To wish I could be marching with the juniordoctors today

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Today, thousands of "junior doctors" are marching in London. A junior doctor is every doctor from the moment of qualification, to the moment they turn into a consultant or GP. They are the work horses of the NHS, the backbone of the system.

My own life has twice been saved by junior doctors.

And I, as a paediatric consultant, could not deliver the service I do without them.

Jeremy Hunt wants to impose (not negotiate) a contract which would, by extending the "normal working week":

• remove safeguards on hours limits - unsafe!
• penalise most those who already work the most weekends/nights
• make it even harder to recruit to those specialities
• cause juniors to flee the country
• disproportionately hit women (hits maternity leave, working pattern, ability to work less than full time)

We already cannot recruit enough junior doctors to train in A&E, paediatrics, obstetrics, and GP. This will make it worse.

If you want there to be doctors to treat you, and your families, please support our junior doctors.

The new contract would see them go back to working the way I did in the earliest years. It was not safe then. It will not be safe.

The reason it (kind of) worked then was that a lot of the patients we keep alive now, died then. So there are more incredibly sick patients receiving treatment 24/7. Whereas in the good old days that the most senior consultant remember, there was a lot more of just tucking people up in bed and keeping them comfortable while they died. The workload is now just too intense to be able to work 72 hours straight, like we used to (and, to be blunt, if you were up all night Friday and Saturday night, then I wouldn't have wanted to be the patients on Sunday night...you did your best, but there is lots of research showing being totally knackered is a bad for mental functioning as being over the limit on booze)

Perhaps we need to go back to leaving people to have peaceful deaths (I'm a very strong advocate of that tbh) the stereotype of doctors having a God complex isn't there for shits and giggles.

I was very involved in the introduction of EWTD, believe me, it definitely wasnt well accepted by 'most'.

This is from the RCP 'The RCP is very concerned about the effects of the directive on patient care and quality of training.'

folly they don't work 48hrs straight anymore. Used to 20 years ago and it was becoming unsafe.

Drs don't clock off when they get to 48 hrs (which is a weekly average, so you could do 90h one week and 6 the next). It is the norm to work overtime every day. The concern is that Hunt's plans remove the financial penalties faced by trusts when Drs regularly work too many hours.

The Royal colleges were largely in favour in 1991. In any case, this isn't about official working hours, it's about the way hours are enforced. Hunt wants to remove incentives that currently minimise unsafe working.

7805 etc '48 hours solid' was quoting what you said, I was saying that they dont do that. You'd be very unlikely to find any JD rota with 90 hours of work in one week either because of the EWTD daily hours limit (in fact I have never seen one).

I think this is my issue with the current publicity surrounding this revised contract. The devil is in the detail - there is so much misinformation out there, and articles are often factually incorrect. Also, I think if the public understood the ramifications of monitoring and band 3 payments to juniors, then sympathy might start to wane.

folly can you explain a bit more for us lay people please?

About band 3 did you mean Lunchpack?

Welcome to everyone elses world, you know the one of working in the private sector!

Yeah, please

I do take your point re critical care nowadays, but wouldn't it be the case that at any given point during the history of medicine, certain illnesses, procedures etc have been at the very limit of doctors's skills, experience and available drugs? And therefore it's all relative? ie yes, thirty plus years ago, plenty of patients who might be saved now, would have just died, but presumably doctors then were dealing with complex decisions relating to very sick patients who these days might more easily be kept alive by modern procedures and drugs. Or am I way off the mark?

I think the problem with the negotiations is that essentially Hunt wants doctors to do more weekend and night work for the same or less pay. It's a simple fact of market economics that if you undervalue your staff they will end up doing a bad job or they'll leave. The biggest problem facing the NHS at the moment is staffing.

petshop as a dr it is much less complicated when you only have 10 drugs to choose from and no specialist treatments. I'm oversimplifying, but if you imagine 40 patients on a ward. If 30 of them are largely receiving nursing care, and either getting better by themselves or dying, that's much easier than if all 40 need intensive medical input.

madbengal it is not in the public interest to overwork medical staff. They make mistakes when tired! Private sector has many perks you don't get in the public sector. I could earn a much higher salary doing private practice.

Lunchpack most doctors are advocates of a peaceful death. OP is presumably referring to conditions we can now effectively treat. For example 40 years ago following a heart attack patients were given aspirin, and put on bed rest. Nowadays we have effective treatments so obviously we employ more aggressive treatments for most.

