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Dr Mathew Stone is on strike. He is one of around two dozen people stood holding placards in the cold drizzle waving at tooting horns from the adjacent road. The conversation between this small group of doctors skips between two topics: the contract and Australia. As they speak through scarves and hoods, the temperature across the coast of New South Wales creeps over 20°C, there is a 0% chance of rain. Dr Stone has a plane ticket to Sydney leaving in three weeks.

Lewisham University Hospital is not an attractive building. Dr Stone silhouettes it’s industrial edges as the steam dances from his white polystyrene cup. It begins to rain and he reaches into the pocket of his high-vis and pulls out a woolly hat. He stands sombrely for a moment sipping his tea, a passer-by asks him what the strike is about and he tries to explain the situation.

The union who represent British doctors, the British Medical Association (BMA), have been in contract negotiations over patient safety and pay with the Government since 2014. Over 20,000 people marched in support of the junior doctors on 17 October last year following a complete breakdown in communications. Since then an agreement has almost been reached with the help of conciliation service Acas. Both sides have given ground but the BMA insists that Saturday must stay regarded as “unsociable hours”. On 9 February, the government denied rumours that Jeremy Hunt had walked away from a pay neutral deal, the day before this strike.

This isn’t the first time Dr Stone has been on a roadside protest against the actions of Jeremy Hunt. In October 2013, following a yearlong clash with local campaigners and hospital staff, the Court of Appeal ruled that the Health Secretary did not have power to implement cuts that would result in the closure of Lewisham A&E.

“I just feel like we’re in an ongoing battle with the Government to keep the NHS going. First they tried to close the A&E. Now they’re trying to tell me 5pm on a Saturday is the same as 9am on a Tuesday! I just don’t buy it. Originally they were happy for us to be working seven nights on the trot. It’s just not right.”

Dr Stone leaves for Australia in three weeks. He is coming back. This time. His trip will take him from Sydney up to Newcastle and finally back down to Canberra. He’s clearly excited about his holiday but he says there’s some work mixed in with the play. He and his partner, who is also a doctor, are going to make contacts and look at areas they might consider living.

He is not alone. When negotiations broke down in September last year Kwiksurveys conducted a poll for The Guardian asking members of the closed Facebook group junior doctors contract forum “If this new contract proposal goes through for August 2016, would you as a doctor leave the NHS?”  Of the 4,129 respondents,  42% said they would leave to work abroad notably in Australia or New Zealand. Another 17.7% said they would leave the NHS and change career, and 11% said they would leave to work privately as a locum doctor.

Johann Malawana is the chair of BMA junior doctors committee. He was tweeting from the Royal London Hospital picket line:

Admittedly, it is far easier to tick a box in an online survey than it is to actually leave for the other side of the world. But figures compiled by Health Education England, the NHS medical training and education body, have revealed significant drops in the number of young doctors applying for training in medical specialities. After medical school all doctors have to complete two Foundation Years to be fully qualified. This new data shows that the number of Foundation Year 2 doctors who have applied to start training as a specialist in the NHS next August has fallen to just 15,855, a drop of over nine per cent since 2013.

The number of Foundation Year 2 doctors seeking to become family doctors has also fallen significantly. Only 4,863 have applied to train as GPs starting this August, 25 per cent fewer than the 6,447 who did so in 2013.

Also huddled in the group is Dr Mary Hynes. She came back from Australia three years ago in order to be closer to her ageing parents. But she is very clear about what it’s like working there:

“The pay and working conditions are far better. When you’re on shift people are always like; ‘Have you had a break?’ Have you had a break?’ It couldn’t be more different here. People think it’s competitive but they’re so desperate for doctors. Hospitals in Newcastle are paying agencies $10,000 for an immediate start.”

Mr Hunt has argued the new contract is necessary to create the so-called “seven-day NHS” outlined in the Conservative manifesto. However critics claim that the number of junior doctors needs to increase since many feel they are already spread too thin.

Dr Stone says he doesn’t want to leave the NHS, but feels like he is being given little choice. He talks of what he feels is a systematic effort to dismantle the system pointing to recent examples such as the privatisation of sexual health services in London.

“Everyone dreams of working in the NHS, very few people want to be private doctors. The pay and conditions might be glamorous but it’s not what it’s about. That’s not why I did this.”

“I feel guilty about even the idea of leaving, but to be honest, I’m not sure they’ll be much of an NHS left to stay for in a few years.”

This statement is greeted by a grave hum of consensus. As the rain continues puddles form and the picket line begins to thin out. The junior doctors have made a rota for people to stay until 9pm in the evening, still social hours under the new contract. The hospital’s hideous ultra-modern photovoltaic panels installed during the developments in 2007 will have generated very few kilowatts today.

Subedited by: David Gregg

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