Author: Nicholas Jephson
Co-Authors ⁄ Presenters: Hugh Cook, Andy Charlwood
“We’re knackered and fed up”: attitudes towards work and trade union membership of junior NHS doctors following the disputed imposition of a new contract
During the well-publicised strike action by junior doctors in the National Health Service (NHS) from December 2015-April 2016, it was claimed by trainee doctors’ groups that junior doctor morale was “desperately low with high levels of anxiety, stress and burnout”. Despite extensive action from the doctor’s trade union and professional association, the British Medical Association (BMA), the new contract for junior doctors was imposed by the Secretary of State for Health in July 2016 (Rimmer, 2017).
This paper discusses data from an ongoing longitudinal study of junior doctor morale and attitudes towards the doctor’s trade union. Twenty-five interviews were conducted with junior doctors during the period of industrial unrest November 2015-June 2016. Fifteen follow-up interviews were conducted from the same sample after the imposition of the new contract in September 2016, to gain a deeper understanding of how attitudes towards the work and trade union membership of junior doctors had changed since the imposition of the new contract.
Findings from analysis of interview data yielded initial resistance but ultimately resenting acceptance of the terms and conditions of the new contract. Data also produced concerning predictions regarding the future of NHS medicine. Interviewees highlighted key tensions between the normative occupational values of junior doctors and their work requirements under the new contract, and emphasized how anxiety around doctors’ decisions to withdraw labour were ultimately a principal factor in halting strike action in September 2016. These findings contribute to non-manual labour process debates by highlighting how workers are complicit in their own subordination through managerial and public evocations of the ‘values’ of NHS workers (Warhurst and Thompson, 1998), in this case principally surrounding patient safety. Further findings uncovered the degradation not only of junior doctors’ employment contracts, but of NHS medicine as a prestigious or even worthwhile career. Many interviewees possessed an openness or even willingness to relocate overseas to practice medicine in a more congenial climate, which raises alarming concerns about future recruitment and retention problems for junior doctors in the National Health Service.
This paper contributes to labour process theory by offering a distinctive and contemporary re-telling of the labour process for junior NHS doctors, during a time of fierce discord with the ruling British government. It illustrates the degradation of work for NHS doctors in England in their own words. In exploring the working lives of junior doctors pre and post-imposition of the new contract, this paper offers insight into the effects of coercive control over the working conditions of public sector health professionals, and illuminates wider concerns about the point at which this degradation might result in major structural changes to the National Health Service.
References
Rimmer, A. 2017. “The impact of the junior doctor contract – a year on” The British Medical Journal , 9th September.