Proposed junior doctors’ contract will be a disaster for mental health

http://www.theguardian.com/society/2015/oct/06/junior-doctors-contract-disaster-mental-health

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We’ve heard very little about how proposed reforms to junior doctors’ contracts would affect individual areas of the NHS such as mental health services.

The vast majority of mental health problems are treated by psychiatrists and GPs. These specialties tend to attract junior doctors with rich life experience, who want to build long-term connections with patients and settle into their own family lives. They often arrive via a career change from another branch of medicine. Under the current contract, doctors who retrain in a different specialty have their previous NHS work and extra skills recognised by continuing to progress up the pay ladder. But under the new proposals, anyone switching specialties would slide right back down to the bottom. Instead of making two of medicine’s most under-recruited specialties more attractive, the new contract would offer a huge pay cut to the invaluable doctors who consider becoming psychiatrists or GPs more than two years after they qualify.

Related: Junior doctors contract row: an explainer

The new proposals also recommend that maternity leave shouldn’t count towards time-based pay increments. As general practice and psychiatry attract large proportions of women it’s another cheap shot at doctors who want to help mental health patients.

Also unpalatable are the proposals to extend normal hours, for which doctors receive their basic hourly rate, to 7am-10pm on weekdays and Saturdays and to loosen the safeguards that ensure they aren’t overworked. The disturbingly predictable result of this would be that psychiatry and GP trainees, who value the reliability of seeing most of their patients during office hours, would suddenly be scheduled to work many evenings and weekends for almost no extra pay. Not an enticing deal if you have to find and pay for childcare for those hours. Especially when patients sometimes don’t want to see doctors at the weekend anyway.Of course, we do work our share of night shifts. But the proposals will hit us hard there too. Junior psychiatrists can cover large areas when on call, often whole counties, so instead of being based in one particular hospital they wait to be called out from home. Such shifts are termed “non-residential”. Under the new proposals these on-call periods are worthy of as little as just 5% more pay. The typical current rate is an extra 40% of our basic salary. Mental health emergencies that occur at night, including suicide attempts and psychotic crises, are among medicine’s most complex challenges. Such derisory recompense for their careful management is an insult to the patients who need that help.

The implementation of this poisonous contract would be the latest blow to the ever-thinner facade of parity between NHS mental and physical health services, with mental healthcare pushed to breaking point by a lack of beds in some areas on some days . Though the whole NHS would be sorely damaged, mental health services have painfully few reserves to call upon when staff are pressurised so brazenly to leave. The proposals do suggest that “flexible pay premiums, essentially wage subsidies, could be allotted to specialties and individuals disproportionately penalised by the new contract, but mental health is worth far more than such an unsubtle sticking plaster.

We want to attract doctors to the vital and satisfying work of helping people with mental health problems because they can see that those people are as worthy of help as anyone. A contract that is so insultingly meagre will do nothing for that.