To wish I could be marching with the juniordoctors today

[nocoolnamesleft]

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.

Trouble is folly, Whilst you might be right that reform is needed, Hunt is not negotiating in good faith

I remember one of my last hours monitoring exercises as a junior doctor. I was called in by a senior manager:

"What do you think you were playing at?"
Confused look.
"With your breaks???? If you had achieved all your breaks, then we'd have achieved 75% for band 2b??!! See, here, look at this, if you'd taken your fifteen minutes here, we'd have been fine, but you only took five minutes. What the hell were you playing at?"

Me "Um, the microwave went ping, and then they crash called me because a baby was trying to die"

"That's not good enough!"

The whole point behind the banding was to penalise trusts who were making doctors work unsafe shifts. And it did seem to reduce it....

The trouble is though mamadoc, that band 3 money - which at the least is half a year's salary to each doctor on that rota - could be spent on patient care instead (not saying it would be of course, but you know what I mean). I really dont know what the answer is. The current system has driven down hours to its credit, the New Deal was introduced in 91 if I remember rightly and was largely ignored until banding came in, but is band 3 really the best way to spend public money? I wish MN had an 'I'm stumped' smiley!

Yes, that's another option. Increase taxes to get that £30 billion per year. Not sure what that would be in real terms as an increase in national insurance? But if people are struggling with losing tax credits, not sure upping national insurance is going to be a winner?

The aging population are living for longer with multiple long term conditions which all need treatment. Current predictions are that by 2030 there will be an increase of 59% of over 65s who will require care for long term conditions which are limiting their day to day living a lot. Dementia and the care needs associated with that is also predicted to rise dramatically, again costing a lot of money. This is what an aging population means and why it's a problem for the NHS in its current form.

Jacks- that is my experience of monitoring too. I bet it's universal.

Monitoring forms sent out accompanied by scary letter threatening GMC action for any falsification (you'd be mad to risk that)

As a consultant I am asked to 'have a discussion' with any of my juniors reporting a breach. (They monitor the electronic submissions live so there's every possibility I could lean on them to reconsider although I refuse)
I am to 'remind them of trust policy' and 'check that they are reporting correctly' 'discuss the reasons for the breach and report back'

It is a horrible atmosphere of mistrust
I wish it were different but classifying Saturday evening work to be paid the same as Monday morning won't fix that.

That, nocool, is why things need to change. Banding worked to reduce hours, but it isnt the way forward precisely because of the example you gave, and the ones I've given.

No one minds staying late to treat a sick patient. Everyone accepts that is the job

What people quite rightly do object to is picking up another 1 or 2 Drs worth of work for months on end (or even years because it seems all rotas your whole career have gaps) That grinds people down.

Band 3 was meant as a stiff penalty for trusts who abuse their junior Drs so of course it is very costly. It is the fault of the Trust if it get awarded not the Drs although it is patients who suffer which is wrong. I've known it happen twice in a 20 yr career and never personally benefitted. I still felt there needs to be some penalty.

Are people not ill on a weekend then?

Thanks for that contribution landrover

I think we're going round in circles a bit now. Banding worked to reduce hours, I agree. There has to be a better way forward though, one that rewards doctors appropriately and keeps their hours within one system of limits (rather than two). Will such a system be found and introduced? Doubt it.

People ARE ill at weekends and there ARE doctors to treat them landrover. What's your point?

cinderella no one denies the existence of the aging population, but whether they are responsible for most of the increase in NHS spending is debatable. But as I say, whether we want to pay for these things is a matter for political negotiation. It's just the right of centre have been very successful in making it look like there is no debate and radical reform inevitable.

I'm surprised by some of the posts on here. I don't want an overworked, unrested doctor treating me. I can fully see why it's not possible to guarantee a doctor will always go home at x o'clock but I think within reasonable parameters (which I realise is the crux of the matter already) they ought to only work a number of hours a week.

