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.

Thats why I said a rota with 90 hours, Dino, because rotas. If you are working those hours, then you are regularly breaching the 13 hours work, 11 of rest WT Regs - I hope you've reported that as the BMA say you are duty bound to do so.

oops - ignore the 'because rotas'

Broken it's really not that cushy in the NHS

6 weeks full pay and I think 18 or something half pay maternity. I know people in the private sector who get 6 months full pay.

Little stuff like you pay for your own Christmas meal, tea and biscuits, no catering at events or meetings. A friend who works in a biotech company had a masked ball at a 5 star hotel for all employees

I also know private sector workers with free travel passes, gym memberships and hospitality allowances. There isn't any of that in the public sector.

You pay for your own professional exams and courses despite these being essential to your work.

Even the admittedly cushy pensions are being eroded (now career average rather than final salary)

Exactly what perks are we cushy public sector works getting?

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.

Well actually most of my family work in the public sector and have better contracts, holidays, pensions than people I know in the private sector so I could easily say 'don't give me the poor public sector workers spiel as I won't believe you'

I also know private sector workers with free travel passes, gym memberships and hospitality allowances. There isn't any of that in the public sector.

Very little of that in the private sector either.

The market will decide in this one eventually - you know, the market that the conservatives love when it's in their interests.

Hunt desperately needs to bring down staffing costs, but he is too thick to realise that if you piss doctors off, and they leave, you'll spend a lot more on locums instead, OR staffing levels will become (even more) unsafe. This is already a big issue and is likely to get worse.

Like it or not, doctors have skills that are valuable and take many years of training to acquire. You can lose them easily, but it's much harder to replace them (especially if you want to limit immigration at the same time).

I cannot think of any private sector role where skills are in such short supply and working conditions are so poor, yet salaries so comparatively low.

Folly is it really your experience that junior Drs are colluding to fake rota monitoring to get a band 3 supplement?

My experience is the exact opposite. Juniors are under huge pressure to under report to save trusts money. When there was a clear breach at our trust recently they re monitored it about 4 times and the juniors had to take legal action to get band 3. Most Drs just put up and shut up as its not worth the fuss.

I don't think it's a real picture at all to say that people are commonly getting 100 percent supplements

Where were you when all the other NHS staff had their contracts and working conditions revised ?ine consultant asked me the other day what I tongues about the change , I said I felt it deeply unfair but felt they should have thrown their force in a couple of years ago when for example conditions for radiographers et al were changed

Sorry, one ad. Thought

Yes misti. Regardless of the public/ private sector debate, you can't expect the NHS to run on goodwill forever. At some point you have to make it an attractive employer, otherwise you get shit workers or no workers

Yes I have known that several times unfortunately mamadoc. One time the rest of the juniors actually turned on the person trying to get them to do it. Another time, there was irrefutable evidence that diary cards were untrue. Thats just two off the top of my head. I'd like to think that there is less of this now, I really hope so.

As said in my post though, I also know of occasions where juniors have been pressured to reduce their hours on a diary card too. The current contract doesnt work, it isnt fit for purpose and has been abused by both sides. There has to be something wrong when you are sitting in a hearing debating with the BMA 15 minutes of extra work by one person and whether that should cost a trust over £100k.

Folly,

I have to pick you up on one point- it takes more than one doctor being late once or missing one lunch break for a rota to be non-compliant.

The rota must only be compliant for 75% of the shifts worked by all the doctors on that rota for it to be ok'd. So you need more than 25% of the shifts to breach before it would trigger a non-compliant re-banding. Or at least that is what we have been told (repeatedly) by our trust and confirmed by the BMA representative. I think I should ask for the data from all of my previous monitoring periods and look into it further. If you are right, we have been well and truly conned. Which is possible, but I suspect you may be incorrect.

By your criteria every rota I have ever worked would be non-compliant. I stay beyond my paid hours most days and it is quite common to miss breaks when working the long 12-13 hour on-call shifts (especially weekends and nights). I have only worked 2 rota's which failed. One of those was a post where 1/3 of the posts were unfilled as we couldn't recruit (or retain) sufficient doctors and the trust would not employ locums. When you are trying to the work of extra people, it's not surprising if you have to work late or miss breaks just to get the work done.

I think it's deeply unfair but I would never strike. I'm a suck it up kind of person as in fact are most Drs

What people are upset about is less the money in fact and more the way the government are arguing it.

People were angered by the claim that Drs are opting out of weekend work and are responsible for increased deaths at weekends. I believe you technically can but I don't know anyone who does. It would not be practically possible. The increase in weekend deaths could be down to a whole host of other factors.

They want to say that work at 9am on a Monday is worth the same as working at 9pm on a Saturday. Most people don't think that is true. The antisocial hours payment is reasonable compensation for disruption to your life. If they are removed the recruitment crisis in A and E can only get worse and more people will die.

I love my job. I realise I am lucky to have it. It gives me a lot of job satisfaction. It is reasonably well rewarded but not a kings ransom. I do think I could make a lot more money a lot more easily in another industry. My friends who left to work in consultancy in the city earn megabucks more than me.

