I'll preface this by apologising for the hastily written comment, I'm sitting in my office doing some dreary admin!
All I can say is that I'm glad I took a training post in Wales.
Many friends and colleagues aren't applying for post-grad training posts because of this debacle. It's estimated that 50% of FY2 docs are holding out applying for core medical and surgical training for this application window (I'll dig out the source later). A surprising amount are taking their certificates of good standing to work abroad. The constant financial constraints and increasing work load in front-line services (general practice and emergency care) is driving them to retirement or abroad. Doesn't take a genius to realise that a further reduction in staff is going to cause even more problems.
The contract is problematic in a few key areas. The most important that safeguards to ensure that we don’t work idiotic hours was changed and monitoring devolved to NHS trusts who are well known to abuse junior staff and play with the numbers. It just doesn't work when the government want to increase access to routine secondary care to seven days a week with less doctors working the same amount of hours. I’m only contracted to work 48 hours a week, and yet I routinely work over 60 with no overtime pay. Again, you don't need to have a degree in astrophysics to see the problem, tired doctors=mistakes. Mistakes=patients harmed.
Secondly, most docs would be taking a significant pay hit in the region of 20-30%. It’s problematic because most of us come out of uni with around £30-40000 in student debt, only to have to pay indemnity insurance, membership and examination fees which are in the thousands. When I personally calculated the new contract on my salary, I’d lose 35% of my pay because of the change in banding.
With that and the near unanimous unhappiness with the new contract, it's pretty clear where doctors stand on the issue. What does it mean for the NHS? Difficult to say. I’d like to think that someone in the government recognises the amazing job that all staff in the NHS provide (not just docs) and they start to treat it like the vital service that it is. Ultimately, it’ll be difficult for the NHS to be dismantled completely, but I could foresee a scenario where routine care is privatized. When compared globally, the NHS consistently is rated one of the best in providing healthcare. Clearly, the answer to the NHS providing world class care is to defund and strangle it to failure…