In the industry in which I work, we cannot work without 12 hours rest from operational duties. An error by someone I work with could cause hundreds of casualties but there are a number of safeguards in place that would have to fail for that to happen. I could fairly easily make a mistake and cause one or two deaths and it has sadly happened, in a very high profile case. That is why we are subject to stringent rules on rest and maximum working hours.

I accept completely the need for a 24 hour NHS and think more needs to be done to develop it but not by pushing doctors (or other staff, but we're discussing doctors) to their absolute limits.

Lifestyle illnesses are the other biggie in terms of demand, but if not those then what are you blaming for the increase in spending and the defecit?

Lifestyle illnesses are interesting. Smokers, for example, cost less than non-smokers over their lifetime as they die young. My understanding is that the growing NHS cost is associated with more expensive treatments, technology, chronic disease and an increasingly demanding population.

Yes but a smoker doesn't just die early out of the blue. First there is public health money on quitting, then there could be COPD and treatment around that, emergency admissions because of breathing difficulties. More risk of getting flu, more emergency admissions. Then maybe lung cancer, chemo, treatments around that. Finally palliative care.

So you're right, all the things you've listed are important issues, but a lot of them are caused from people not taking their own responsibility for their lifestyle then expecting the NHS to fix them all with the new technology and expensive treatments.

Agree (again) wit Mamadoc- no one minds staying late to treat a sick patient as we all accept that this is a necessary part of our job.

What I, and other Drs, find unacceptable is trying to take on the extra work due to unfilled posts. For months, not a few days or weeks. That means picking up the extra nights, long-days and weekends. It means staying late to complete routine work because there are simply not enough of us to get that work done in "usual hours". We do the extra work because we don't want patient's to suffer, but it does become a grind. It has happened in every single post I have worked in from FY1 onwards.

I also agree Band 3 has worked to reduce hours. It was meant as a stiff penalty for trusts who abuse their junior Drs so of course it is very costly. Remove the stiff penalty, and the trusts will ignore it. The only thing they seem to react to is something which will impact on the finances. Our complaints, raising concerns about the gaps in the rota and the impact this is having on patient care, on staff morale and our training etc- all get ignored. However, when they've had to back pay on Band 3 due to failing monitoring management sits up and takes notice. They start making changes- which only a few weeks ago they told us were "not needed" (or ignored our complaints totally). Unless something with teeth is put in place, you may as well not bother as the trusts will ignore it.

Smokers contribute a shitload in tax.

Folly- why one system of limits?

Do you mean as opposed to a limit on normal working hours and a limit on on call (antisocial) hours?

I think that most people in most jobs do make a distinction between working 9am-5pm Mon to Fri and working evenings, weekends and nights and would expect to get more money for working antisocial hours.

Rewarding doctors for doing antisocial hours goes some way to compensate those who work in acute specialties. If you take away this incentive then less and less people will choose specialties with a lot of on call work eg A&E, paeds, O&G, acute medicine and surgery and everyone will want to be a dermatologist!

Saucony - even if that was enough tax to cover all their treatment (and they don't smoke roll ups and cheapy tobacco), does that argument count for obesity and all its associated illnesses too?

YANBU any change that worsens conditions for NHS doctors, and therefore the public, is very worrying. Especially changes which are so discriminatory to women who need time off for mat leave etc.

I have enjoyed this thread without understanding it fully.

Are you a junior doctor until about 28? Does the salary jump hugely then?

How can doctors work such long hours? I'd be clumsy if I had to. Pilots have more regulated hours, but I expect they don't have such an unpredictable workload.

Thanks doctors anyway, I think that you do a very important job. You know.

Ava

You're a junior until/unless you become a consultant or a GP. So I was a junior from 1997 to 2010, when I became a consultant at the age of 36. Which is fairly average for a consultant, though GPs finish training a few years quicker. Then your salary makes a jump....but not as much as the papers/government would have you believe...

Thanks. I had believed that medicine wasn't a profession that you go into for money, but you should be paid fairly for what you do, which is a thing that not many people can do.