power and access to the media to perpetuate half truths, and misinformation. Doctors on the other hand have Twitter. That is an unequal playing field.

His argument, that 6000 lives will be saved and that consultants are the barrier to preventing this, is unevidenced and unfounded. The day you’re most likely to die in hospital is a Wednesday, but this is never spoken of.

From freedom of information requests 0 consultants out of 4095 have opted out of weekend working.

He has deliberately conflated elective and urgent care to further confuse the situation.

Tim Farron’s final value was about quality of life: “spending time with people should never be sacrificed on the altar of profit or growth”.

One of the things that has been missed in this is that the junior doctor contract which is being negotiated alongside the consultant one, will lead to Monday-Saturday 7am-10pm being considered ‘normal working hours’. This will result in a pay cut but more importantly, it will mean that doctors are able to spend less time with their families, something we should all cherish.

There are far more issues and more than I can go into here and I actually agree with several of the changes Mr Hunt is proposing, but I think his methods of achieving his aims are Illiberal. We should champion NHS staff being given a platform to debate this properly and their right to a good quality of life.

That is why I passionately believe this is more than a work dispute but a liberal cause we should all champion.

* Christopher Kane is an Academic Clinical Fellow in Palliative Medicine and one of the 17000 Lib Dem new members who have signed up since the May 2015 general election.

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36 Comments

  • David Faggiani 30th Jul '15 - 5:03pm

    Good stuff, Chris! Very persuasive.

  • ok, but my father-in-law was kept in hospital longer than necessary because by Friday lunchtime no specialist would be in until Monday to look at results, and I was on e told by A&E on a Friday that I might have to stay in ober the weekend until a consultant could look at me on Tuesday, so if others have had similar experiences you can see why Jeremy Hunt’s campaign might have resonance.
    I don’t at all believe that hospital staff work 7 hours a day Monday-Friday, but they won’t win against the argument that illnesses happen 24/7. Everyone knows that they do, and everyone has an interest in the necessary facilities and expertise being there when they or their loved ones need them to be.
    Medics might win if they change the argument to resources though, and for
    exactly the same reasons.

  • Ruth Bright 30th Jul '15 - 5:41pm

    Sara – quite right. Having (like most parents at some stage) crawled to various grouchy doctors’ receptionists for timely appointments for sick children I think Jeremy Hunt has a point. Try giving birth on a Bank Holiday Monday and see how much fun that is. “The consultant does his round on Tuesday” is not much use then!

    Where would residential care be without round the clock staffing from people on the minimum wage? Everyone takes the commitment of care assistants for granted and they do not enjoy a fraction of the career status and salary of doctors.

  • Mavarine Du-Marie 30th Jul '15 - 5:49pm

    Tim Farron’s final value was about quality of life: “spending time with people should never be sacrificed on the altar of profit or growth”. Makes this a worthy fight to find a solution that both suits the vocation and the needs of a home life, it has been going on for far too long and at what cost to patients and hospital staff.

  • Sadie Smith 30th Jul '15 - 6:03pm

    I do think things have improved.
    It used to be very difficult to find the on call doctor, who seemed very young. I certainly know of groups of Consultants who ensure there is proper cover. I suspect they stretch their hours.
    We do need to take notice of this. I suspect there could be unintended consequences.
    I am ablso sure that we should keep an eye on hospital discharge and aftercare. They did it perfectly when I was an inpatient about three years ago, but it was from a Rehab ward with a brilliant manager and good staff. Not everyone is so lucky. And I did know what they were supposed to offer.

  • Richard Underhill 30th Jul '15 - 6:14pm

    On a “Bank Holiday Monday” i had an accident in my garden. my wife took me to the hospital but their load was double a normal day, so it was about four hours before i was seen at all and it was the small hours before i was told that certain skills were not available that night. It may be that the overload is caused by GPs closing, but opening hours and hours of work are not the same thing in a multi-doctor practice.

  • Christopher Kane 30th Jul '15 - 7:15pm

    Everyone is in agreement that weekend in-patient provision needs to improve, and in fact it has made great strides over the past few years.

    My point is simply that the use of zombie statistics and disinformation is an illiberal way to go about it.

