The junior doctor workforce is “balancing on a knife-edge”, the chair of the BMA’s Scottish Junior Doctor Committee (SJDC) has warned.
The one-year anniversary of the publication of the Scottish Government’s Expert Working Group report on 48-hour maximum working week is just four weeks away however junior doctors in Scotland have seen very little progress on the urgent recommendations that were made to improve their working lives.
Three principal conclusions were reached in the report, with 14 recommendations within them. Forty-eight weeks since the report was published, just one recommendation has been implemented: limiting the number of consecutive long shifts to a maximum of four in any seven days.
Other recommendations, which have not been implemented, included:
- Improving facilities, including overnight rest areas for all night-shift staff, and sleeping facilities for post-night shift who are too tired to drive home and/or arrangements to be driven home. SJDC has suggested a small – yet still impactful – way to improve facilities for junior doctors is to provide them with a secure space to store their belongings, however no progress has been made to attempt to meet this need.
- Ensuring a minimum of 30 minutes continuous protected rest after approximately four hours of duty and developing a supportive culture that encourages and enables night-time staff to nap during breaks to combat fatigue.
- Ensuring that all rotas comply with working time requirements and allow junior doctors to achieve the educational outcomes of their training programme.
- Provision of basic education and unit induction regarding sleep, fatigue and working nights for all staff – highlighting the need for an improved awareness on the effects of fatigue to minimise risks to staff and patients.
Breaks have been recognised as a critical issue of safety by all stakeholders – however the issue of junior doctors unable to take their breaks and rest periods remains, with no proposed approach or plan to lead change that is urgently required to address this.
Dr Lailah Peel, chair of SJDC, said: “Make no mistake, junior doctors in Scotland are angry. We are balancing on a knife-edge right now. Morale is rock bottom, we are exhausted, depleted, and struggling to see the light at the end of the tunnel. The workforce is buckling under the current workload pressures and I’m increasingly having conversations with colleagues about their concerns over unsafe working environments. Add in this year’s real terms pay cut and you are looking at a workforce that feels extremely under-valued and I have serious concerns for the wellbeing of my colleagues.
“Limiting the number of long shifts in any seven days was a key priority for us in our own wellbeing report, and it has of course been reassuring to hear of positive rota changes across Scotland from August – however I am still hearing from colleagues who are working rotas which contain five consecutive long shifts, and that’s simply not good enough almost a year down the line from the EWG report being published. It’s also worth pointing out that the report sat gathering dust for nearly two years before it was finally published so things have been going on much longer than is acceptable. I continually have to remind colleagues of their full break entitlements, particularly those working longer shifts.
On what further action could be taken, Dr Peel said: “People have, of course, raised the question of industrial action – not surprising given many of our wider NHS colleagues are preparing to ballot in the coming weeks and months too. In our recent pay survey, feedback we received was clear from junior doctors, who responded showing they are angrier and more prepared for potential sustained strike action than our more senior colleagues. This is understandable given the situations we’re working in: understaffed, overworked and at points dangerous for both ourselves and our patients. No one wants to strike – we care deeply for our patients, who are already being impacted by the current situation – and this isn’t a decision we would take lightly, but if things do not improve, I struggle to see how it could be avoided.
“There is no resilience left in the system. We are struggling – and we know this winter is going to be the worst ever, worse even than last year. I implore the Cabinet Secretary for Health to act now before the junior doctor workforce in Scotland implodes.”
Notes to editors
- 92% of junior doctor respondents said they would be willing to take some form of industrial action in response to this year’s pay award – compared with 78% of the overall membership.
- 85% of junior doctor respondents said their morale had been decreased by the pay award, compared with 75% overall, while 68% of juniors said they were more likely to leave the NHS, compared with 58% overall.
A long shift is defined as being more than 10 hours.
Scottish Government Expert Working Group 48-hour working report
NHS Lanarkshire has expressed its concerns for patient safety, with one of the issues being staff shortages