Abstract
Two months ago I asked you for advice for new medical students. 1 I’m still seeking it. Are these bright-eyed recruits being sold a career that has lost its magic? Is professionalism as we knew it dead, replaced by miserable clock watching? Medicine has much to be proud of in its evolving embrace of shared decision-making, acceptance of new technologies and willingness to tackle complex challenges posed by our ageing population and multimorbidity.2,3 Yet, when I speak with doctors of all ranks, from professors to junior doctors, whether in hospital specialties or primary care, there isn’t much that feels good. Reports are everywhere of low morale and disillusionment. The reports ring true with each conversation and anecdote. The NHS faces unprecedented financial challenges and spiralling demand for services, the implications of which are an impetus for spending cuts and service innovation. Following the discontent caused by the Health and Social Care Act, a restructuring that the profession largely opposed, instability has become established. People yearn stability. Financial considerations dominate minds that wish to be preoccupied with the health and welfare of patients. Until recent months, these unwelcome priorities primarily affected senior doctors. Now, with a government push for an ‘extended’ 24/7 service, junior doctors feel victimised, bullied into accepting a new contract and threatened with longer working hours for no more pay. 4 There are two central issues. First, whether or not the government is steering the NHS in a sensible direction? It is a complex debate. Is the government responding pragmatically to a crisis in service delivery? Or is there a grand design to dismantle the NHS? Whichever side you choose, the second issue is more straightforward. Any change is difficult, well-nigh impossible to introduce with an unwilling and demoralised workforce. If the government pits itself against consultants, general practitioners and junior doctors, how can the health service deliver satisfactory care to patients on a day-to-day basis, let alone contemplate fundamental reform? There can be no transformation with reconciliation.