    The debate should be fair and open, and there should be a sensible discussion about the best way forward rather than this constant demoralising rhetoric.

    The DoH has already opened discussions about removing other health care professionals anti-social pay, they’re just waiting until the difficult of doctors is dealt with first. So yes this is as much about the HCAs as it is the doctors.

  • Little Jackie Paper 30th Jul '15 - 8:13pm

    Well….I think that there is a certain missing the point here. We can argue about doctors working hours in the same sense more or less as we can argue about anyone’s hours. The point here basically about whether, ‘we,’ want/need seven day provision and if so, candidly, how to fund it. I don’t think that Hunt, the doctors, patient groups or anyone else has really addressed this.

    At a time of fiscal consolidation the NHS has only been asked to make, ‘efficiency savings,’ (whatever that means) and the Conservative manifesto appeared to talk about increases in spending.

    I’d – of course – like a full-blown 24/7 NHS, but then I’d also like full-blown motherhood and apple pie. So do we argue for the NHS as exemption from deficit reduction, with all that implies? Do we move spending from other parts of the NHS, and if so then what? Do we accept NHS down-time as the price we pay? Or do we move to more patient payment via insurance?

    As others have pointed out people get ill 24/7 – but that happens in countries like Germany where there is more co-payment.

    Perhaps none of these arguments in themselves are new, but they seem to be sharper now. So yes, let’s have the debate about doctor/NHS working hours. But let’s at the very least address quite what sacrifices we make if indeed we want 7 day full-blown service rather than pretending it’s not a factor.

  • Little Jackie Paper 30th Jul '15 - 8:21pm

    Simon Shaw – You are, of course, quite right that, ‘the NHS,’ is not the same thing as, ‘doctors.’ But then I’d struggle to see how Hunt’s vision works without doctors and support teams. I don’t know that he’s explicitly said that, but the article here talks about, ‘7 day services.’ In context I would take that to mean the doctor AND the support team.

    Now, to be clear here I make no value judgment here on whether, ‘7 day services,’ are a good thing or not. But I would observe simply that that has a resource need and no one really seems to be addressing that.

  • Sorry, Liberal Democrats, but step very carefully on this one. Lies, damned lies and statistics………..

    There is a very selective quote in the main article about “you are most likely to die on a Wednesday”. A full quote from the same research actually suggests that patients are more likely to die in hospital if they are ADMITTED at the weekend. It takes them until Wednesday to die. The study, in the Journal of the Royal Society of Medicine, found that patients were 16% more likely to die if they were admitted on a Sunday than mid-week.

    More to the point is the lack of weekend working by GP’s (who operate a very well paid weekday casualty clearing station and are reluctant to make home visits). This has intensified in England under the Lansley changes.One consequence is the clogging up of A & E at weekends.

    Like everything else money makes the mare to go if Hunt is to be taken seriously. But please, Lib Dems, before you go charging in let it be on FULLY researched based evidence.

  • “Admission at the weekend is associated with increased risk of subsequent death”

    But – Only emergency cases are admitted at weekends. Routine appointments, which carry a much lower risk of death, are all admitted during the week.

    Lies, damned lies and statistics!

  • COI: doctor who works exclusively for the NHS.

    Also consumer in the NHS – it’s not really an ‘us and them’ issue.

    We want to see improvements in the NHS and out of hours provision is hardly perfect, having both given and received it, it’s challenging for all.

    The article cited above, however interesting, shows similar mortality in different countries with different health systems, it’s not as simple as more weekend working = lower mortality.

    Jeremy Hunt’s advisors aren’t stupid, they have a reason for scare-mongering and bringing the NHS into disrepute. The man wrote a book on the privatisation of the NHS. Possibly a large conflict of interest there.

    Is this anything to do with the Lib Dems? I’d say the NHS allows incredible equality in health care, and is something to be nurtured,

    Yes, it’s expensive, yes the money has to come from somewhere, but this tactic of manipulating data and public opinion against the NHS is wrong.

  • Christopher Kane 30th Jul '15 - 11:30pm

    Regarding the science: it actually talks about a 30 day increased mortality of 16% if admitted on a Sunday. The day with the highest mortality is a Wednesday. This ‘weekend effect’ is replicated worldwide, and seems to be mainly down to cerebrovascular disease. It is not simply, staff it more and it will get better. It is a misrepresentation of evidence

    I didn’t link this originally as BMJ isn’t normally open access but have a look at this http://www.bmj.com/content/351/bmj.h3575/rr-2 which explains the actual evidence as we have it..

