#JuniorDoctors How About we Liberalise Medicine Just a Bit…

I need to be absolutely clear on this, I bloody love doctors. They are awesome! When I was a boy I got a thing called testicular torsion. I won’t bore you with the gruesome details, but what I will say is that it was ****ING painful!! But guess what? One of those wonderful doctor people fixed me right up and now my testicles are all shiny and perfect again…

So it should be quite clear that I don’t want to see doctors mistreated in any way. I hope that they get paid well and don’t have to work arduous hours. I want what they give to society to be rewarded with the good life…

The thing is though, I do feel awfully sorry for Jeremy Hunt. And that’s not just because his name rhymes with runt… Poor Jeremy and a few bureaucrats are in a rather ridiculous position. They have to negotiate the pay and conditions for almost all the doctors in the country.

Just think about that for a second… Jeremy Hunt has to work out a package of pay and conditions that makes almost every doctor in the country happy. Most small companies fail at this and they might only be doing it for 10, 20 or 30 people. Little old Jeremy is set up to fail, it’s an impossible task.

The way doctors’ pay and conditions are negotiated is insane. Imagine some poor sod was responsible for negotiating the pay deals for all the estate agents in the country… And for one reason or another they had to cut their car allowance. No longer could Terry the Estate Agent of Foxtons afford his BMW 1 Series or his Audi A1… What do you think would happen? There’d be cocaine fuelled pandemonium, society would collapse and ISIS would invade…

Thankfully though no one is responsible for setting the wages of all the estate agents, because that would be mental… But here’s the rub, the imaginary estate agent example I’ve provided is exactly what happens with doctors and teachers and various other professions in this country and it’s completely ridiculous. Every so often we have to go through these pandemonium phases because no one can agree what a doctor or a teacher or a nurse should be paid — or the hours they should work. But no one ever asks how a centralised system is meant to agree on this.

So while I do bloody love doctors it would be nice to see just one of them ask for the liberalisation of the medical profession in terms of pay and conditions. How about the #JuniorDoctors ask for all the pay bands and universal contracts to be scraped..? Why don’t they ask that instead of negotiating their wages and hours with one man they negotiate directly with their employer — the hospital or practice they work at.

In this scenario individual doctors could more easily find a deal that suits their needs. Maybe they negotiate less pay for better hours, or even more pay for less sociable hours. They and their employer work it out between themselves — just like the rest of us…

Then poor old Jeremy doesn’t have to be called a Cunt everyday because he has a silly name and a ridiculous job…


  1. As a junior doctor. I would love to see the contracts done more liberally and less centrally. The trouble with the current system is that all our pay, our hours, our jobs, our qualifications, these are all done by a central beuroucracy. So to liberalise the contracts you would have to dismantle the entire career structure of doctors and replace it with something new. And the admin staff in the hospitals are currently in no position to be able to produce contracts and career ladders. So without a huge NHS reshuffle, the hiring of new admin staff and a lot of money moved from the central beuroucracy then this can’t happen.



    1. I don’t doubt that it would be a very difficult thing to achieve. These things always are. However in various ways the NHS seems to be careering towards the buffers and unless we begin applying the brakes and attempt to change track there will be an almighty crash.

      I think changing the way doctors and nurses are hired would be an important first step.



  2. What really irks in all of this is these overpaid doctors harming their customers by striking because they want more money whilst telling them that it is for their own good (the future of the NHS). This is complete hypocrisy- they are striking because they are greedy and are indifferent to patient outcomes.

    They have invested their collective bargaining power into the hands of a union who have picked a political fight with their employer. The threat is that if they don’t like their new contract they can emigrate, however the current market for doctors in places like Australia is not actually as buoyant as you might suppose.

    So kudos to Jeremy Hunt for standing up to them so far and hopefully this conflict will lead to the implosion of the whole sorry project. However my prediction is he will be undermined from above when the going gets tough.

    If the drones in the USSR National Food Service had told Stalin that they wanted to decide for themselves when they worked, and at what rate of pay, they would have been off to the gulags in pretty short time. Not an option for Hunt, unfortunately….



    1. The locum market is one indicator that points to a supply/demand mismatch, so is the number of empty slots on non consultant grade rotas.

      Some conservatives find this difficult however and advocate some kind of central action on locums. Such commentators reveal themselves to be fascists rather than true believers in free markets.



  3. Excellent analysis in this post.

    I would add for completeness that it doesn’t matter if doctors are ‘liked’, only that their individual market value is efficiently and dynamically determined.

    Descriptive values of worth are the currency that arises when government is involved as a substitute for supply, demand, pay, conditions, productivity etc. Ken Ferguson is using such language above, thus missing the point of the original article.



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