To think the junior / resident doctors are greedy, selfish, entitled & lazy?

@RobinStrikeExactly. Users of the NHs are being punished twice over. Inefficient use of resources and other doctors being really fed up. The IFS has always had medical degrees as the best degree in terms of earnings. Dentistry high up too. Economists third. However economists from lower grade universities can struggle to get better paid work, doctors don’t. Hence they come out top. The doctors who compare themselves to other high earners never factor in that these people have far more competition for the jobs and don’t get overtime and work longer hours without enhancement. The BMA is not the friend of the public who undeniably suffer.

YANBU at all OP. I don’t know anyone IRL who supports them and the medics that I know are absolutely furious at their actions.

That article destroys the BMA’s arguments. There was a similar-ish, but more limited, article in one of the newspapers a few months ago that pointed out that RPI is a misleading index for the BMA to use.

Add in the other stuff that the Times article comments on and I think we have good support for the pp’s astute comment above that junior doctors now seem to want both kudos and the sort of income that less cherished professions like lawyers, actuaries and accountants can receive.

This looks to me like the beginning of the end of respect for medicine as a profession. That’s sad. But they’ve brought it on themselves.

I attach two screenshots from the article for those who don’t want to click.

Today’s article by Tom Calver in the Sunday Times shows how resident doctors compare against other graduates. I’m not saying they all have the same measure of responsibility it it is one of the measures the BMA uses, comparing with other graduates. It also shows their salary in comparison with doctors in other countries, and against the 2008 stats the BMA love to use. If the strikes weren’t causing the NHS to haemorrhage money it could be invested in the training places, paying exam fees and more in the additional requirements they want
Can the BMA feasibly still claim junior doctors are underpaid?

https://www.thetimes.com/article/895fa55c-65eb-446d-8542-ef5eadfa0158?shareToken=e7e485a1d0484e965ba947562c745484

I support them 100%. If beneifit claimants can get their benefits increased for doing sod all, all day, every day. Then why cant junior doctors, who work long hours under great stress, get 1. I work for the nhs and believe me, they HAVENT been offered a 28% pay raise. I dont know where you got that from op. A new doctor currently earns around 35k a year. Thats not much when you literally have a persons life in your hands.

Above should read "use more resources" not "is more resources".

it would be unusual to have a whole list of entirely similar patients though,

Wrong again, I heard what he said to each of us. 6 bog standard lens replacements under local anaesthetic in people of a similar age.

. If there's an anaesthetist doing the blocks, they can be starting the next case while the first is still being finished off.

This wasn't the case, we were taken and returned one at a time, both for the cataracts only session and for the recent cataract/glaucoma session.

This is what I meant earlier about how frustration it is to see parts of the NHS work well and the identical procedures/adminisration/whatever is more resources or be done badly.

In private industry if two sections doing the same type of work had different productivity outcomes, the worse one would be JFDI'd.

with insight that none of this particularly useful in a thread about RD strikes...

you may have been having the exact same operation done by the exact same surgeon under private and NHS conditions..... it would be unusual to have a whole list of entirely similar patients though, and even more unusual for an individual patient to have a full grasp of everything else's surgery/medical problems when they're only in theatre for their own case.

There are minimum standards in ophthalmology surgery/anaesthesia which IIRC do advise that there should be an anaesthetist available within the theatre suite whenever needle blocks are being performed even if it's the surgeon doing the block (I've certainly been that anaesthetist in the past). There's a little more 'freedom' in the private sector (and quite often the higher risk customers will have been batted back to the NHS so they're looking after a bunch of more physiologically robust customers there). Where there isn't an anaesthetist available the surgeon is responsible for managing resuscitation in the event of one of the rare-but-not-unheard-of, unpredictable, life-threatening complications of needle blocks. It might not look terribly efficient when everything's going well, but if you were the unlucky patient, you might be grateful that there was a relaxed looking anaesthetist hanging about nearby.

Purely topical anaesthesia is slightly different and low risk in terms of the anaesthetic and there isn't usually anaesthetic allocation to those lists, but given that a large chunk of the eye-surgery population is in pretty poor health it is often prudent to have someone with intermediate life support skills around because just occasionally they throw you a massive curve ball. Not everyone's suitable for topical anaesthetic, but if they are then the surgeon's will bosh through a whole bunch of them fairly quickly. Usually the aim is to cohort patients on lists so that there's all topicals/ all blocks without sedation/all complex patients to max out on efficiency but that isn't always so practical and sometimes things have to change on the day.

Lots of surgeons are very happy to do their own blocks and that does cut some costs when it goes well (particularly important in the private sector because you don't have to pay for the anaesthetist). If the surgeon's doing the blocks though they can't be operating at the same time and productivity may be lower.... means you'll all be waiting even longer for your operations. If there's an anaesthetist doing the blocks, they can be starting the next case while the first is still being finished off.

