I've proved you can stop junior doctors quitting the NHS... and it isn't about money, writes PROFESSOR ROB GALLOWAY
Unless there is a dramatic change of events, this Thursday will be the start of the 11th round of junior doctor strikes.
The lack of resolution is damaging for all and there seems no end in sight; indeed, the resolve of the junior doctors is hardening — with 98 per cent backing further strikes in the latest ballot.
Yes, the strikes are about pay. But it's also about conditions — you only have to note the endless stories of junior doctors heading off for 'better lives' in Australia to see this.
And as well as resolving the issues of pay, what will also make a real difference is the way junior doctors are rostered.
I know this because in my hospital in Brighton, junior doctors aren't leaving to move overseas — they're joining us.
![Professor Rob Galloway (pictured) argues that the way to resolve the junior doctor strikes is through a more flexible rota system](https://i.dailymail.co.uk/1s/2024/06/25/01/86521495-13565419-image-a-74_1719274296439.jpg)
Professor Rob Galloway (pictured) argues that the way to resolve the junior doctor strikes is through a more flexible rota system
![The resolve of the junior doctors is hardening ¿ with 98 per cent backing further strikes in the latest ballot (stock picture)](https://i.dailymail.co.uk/1s/2024/06/25/01/86521637-13565419-image-a-76_1719274345474.jpg)
The resolve of the junior doctors is hardening — with 98 per cent backing further strikes in the latest ballot (stock picture)
![Junior Doctors attend their picket line at St Thomas' Hospital in Westminster on February 26, 2024](https://i.dailymail.co.uk/1s/2024/06/25/01/82694095-13565419-Junior_Doctors_attend_their_picket_line_at_St_Thomas_Hospital_in-a-75_1719274303536.jpg)
Junior Doctors attend their picket line at St Thomas' Hospital in Westminster on February 26, 2024
We are not paying them more, we can't, that's a national decision. And this is not about giving them special treatment over providing the best possible patient care.
It's about our rota system — bear with me, this is not an HR lesson but something that makes a difference to patients.
Currently, junior doctors are often not told where they will be working until a few weeks before they start the job. And even then they're often treated as rota 'fodder', put on rolling rotas of endless weekends and nights, with no thought for the needs of their own lives.
This is what happened to me as a junior, missing one of my best friend's wedding. Boo-hoo, you might say.
But I know of junior doctors who've been rostered to work the night of their wedding day, or being unable to take holiday with their children during the school holidays — instead being told to organise their own swaps with a colleague, if they can find one to do this.
This is not an urban myth, but a reality of an unacceptable way of managing staff. These highly trained junior doctors often leave medicine in its entirety or work as a doctor abroad.
The upshot is patients suffer, the doctors suffer, and billions are wasted in agency fees.
In my hospital we have developed a new way of managing our staff which is transformational.
![Student doctors in their training go round the wards at a teaching hospital](https://i.dailymail.co.uk/1s/2024/06/25/01/86521639-13565419-image-a-77_1719274353410.jpg)
Student doctors in their training go round the wards at a teaching hospital
![Junior doctors committee members who are in dispute with the government over salary arrangements carried out their 10th strike in a year on February 26](https://i.dailymail.co.uk/1s/2024/06/25/01/82694043-13565419-he_British_Medical_Association_s_BMA_jJwith_the_government_over_-a-78_1719274360838.jpg)
Junior doctors committee members who are in dispute with the government over salary arrangements carried out their 10th strike in a year on February 26
The number of hours each doctor needs to work in each rotation (junior doctors often do four to 12 months in a specific area such as A&E, before rotating to another specialty) is calculated — and then they work those hours across that rotation.
They can choose when they will not work before the rota is made.
With the rota compiled eight weeks before they start their job, it means they need to be organised in planning their leave, but then they have the work-life balance they want.
As long as we can cover the needed shifts, they are allowed to be off when they want to be. And if requests were made after the rotas were compiled, the rota teams are there to help as needed.
After we introduced this scheme in 2016, we had one junior doctor who only did every other weekend and occasional full weeks because of childcare commitments.
Without our flexible rota, she would have left the NHS. But she did a part-time job — knowing the hours she was committed to — for three years, before continuing with her formal training. She now works as a GP.
Many others — who would normally have left the NHS and worked as an agency doctor — stayed working for us for an average 18 hours a week.
They could go off travelling for a few months and then come back full-time for a few months, all within their contracted hours.
All this is just common sense. But the main barrier to implementation of these ideas was that the standard NHS rota system, which most hospitals use, is not designed for this degree of flexibility.
So when I was managing our departmental rotas, I ignored the rules and collaborated with an independent group of computer geniuses who set up a new system called healthrota.
The system, using algorithms, plus sensible thinking, helped create rotas which worked for staff — and patients — and with fewer gaps in cover, so reducing expensive locum costs.
![Junior doctors hold placards as they stand at a picket line outside St Thomas' Hospital in Westminster in London, Monday, March 13, 2023](https://i.dailymail.co.uk/1s/2024/06/25/01/82693157-13565419-Junior_doctors_hold_placards_as_they_stand_at_a_picket_line_outs-a-79_1719274364936.jpg)
Junior doctors hold placards as they stand at a picket line outside St Thomas' Hospital in Westminster in London, Monday, March 13, 2023
![In April, the chief executive of the NHS, Amanda Pritchard, wrote to hospital leaders saying that they need to 'improve rota management'](https://i.dailymail.co.uk/1s/2024/06/25/01/86521541-13565419-image-a-73_1719274292096.jpg)
In April, the chief executive of the NHS, Amanda Pritchard, wrote to hospital leaders saying that they need to 'improve rota management'
We then went on to roll this out to all doctors at the trust where I work — this system has now won multiple awards, had scientific papers showing its effectiveness and been shown off as a vanguard of good practice by the NHS.
In April, the chief executive of the NHS, Amanda Pritchard, wrote to hospital leaders saying that they need to: 'improve rota management by exploring the opportunities technology offers to move towards greater self-rostering, so doctors have greater control over their lives while meeting the needs of the service'.
But the bad news is that most hospitals are not adopting this new way of working.
And the NHS team which, over the past few years, has been helping hospitals adopt new ways of rostering staff was disbanded last year.
Unless this is sorted, even if the pay dispute is resolved, I don't think we will solve our junior doctor crisis. And yet again, ultimately it's patients who will lose out.