Review on morale


The Chair of the Academy of Medical Royal Colleges has been commissioned to review the morale and wellbeing of junior doctors. Whilst we are pleased that the morale of NHS staff is now receiving attention we have some concerns and offer potential solutions.

The Health Secretary announced this review shortly after he imposed a contract on doctors in training. We agree that a review into the morale of NHS employees is overdue but conducting it while junior doctors remain in dispute with employers may well result in erroneous conclusions.

The terms of reference of the review specifically exclude matters of pay or terms and conditions of the service for junior doctors. We fear this leaves the review unable to examine arguably the most significant cause of loss of morale, the imposition of a poor contract. In September 2015 the Group of Anaesthetists in Training and 9 other trainee committees – in total representing over 9000 trainees – commented on the effect of contract imposition. That statement observed

positive morale in NHS staff translates into excellent care. A poorly thought out enforced contract will lead to irreparable harm to morale within the NHS workforce, an increased incidence of burnout in junior doctors and a devastating rise in attrition rates.

Recent months have strained the relationship between junior doctors and employer side organisations, NHS Employers and the Department of Health, and their leaders. However well-intended we fear this review lead by a senior healthcare establishment official may struggle to be taken seriously. We believe that leadership of the review should be (shared by) or (include) doctors in training with professional leaders, supported and assisted by other organisations as appropriate.


  1. A review into the morale of doctors in training should be led (in part) by elected representatives of trainees such as the Academy Trainee Doctors’ Group.
  2. The terms of reference of such a review should be all-encompassing rather than narrow and arguably omitting the greatest cause of unrest; pay and terms and conditions of service.
  3. The review should be conducted only after imposition of a contract is withdrawn and the contract dispute over, or it risks becoming part of it.

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