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Interview with Dr Sam Pollen for Confessions of a Junior Doctor

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There are over 60,000 junior doctors in our NHS hospitals, from as young as 23, they work in every department, from the corridors of A&E to the operating theatres of surgery. This new series, Confessions of a Junior Doctor, explores the story of the NHS in unprecedented times, told by the junior doctors on the front line. In this interview Dr Sam Pollen discusses his personal experiences working at Northampton General Hospital and gives his personal views on the NHS.

You’ve taken part in a new series, Confessions of a Junior Doctor. What’s it about?

The show is about the current state of the NHS and the daily life of a Junior Doctor, and how those two things influence each other and interact. It’s about the challenges we face, but also the privileges we enjoy, in our career. It’s a difficult career, it’s very taxing, academically and life-wise, but you also get the opportunity to be part of what is often a very important and very scary part of people’s lives. So it’s both a challenge and a privilege.

Why did you decide to take part?

I don’t know. It seemed like a good opportunity – I’m always looking for things to do differently. I have lots of thoughts and opinions about my career and how the NHS is going, and I felt like I could express them pretty well. So I thought “Why not get involved?”

It follows you working in Northampton General Hospital. What was your job when the show was being filmed?

My job at the time was on a ward called Collingtree, it was in adult medicine, specifically gastroenterology, so that’s conditions to do with anywhere from your mouth to your bum.

How did you find the experience of being filmed while you’re working?

It was a little bit odd and intimidating at first – it was weird having someone following you around. And obviously normally when you see a patient, the curtains are drawn and it’s just you and the patient, and you’ve got that privacy. It was interesting how, having two other people in the room, with a camera, affected the way patients interacted with us. It was an interesting dynamic. But I got used to it as it went on, and the team were really nice – it was great working with them. And they were looking to make not only a great documentary, but also they were genuinely curious about how the job works.

How long did they follow you around for?

I think, all in all, it was about three or four months. On and off.

Were there times when it made an already stressful job more stressful?

Definitely. There were times, particularly when we were really understaffed it was often difficult to deal with the cameras being there at that point, but the team said to me “This is what we want to see. You have a very stressful job, we want to show people how stressful it is.”

Describe what life is like for a junior doctor at the moment.

For my job on Collingtree ward, there were usually about three juniors on at a time, and there were 41 patients on that ward, and we often had 20-30 outliers, patients who are under our care but not on the ward, they’d be on the ward next door. So we’d split them among the three of us. You have to see every patient every day, and you have to complete all of the jobs that you’ve generated with those patients – referrals and doing bloods and things like that. So you get in in the morning, have the ward round with the consultant, and the consultant sees every patient. You have to do everything for all of those patients. Often, if it’s a good day, and you’re rattling things off, you can get through things quite quickly. But with the level of understaffing and the sheer volume of patients that we have, and the velocity with which people come in to hospital, you end up, at the end of the day, finding yourself with loads and loads of leftover jobs. If you don’t do those jobs, they’re not going to get done, and your patients suffer as a direct result of that. So you have to stay behind to complete all of those jobs. When it happens a few times, it’s fine, but when it happens every day – having to stay later and later, and you’re not getting paid for the extra hours that you stay at work – it can become very demoralising, and you feel like there’s no end to it.

How many hours a week were you contracted to work, and how many were you working in reality?

On my job in Collingtree, I was paid Monday to Friday, 9 to 5, and then every week you’d also have one on-call shift in the evening, from 5 til 10pm, and every three weekends you’d be working long days on Saturday and Sunday. And when you were working 9to 5, you’d regularly be there until 7:30 or 8pm. That doesn’t seem much when it’s the odd day, but it really stacks up when it’s very frequent.

In the film, you are clearly considering leaving the NHS. Why was that?

