As Chief Executive of the NKF, I have recieved this letter from Dr Alex Riding signed by 2,300 people.
The NKF makes no comment, however believes that this letter should be available for you to read.
Letter From :-
Dr Alex Riding
130 Lichfield Road
Dear Mr Statham,
Thank you for taking the time to read this letter which is signed by over 2,300 people,
including consultants, GPs, junior doctors, nurses and other healthcare professionals and
NHS Employers' proposed junior doctor contract threatens to drive thousands of UK doctors
away from the NHS, leaving a critical shortage of medical staff and creating the biggest crisis
in the NHS since its inception. This will affect the safety of all patients in the UK. Over 3,000
doctors have recently applied for a certificate of good standing from the General Medical
Council, in order to leave the UK (1). A poll of 6,000 junior doctors (12 of the national total)
showed a staggering three quarters would resign if this contract is implemented and nearly
half would emigrate (2). To date 13 leaders of medical Royal Colleges have contacted the
Department of Health to express their grave concerns for patient safety and welfare of
doctors over the proposed implementation of this contract (3). A doctor, former health
minister and current conservative party MP Dan Poulter has also raised grave patient safety
concerns if this contract is implemented (4). One of Britain's top hospital chiefs, Sir Thomas
Hughes-Hallet, the chairman of the Chelsea and Westminster hospital, has written to the
government, warning of the impending NHS crisis, their clumsy handling of contract
negotiation with doctors and the imminent danger to patient safety (5). Over 200 consultants
at Great Ormond Street hospital have written to the secretary of state for health echoing
these concerns (6). Finally, during the recent parliamentary debate on the 28th October
regarding the current junior doctor contract proposals, MPs, Heidi Alexander (Lab and
shadow health secretary), Dr Philippa Whitford (SNP), Dr Sarah Wollaston (Conservative),
Lyn Brown (Lab) and Andrew Gwynne (Lab), to name a few, all made speeches about the
dangers this contract poses to patient safety (7).
The government proposed contract changes supported by the Dentist's and Doctors Review
Body (DDRB) will redefine normal working hours from 7am to 7pm Monday to Friday to 7am
to 10pm Monday to Saturday (8). Up to one third of doctor's pay is currently made up of a
supplement for unsocial hours work. Even though the Department of Health has stated that
basic pay will be increased by up to 15, the redefinition of our normal working hours and
reduction in out-of-hours pay supplement will see nearly all doctors, including GP's in
training, receiving a significant pay cut, up to 30-40 for some (4, 9). This is on the back of a
15 real terms pay cut to doctors pay over the last 6 years (1). Medical students currently
graduate from university with a minimum of £50,000 debt (4). The imposition of this contract
will lead to a recruitment crisis of new doctors in the UK for a generation, as medicine will
cease to be a financially viable career for all but those with significant family financial
This contract also brings to an end automatic annual pay progression for junior doctors in the
NHS. This will significantly disadvantage all women who decide to take maternity leave.
Currently over half of qualifying doctors are women. Furthermore, doctors who decide to take
time out of their medical training to undertake a PhD or contribute to medical and scientificresearch will also be financially disadvantaged by their choices. This will lead to a lack of medical doctors contributing to the development of new treatments and furthering our knowledge of diseases.
The government has constantly argued that these reforms are necessary to provide a truly
seven days NHS. Yet they have never attempted to define what they mean by this or how
they intend to achieve it. Two articles have been published, which they quote (10, 11),
showing there is a small but significant increase in the mortality of patients who are admitted
at the weekend in the UK. Firstly the data in this paper for the 'weekend effect' includes
mortality numbers from Friday through Monday, so the statistic that the government quotes is
not specific to Saturday/Sunday. This 'weekend effect' is a trend that is not exclusive to the
UK, but is seen in many other countries including the privatized US healthcare system (10).
Neither of these articles present any evidence for the cause of this increased mortality, which
refers to the 30 day mortality, meaning that a significant number of these patients die after
discharge, at home. In fact, both papers show that the mortality rate of all patients present
within the hospital on Saturday and Sunday is actually statistically lower than during
weekdays. Despite all this evidence the Secretary of State for health Jeremy Hunt has
somehow decided the cause of 'increased mortality' is due to insufficient staffing of doctors in
the NHS during 'the weekend' and hence the need for contract reform. They have never
presented any evidence to back this assertion and indeed no published evidence currently
exists for this - even the paper they keep quoting makes clear that this link cannot be
assumed. Recently, Dr Andrew Murinson, a conservative MP stated in the parliamentary
debate on Wed 28th October, after assessing the evidence that,' no causal link has been
established between doctors' rostering and excess weekend deaths,' 'and I do not think that
junior doctors' hours are a principal driver in the problem (7).' The editor for the BMJ has
written to the secretary of state to inform him that he has publically misrepresented the
findings of the academic article he quotes, which is published in their journal (12).
