AIBU unreasonable to say everyone should know about the junior doctor's contract the government is trying to impose?

[Addictedtocustardcreams]

The government is seeking to impose a new contract on junior doctors. By junior doctors I mean all those in training I.e. Not consultants and GPs. Starting salary for these doctors is £22636 plus a supplement for additional & antisocial hours worked.
The contract seeks to re-classify normal working hours so that 9am on a Tuesday will be the same as 9pm on a Saturday night (so normal hours Include up to 10pm 6 days a week). This will lead to a pay cut of 10-30% for all junior doctors depending on which specialty they work in. They also propose to remove certain safeguards over lack of breaks & working over contracted hours.
They also propose to entirely scrap a pay supplement for junior doctors training to be GPs. This was designed to make pay equivalent to that of a doctor in hospital training who receives the pay banding I mentioned above. There is already a recruitment crisis in general practice. One in ten posts in England are unfilled in a recent survey. Many training posts are unfilled too.
You might think this doesn't matter to you but we are all patients sometimes. I know people who won't be able to afford their mortgage if the contract is imposed and they plan to emigrate. What will happen to the NHS then?

What seems sad to me about this thread is that people don't trust or believe in Drs very much anymore. That's the missing link. If the Drs are saying this is unfair and conditions mustn't get any worse or they will leave..believe them .. they are saying this as people who care about others people's lives and providing a service for sick people. Medicine is an altruistic profession but the govt are not respecting them in the way they should. At the same time the govt will not be willing to accept blame.

And many consultants don't do private work because they believe healthcare should be free or it would detract from their NHS work so not all consultants have extra income in this way.

That's all fine and lovely leave but ask yourself why people don't believe much in doctors anymore. Many people have had terrible experiences with healthcare and are less inclined to believe that all the problems will go away if we just hose ever more (borrowed) money at it. (Stafford springs to mind...)

This whole "we will leave you up shit creek unless you accede to our wage demnds" does not sit right with me either. It's another persuasive argument for de-centralization and competition amongst providers.

I don't know any consultants in DH's field without PP's. The fact that there are a few ideologues out there does not negate the fact that most are raking in extra cash. An income stream form PP is not even available to many doctors in other healthcare systems with whom you want to - selectively - compare basic wages, incidentally.

Genuinely curious, do you honestly believe the NHS is the best system for patients (despite being adopted by precisely zero other countries) or do you just prefer being an employee of a nationalized industry with collective pay bargaining? (I asked DH and was not satisfied with his answer! )

Private income is not available to any grade below consultant or GPs. It's not our fault managers and govt have cut the service, if they listened to the Stafford report and insisted on safe staffing levels and listened to Drs about fatigue and working conditions and safe staffing things would be better. But they don't listen and they have done a good job of convincing the public we are lazy via their media spin. We are not politicians and we don't want to be the the govt just doesn't support the service.

Commonwealth Fund comparism again

Yes, the NHS is the best value-for-money health care system IME, having worked and trained in the US, Germany and the UK (and in Uganda! )

I typed a hugely long probably too verbose post and then lost it, you'll be please to hear, and now don't have the moral fibre to type it all again.

No private income here - neither from my husband nor me.
GPs are not NHS employees - no employed rights, but none of the freedom of a self-employed small business either as we only have ONE client who imposes our contract on us
People are amazed and not impressed when we inform that there is a fee for, say, travel cancellation forms/Fitness to perform for their children who are participating in a panto/letters for the gym - there is an expectation that the tax payer will pick up the tab for all of that.

Much as i know next to nothing about lawyering (other than what my brother tells me), I'd suggest that most lawyers don't know much about the reality of the physical and mental demands of doctoring.

AyeAmarok, I have no idea what the popular or sought after specialties are currently, but would imagine that this would vary from area to area?

Not sure "efficient" is the best measure of healthcare from a patients' point of view, but I take your point. The CF measures the amount of healthcare delivered per pound on which the NHS fares well. It doesn't measure whether or not your granny has been festering in her own shit for days. But if she's in our local NHS hospital, there's a good chance she has!