@ImdunferMy U3A doesn’t have an app. It just has a web page.

You already can't book a GP appointment without online triage at many practices. At mine the receptionist fills it in while on the phone to the patient if the patient hasn't got access. It works and there are fewer people needing this every year, even the elderly mostly like smart phones! Most U3A groups, clubs for the retired with a big age skew on membership, are managed by apps.

What about elderly people who may not have access to smartphones and computers?

It shouldn't be opt in. It should just be the way it is.

This is changing. In Scotland you can opt into paperless communication via text. No more missed letters.

The booking system needs to be a lot more complicated than that unfortunately, and tuned per department to clinical need that can only be decided by a consultant. That's the function the consultant's PA used to carry out so effectively.

A person who can't walk up the stairs to get to bed should leap frog someone who's having trouble walking 4 miles due to breathlessness from an inefficient heart, but not for so long that the person who can't walk 4 miles turns into a person who can't walk upstairs.

I was answering the person who was saying their friend used creative accounting to pretend they were earning less than they were so their kids could get the full loan.
Obviously if you are lower income then your kids should have the full loan.
but actively lying to choose it, when you could afford to top it up as a parent, is weird.

I could have done that… but it wasn’t even a consideration

They are not only being paid to do this but have now been given a target that they must do this for 1 in 4 referrals!

In a private company, the initial workaround to that situation, if you are running a big enough operation, is to over schedule by the 20-25% of people who you know won't turn up, prepared to extend times and pay overtime for the rare days when they do.

In practice, one of our ologies is doing that, but the only way they can force the system to double book is to give out appointment times that are before the clinic is even open and then ring the person and tell them not turn up until later. I kid you not, we have exactly that going on on Monday morning for an NHS cardiologist-monitored MRI.

Parts of the NHS are trying really hard. In recent months we've had routine gastroscopy on a Sunday and have routine ultrasound scanning tomorrow also on a Sunday. They are doing their best with seriously creaky administrative systems.

A referral should be able to be made with a few mouse clicks. The system should automatically find the soonest available appt. The NHS is still living in the 70s with talk of letters and secretaries etc.

I work for a private business and we have a budget a fraction of that of the NHS and that's how we do it. Why is the NHS so resistant to modernisation?

I can imagine the referral problems getting worse. I forget the exact details, but GP’s are going to start referring for “advice and guidance” regarding a patient, rather than an actual consultant appointment. Which sounds like another way to get waiting lists down fraudulently whilst pinning the blame on the hapless GP, who frankly might as well be replaced by Alexa at this point.

Agreed. Once upon a time, GPs referred directly to consultants. Consultants prioritised referrals and their secretaries fitted them in and sent out appointments. If a patient was, or became, unable to attend they had a direct line telephone number to the secretary who had sent out the appointment; who would then fill the slot with another patient. DNAs - wasted appointments - occurred but they were rare. There was the added benefit that GP/consultant dialogue often resulted in an alternative approach, including direct admission.

Central bookings put an end to that, and long waiting times compounded problems, as patients circumstances changed, including death. Between 1 in 4 and 1 in 5 appointments are wasted now - and it is entirely fixable.

https://digital.nhs.uk/data-and-information/publications/statistical/hospital-outpatient-activity/2024-25/summary-reports

The variation from one unit to the next drives me nuts. It's as if they can't say "this is what works in another department/another hospital/another NHS Trust, do it here! Even for things where there appears to be no clinical reason not to.

Between me and my husband we are under the care of two NHS districts, four NHS hospitals (was 6 in the last 2 years) 6 different ologies with 7 different consultants, and several different appointment booking systems, some of which demand confirmation and send multiple phased reminders and some of which don't. Some of which are wasting serious amounts of money to send paper letters of appointments and appointment notes when others in the same hospital are using apps and free email.

I love the whole principle and ethos of the NHS. I hate it failing to deliver those when some of the solutions are simple and already in practice in other parts of it.

When I saw my eye consultant the hospital said I was only the third person to turn up. No reminders sent so he twiddled his thumbs all day. The NHs is not fit for purpose. Wastes resources and needs to understand what modern business looks like and what efficacy and productivity looks like.

I have given you an example of the exact same operation done by the exact same surgeon under private and NHS conditions. What more do you want?

The anaesthetist did one local anaesthetic per hour and stood around waiting for the next patient. When I had cataract surgery in a private hospital the surgeon did the anaesthetic. In the NHS, with the same surgeon, their was an anaesthetist with similarly relaxed workload

tell us you're not an ophthalmic surgeon/anaesthetist without telling us you're not an ophthalmic surgeon/anaesthetist! There are usually medical reasons for the set-ups you've described. Despite the fact it often does look pretty chill, day case eye surgery is definitely not as relaxing as you might imagine. There definitely are inefficiencies in the NHS, but I think you've probably picked a bad example here.