In the midst of the contract dispute Ham&High reporter, Chloe Chaplain, spent two days shadowing junior doctors at the Whittington Hospital.
In recent weeks the junior contract dispute has made headlines across the country.
It sometimes seems that junior doctors and ministers are playing tug-of-war with facts and figures - both claiming to care more about the NHS than the other.
As a service user, it can be hard to see past the political jargon and the demands of an angry union. In an attempt to make sense of the debate, I spent two days as a junior doctor at the Whittington Hospital.
For the majority of the two shifts, I was in the Obstetrics and Gynaecology department.
Like many hospital departments, there are two types of junior doctors working in it – foundation doctors, two to three years post graduation, and registrar doctors, who are more senior but not yet consultants.
The consultants oversee the department, help teach junior doctors and are the final decision-makers for complex cases.
Foundation doctors are generally the first to be called to the patient and do a lot of running around. This is what I spent Sunday morning doing as I shadowed Fran, the foundation doctor for the postnatal ward.
We visited patients who had been flagged up by midwives as requiring a doctor’s assessment, prescriptions or who were ready to be discharged from the ward. At the same time, we were on-call for any walk-in patients concerned about their pregnancy.
During the shift Fran, who graduated from medical school three years ago and has a minimum of seven years training to go before becoming a consultant, was called to a walk-in patient with reduced fetal movement.
She decided she could not make a final decision alone so called the registrar available, Reena, who made the call to keep the patient in overnight for observation.
As a registrar, Reena is a more senior and experienced junior doctor. She does a similar job to Fran which, to my inexperienced eyes, seemed to be just about everything that needed doing.
I shadowed Reena for 12 hours on Friday which was spent running around all the wards - gynaecology, labour, A&E, clinics, postnatal, prenatal... to name a few.
This was followed swiftly by jumping from surgery to surgery to remove cysts and perform sterilisations, visiting existing patients with the consultant, admitting new patients and simultaneously guiding the junior foundation doctors when required.
I was prepared for a long day and a busy schedule but the experience still surpassed my expectations: I barely had time to get a drink, let alone go to the toilet.
At one point I mentioned something hopeful about water and Luveon, a foundation doctor, turned to me smiling and said: “So now you are feeling what it is like to be a junior doctor, dehydration, hunger and a full bladder.”
Sunday was slightly slower, as there were no elective surgeries - scheduled in advance as opposed to emergency procedures - or elective staff. Today the junior doctors would be looking after in-patients and were on-call for any urgent requests.
During a rare chance to sit down, Reena spoke to me about the contract negotiations and said that, since they had begun, morale was low amongst staff.
She said: “I have never seen it like this. My own juniors who are one-to-two years out of medical school are looking to either move abroad or move to other professions that do not involve working in patient care.”
Peter, a foundation doctor listening to our conversation, turned to me and said: “I feel that what the government is doing has cheapened us and our profession and that they see us as service providers who are interchangeable with one another.”
Peter is certainly not alone in his views. The cry of “our work is not valued by Jeremy Hunt” was following me around the hospital.
Doctors told me they would never let their sons or daughters go into the NHS and juniors openly said they were thinking of leaving medicine all together.
One junior, who had just begun his first year of rotations, explained that he and his housemates wanted to leave because of the unrealistic anti-social hours.
Considering he had just spent at least five years studying, plus a year training on the job, I was surprised by this decisiveness.
I spoke to Rachel, another registrar, about working conditions. She told me she was due to finish at five but would probably stay until at least seven, looking after patients, as is the norm.
After my research about non-basic pay rates for working later or on weekends, I asked if she would be paid these rates, or any-thing, for working extra? She laughed and said no.
It did cross my mind that many professionals work later than contracted for no extra pay. If I had just worked 12 hours for the fifth day in a row, however, I might be less inclined to do so.
Rachel said: “We always stay late because, if there is work to do, we’re not going to abandon patients. As a doctor you just wouldn’t do that.”
