I Want Doctors Talking About Their Hopes, Fears and Working Lives

[box]Last week, we interviewed Johann Malawana, Chair of the BMA Junior Doctors’ Committee and founder of TMS. By Rob Cleaver and Helena Angel-Scott[/box]

BMA junior doctors committe chair Johann Malawana. Portrait, neutral

Back in 2004, the then president of Barts and the London Student Union founded a newspaper with London Medgroup. The aim was to make students at the five London medical schools aware of the issues, political, educational and social, that most concerned them. That newspaper was The Medical Student and that student union president was Johann Malawana.

Eleven years later, he is a registrar in Obstetrics and Gynaecology and recently took up the position of Chair of the Junior Doctors’ Committee at the BMA; the lead representative of over 50,000 UK junior doctors. In the wake of recommendations made by the DDRB and the Department of Health, he took up the role in order to deliver a safe and fair contract for all of those doctors and for the students that will take up the baton in the years to come.

We met Johann at BMA House to ask him about why we must keep fighting for a fairer, safer contract, what the Government can do to encourage reopening of discussions and what we as medical students can do to further the cause.

What would be the logistics of a junior doctors’ strike?

We are in the middle of ballot action; we will have a result of the ballot on the 19th after it closes on the 18th so we will await what the membership wants to do. If it is a positive “yes yes” ballot then the ultimate decision rests with the council of the BMA, its highest body. It’s very hard to say at this stage what we will do but more information will follow in the days and weeks to come*. We’re trying hard to put information out as fast as possible, which is what medical students and junior doctors want, but we are constrained within legal frameworks.

So plans are being made behind the scenes?

There’s a lot going on behind the scenes. The legislation is such that you have to jump through hoops. The system is set up so that at any stage you can make a mistake and an injunction can be brought against the union. You have to make sure you’ve jumped through the hoops before you proceed with any action.

Is there anything that the government could do to reopen discussions with the BMA?

We’ve been really clear throughout. My job isn’t to deliver strike action, it is to deliver a safe and fair contract. That’s the job of the junior doctors committee and the BMA. What we need to do is see a government that is actually willing to engage in meaningful conversation where they don’t impose a contract and are actively trying to have a framework for that contract that is both safe and fair.

If a strike goes ahead are we impacting patient safety, if only for a brief amount of time?

The question is whether the contract outlined in the proposals itself has an impact on safety. The equivalent is it is like a cancer, if you have a cancer and don’t do anything it gets worse and worse and worse whereas if you do something about it, in the short term the surgery is traumatic to the individual but in the long term it is preventative. Strike action in this scenario would be very similar. We’ve been backed into a corner and have very few options left. If we do this, we will do this because we have no other options left, the government is imposing a contract that is unsafe and unfair.

How can medical students get involved with the strike if it goes ahead?

The most important thing to do as a student is to follow the guidance of the medical school. Being an employed doctor you benefit from the protection that legislation affords and the protection that being a member of the union affords. Students aren’t employed and don’t benefit from protections. Depending on what happens with action, I wouldn’t want an individual student to jeopardise their future. In the same way that a doctor with visa implications may, as a result of industrial action, have a detrimental effect on their visa and not just their employment.  The advice I would give to students is, if it has any impact on their education I would want them to protect that first. There’s no point doing all this if it jeopardises their future. In the same way, I think medical schools need to be realistic about this, honest about this, and not scare their students into not doing things that they can do. Of the student groups that I’ve met with, I think students need to focus all their energies not on fighting the medical school but on getting the message out there to the public.

Frankly, I’ve only got a few years left and that’s it my training is done. This contract doesn’t massively affect me as much as it affects medical students. We’ve been clear from the off that we’re not willing to trade one generation off against another. Many of the proposals that we are completely opposed to are where the government are effectively trying to buy off doctors like me to sell out doctors like you and we don’t think that is acceptable. If you make it completely untenable to anyone below ST3 then it impacts how we deliver care because you guys will be my junior doctors one day and if it is impossible for you to do your job it has an impact on me in a selfish way. We don’t think that is an acceptable route to take.

Do you think that the situation will impact the number of applicants to medical school?

I honestly don’t know. The real impact I think will be how many people apply for specialty training this year — that will be the first impact. There is a degree about realism about this. It is easy for us to say something that might be construed as scaremongering and saying that applications will decrease. Being a doctor is a fantastic job. My job is delivering babies. It’s an amazing job. It’s not an easy job but it is incredibly personally rewarding and I feel like I’ve done something useful with my life. At the same time we are talking about a job that is difficult and stressful. Would I recommend a career in medicine? Of course I would because you don’t go into medicine for financial reasons. However, “going to medical school” and “working for the NHS under this system” are two very different things and these applicants will have to make decisions. We need to, as a profession, understand that it isn’t just about sticks, it is also about carrots; we have very intelligent and talented people and sometimes to get the best out of them you have to value and reward them.

The pay protection offer that is currently on the table, obviously that doesn’t apply to students who haven’t signed a contract yet…

It doesn’t even apply to half the doctors on the system too.

Yes, and it is definitely something talked about at medical school, as final years we feel a frustration that we can’t be as involved as we want to be despite the fact that we’ll be signing the contract too. We feel that maybe we’ll be unfairly disadvantaged.

I think you will be. I think you will be. Under the proposals outlined, they want to save money on the long term staff bill. That means, compared to the salaries and conditions we enjoyed, you will be disadvantaged in real and in relative terms. That’s the main thrust of what we are saying. It would be easy to negotiate a contract that is effectively just protecting current employees but i’ve been clear through the process that the JDC is not going to trade one generation off against another.

If a strike does go ahead. How will this impact on public relations?