The government's claim that we currently do not have a 7 days NHS and that doctors do not
work weekends is misleading and an alarming trend is emerging demonstrating it can
actually harm patients. There have been numerous reports of the so called 'Hunt effect',
where patients are delaying presentation to hospital until Monday in the mistaken belief that
there will be no doctors and they will be at increased risk (13,14).
The government has blamed the British Medical Association for leaving the negotiating table,
however, 'instead of proper negotiations NHS Employers insisted the BMA accept 22 out of
the 23 recommendations made by the DDRB without question (15).' The government
subsequently stated they will impose this contract on junior doctors from August 2016.
Junior doctors, have been put in an impossible position, none want to strike but we cannot
accept an unfair and unsafe contract being forced upon us. David Cameron had previously
proposed to remove the application of the European working time directive to doctors
working hours (16). Financial penalties to hospitals who overwork doctors are to be removed
and plain time working has been extended to a 90 hour week. It seems obvious doctors will
end up working even more excessively long and antisocial shifts, in a dangerously
understaffed environment and be completely demoralized (17). Referring to the European
Commissioning figures from 2014, the UK currently has 2.71 doctors per 1000 people, which
ranks 24th out of 27 European nations (18). I think these figures would suggest that we need
to invest in more doctors not drive the last remaining few out of the profession or country.
In summary, unless this contract is opposed by all UK healthcare professionals, patients and
the public, we can expect the NHS to enter the biggest staffing crisis since its birth and one
that it is unlikely to survive. What this will mean for patients, is that there will be insufficient
doctors to safely run hospitals up and down the UK. A&E waiting times will sky rocket,
outpatient clinics will be cancelled, two-week cancer referrals will be unachievable, elective
surgery will be postponed or cancelled to name but a few. Furthermore, emergency services
will be severely affected meaning lives will be immediately put at risk. This crisis will be
sustained for many months, even years as there is no obvious solution. Many believe that this will inevitably lead to privatization of a large proportion of the NHS and massive health inequality across the UK for future generations.
The junior doctor contract debate is the most important issue to impact the quality of patient care in the UK for a generation.
Firstly, we ask that you send a message to Jeremy Hunt MP and the Department of Health to ask them to withdraw the imposition of an unfair and unsafe contract on UK junior doctors that will risk the safety of all current and future patients in the UK; secondly, to ask them to start negotiating fairly with the British Medical Association to plan a secure future for UK doctors, all patients and the NHS. We also encourage you to educate your members and the public on the implications of this contract for their future healthcare. All of us, and our loved ones, will at some point be a patient within the NHS.
Patients need a voice in this issue. Please help us to make this possible.
Dr Peter Arthur-Farraj Neurology Registrar GMC 7169625
Mr Yezen Sheena Plastic Surgery Registrar GMC 6149360
Dr James Rowson FYi Doctor, GMC 7493662
Dr Sundeep Grewal Geriatrics Registrar GMC 7049721
Dr Paola Rodriguez GP Registrar GMC 7177345
Mr Ashmal Jameel Ophthalmology Registrar GMC 6163912
Dr Mary-Ellen Lynal Academic Clinical Fellow in Psychiatry GMC 7411812
Dr Zoya Georgieva Academic Clinical Fellow in Haematology GMC 7427040
Dr Katie Au General Adult Psychiatry and Medical Psychotherapy Registrar GMC. 6142948
Dr Shreya Dhar GP Registrar GMC 7177326
Dr Nalinie Joharatnam Oncology Registrar GMC 7177100
Dr Sujit Mukherjee Gastroenterology Registrar GMC 7090328
Dr Sophie James Gastroenterology Registrar GMC 7140514
Dr Edward Needham Neurology Registrar GMC 7037080
Dr Subhadeep Roy Medical Registrar GMC 7169867
Dr Peter Daum Emergency Medicine Registrar ST2 GMC 7140471
Dr Jolyon Cohen Anaesthetics ST1 GMC 7169545
Dr Harmandeep Singh Bhatia Cardiology Registrar GMC 7036629
Dr Harriet Nerva FY2 Doctor, GMC 7459545
Dr Alex Riding Renal Registrar GMC 7045823
Dr Jinesh Patel Anaesthetics Registrar CT3 GMC 7090199
Mr Jack Groom medical student, Oxford university
Dr Sathiji Nageshwaran Clinical Research Fellow in Neurology GMC 7169737
Dr James Barnett GP partner GMC 7021000
Mr Krunal Patel Neurosurgical Registrar GMC 6149297
Plus an additional 2,300 signatures (see attached documents).