I understand the demands of the job a fair bit from DH. Nobody wants tired exhausted demoralized doctors, and nobody sane expects medics to be the fall guys for a failing service. However, I think it is also fair and reasonable to point out the many positive things that exist in doctors' pay and working conditions, many of which are not enjoyed by those in the private sector any more. (And yes, it's a horrible cliche, but those protesting may well find that people without decent pension provision/overtime payments/fixed reasonable working hours feel a little aggrieved at paying ever more tax so that doctors can continue to enjoy those things).

Surely anyone who is a lawyer who has a sibling who is a doctor and vice versa like Pacific and I do know a reasonable amount about the other sibling. I am sure most people know GPs are not NHS employees.

Many of those posting consistent with the MN demographic are not consultants yet, still junior doctors we don't really get the age 40 - 60 perspective where in law and medicine the bigger money tends to come. Whether the juionr doctors on here who become consultants in the next 10 years won't earn as much as the older ones we can't really tell yet. That may be so and when sixth formers see that they may well be picking law not medicine (and I'm afraid I have done far too many parents' evenings at private schools on the careers stands to know that the children dragged to the legal, medicine and accountancy stalls are directed there for standing and money. Yes there can be altruism in all three and I dubt anyone on MN would believe me but as a lawyer I help people every day and do as much of God's work as any doctor, but pay is part of the picture for most people picking careers.

I certainly agree the NHS is good value. I don't want us to charge for everything. I was just telling one of the children the other day one advantage is that there is no advantage to pushing treatment you may not need on you which purely private systems might and as my philosphy on health is that often leaving well alone can be the best way to do no harm that is no bad thing.

I think you have hit upon a good point there Pacific - that nothing "free" is ever valued by the consumer and also that the average person in the UK is hard wired not to associate healthcare with cost (and is appalled when asked to pay for something!)

Exactly Grazia - I remember being in my 20's complaining to DM and BF (now DH) about demanding clients. She said "it will be worth it when you're a partner" and encouraged me to work hard and get more experience, which just made me huffier. It seemed like an impossible goal when at the sharp end trying to keep all the plates spinning...

Anyway - here I am, made partner 2 years ago, and it turns out my bloody mother was right about everything!

On a serious note, I do think there is something to be said for deferred gratification. The manager of Costa or wherever who earns the same as as a junior doctor now will still in all probability be earning that amount (plus inflation) at retirement. Junior doctors, with a fair wind, will not.

Young girl - your husband cannot be retiring with a £50k pension under the scheme at 55. Either he hasn't understood the changes to the pension scheme or he hasn't just got an NHS pension. Retirement age is now 67 and he'd be looking at an annually of about £40k at 67 as long as he's careful about the new tax cap which will affect that. It's rather complex for those in the changeover years ( which if he became a consultant in 2013 he will be) and certainly not the generous scheme it used to be, if he retired at 55 he'd be taking a significant loss to that figure.
They've been chipping away at those 'generous' rewards from many directions for years now. And I don't expect them to stop that with these contract changes.
I have actually had and am still having very good care for myself (I have a chronic health condition) and our wider family under the NHS and to be fair the only complaints we've had healthcare wise have been problems with family that live on the Wales / England border and BUPA in London(Elderly relative). I do not think it's perfect on any level but the Media horror stories are not my experience and I've first hand experience of several hospitals in our region.

I am a junior doctor in paediatric training. I love my job, but it is so hard. I am a junior doctor in training, but if you bought your child into a and e, I could see them and decide to send them home. Sometimes this terrifies me. Sometimes I send a child home and I can't stop thinking about them all night. I worry all night about a bleep going off and that child coming in dead. I sometimes ring the parents the next morning to check they are ok. I walk into the ward at the beginning of a shift terrified that a child will be there that I sent home, that I will have made a mistake. Not because I am worried about being struck off, but because I don't know how I could live with the stain of that on my conscience. The same goes with baby checks. I worry all the time.

I will stay late happily, if a child is ill, or a baby has been born prematurely and it is all hands on deck - because that is what we all do, because everybody wants the child to get well/ stable as quickly as possible. I will come in for a day shift and get sent home at eleven in the morning because they need me to come in for the night shift.

I will go home and study for the exams I need to take to make me a better doctor, but that cost six hundred quid a time. I will go on courses on my days off because study leave is just too hard to get.

I work part time. I have three children under six. That is thirty hours a week. I get 60% pay for this (less than 30,000 and that includes fifty per cent banding). I really think this is fair. My pension is nowhere near what nhs pensions used to be.