We are concerned obviously with how the profession is perceived, that is an important factor, but we must recognise that if we are in a situation where the government carry on as they are, we will have a bigger problem with how we deliver safe patient care in this country. We have to be clear that the reason for why we are doing this is because we are trying to prevent a bigger problem facing the public and part of our job is to get that out, your job, doctors and medical students have a responsibility to get that out to the public.

What is the most effective way of getting the public on our side?

There’s a lot of doctors out there who are engaging the public, the meet the doctors campaign, the grassroots campaign, they’ve been fantastic at keeping the issue in the news permanently since the BMA ended discussions. We, doctors and medical students need to get out there, talk to friends and family and anyone who will listen and explain to them the reality of the situation. As the campaign has shifted from large protests over into the educating the public phase we’ve found that there’s a lot of support out there from the public because once you get past the media and the papers, people actually do see the reality of what doctors face.

Regarding the media, do doctors and students benefit from basic media training to ensure they stay on message?

What i’ve seen largely of doctors in the media is them talking from the heart – i don’t want doctors being polished publicists, I want them talking about their fears, hopes, aspirations and working lives. One of the key criticisms levelled at the BMA is that we’ve whipped up all the anger and forced doctors into making these decisions. I don’t have magical powers, I can’t actually convince 50,000 people to do something that they don’t believe in and one of the things I need to get across to the government that these are very intelligent people who are interested in the details and their analysis has shown that actually that they are supportive of the BMA because they reflect their own views on the contract.

What is the situation with the Royal Colleges and their royal charter? Is there anything that you can add?

In general, there’s nothing much I would add that isn’t already out there. The secretary of state has invited the colleges in for a chat and have reported their experiences publicly. Junior and senior doctors would hope the colleges would reflect the views of their members.


An unhappy doctor doesn’t make a good doctor, they just make a body filling a rota.


Do you think that certain specialties will be impacted in particular?

Any contract that has advantages and disadvantages will inevitably have an impact on how people make decisions. If it makes it untenable for doctors in certain circumstances of course there are going to be disparities between specialties.

A&E is popular with students but is unpopular at specialty levels because it is perceived as being almost impossible. As well as this more students are considering applying to Scotland and Northern Ireland to avoid the new contract. What do you think about this?

That reflects what students are saying to me up and down the country.

I want doctors to stay working in the NHS, anyone with a medical degree has choices to make. It would be impossible to continue if we see an exodus of doctors out of the NHS but I think people need to make realistic choices for themselves. If my job was untenable, then there are things in my life more important than my career and I would always put those first. I want young doctors to make decisions that are best for them. An unhappy doctor doesn’t make a good doctor, they just make a body filling a rota.

Do you feel that the media are a barrier to the truth?

Any form of media has an editorial line. Individual reporters that I’ve met have always been professional and nice. I’ve no personal issues. I believe some papers have an editorial line purely because that’s the opinion they’ve always had. Even the ones that aren’t the most supportive of the BMA or me personally have also published stories about junior doctors that have been very positive. I think that says something about junior doctors’ standing in society that papers that have an allegiance to a government or specific minister have been publishing stories that show that there is a problem and I think it is a shame that he [Jeremy Hunt] refuses to take that information on board.

Do you think that personal attacks on the figureheads of the movement will increase in prevalence in the press?

I’m sure they will. I’m sure they will. I was very aware when I took this job that I would be a target and would expect a lot of mud to be thrown at me. I had a view and a goal that I wanted to achieve and I’ve never shied away from sharing my view. I was very aware it would turn personal because if we are successful then this will be a massive change to a line of policy that a majority government with no electoral pressure or procedure to block them will have changed the course of their action. We have to be honest, it is a fundamentally difficult and different fight to have because the government has a lot of constitutional power. I was under no delusions about what the job would involve but that’s no reason to shy away from the fight.

Jeremy Hunt has consistently used the argument that there is increased mortality rates on the weekend. Is there any way we can offer the counter argument.

Obviously already he has been shown to misunderstand and misrepresent figures. I think we will see more of that over the coming weeks that people will see more holes in the arguments and I think it will be spoken about more liberally. A lot of the information is already out there and students will do as students always do; look at the information and evaluate it.

The OECD said we need 27,000 doctors and Christopher Smallwood from St. George’s Hospital Trust said we need a large increase in available funding, if we are successful do you think this sets a precedent for reforms within the NHS being driven more by clinical staff?

The junior doctors and BMA are not barriers to reform, let’s be clear. I want to solve the problems I see on a day to day basis to make the NHS more responsive to the needs of both patients and staff. We can’t make reform at the expense of the staff themselves though. The government needs to understand what the problems with the NHS are but it doesn’t seem to be able to. The problem is not to do with staff and the government has picked a fight that we needn’t have had and isn’t one that the medical profession ever wanted. The Secretary of State decided this is what he wanted to do and unfortunately the result could be relatively catastrophic. As a profession we need to realise that whatever happens we will be the doctors that deliver care in the NHS and that we will always be there for our patients.

Ultimately, it would be far more damaging to allow the government to make the environment unworkable and that is what we must try to avoid.

Do you think, personally, that privatisation is in the future for the NHS?

If the government has a view that it wishes to take the NHS in a direction that isn’t the one that the public agree with then it is up to us as a society rather than us as a profession to express that view on those plans. My overriding concern currently is to deliver a safe contract for our junior doctors but by having an empowered group of doctors we can avoid unwanted remodelling of the NHS going forward. Empowered doctors can stand up for the NHS, their jobs and their working lives and have an environment that provides the safest possible care for our patients.

Johann was speaking to Editor-in-Chief Rob Cleaver and Education Editor Helena Angel-Scott on 11th November at BMA House.

*Since the interview the dates of proposed strike action have been outlined as three potential days of industrial action on the 1st, 8th and 16th December.

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