    The mirror article is the start of FOI requests which are still coming in, it’s the only place this is currently in them public domain. It clearly demonstrates that consultant opt outs, to elective working, are not a barrier.

    My point is though that whether or not you think we need seven day services is irrelevant. (I think we do) the point is we should never allow someone to dictate their own narrative without giving equal right of reply to the other side.

  • What this 16% increase actually translates as is for every 475 people admitted to hospital on a weekend* 1 more will have died as a result.
    *16% is actually the Sunday figure, Saturday is 11%.

    Sounds wrong? Most people have a limited understanding of statistics. The 16% increase is a relative risk increase, quoting things in relative terms can be useful but also makes the problem sound much worse than it is.
    The average absolute risk of dying if admitted to hospital is 1.32%. A relative increase of 16% means the absolute risk is then 1.53%, an absolute increase of 0.21%.

    I really do recommend clicking on #weneedtotalkaboutjeremy in the article. It takes you to the response from doctors where all the figures are referenced.

  • The BMA is exactly like every other Trade Union where their members interests always come before those of their consumers.Doctors had enormous pay rises under New Labour, time to stop whinging.

  • Richard Underhill 31st Jul '15 - 8:51am

    ” … Lib Dems should champion the consumers of public services rather than the producers.” Yes.
    A lot of the work that hospitals do, which GP practices could do if they were open, is at a lower level than mortality.”
    i joined one of these low level consultations at the local GP practice, but it is difficult to get this issue on the agenda.”

  • “Regarding the science: it actually talks about a 30 day increased mortality of 16% if admitted on a Sunday. The day with the highest mortality is a Wednesday” – right, but if (for example), you’re admitted with a stroke what matters is how you’re treated in the first few hours. You’ll need a series of scans to establish the type of stroke, and if it’s not the wrong type, and it’s a severe stroke then an anti-clotting drug will improve the likelihood of a good outcome: including the likelihood of surviving through the following Wednesday. So – because early treatment is critical – it’s the date of admission that matters, not the date of death.

    It would, on the other hand, be a simple matter to exclude routine admissions from the study. Or to control for them in the statistical analysis. Indeed that was done in the “N Freemantle, M Richardson, et al” study linked above.. They even say “These findings are consistent for emergency and for elective admissions ” and “the risk profile of elective patients admitted at weekends may be different and possibly higher from that of those admitted during the week “. They also controlled for a number of other factors.

    However, as Christopher points out, this may not be all (or even at all) due to lack of consultant availability. This study did not address that question, though it did hypothesise that lack of staff, including senior staff, is a possible factor. It’s also possible that other weekend working practices contribute: perhaps more agency staff, perhaps fewer technicians to operate scanners, perhaps different routines, could be a factor. And, of course, it’s possible that there’s a difference in the patients themselves, but this study didn’t find any (not that it was designed to find them).

  • Laura Gordon 31st Jul '15 - 10:46am

    GPs are a red herring. Places where they have experimented with opening GPs all weekend show that people don’t go on Saturday afternoons or on Sundays – people only want to use medical services when there are emergencies, for which A&E is more appropriate. Full weekend opening of GPs would be expensive with relatively little benefit.

    Similarly the delays in A&E and breaching the 4 hour rule are usually not an A&E problem – usually it’s a problem of getting people out of A&E into a bed elsewhere in the hospital, where the blockage is bed availability. The blockage for THAT is usually discharging people, where the main barrier isn’t consultant availability, it’s getting care plans in place, adaptations to homes needed to reflect people’s illnesses, etc. Or people being admitted to hospital because the basic care they need is not available in their home, although it could be provided there are much lower cost.
    Bottom line: integration of health and social care is vital, and if you slash the care budget then you put hospitals in crisis.

