The RCOG is extremely concerned by the Government’s proposals for junior doctor contracts in England.
Both obstetrics and gynaecology are high-intensity emergency specialties and units around the country already provide seven-day services. The majority of care is delivered by junior doctors and the College has been examining models of 24/7 consultant care where appropriate.
The new proposals are meant to enable seven-day care in the NHS by adjusting contracts for junior doctors so that work carried out in the evenings, at nights and weekends is considered “normal working hours”. Instead there is now a significant chance of returning to the ‘bad old days’ of over-burdened junior doctors in danger of giving sub-standard care. This is unacceptable. If left unchallenged, the proposals could significantly compromise safety and the lives of mothers and babies in England.
These proposals will also have a serious and negative impact on the morale of our specialty’s 1,600 junior doctors. There has been the failure to consider the already difficult working conditions in the labour ward and this will lead to early retirement or an exodus from across the profession, consequently harming patient care.
The National Maternity Review set up following the tragic maternal and neonatal deaths in Morecambe Bay NHS Trust is charged with ensuring that standards of care improve and that doctors are supported to deliver high quality care. This new contract will make it much harder to achieve these important objectives.
The unintended consequences of the new proposals are:
- A direct impact on patient safety – the proposals extend junior doctor working hours. This is detrimental in an intense working environment such as the labour ward where there is a correlation between concentration levels, exhaustion and safety. Other staff providing maternity care such as paediatricians and obstetric anaesthetists will also be affected and this is a threat to multidisciplinary teamworking.
- Severely disadvantaging doctors with caring responsibilities – the proposals are rigid and a disincentive for doctors seeking flexible working patterns. This represents a U-turn to the principles outlined in Shape of Training.
- Lower recruitment and retention into the specialty – fewer junior doctors will want to train in O&G because the contracts will impose unsociable working patterns and do not recognise the level of intensity and responsibilities involved in providing high quality maternity care. In addition, we are already aware of significant trainee staffing issues with gaps in rotas of 20-25% which these proposals are very likely to exacerbate.
RCOG President Dr David Richmond, said: “Significant disquiet has been expressed by our junior doctors and consultants since the publication of the proposals. There is the collective feeling that junior doctors are being unfairly penalised.
“Our junior doctors provide high quality care, often in unpredictable circumstances where emergency treatment is required. These new proposals are ostensibly designed to meet cost efficiencies but will impact upon patient safety. Coming so soon after the Kirkup report into Morecambe Bay, they appear short sighted and contradictory. We need to invest in our workforce and support our staff, not discourage recruitment, innovation and integration between healthcare professionals.
“It is imperative that the BMA re-engages in contract negotiations with the Government on the Review Body on Doctors' and Dentists' Remuneration proposals and I urge the Secretary of State and NHS Employers to withdraw this contract imposition and re-engage in a dialogue with the BMA Junior Doctors Committee.”
Dr Matthew Prior, Chair of the RCOG Trainees’ Committee said, “We agree that the NHS should provide safe care seven days a week and indeed doctors in obstetrics and gynaecology already work day and night, seven days a week.
“There are currently gaps in junior doctor rotas throughout the country. We already have 15-18% drop out rate in our specialty and we fear imposing a new contract will result in more junior doctors choosing to leave the specialty and the country. This would compound the rota gap problem directly affecting patient care.
“The proposed contract will result in more work provided out-of-hours, risking the reduction in supervision and training for junior doctors. It has also lowered the morale of an already overstretched group of hardworking doctors. Imposing a contract in isolation to the outcome of the consultant contract reforms will compromise patient care.
“The RCOG’s Trainees’ Committee is ready to work with the BMA and Government on proposals for how we can address the problem of staff shortages and issues of recruitment and retention in the specialty.”
Read the full Trainees' Committee statement.