(1) Doctors without borders. The Economist. Sept 26th 2015
http'iiwww economist cominel'l's[britajni21667931-some-ju njar -doctars-consideroostrike-wll ile-otlJers-pack-their -bags-docto[s-
(2) Junior doctors will quit NHS if Government contract changes go ahead. The Telegraph. Oct 6th
http'llwww telegraph co ukloewslnhs/11915835(junjor-doctors-will-quil-NHS-if-Goyeromenl-cootracl-cbanges-go-abead html
(3) Royal College leaders express concern on junior doctor contract negotiation. 25th Sept 2015.
https·lfwww.rcploodon.ac u k/press-releasesfroya I-college-Ieaders-express-con ce rn-j lJ n iar -doctor-
(4) This junior doctor contract puts patients in danger. Dan Poulter. The Guardian. 4th Oct 2015.
llttP'f !www ttJeglJ2lrdia n .comicommentjsfreef20 15focl104!juDior -doctor -contract -patients-danger
(5) Jeremy Hunt is conning you ... The NHS is broke and crippled by fear: Top hospital chief's
astonishing outburst in bombshell letter to the Government. The Mail on Sunday. 11 th Oct 2015.
http'!lwl'l'w cI a ilvma i I CQJJk/ilii.w5Lar.tlcle.::32lilll41LJJ;;Ieill)!:l:::1.i.m.t:cCQ.DlJlng:Nl::lS.~im2ls;lHe.ar:.b.Q.s.pillil::dlief;;:a;llQn§lliD.Q.:
olltburst-homhshell-Ietter-Government h tml
(6) Lives at risk: 214 GOSH consultants pen open letter to Jeremy Hunt in Junior Doctors fight. The
Express. 29th Oct 2015.
http'flwww express .co. uk!news/uk!615471/J unjor -Doctors-214-Great-Ormond-Street-consultants-join-
(7) Junior Doctor Contract. Parliamentary Debate. House of Commons. Wed 28th Oct.
bttp"//www.publications parliament.uk/Qa(cm201516/cmbansrd/cm151 028/debtextl
151028-0003. htm#151 02840000001
(8) The NHS Employers organisation's submission to the Doctors' and Dentists' Review Body
bttp"i/wWyV nbsemployofs orglcase-stlldjes-and-resources/2015/01/nbse-submissioo-ddrb
(9) Contract reforms (DDRB July 2015): Modelling the effect of junior doctor pay during specialty
training. Steven Bishop. Illtpsildrive google com/file/rifQS H7iri69DOeYNOErVIREekFDZIR4cE81 cWwwViJM8lJljdOMwi
(10) Weekend hospitalization and additional risk of death: An analysis of inpatient data. Freemantle et
al. 2012. J R Soc Med. 105(2): 74-84.
(11) Increased mortality associated with weekend hospital admission: a case for expanded seven day
services? Freemantle et at. 2015. BMJ. 5; 351.(12) Jeremy Hunt criticised for 'misrepresenting' NHS
weekend mortality facts. Independent. 22nd Oct 2015.
11 Up' /lWyVW. io d e penden t. co uk/I ife-styl elh oa Itb-and- fa mil los/boa 11b-newsueremy-h U ot -crit icised-for -mi s rep reseo ti n(J -0 h s-
(13) The Hunt file: doctors' dossier of patients 'put at risk' by health secretary. The Guardian. 7th Oct
blip) /www III eg II S rd is o.cnmLs.o.cie1yL2.Q15Lo.c1LDlL1he.:hwll.::.flle.::.d.dns.sieI::.Of::p.atieJlts.i:l;.Jtcai::illiK:b)l-bea lib-secreta ry
(14) A woman actually went blind 'because of Jeremy Hunt's NHS claims'. The Metro, 9th Oct 2015.
bttp 'f/metro co ukf2D 1511 O/09Ia-woOla n-actua !I)I-went -bliori-beca! lse-of -jeremy-hllDts-ohs-ciaims-543051 II
(15) BMA JDC Press release. 26th Sept 2015
bttp'llbma orO IJklnews-views-aoalysisinewsfZ015(seplemherijlloioc-doctccs-plan-!o-ballot-foc-indllstrial-actioo
(16) David Cameron to demand opt-out on EU work law in referendum negotiations. The Telegraph.
10th July 2015
http'l/vvwwtelegraph co IIklnewslnewstapics!ellreferendumI11732668Idayjd-cameron-working-time-direclive-eu-
(17) Junior doctor's strike receives overwhelming support, poll shows. The Guardian healthcare
network. 29th Sept 2015.
http'ilwww thegl :ardjan corn/hoa ilbcare-nelworki20 lSlsep/29ljl mjor -doctors-strilie-51 Ipport-poll-cootract-nhs
(18) UK has fewer doctors per person than Bulgaria and Estonia. The Telegraph. 3rd Jan 2014.
bttpllwww telegraph CO Ilkinewsibeallh;-J 05503351\ JK-has-fewer-doclors-per-person-lhao-Bulgaria-and-Esloois html