    Are there improvements that could be made to improve services at the weekend: absolutely. But most of the NHS *that needs to* is already operating on a 7 day schedule, and the parts that aren’t generally don’t need to be (e.g. elective treatments, scheduled treatments, or non-acute treatments) – there’ s no reason to increase costs by having elective knee operations on the weekend! Assuming they aren’t and accusing the doctors of being a cabal defending their privilege, as some have done (both Jeremy Hunt and on this thread) makes it harder to have these conversations – when any group feels under attack, they close ranks.

    Also, yes doctors make a good salary – but in the context of other public sector professions, it’s not disproportionate. My partner works evenings 5 weeks out of 6, and 3 weekends in 6, meaning family life has to fit into one week of evenings every 6 weeks, and the other 3 weekends. He can only take leave on one pre-determined week in the six week cycle, so we will never be able to take a 2 week holiday (even for our honeymoon!), we have no flexibility about when we take it, and bank holidays don’t exist. He earns his pay – and he’s not wingeing about that, he’s wingeing about being accused of not offering a 7 day service, which is quite obviously bollocks!

  • Katerina Porter 31st Jul '15 - 3:36pm

    An exhausted doctor is a risk

  • Richard Underhill 31st Jul '15 - 5:01pm

    In the short term the Department of Health is unlikely to get 7 day working at all GP practices, partly for contractural reasons, partly because some practices only have one doctor, although there may be nurses and othe rhealth professionals.
    A possibility is something comparable to the opening hours of the pharmacy service.

  • There’s been a decline in single practice GP’s over recent years – partly for financial reasons, partly for clinical reasons of the benefit of shared expertise, There is also the issue of conduct and safety (remember Shipman ?). The number of single handed GPs in England has almost halved over the past decade, In 2002 9.1% of GP partners were single handed providers of general practice. In 2012 it had dropped to 5.5% .

    The IFS reported in November, 1914 that “smaller practice sizes typically deliver worse health outcomes for patients, particularly in single-handed practices”. There is the further issue that some patients may wish to have a choice of the sex of their GP when they discuss certain issues.

    The number of family doctors earning more than £100,000 a year has quadrupled in less than a decade, according to evidence submitted to the last annual NHS pay review. More than 16,000 GPs are paid six-figure sums, including more than 600 on more than £200,000. There was a steep rises in the early years of the GP contract introduced by Labour in 2004, while doctors were allowed to give up responsibility for out-of-hours care.

    Now I respect my own GPs and I don’t begrudge their earnings – but it is pretty obvious that larger practices ought to be able to offer more flexible opening times at weekends reducing pressure on A & E and providing a measure of home visits. My town has a Medical Centre shared by four practices – total sixteen GP’s. Yet it is impossible to get an appointment between 5.00 pm on Friday and 8.30 am on Monday. This can hardly be described as patient friendly.

    And finally let’s be clear – GP’s operate as sub contracting businesses to the NHS.

    My conclusion is that Norman Lamb ought to be well placed to develop an evidence based Liberal Democrat health policy balancing the needs of patients and doctors – but putting patient needs first – but don’t let’s leap into knee jerk policy without proper consideration. This also goes for the blood transfusion service which should major on patient safety rather than PC correctness.

  • Richard Underhill 31st Jul '15 - 10:10pm

    Even in multi-doctor practices these issues can be difficult. My mother insisted on a female doctor. There was only one in the practice and she was part-time. Some doctors used to insist on having husband and wife on the same list. My father therefore was with a part-time GP. He had an annual check-up and died the next day. The doctor was ‘phoned at home and said that there must be a mix-up in patient records. There was not.

  • “The BMA is exactly like every other Trade Union where their members interests always come before those of their consumers.Doctors had enormous pay rises under New Labour, time to stop whinging.”
    Pay isn’t the issue. Doctors feel that their time for a private life is threatened. They are working their arses off, and Jeremy Hunt’s posturing comes as a slap in their faces – “work harder!” is the message they are getting, and they are understandably insulted.

    Doctors can’t strike for ethical reasons. If their grievances aren’t addressed, then some will leave the NHS out of desperation. If just a few doctors start leaving, the situation can spiral out of control as workload and burnout rates go up, pushing more out, and closing the spiral (this has happened with nurses in hospitals in ‘special measures’, where recruitment can’t keep up with the burnout rates). It is would be a dangerous situation that will be difficult to fix once the fire is lit. It is not such an unlikely scenario – there is huge anger among doctors that all of us need to take heed of.

