Excellent healthcare has clinical research pulsing in its veins

The junior doctor contract not only deters the lab work that leads to breakthroughs, it threatens quality of care, argues Amitava Banerjee

April 28, 2016
Scott Jessop illustration (28 April 2016)
Source: Scott Jessop

What do the Human Genome Project, in vitro fertilisation and the discovery of the link between smoking and lung cancer have in common?

The answer is that all these medical breakthroughs were led by UK-based clinician scientists: doctors who combine seeing patients with research.

This matters to patients because high-quality healthcare has cutting-edge biomedical research pulsing through its veins. Jeremy Farrar, director of the Wellcome Trust, wrote in The Daily Telegraph last year that “working as a doctor made me a better researcher. But working as a researcher made me a better doctor, too.” Sir Bruce Keogh, medical director of NHS England, said in his 2013 Review into the Quality of Care and Treatment Provided by 14 Hospital Trusts in England that “the best treatment is delivered by those clinicians who are engaged in research and innovation”. And the 2013 Francis Inquiry into serious failings in care at Mid Staffordshire NHS Foundation Trust also highlighted that research alongside clinical care saves lives.

Patient safety is at the heart of the dispute between the UK government and junior doctors, who were due at the time of going to press to conduct two all-out strikes earlier this week. Jeremy Hunt, the health secretary, is imposing a contract on the basis of misinterpreted evidence of a “weekend effect”, whereby patient mortality is supposedly higher on Saturdays and Sundays. Junior doctors maintain that patient safety will be compromised by spreading overstretched five-day resources over seven days without more funding. The Department of Health revealed last month that it does not know how much seven-day services will cost. Better research into issues such as staffing levels and service needs would make implementation of any contract easier. Data save lives, time and resources and turn otherwise opinion-based policy into evidence-based policy.

As junior doctors’ morale hits its lowest-ever ebb, staff recruitment and retention threaten the short- and long-term future of medical research. Of the country’s 54,000 junior doctors, at least 2,000 are in academic posts at any one time, and the majority pursue research at some point during their training. They are the lifeblood of both clinical and academic medicine.

The benefits of UK clinical research extend far beyond NHS patients, leading to economic gains in the pharmaceutical, technology and university sectors, and to improved treatments in the developing world for malaria, tuberculosis and HIV. The new junior contract directly deters research because those doctors who take time out of training to pursue it will not receive the same pay progression as their clinical colleagues. The pay premiums proposed for “agreed research” in restricted disciplines will be available only to those who obtain their own research and salary funding and write up their results for a research degree. Given uncertain academic clinical career trajectories, this will result in a lack of security for academic trainees – especially part-time ones – and may result in their not being valued as much as their clinical counterparts, making recruitment to clinical research challenging.

There are also indirect deterrents for would-be clinical academics, including perceived gender bias and hierarchy in the career structure, rising tuition fees for further degrees, lack of geographical flexibility in terms of where they carry out the research and a shortage of properly supported research posts on completion of training.

The privilege of my job is to help people with heart problems in clinic by applying the latest research, while taking the questions thrown up by my clinical work back to my research. Two things keep me in touch with the passion and innovation of my junior colleagues. First, I teach medical students and junior doctors. Second, I interview applicants for medical school. The message from potential applicants, those currently at medical school and those who have already graduated, is that a career in medicine, particularly research, is getting harder and less attractive.

Junior doctors are not stupid and they will not stay for a contract that needs to be imposed. To add insult to injury, a discriminatory equality impact assessment recently showed the 60 per cent of medical students and junior doctors who are women that the government does not value them, saying that the new contract would “impact disproportionately” on them, but that this was a “proportionate means of achieving a legitimate aim”. How will future medical female academic leaders such as Dame Sally Davies, the chief medical officer for England, and Jane Dacre, president of the Royal College of Physicians, be produced?

In 2006, the US Institute of Medicine devised the concept of “learning health systems”, according to which healthcare, education and training are continuously informed and improved by research. Sadly, healthcare and research in the UK are diverging rather than converging. If we want the latest drugs, diagnostics and trials to be in the UK, then the infrastructure and the manpower to do research has to be preserved, with coordination across the health, education and finance sectors. The alternative is that patient safety and quality of care suffers.

Amitava Banerjee is senior clinical lecturer and honorary consultant cardiologist at the Farr Institute of Health Informatics Research, University College London.

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