Nurses don't get paid enough. Some of my best friends are nurses. And God knows nurses got me through my early days in medicine when I didn't know my arse from my elbow. What the government are doing to them is also crap.

Successive governments have all but destroyed the teaching profession. My mum is a teacher. It is crap, they should also be paid more.

I don't know how we will pay the mortgage, childcare etc with what the rcpch say will be a 15% pay cut for us. Also because I am part time I will be in training forever! So this contract is discriminatory against less than full time trainees (ie mostly woman).

I actually cannot believe this is happening. I have always said I wouldn't strike, but I think we have to. Junior doctors in Australia did it a while back and I think it lasted twelve Hours! I actually think we should band together with the nurses because the government is screwing them too.

Younggirlgrowingold....Don't book that holiday just yet .....

Under this junior contract proposal any fees earned by any private practice goes to employer, not that much is available to juniors perhaps the odd police report would be chargeable, and crematorium fees could, for me really not worth having to do the tax return as so infrequent, prefer just not to charge the parents which is what I and most others in my speciality do. Not a big issue for me... but this is where it will become interesting for your DH.

New consultant contract coming, how will you feel about a pay cut and them taking his PP but not covering any indemnity for it.

I suspect they will be offering and expecting a 24/7 contract, he may have to buy his way out of the NHS time for private practice, there is an argument that he should he has been trained by the NHS after all

So break it to him gently but if her isn't doing that much work for the NHS, he might not be holding on to that pension and might find himself deciding to walk away from the NHS and just do private practice. With market forces there may not be enough pp to support all these consultants. so hopefully he will be happy with a basic pay rise, agreeing to cover 24/7 loss of supplements, and buying out his private time from the nhs.

Areas are very different, and thats why its important that new contracts reward those who are working the hardest, longest, unsociable hours, and who have been for years. This contract doesn't, and that is why its unfair, it gives people who do no out of hours work a pay lift and those who do the most a pay cut...

In paeds a significant proportion of the service is consultant led if not delivered, my consultants rejoice to find out they have a senior trainee on and may get a few hours sleep during their friday 12 midday to monday 9am stint. They too work 120 hours., yes at the coal face work those weeks and they deserve their pay and more. Imagine 2 h sleep all weekend and then a clinic of 15 patients on a monday afternoon, it happens.

I don't actually think that 'most' doctors supplement their income through private work.

Of the 7 doctors in my family, only one does or did do any private work. So out of two GPs, four consultants and one whatever it is that's just below a consultant, actually only my dad did any private work. And he did that on Saturdays and on Wednesday evenings as a 2nd job!

YoungGirlGrowingOld

( just playing catch up in between night feeds.)

You are right to want is to ensure the truth is told on this thread.

Dr Karen Kapoor, is an ENT consultant who took a picture of his pay slip that went viral.

His contract is different to what we are discussing because he is a consultant, not a junior.

However thank you for providing the opportunity to clear up another misconception that he was complaining about his pay.

He took the picture as the Health Secretary suggested that a "major barrier to 7 day services was the opt out clause in the consultant contract."

RH Hunt also suggested that Consultants need to be professional and remove that clause. He then linked the deaths of a number of people to consultants not being available at the weekend because of that clause. A statement which was I suggest not well researched.

Dr Kapoor photographed his payslip in outrage not at his pay, but at comments that suggest he is unprofessional and doesn't care and doesn't work weekends.

He was trying to explain, trying to emphasise that that clause is there to actually protect senior members of staff or staff who become ill and can't do on calls anymore after 40 odd years in the NHS but who we don't want to retire on the basis they are not physically able to work 120 hour weeks safely.

Dr Kapoor, was pointing out that if he wasn't a professional he would have looked at that clause in his contract thought £1.20 per hour, I don't need that, I can survive on my salary alone, NO THANK YOU, but he hasn't done that and ( actually evidence has gathered only a handful of consultants that have, so clearly no "barrier," to 7 days services. )

The barrier to good 7:7 services is resources aren't adequate for 5/7 full days never mind 7,

Further still the death bit...

