For years I’ve been a staunch defender of the NHS in Great Britain. When Germans speak questioningly (or sometimes downright badly) of it, I’ve always said it provides fair, efficient, good quality care for the patients and is brilliant for the doctors.

Brilliant for the doctors because of the excellent, well-planned teaching it delivers to its medical students.

Brilliant because of the on-the-job training it offers its junior doctors, well integrated alongside the service they provide for patients.

Brilliant because of its centrally organized junior doctor training program that requires doctors to work in a mixture of super-sized university hospitals and smaller district generals, allowing them to learn to deal with varying levels of resources and to get used to working with bosses with different methods and ideas.

Brilliant because of the research and audit which is incorporated into each clinical role, however big or small the hospital.

Brilliant because of the chance to very often work in a team of international doctors and allied health-care professionals.

But for years, the NHS has been in trouble. Largely it seems because of poor management. Possibly because such a system is not sustainable.

There have been signs of it floundering, but the NHS machine has trundled along – mainly due to the commitment, diligence and good will of all its workers.

This is about to change big time.

A government seeking to cut costs has had the idea to change the pay scale of doctors. Out of office hours work was previously financially rewarded on a different scale to care of patients during normal office hours. Henceforth however, doctors should be paid the same regardless of whether they are in work on a Monday morning or missing a day spent with the family on Saturday to be in work. This means up to a 30-40% pay cut for some for exactly the same work at anti-social hours. This is being shamefully sold to the public as a move towards better round the clock care. 

But with this move, the good will is quite understandably coming to an end. Doctors are on the march. They have taken to the streets and to social media platforms. Yesterday 20,000 doctors (and seemingly every single one of my doctor friends on Facebook) turned up in protest to a rally in London against the proposed new contract.

And it’s not just about the money. Doctors (along with nurses, teachers) have had a pay freeze for the past 5 years already and haven’t really been heard to grumble about it. At the core is the lack of value that the state-based system places on its workers, the fear that the quality of doctors will suffer with the proposed changes (with many bound to consider better options abroad or in another branch altogether) and the suspicion that the NHS is being surreptitiously pushed towards privatisation.

From the viewpoint of a partly privatised healthcare system here in Germany, I don’t see this as being all evil. The question is if this is the end of the NHS as we know it.