    So before you casually go Union bashing, Kevin, pause to consider that maybe BMA members’ interests are more aligned with their consumers than you’d like to think.

  • Stephanie da Roza 1st Aug '15 - 8:04am

    Disclaimer: I am a junior doctor.

    I just wanted to say that doctors are exhausted. Officially we work 48 hours a week but also unpaid overtime. This is just clinical work. We also have to attend courses and study for postgraduate exams as well as completing audits, attend conferences and prepare for presentations. All of which is compulsory for career progression. Check the NHS pay scale. I have been working for 4 years and becoming an ST2. I get 50% extra for working nights and weekends (1/3 weekends – last 6 months I did 1/2 weekends, 1/8 nights so 1 full week of nights every 2 months). My pay BEFORE tax and deductions (including the 50% banding supplement) is £18 per hour for clinical work ONLY. 1500 doctors leave the UK for Australia and New Zealand every year. The conditions are better over there. We all want 7 day services, but we are stretched to the limit, doctors are jumping ship and so there is a shortage. The result is that more locum (or freelance) doctors are being used, they cost a lot more. We are tired and demoralised. We are going on social media because we have no other outlet. We cannot and won’t strike because we care about our patients.

    Jeremy Hunt is telling a bare faced lie. Disregarding all the arguments about the mortality statistics, which are at best shaky. He said that the opt out clause for NON-EMERGENCY weekend work (there is no opt-out clause for emergency work) was a major barrier. Freedom of information requests have been diligently put in to every acute NHS trust in England to find out how many do opt out. It will take a number of weeks for every trust to get back to us but the results are public and can be viewed live here:

    https://www.whatdotheyknow.com/user/kiara_vincent?utf8=✓&user_query=weekend+working&request_latest_status=&commit=Search+contributions+by+this+person

    There is also a useful graph which is also updated live as the results come in. This is the easiest way to look at the data but if you don’t believe it, please just click on the link above to check the data.

    https://magic.piktochart.com/output/7136876-consultant-opt-out-figures

    We understand that it’s difficult to make an informed decision with all the negative press that is going on, but we work hard 24/7 to provide a service already. We want to provide better services on the weekend but we are already stretched to capacity. The new contract would mean a pay cut for junior doctors. We are tired and feel under appreciated.

  • As a midwife I find the insinuation that giving birth on a Bank Holiday is a scary prospect highly insulting.
    Maternity Services is an acute service which provides care for birthing mothers 24/7 365 days a year- including Christmas and all other Bank Holidays! Midwives, Consultants, junior doctors, HCA, nursery nurses- we are all there working hard to provide a safe level of good quality care for all.
    The only reason service might be deemed as falling down is the fact that we are desperately understaffed and are caring for an increasing work load, and an increasingly complex work load at that.
    There is no need for all the bashing of staff that are already working hard in difficult circumstances, and there certainly is no need for all the scare mongering of the general public.
    What we need is an open discussion on what needs to happen to improve overall services – no one side bad mouthing the other.

  • Richard Underhill 1st Aug '15 - 5:55pm

    Christopher Kane 30th Jul ’15 – 7:15pm “Everyone is in agreement … “.
    That is the fastest way to lose an argument in a Liberal Democrat debate about anything.
    Please see the chairmen and women scrutinising the hall at conference for any dissenters.
    Even on clomate change, where the science is overwhelming, there are people who disagree, some quite prominent.

  • Richard Underhill 1st Aug '15 - 6:07pm

    Stephanie da Roza 1st Aug ’15 – 8:04am ” .. a junior doctor. doctors are exhausted.”
    A plea from the heart here. Are you a hospital doctor? Do you have a preferred career progression?
    If you become a consultant would you accept weekend working if there is no overall increase in hours?
    If you ever decide to try a career in politics would you consider the Liberal Democrats? Doctors are popular and trusted as caring.

  • Simon Gilbert 1st Aug '15 - 6:11pm

    1. Mr Hunt and Dave talk about weekend hospital mortality rates
    2. They use this to argue for more routine (elective, non urgent) care at weekends in hospitals and in GPs.
    They are either being disingenuous or stupid in their arguments.