Absolutely, more people die on a Wednesday than a Sunday but the Health secretary suggested that more people die at the weekend, they don't ... 30 days after admission was the evidence .. on a Wednesday,

Relatively, more people who are admitted on a Sunday have died by 30 days later by comparison with other days of the week; it's not unique in the NHS and is seen in HC systems were consultants alone deliver care. It's difficult to work out the cause ... Or signifucance, per hospital bed day because elective work is done during the week which dilutes the statistics; it is thought most likely that most likely people act differently at the weekend ( get drunk Friday night fall over etc ) don't consult unless they have and present sicker. But who knows .. What we do know is that consultants do not use the opt out clause and you absolutely you are actually less likely to die over the weekend than during the week.

we are not opposed to working to improve OOH services or 7/7 working for urgent care, we do that already. We are opposed to putting people at risk by increasing elective 7/7 services before we have sorted out the urgent care issues.

Once the above issue was agreed that the 7/7 24/7 service would focus on urgent care consultants entered back into negotiations.

This was important because what we don't want to do is make everything worse. We admit it is hard to find the right balance for 5/7 services, that in some specialist need to come and join the acute party more frequently.

But 7/7 service needs to be across health and social care in many different roles to work not just the consultant .... and nobody has told us how we are planning to pay or staff that.

As you have sadly experienced poor standards of the weekend, you will appreciate how important it is for Drs to stand up and say, hang on ... We need a proper plan to improve urgent care first and if and when we can affoard and want it we can then try and move forward with a plan for elective care too if that's what the taxpayer wants. Which is what we are trying to do,

( I am sorry you had poor care for your relatives, I hope you have or will raise it as an issue. I truly am) we have to get better we are not saying it's perfect ...

But your poor experience & DH lifestyle and private practice earning potential should not be used to decide my pay reward or terms and conditions, when I have met all my competencies, jumped through hoops and am performing as my last yearly assessment says, "above and beyond" it's like you being told that although you brought in a lot of work to the firm and did a fab job, the clerks in our other office St elsewhere have made the place a mess, so we are cutting your pay to pay for the cleaner in their office?

We are cost efficient as a healthcare provider, efficiency may not be a great markr of the care received as you say but it doesn't suggest that the tax payer is getting a bad deal for his £ spent.

Can we improve care by cutting wages of those providing the most out of hours care and increasing the general salary of those who don't .?

Again, telling the truth about my husband's income is unpalatable to some doctors, so I must be lying. I am not, as it happens - the fact that you think I am says more about your position than mine.

I did not mention retiring at 55. If he retires at 67 - great. He has mentioned retiring sooner simply in order to spend some time with his family overseas - not in the context of his pension, and he quite possibly would expect to receive less if he did. Subject to that, the amount on which he expects to retire (about 50k pa) is 100% correct. Yes, his only pension is NHS. I binned off my private pension and bought a btl instead, because his pension was so much better than any annuity I could afford to purchase. I see so many doctors with little idea of how poor most private pensions are.

Xander - I actually said I was happy not to spend the money on holidays. You have inferred the opposite. What I would like to avoid is my grandchildren (and yours) paying for ever more borrowing to fund public sector pay and pensions. Most of the things that are being complained about on this thread (long hours, poor work life balance, etc) are the same for everyone. Few of whom have a consultant's salary to look forward to, however. More circumspection required on both sides.

I can't remember my previous login but just thought I would share my opinion as a Jnr Dr. I have two children under 4.

This new contract will not only reduce pay but will allow employers to force us to work more than our contracted hours for less pay.

Just to put things into perspective, last week I worked 80 hours! I'm contracted to work 48 hours. The extra hours I worked are not paid, it's because I love my job and my patients and sometimes you can't leave! If there at crash call at 5.30 pm you can't just tell everyone you've finished work for the day. If an agency Dr had covered the extra hours I worked last week alone they would have earned in excess of £900. Yet for this quarter I earn £1800 pm. Needless to say I'm beyond exhausted and if I had been forced to work an extra day I don't think I would have been safe.

Under this contract we will work longer hours. We will not have job/ payment protection if we choose to have children.

I know many Drs who can't afford to cover their living expenses. I'm one of them. My husband works and we therefore rely on childcare - which is expensive.

We have made the decision to leave because even the current contract is awful. They were supposed to improve current working conditions and not make it worse. In the UK the NHS holds us ransom by forcing to train for 12-13 years after medical school. In other countries including Europe training is shorter- nearly half that. Drs are not abused for over a decade and then paid a low salary.