I'm not asking for any more money
I'm actually ok about some cuts if we're all in it together. I'd rather get less pay than have services cut for my patients
I just dislike the misrepresentation

Ps I didnt say commonly getting 100% mamadoc, that wouldn't be true. I'm trying to just say things as I've seen them (no agenda either way), having been involved in this since the 90s.

folly wouldn't you say that beyond the mechanics of contracts, Hunt needs to address morale more generally? Poor morale leads to poor care and his handling of the debacle has been terrible for morale where I work

Oh absolutely 7805, I dont disagree with that at all. One issue is the number of medical students though, that should have been addressed years ago by the previous government, and continued by this government. Medical Workforce planning has always been a joke.

Still, I do think there is a lot of misinformation out there about the current JD contract. It needed reforming within months of being introduced tbh. There has been a great deal of reluctance to renegotiate by the BMA (going back many years) and I guess this is the result sadly.

Most middle grade A&E Drs are Locums now as they can't get any to work under contracts. The conditions and pay are just not good enough for experienced doctors. If doctors in other specialities follow suit then I can't see how the NHS can support itself - but that's what Cameron wants someone to blame when the NHS folds.

This stuff about underfunding is a bit of a misunderstanding of the financial situation the NHS finds itself in.

There is an aging population who require more care and the lifestyle related illnesses (smoking related, obesity etc) are rising exponentially as well. People expect the NHS will fund everything from weight watchers to gastric bands to abdominoplasty, while taking no responsibility for it themselves. People want CHC but also to pass on their assets to their kids rather than contribute to their own care.

By 2020 the NHS will be in defecit by £30 billion. The Government has promised £8 billion additional funding, so the NHS needs to find £22 billion in efficiency savings AND cope with the increase in demand through cuts in social care.

So it needs to do things differently. I'm not sure that changing junior doctors contracts is the right way, although what is being presented as fact in the media and what is actually suggested are not the same, but the attitude of "Tories are trying to dismantle the NHS deliberately" ignores the issues that any political party would face and that EVERY party would be in charge of an organisation with a massive deficit and none of them at the election had a particularly good idea of how they might address it.

And agree with Mamadoc,

I'm not saying falsifying monitoring details doesn't happen, but I'd say it is quite rare. I have never experienced it. The risk you take is pretty big- there is a form that goes with the monitoring diary which you have to sign to say everything you have written is correct and that you understand that if it is not then you will be subject to disciplinary procedures (likely lose your job) and referred to GMC for fitness to practice (likely sanctioned at the very least). You would probably lose your training number and would struggle to get a job. I'd be surprised if it was an everyday occurrence due to the risk involved.

Th trust I work ask us to have the forms signed by a consultant (or charge nurse) to say we were there when we said we were.

Frequently things are rearranged and nursing staff warned we are on monitoring to ensure compliance. Someone gets sent round to ensure we are going home on time- this does not happen outside monitoring periods.

As a cohort, we now collect all the forms together and photocopy them.We also get a signed receipt from the HR office confirming they have received them. The reason we do this as there is a tendency for the forms to be "lost" when it looks like they are going to fail. Then the HR department said as they didn't have enough of the forms that they would have to re-monitor us.

I have also been subject to pressure to change what I put on the monitoring form. A colleague had his diary card questioned repeatedly, despite the consultant on the ward confirming he had stayed late as he had stated in the form- with the constant reminder that we have to sign a separate form to say that we understand the repercussions (formal disciplinary procedures and referral to GMC) of lying on the monitoring forms. The pressure put on us can be pretty unpleasant.

A friend working in a different trust was called into a meeting along with her colleagues after a non-compliant monitoring outcome and told if they insisted on being paid, rather than agreeing a repeat monitoring, that they would be responsible for patients missing out on treatment due to money and various other attempts at emotional blackmail.

Sorry Jacks 11, thats incorrect.

Not all the rules have a 75% threshold. The maximum duty length threshold is 100%.

Recent work has suggested that most health costs are incurred at the end of life, regardless how old you are. So the aging pop is not necessarily what is crippling the NHS. Here's a radical thought to address the NHS deficit: they could raise taxes! It is not inevitable that the NHS needs reform, it's a political decision.

Oh and Jacks, I agree that juniors are pressured too, have already said that. I noticed in your post you highlighted the lack of trust you and your colleagues have in HR. Thats one major issue - the whole monitoring process has led to mistrust on both sides. Salaries should not be dependent on 2 weeks of diary cards twice a year, its bonkers (for everyone).

I don't think the consequence will be people leaving for abroad or non NHS jobs (although there will be some of that)

The main problem is that reducing antisocial hours payments will drive people away from acute specialties like A&E, paeds, O&G which are already struggling to recruit. It will make it harder not easier to have a 24-7 NHS and it will harm patient care.

I don't understand why people aren't talking more about that.

Also taking away the penalty for Drs being overworked will reduce patient safety.
In my shortage specialty we have a chronic recruitment problem and rota gaps are the norm. My trainee went on Mat leave and the Trust tried very hard not to replace her and just make the others cover because the locum agency rates are extortionate. Then the others are overworked, they get sick and go off too and the whole thing falls over. That was the situation that led (finally)to the band 3 award to the few left standing. If there was no prospect of a penalty why bother trying to get locums? Why not work the other Drs into the ground?