‘I’ve had days when my soul has been broken, my resilience wrenched, crying at times like a child,’ says Dr Anita Raja, describing the way her job as a GP has made her feel. You might assume she’s referring to her time working on the frontline during the pandemic. In fact, she’s talking about now; a period NHS England’s chief executive Amanda Pritchard warns is an even tougher challenge for the health service than when Covid first struck.
‘I have had days when I’ve seen patients who’ve been waiting weeks to be seen, accumulating a list of problems they would like to discuss in a 10-minute consultation,’ says Raja. ‘Many times I have had to deal with seven or eight problems in that time slot, leaving me broken, as now I am running late and will be faced with numerous unhappy patients.’
For evidence of the crisis, look no further than the statistics: 7.6 million people are now on NHS waiting lists in England, a record-breaking figure. About one in 20 of those on a waiting list in England in June were not receiving treatment for at least 52 weeks and, in April, it was reported that one in 10 are having to wait more than 12 hours at A&E before being seen. NHS staff speak of overwhelming pressure, with almost half of doctors saying that their mental health is worse now than during the pandemic.
Additionally, everyone from consultants and junior doctors to nurses and dental trainees have taken to the picket line to strike, with Professor Sir Stephen Powis, national medical director of NHS England, warning in July that strikes were the toughest in its history – junior doctor strikes are the longest on record.
‘When I started this job, I think I said the pandemic would be the hardest thing any of us ever had to do,’ Pritchard says. ‘Over the last year I’ve become really clear... it’s the months and years ahead that will bring the most complex challenges.’
The strike action is designed to send an urgent message to the Government: pay NHS staff fairly to improve working conditions and maybe the system won’t crumble. Will they be heard? PM Rishi Sunak said in July that there would be no more negotiations on the pay offer put forward earlier this year – which for junior doctors ranges between a rise of 8.1% and 10.3%. (To achieve pay equivalent to 2008 levels, junior doctors would need a 35% pay rise when accounting for inflation.)
In February, nurses in England were offered a 5% pay rise and cash sum of £1,400-a-head, which the Royal College of Nursing (RCN) rejected since inflation has regularly been over 10% during the last year. Both the Labour administration in Wales and SNP Government in Scotland have offered NHS staff much more by comparison. Across the rest of the NHS, the Government announced a 6% pay rise for consultants, GPs and dentists in July. Again, falling far below inflation.
For Raja, the future of the NHS is in jeopardy if the Government does not cooperate with striking staff. ‘There’s a lot
of unaccounted for work and overtime that you put in out of goodwill, and the NHS has relied on that for years, but that goodwill is running out,’ she says. ‘Not just for GPs but for all doctors, nurses and healthcare professionals, who would never have even thought to negotiate their pay 10 years ago. Now, pay is so poor and Government contracts for practices don’t fully cover basic rent and bills for the facility as well as salaries for staff. Nurses are using food banks, and practices are closing down because the running costs are not viable.’
The mass exodus of healthcare staff speaks for itself. In 2022, 1,000 doctors left for Australia alone, and 33% of UK qualified doctors are currently not working in the UK. In the year to March, 12.9% of GPs under 35 quit, the highest rate on record. A survey by the Royal College of GPs last year found that 43% of GPs leaving the profession cited burnout or work- related stress as a factor in their decision.
‘A typical day for me as a GP has changed quite significantly in the past 10 years,’ Raja says. ‘Patient expectations, service demand and population size have increased, yet the number of GPs has reduced by 2,000.’ She goes on, ‘On average we work from 8am to 8pm, seeing 60 to 100 patients per day, which is far more than the safe number.’
For Dr Rumbi Mutenga, a junior doctor who spent the last year working in A&E before deciding to start GP training in August, the challenges the NHS faces now are also largely due to the backlog that was created during the pandemic.
‘At the start of Covid, a lot of additional workforce came in,’ she says. ‘Medical students graduated early to enter the workforce, retired doctors and nurses returned, there were so many extra bodies compared to now. Then when you factor in the appointments that were paused, we now have a backlog. At the same time, the NHS is haemorrhaging medics, and so of course waiting lists are getting longer.’
She recalls stressful shifts working in A&E where patients would be waiting up to eight hours, only for her to spend seven minutes explaining a blood test result before discharging them. ‘It can be very, very frustrating for patients,’ she says. ‘In the worst situations, people are waiting 12 hours to see a doctor in A&E.’
Raja is eager to make one thing clear about the waiting lists, though: the strikes are not the cause. ‘Appointments are cancelled daily due to a lack of doctors, hospital beds and resources,’ she says. ‘Doctors are fighting now because they want to save the NHS. They’re frustrated seeing their patients die in the backs of ambulances because there aren’t enough beds in A&E; that 500 to 1,000 people are dying every week because they can’t access care. They’re scared at how bleak everything has become. These days, I worry the NHS won’t even be here in the next 10 years without change.’
How to help striking workers
■ Write to your MP to demand fair pay. Trade union Unison has a template you can use.
■ Shout about the strikes on social media and use trending hashtags to increase visibility: #NHSStrikeNow #PutNHSPayRight.
■ Honk your horn when you spot an NHS picket line, or call into radio shows discussing the strikes to voice your solidarity.