    The real aim is to reduce pay by making routine (non urgent) services available at weekends, without having to pay the market rate for this.

    As Drs are not particularly militant, and they have a weak union, the most likely outcome is withdrawal of labour – not as a strike but by doctors reducing their individual clinical commitments, retiring earlier, locuming or emigrating. Thus you won’t see a unionised struggle, more a silent exodus.

  • Stephanie da Roza 2nd Aug '15 - 12:43am

    Richard Underhill: Thanks, I am a hospital doctor. I am a qualified doctor training to hopefully be a paediatric consultant (minimum of 10 years after medical school). All of the acute hospital consultants I know already do weekend work. There is a consultant every day, including Saturday and Sunday in doing s ward round, every child under their care is seen. They are a phone call away at all times and very happy to come in if necessary. I’m not even sure you can opt out of working weekends (there is an opt out of non-emergency work, no one can opt out of emergency work unless the doctor themselves has a good reason (for example during pregnancy, some doctors don’t work nights but will still work evenings and weekends). So to answer your question, of course I will do weekend work. We all expect to. But I don’t see how a Saturday elective procedure or non-urgent outpatient clinic is going to reduce death rates of patients admitted on the weekend. You may not believe this but the day you are most likely to actually die is a Wednesday. I agree with Simon Gilbert. I love my job and would not be considering politics any time soon, but I would consider being a lib dem MP.

  • Jo Richardson 2nd Aug '15 - 12:06pm

    Seven day working is not an issue for any of the staff I currently or have ever worked with, but those of us working in the nhs are entitled to days off at some point in the week with our families, just the same as everyone else. What would you say if you went into hospital mid week and got told the specialist you needed to see wasn’t in until saturday as they were on days off before working the weekend? You can’t have your cake and eat it unfortunately; the issue is not whether staff will work weekends but whether there are enough of them to safely cover 24/7. Without proper funding, nowhere in the nhs will be able to provide this cover. To expect any staff group to work over their hours consistently without extra pay is wrong and I would be surprised if anyone outside the nhs or emergency services would be prepared to do so.

  • Simon Gilbert 3rd Aug '15 - 11:50am

    Here is a question:
    For non urgent appointments, who should pay for the convenience of weekend or evening appointments?
    The cost will be higher, as secretarial, lighting, heating, doctor time will be more in non urgent facilities.
    So if this is mostly for working people, they are benefitting from a more expensive service.
    There is an opportunity cost to this, for example fewer overall appointments and longer waiting times.

    So if an appointment that is convenient for work is desired, why should the state pay for this convenience?
    If the individual, or their employer, feels it is worthwhile perhaps they could pay a supplement for this added convenience.

    In air travel everyone in an aeroplane will be as safe as each other, flown by a qualified pilot, but the money raised by those who book late or book in business class, increases the number of viable flights for all, and reduces economy seats.

    Should access to healthcare for all mean that the state has the monopoly on healthcare funding?
    Could top up payments bring benefits to all patients?
    These are real discussions given the £20 billion underfunding of the system.
    To put it another way – would you like your non existant appointment during the week or during the weekend?

    Urgent care is different from convenient care and the NHS doesn’t have the financial luxury of choosing gold standard convenience currently.

  • Stephanie da Roza 8th Aug '15 - 4:53am

    David Wallace, almost all hospital doctors, including consultants do work nights and weekends (as posted above), we are already underpaid for the amount and type of work we do. Some GPs also work nights and weekends (Out of Hours GP service). Try to get a lawyer to work a taxing 12.5 hour overnight shift on a Sunday which involves acute life and death situations and see what the bill is. Would you really want a lawyer that is willing to accept £18 per hour? That is the comparison you are making.

    As I said above, 1500 doctors leave the UK for Australia and New Zealand every year, that does not include the ones who leave medicine for different careers and for other countries such as Canada and the US. Why do you think this brain drain is happening. If we quit (which I am loath to do), the NHS will just be more difficult to run, but because this contract is being unilaterally imposed on doctors (and involves a 20% pay cut for junior doctors) and we cannot strike, at what point do you think we should leave?

    If you as the taxpayer are our employers, would you like to decide? I’m interested to hear what the general public really thinks a doctor is worth.

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