As well as this, there is pressure to complete work before the weekend when, without elective staff, it’s hard to discharge patients and get prescriptions.
All support staff, like sonographers, physiotherapists and dieticians, are not contracted to work on the weekend. Junior doctors and some consultants do, to provide on-call, urgent care.
In relation to weekend work, Jeremy Hunt has repeatedly used the phrase ‘seven day NHS’. I put his theory to junior doctors and the response was “we already work weekends so we don’t really know what that is supposed to mean”.
Reena explained that, without employing more elective staff, weekend care could not improve.
She said: “Although you have a surgeon, you don’t have the technical staff to sterilise equipment, to provide recovery care or to ensure discharge medication is prepared and dispatched. By increasing the number of junior doctors you address none of this.”
A consultant agreed, saying: “If we are to have a better service on all seven days, we need more staff overall. This is not the medical profession being against change or closing ranks. Hunt’s plans are simply not feasible unless there is investment into people.”
Many echoed these views, arguing that what is most needed is more staff to relieve pressure. And, as Hunt announces funding of £4billion for technology to create a ‘paperless’ NHS, the discontent and frustration continues to spread.
There is no doubt that junior doctors are a deeply embedded, central part of the NHS, along with nurses, porters, consultants, midwives and admin staff.
Because of this I couldn’t help but feel a sense of apprehension, considering what is at stake. As these people are feeling pushed to the point of industrial action, what will the consequences be on our vulnerable health service?
Friday’s shift:
8am - Shift begins, meet Dr Aggarwall who takes me to Gynaecology and Obstetrics.
9am - Begin a ‘ward-round’ in the early pregnancy day-clinic.
10am - Went to visit another junior doctor on a general ward who was caring for a leukaemia patient. Sat in on the patient consultation to discuss her end of life care at home.
11am - Called to A&E to visit a urgent patient.
12pm - Ban on day treatment ward to ‘consent’ patients ahead of their surgeries.
1pm - In theatre preparing for the first surgery which is a sterilisation. Surgery done by a consultant, two junior doctors, two anaesthetists - one of which was also a junior doctor - and a team of scrub nurses.
2pm - Second surgery begins which is the removal of an ovarian cyst.
3pm - Before the third surgery, the doctors check on the first patient after hearing they have pain and high temperature.
4pm - Back in theatre for the final surgery, which includes a womb biopsy.
5pm - Surgeries now complete so doctors check all patients are recovering well and the consultant goes home.
6pm - Elective staff have now left so the junior doctors are on-call for the rest of their shift.
7pm - In the last few hours we are called to see various patients across gynaecology and obstetrics that nurses or midwives are concerned about.
8pm - Hand over to the team covering the night shift, ensure they have all patient information they need.
8:30pm - End of shift.
Sunday’s shift:
8am - Shift begins - hand over
9am - Accompanied the junior doctor covering the postnatal ward for the day in her morning ward-round.
10am - Visited all new mums that needed doctor assessment. Arranged prescriptions, follow up treatment and discharge papers.
11am -Paged to urgent care to visit concerned pregnant woman who had come to the walk-in clinic which remains open on weekends. Consulted with other doctors and make appropriate plan for her observation.
12pm - Met with consultant who was also on-call. Discussed current patients and any complex cases that may need specific care or observation.
1pm - Visited a mum recovering from a C-section in the early hours of the morning. She was in the high dependency unit with her new baby so staff could keep a close eye on her.
2pm - Went to the general ward with one doctor to visit and assess two patients suffering from Sickle cell disease.
3pm - Attended a service of remembrance for babies and children who had died prior to birth or during their early lives. Patients and parents spoke at the event to remember their children and other who had not made it to birth. This was attended by many members of staff from the department.
4pm - Doctors paged to A&E to see a patient.
5pm - My time at the Whittington was over and I went home. The junior doctors were on-call for another three hours after I left before handing over to the night shift team.
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