I've spent most of my career working in Ireland, doing 36hour shifts weekly, 100+ hour weeks. My DD was born last year and there is no way I would go back to working like that. I worked my last 36hour shift at 30 weeks pregnant and during that time I ate one meal, and slept for 25minutes. Surely nobody is advocating a return to treating any employee that way!

Well, juniors currently get a basic salary plus 'banding' which is a supplement paid to reflect the anti-social/out of hours nature of their work. So if you only worked 40 hours during the week, you would get the basic salary you usually see quoted in the press.

If you do more hours - anything from 41 - 48 and/or work weekends, you get the banding on top of your basic salary. Banding is a %age of your salary, and is a sliding scale, so the more out of hours commitments you have, the higher percentage you get (it's either 20%, 40% or 50%) on top of your basic salary. There are two sets of rules around doctors hours - EWTD (Working Time legislation) and the New Deal (these are contractual and are what is being changed by Jeremy Hunt). Needless to say they are different to each other so thats a nightmare in itself.

Twice a year, junior doctors' hours are monitored, each group of doctors on a rota filling in diary cards for 2 weeks at a time to check their hours against the New Deal and against the rota they are supposed to be working. If their hours breach the New Deal rules during those 2 weeks, and it can be just one doctor who has worked too many hours or not had a 'natural break' then the rules are deemed to have been broken and the rota is now 'non-compliant'. That means that all the doctors on their rota get an extra supplement and their banding goes from 20, 40 or 50% to 100% (this is called band 3) ie double their salary. This carries on until they leave that rota.

Nowadays, trusts would insist on a second diary card exercise if it looks like the rules have been broken just to make sure, but that 100% supplement is still based on what doctors themselves record as their hours. Band 3 was introduced to force trusts to reduce juniors hours, and to be fair it has worked in that sense, but it surely isnt the way a professional group should have their salaries ascertained. During monitoring I have know one or more juniors pressure colleagues to up their hours to get 'band 3', and I have also known senior staff pressure the juniors not to record all their hours. It simply doesnt work.

But that feels a tad dismissive of the overview these consultants have of their specialisms as they are now. It's not like they retired thirty years ago, they're all still working so must have (I would hope!) a pretty thorough knowledge of how things work now too. One was a national clinical director. It didn't feel like a grumpy kind of "we did it, why shouldn't they" type rant, but something much more considered and set against conditions as they are in medicine today. Anyway, as I say, I don't have any knowledge of my own so should probably just leave it here, but I do think it's concerning that if things are as bad as you say, junior docs don't have the unanimous support of their seniors.

Sorry, should have said, that was in response to 780539.

Broken, my thoughts exactly.

Oh! folly that's some sneaky practice!

I have family in the private sector (not medicine). All have lovely contracts and lots of perks. Please don't try and sell me the "poor private sector workers" spiel as I simply won't believe you.

Private companies who want to keep good staff pay to do so if not in salary then in some other way.

Thinking of 21yr old niece with A levels on nearly £30k. She earns it and I don't begrudge that, she also gets help with season ticket costs and lots of social stuff.
She doesn't work anything like the hours of a junior doctor or make the same kind of decisions.

I am behind the doctors all the way. Am not a doctor but am a nurse and have seen too many exhausted doctors in my time.

"You'd be very unlikely to find any JD rota with 90 hours of work in one week either because of the EWTD daily hours limit (in fact I have never seen one)."

I have worked plenty of 91 hour weeks (night shifts starting at 9pm, finishing the post take ward round at 10am, often not actually going home until later.

Private sector has many perks you don't get in the public sector.

I think you'll actually find it is well known for being the other way round.

"Welcome to everyone elses world, you know the one of working in the private sector!"

My DH works in the private sector, not as a doctor, earning the same as I would be if I was at work rather than taking a few years off with the DC.

His core hours are 10am-4pm in a 7.5h day. He can be flexible about when he works in reality so can get time off for school plays, school runs, coming home for dinner every night. He gets 25 days holiday + PH. He doesn't work weekends or evenings or public holidays. His company pay for all and any training he requires. His company pays for any conferences he attends.

I have personally paid thousands for huge chunks of the compulsory training and exams that we need to progress. My work-life balance is way off his. After DD3, I could choose to go back part time at 30 hours a week or not at all.

The private sector looks rather attractive to me at the moment!