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The Royal College of Psychiatrists Improving the lives of people with mental illness

Junior Doctors – your feedback needed

Consultants supporting Maudsley NHSLast week, the first Junior Doctors’ strike took place, with many of our Psychiatry Junior Doctors taking part. The College has continuously called for a negotiated settlement to the dispute, and whilst we are pleased that next week’s has been called off, there still remains the possibility of a further strike on 10 February.


Importantly, I want to reiterate that both myself and the College respect the views and position of our junior doctors, and we are confident that our Consultants and SAS Doctors are ensuring that patient safety and care is being maintained during these strike days. I work closely with our Psychiatric Trainees' Committee, and know that they too feel this way. It was heartening to see on Twitter the pictures of our Consultants not only looking after patients and covering for our juniors on the ward, but also ensuring that our juniors were being looked after too. As the picture illustrates this extends as far as Chief Executives. I am not surprised though – how can we be kind and compassionate towards our patients if we are not the same to each other? If the press is to be believed (yes, I know what you are thinking but they do get it right sometimes) this was not a universal experience across the health service.

Terms and conditions are not part of the remit of any Royal College. But that does not mean that we have nothing to say. Indeed, there is a mood to make sure that our voice is heard more during this dispute, perhaps because we are all mindful of previous failings. For our part, we have been lobbying on the importance of using the negotiations to undertake a wider review of the factors concerning the ever increasing numbers of UK medical graduates who either defer or leave the UK medical profession to practice overseas, or simply opt out of medicine all together. This is not out of professional self interest – far from it. It is an issue that affects patient care. There is now so much evidence that links the mental health of the workforce with the standards of care delivered that I find myself saying something I never thought a card carrying academic would say – we do not need more research on this. It is established beyond reasonable doubt that the highest standards of patient care are delivered by energetic, motivated and well rested doctors with a positive work life balance.

For the moment I am in regular contact with those in Government and senior levels of the NHS, and via our Psychiatric Trainees' Committee, the Secretary of State has asked to meet with some of our psychiatric junior doctors to discuss the wider issues surrounding the work of junior doctors, which we have agreed to do once the current contract dispute is settled. That these issues are important and predate the current dispute is clear – as David Cameron correctly pointed out in 2006, saying that doctors “join the NHS in their twenties, full of idealism and vocation. By their forties, far too many are demoralised. From idealism to demoralisation in half a career.” [1]

But for now we want to hear more from you. Both myself and the Psychiatric Trainees' Committee would greatly appreciate any feedback you could give on what wider issues you would like to see addressed. You can email We would also be keen to hear about your experiences of the strike day, whether they be positive or negative, and to share any good practice that emerged as a result. There is not a single member of this College, whether they be junior or senior, who wishes to see harm come to patients, so please give us any feedback you can that we can then share.

But let’s hope it won’t be needed. We all want an agreement to be reached without the need for further industrial action. The RCPsych will continue to monitor the situation closely in the coming days, and ensure that our own actions reflect the needs of patients, members and fellows.

[1] David Cameron 2006 speech to the Conservative Party Conference


Professor Sir Simon Wessely

Image: Chief Executive and Junior Psychiatrists at South London and Maudsley NHS Foundation Trust


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Re: Junior Doctors – your feed
There are clear and understandable concerns around the current contract. However, I think the real threat to the pay and conditions of current juniors are the recent changes to pension taxation that havent really registered with many people owing to their complexity. Essentially the lowering of the lifetime allowance and the reduction to the pension annual input amount will hit current juniors very hard- with a reduction in annual income in retirement of around 20k per annum. If the proposed changes in the march budget are enacted as expected the pension as we know it will virtually cease to exist. At that point tecruitment and retention may well be devastated as there will be little reason to stay in the nhs.

The changes are complex and not easy to understand, and its all in the future anyway, so the tendsncy is to just ignore. But the long term impact on pay and conditions is of an order of magnitude greater than anything j hunt is currently proposing.

Ee can already see the impact of the relatively minor changes in lifetime allowance reduction with early retirals- i am very struck that i am one of the older consultants left in south east scotland and i am only 48, and the changes thus far are minor compared to what is to come. I think the exodus will increase markedly when people understand the true impact of the proposed changes. So lobby now before it is too late
Re: Junior Doctors – your feed
I would like to have a real 37,5 hours week like our Scandinavian colleagues. Child care provisions and making sure that get get the same chances as men. Pay should be equal to google or city high earners.
Compared to the great majority of Western health services, the NHS is underfunded and underdoctored. The many Trusts who are overspent have been told to reduce their 'headcount', a word that tries to distance itself from the reality of even fewer doctors and nurses. With higher morale amongst the 'headcount' , the NHS would function more efficiently and economically.
Even if more staffing at week ends then equalises the statistics (which is by no means certain), the Kings Fund calculate that it would not attain the NICE criterion of value for money.
To try to steamroller the current proposals is pursuing short term politics rather than the good of the NHS.
The only possibility that makes sense is if there were an intention to make the NHS fail so that it could be more easily privatised at greater cost as with PFI.
Re: Junior Doctors – your feed
Good to hear consultants covered but shouldn't trained specialists alway s be on site allocating tasks to trainees appropriate to their level of training or doing it themselves if they are not official trainers? Now's the time to abandon this archaic system relying on inexperienced staff to carry the workload!
Re: Junior Doctors – your feed
I totally support the strike, and in conversations with some consultant colleagues, there is a feeling we should be out in support. It is as has been said about the future of the NHS - which is being attacked and eroded on many sides. Should we care? I at least do. I have a vested interest, one of my daughters is a junior doctor, 3 years post grad, and with many colleagues supporting the strike, and also talking about life in Australia or elsewhere. As a psychiatrist (CAMHS) i see the awful results of years of cuts and underfunding, the sense of being under seige - it is far worse for adult colleagues. The attacks on psychotherapy, which has been reduced to minimal mechanistic interventions, directed from the government which wants depressed people back to work asap (there are of course many good reasons for this), shows however the triumph of vested interests over real understanding of the therapeutic needs of service users and indeed the needs of staff.
I've gone off subject - the changes to pensions are critical, although this is not limited to doctors. Many issues are tied into this of course
Re: Junior Doctors – your feed
Simon, Thank you for allowing open debate via your blogspot. Not sure if the College takes our ramblings (mine included) seriously. One of my main teachers from Aberdeen, Graeme Catto, worried about the core role of doctors of the future e en in the mid 90's. In Psychiatry, this is very real with increasing numbers of non medical prescribers, AC's and Physical care nurse practitioners. What Graham suggested was that doctors were in the best position to make overall care plans. Therefore, should we not train number of CTOs to write simple English care plans including a treatment plan, a risk management plan and a discharge and aftercare plan 3 bullet points each/
This will promote true collaborative working skills and satisfy the Human Rights agenda.

Re: Junior Doctors – your feed
I simply want to say that I am very proud of all the colleges uniting to support the junior doctors in this extremely awkward situation that these politicians have put them in.
Re: Junior Doctors – your feed
You all should be ashamed of yourselves, you want to be a doctor who help others - well you are contributing to the collapse of the NHS - you are hurting the old and the vulnerable - shame on you
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