Some Jnr doctors cover agency shifts during the little free time that they have in order to afford paying for their rent/ mortgage/ childcare etc. this means we are even more tired when we come to work. Is this the kind of Nhs you want?

I know many others who have left this year and many more UK trained Drs who will leave next year. The NHS will have to recruit even more foreign Drs in order to get by. Our colleagues in other countries are treated better than in the UK. Even if we didn't get paid a lot of money, the salary should match the work load.
We shouldnt be that tired and making life or death decisions.

Young girl - you said "But the pensions are there - DH has one. In what other job can one retire on 55 or 60 on 50k plus a year?"
Well a more concise version of my answer is - what other job can one retire like this.... You can't do this as an NHS consultant under the current pension scheme so your point is pointless.
The constant chip away at pay and conditions does nothing to improve service and so far is exacerbating problems such as recruitment. I cannot understand why staffing contracts of the healthcare workforce who already go above and beyond are fair game but poorly negotiated PFI contracts that have huge wastage and massive costs don't get a look in.
If the real aim was to reduce costs to the NHS, now and in the future, the problems with this would be getting reviewed and tackled.

Young girl, we are not asking for more pay or less hours than now,

We asking for it not to get worse for those doing a lot of hours.

We are asking for a contract that doesn't increase pay across the board, but rewards those working the hardest for their employer to the
same extent as now and doesn't waste money increasing pay for those not contributing to a 24:7 contract.

My brother apparently can retire at 55 on a £60k NHS pension (plus large lump sum ) and has been advised to ensure his NHS earnings stay low so he does not breach the pension ceiling - where funds exceed a particular level (which varies but is coming down to £1m except for protected funds) then huge tax penalties are applied. Someone said that would not be possible but as far as I know it is accurate. He was also advised if he retired today the pension would be £30k. It seemed accurate advice. His non NHS income is many times his NHS salary and I am sure he'd carry on with those other areas of work once he leaves the NHS. Now I know we are all very successful, clever, hard working, Oxbridge (some of us) top of the tree people and he has the silver merit award so may be that is why he is doing much better than some on here expect consultants to do.

However I certainly sympathise with anyone including my lawyers daughters and my cleaner when we all work very hard. I rarely see people who work as hard as I do. I had 1 week holiday last year and my doctor brother live in clover on the holiday front by comparison and I work 6 or 7 days a week as indeed does he.

i certainly sympathise with young doctors who might get less pay (I have 3 20 something children early in careers and know how hard life can be now and how hard it was in my day too at that life stage). Any system needs to incentivise those who are effective workers or people vote with their feet and leave.

I said "55 or 60" - meaning I have no idea what the retirement age is. But even if it's 70 the point still stands - no other job offers 50k a year for potentially 20 odd years. Multiplied by every single consultant in the NHS.

It doesn't matter how you chip away at it Xander. It's still unsustainably generous. And I say that as someone who stands to benefit enormously. At least I am honest about it. We don't need the money and are looking to buy a second home in addition to our btl. Do you really think the country should borrow money to pay more to people who will end up with those opportunities? I certainly don't.

PFI is of course equally or more unsustainable. To me, the entire debate only proves that the NHS cannot and should not survive in its current form. I for one won't mourn its loss. Others who have received better care probably will. Those employed by it certainly will, especially the more senior doctors who have had their mouths stuffed with gold by the last government.

Everything that you have said about junior doctors applies equally to everyone training in a professional career. I personally don't think you can become terribly good at anything working less than 35 hours a week, but that may be an extreme view. Most people who have children at a "training" stage in their career struggle with work life balance. Yes they are not "junior" at 30 odd and yes life doesn't always fit into a neat plan.....junior doctors still have phenomenal opportunities to earn MUCH more than the VAST majority of people in the UK.

Grazia's post reminded me of the time as a NQ lawyer on a deal in London, out of the house 15 to 18 hours a day, worked 9 weekends on the bounce, hallucinating with tiredness....came to the depressing realization that my cleaner (essential because of hours) was being paid - by me - more than twice as much as I was actually taking home for the same hours. It's life - she is probably still earning that amount but putting the hours in gave me the opportunity to earn more in later years.

