In an article published in the Journal of the Royal Society of Medicine, Ailsa McKay, Ravi Parekh and I discuss some of the implications of the imposition of the new junior doctor contract in England's NHS. For doctors, the contract's imposition is distressing for several reasons. First, the contract is incompletely developed, and there are errors in the associated ‘pay calculator’, and heavily criticised, unrealistic rotas have been published. Doctors are therefore unable to determine the hours they are likely to work under the new contract, how these will be distributed across the week, and the impact on their salaries. This uncertainty is compounded by lack of clarity around the government’s rationale for imposition: provision of a ‘seven-day National Health Service’. The government has not clearly defined what it means by this, and the proposed rotas do not redistribute services evenly across the week. Indeed it is unclear whether the new rotas will provide any enhancement of weekend cover. Nor is it known what impact the proposed new working patterns of junior doctors will have on clinical outcomes, mortality and National Health Service productivity.
NHS budgets are under considerable pressure. It is therefore unsurprising that many NHS Integrated Care Boards (ICBs) In England will aim to prioritise price in contract awards, But this approach is a significant threat to community-centred healthcare. While competitive tendering is a legally required, an excessive focus on costs in awarding NHS contracts risks overshadowing key factors such as established community trust, local expertise, and the long-term impact on continuity of care. This shift towards cheaper, often external, commercial providers threatens to cut the links between communities and their local health services. The argument that competitive tendering is solely about legal compliance, and not cost, is undermined by the very nature of such tendering, which by design encourages the lowest bid. This approach risks eroding the social fabric of local healthcare provision, where established relationships and understanding of specific community needs are essential. Establishe...
Comments