A lot of juniors in this country are demoralised with the way medicine’s going, because of the way it’s being run. Medicine is a fantastic career, it’s a great opportunity to be intellectually challenged, to get to work with people, to have a really, really rewarding career. And when you have a good day in medicine, it is fantastic. But with the chromic understaffing and the chronic underfunding, and the major problems within the NHS, medicine may be a fantastic career, but the job is becoming unworkable. It’s difficult in to pursue a career in medicine in this country and have a life outside of that, because of the way the job is structured. When you look at the way the healthcare systems and the infrastructure and the contracts are constructed in other countries, particularly in Australia and New Zealand, the culture is different. They understand work-life balance, they understand that doctors are people, and that as well as wanting to pursue a high-octane, very rewarding and difficult career, doctors also need to have a life outside. If I was a patient, I would want a rewarded, satisfied, fulfilled doctor rather than an overworked, exhausted and demoralised doctor. So for me, it’s a choice between staying in this country and leaving medicine, because I can’t do it here anymore, or do I continue to pursue the career that I love, and have a life outside of that, and be a happier person. So it’s really a question of where can I be happiest? Don’t get me wrong, I think the NHS is the greatest institution this country has seen, it’s fantastic, all of the doctors I know have gone into their career strongly believing in the founding principles of the NHS. Equal healthcare for all, regardless of how much you earn. But what we’re seeing is it being turned into a business. Profit is coming ahead of patients, and it should never be that way round. I’m not sure I can put up with the stresses of the job in this country and work within and support a healthcare system that I don’t morally agree with.

You say junior doctors are hugely demoralised. Can you quantify that in any way?

I believe the current statistic are like this: When you come out of medical school, you do two foundation years, F1 and F2. You have to compete those years if you want to become a doctor. After F2, you choose a specialty. Generally, over the last decade or two, above 75-80 per cent of doctors finishing the foundation programme go on to apply for specialist training in the UK, because the training programmes have always been very prestigious. But with the introduction of the new contract and the general feeling that we aren’t listened to by the government, and are treated as commodities, that number has dropped to just above 50 per cent. The other half are either leaving medicine, leaving the country, or doing an F3 year, working as locums, not on specific contracts, while they save up some money and decide what to do next.

So I’m going to make you Health Secretary now. What are you going to do to improve things?

Oh, thanks very much! I’d tackle the issues at their core. We’ve seen, over the last few years, that the way the government has dealt with the NHS is instead of hiring more frontline staff, and rewarding and encouraging frontline staff, giving us more doctors, more nurses, more physiotherapists, more healthcare assistants, what we’ve done, exponentially and increasingly, is hire bureaucrats, managerial staff and co-ordinators. Those jobs are very important, and the hospital wouldn’t run without them, if you’ve got a boat with eight coxes and one rower, it’s not going to work. We need more feet on the ground. I don’t know whether this is a genuine crisis on the part of the government, or a deliberate act to sabotage the NHS in order to ripen it for privatisation. A lot of people feel that this is being done deliberately, as part of a plan to privatise the NHS. What I would do, and what a lot of us want to do, is fully re-nationalise the NHS, invest in frontline staff, invest in training, and really pump funds where they are needed.

So do you think that, at present, the very existence of the NHS is under threat?

I believe it’s under very real and significant imminent threat. I think if we continue to move at the rate we’re moving, and we don’t fight for what we have, I think within ten years we could not have an NHS anymore. And the scary thing about that is that the NHS has existed for decades now, it’s the envy of the world over, and once we lose it, we won’t get it back. Once we privatise the system, and once this mechanism of profit generation is put into the hands of the private sector, it won’t be renationalised. It’ll go the way the railways went – we’ll see a sharp decline in quality, and a great increase in price. People don’t really realise the full extent of the problem, they think it’ll all be okay, but we’re nearing the point of no return. People will have to start paying for their health care, and they’ll wish they’d done something when they still had a chance. I would say to people, if you care about the population of this country, and you care about your health, and the health of the people around you, fight for the NHS.

Confessions of a Junior Doctor is a four-part series on Wednesdays from 19th April at 9pm.

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