Sorry but you pay your money and take your choice, with careers and everything else!

And we do benefit later. 30 years on I sit here at home in a very nice house (mortgage paid off last year) doing work I adore so much I choose to go away for just a week in the last 12 months.

I don't however think making people work until they are too tired to do a good job is wise. I've often worked with lawyers who send staff home to sleep. I remember my daughter saying they had hired someone at the same level as her from another firm who had worked normal hours so that new recruit had much less experience just because of working fewer hours and we are avoiding on this thread the elephant in the room 0 that the NGS has a major problem with female doctors going part time caused by a 60 or 70% entry being female and these women being sexist or married to sexist men and choosing to work part time. I've worked full time for 30 years so not surprisingly that paid off.

I believe doctors pensions have already been changed. I suspect some of my brother's pension is based on whole career earnings not end of career earnings - no more two thirds of final salary which presumably my father retired on at 63 when he was forced out of the NHS by compulsory retirement at that time - he wanted to carry on (he kept on working full time with other private work after that).

If I were a young doctor I would certainly be lobbying against the changes and thinkings of ways to earn additional income. Some have become permanent locum GPs for example and in London there is scope for private work if you are good.

I think it is very interesting & informative to hear about other work life balances & experiences. I think that I, like a lot of other doctors know a lot of doctors so don't necessarily see what those in other professions are doing. My overall perception is that there are plenty of people in high flying London jobs who put in the hours doctors do or more. I do however support the posters saying it is very stressful. That is not to say other jobs aren't stressful but I think there is a particular kind of stress linked to knowing if you fuck up someone might die. Then there are all the emotional aspects to deal with- upset patients, angry families etc which I think take a big toll. When you look at the stats for suicide amongst doctors I think that gives some evidence of the pressure it can apply to people's mental health (obviously there may be an issue with easier access to means to complete the deed but if all was rosy presumably people wouldn't be trying in the first place).
i think the posters saying well I know a doctor & they don't work that hard are also being a bit unfair. I know lots of doctors. Depending on their personalities & chosen specialities some of them work insanely hard, some not so much. I am sure if we have the same annecdotal discussion of the legal profession (mentioned a few times on this thread) we would find the same.
I also think that when grazia mentions her brothers pension- I have no idea whether this is correct but it is 100% certain that todays juniors (the ones they are looking to impose the contract on) will not have anything like those type of benefits.
I mentioned MTAS above- this was a drastic change in Drs training imposed a few years ago when Drs argued against it. As mentioned pension benefits have been massively reduced too. So if members of the general population are wondering why Drs are suddenly being all moany I think you should be aware there is a big background to all this & a significant worsening of terms & conditions & pay could be the thing that means doctors finally lose the goodwill the NHS has been relying on, with the result being emigration, resignations or just worsening of the service.
Finally "oh it's fine they can all do private work" this is much less the case outside of London for starters (my SIL works in London so I know a bit about private provision there vs up with me in the north west). Also how many private a&es do you know? So depends a lot on speciality. A&es being one of those with recruitment issues already.

Anecdotal tales about a doctor family member do not really mean much in the overall picture so presenting those as meaningful is pointless.

Addicted, that is right. My brother who is 20 years into his career at least would have had older pension rights although he is affected by the general law changes which limit maximum pension benefits which affect anyone lucky enough to have a pension (not me then). Younger doctors don't have the same deal.

I agree. My father did private work in the NE for decades and gave up NHS pay for that but there was nothing like the amount available in richer areas of the country. My brother comes to London every week - 3 or 4 hour journey (imagine that with a young family - many a day he leaves home at 4.30am to fit it all in) and given what a small proportion of his income the NHS consultant salary is he only carries on with the NHS until he is 55 for the 30 year pension in retirement. He certainly does not enjoy working for the NHS, all the awful managers you get, the interference in your life etc. I work totally alone, eat what I kill, no holiday sick pay maternity rights or anything but at least I am entirely in control of my own destiny and only as good as the last piece of legal work I do. If I get it wrong I can be sued for £500m and I would lost the house and everything I have as insurance rarely covers claims. So it is not without risk working as a lawyer but yes no one would die and I am glad i do not do family law which must be similar - where a child loses a parent forever in some cases on divorce. Emotionally difficult stuff.