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.

I was there yesterday, with my dc.

Dd (5) asked why Hunt wouldn't come and talk to us, bless here.

If this contract goes through a lot will either leave medicine or change careers. These gaps will then need to be plugged by expensive locums, but Hunt has capped their pay, meaning there won't be many locums soon. All this means the understaffing will become a lot worse, and patient safety will suffer.

Whenever this is brought up, a significant proportion of non-medics want to talk about it being a race to the bottom. This isny about that, but the systematic dismantling of the NHS.

How much does a locum earn?

Depends how in-demand they are. Going internal rates for a registrar seem to be £40-50ph in my area, but could be much more than that if it's short notice, a particularly antisocial shift or they're desperate (e.g. would have to close the hospital to admissions if they could not find someone). Obviously if booked through an agency the hospital will actually pay considerably more than that to the company.

iPaid

Depends on a number of things- e.g. what grade is the locum post and experience of the locum doctor.

There are also different types of locum posts, which attract different salaries. There are long-term locum posts (locum appointment for service or a locum appointment for training) and then short-term locums (for a few days, weeks or a couple of months). The short-term locums are often done through agencies, which charge more than the longer-term locums. Again, hard to give you a ball-park figure as it is so dependent on the job, the doctor and how difficult it is to get the shifts covered.

As a guide, the longer-term locums (as long as not done through agency) earn pretty much the same as the doctors in training posts.

"This isny about that, but the systematic dismantling of the NHS."

I'm not sure it is about that for everyone protesting because the dismantling has been going on for a while. How many junior doctors were extolling the virtues of the NHS then? I can see why some NHS workers are finding that hard to swallow.

Sure, wages are a factor. Not the only factor- most of us are concerned about the fact the safe guards about unfair and unsafe hours are going to be removed. Nothing with real teeth/deterrent is going to be put in place, so it is without doubt that rules will be ignored routinely (as the consequences will be worth the risk of getting caught out). That is what happened in the past and was stopped by stiff financial penalties for trusts where rota's were not compliant.

As the OP said, it is also the removal of incrementals- which disproportionately effect those who work part-time, women who have gone on maternity leave or those doctors who take time out for clinical research/PhDs and those who change specialty.

The changes will also make it harder to recruit to specialties already struggling to fill posts.

The NHS is a wonderful thing, in my opinion. Yes, it has it's problems and no-one is suggesting it is perfect or always gets things right. But outcomes are a lot better than this government would have you think. I have no issue with evidence based change or re-organisation- that is thought through carefully and funded properly.

Late to this & apologies for massive rant

Firslty junior doctors are not wet behind the ears teenagers - you are junior right up till your consultant post - armed with years of postgraduate exams, training etc that costs your personally a fortune.

I think doctors have been vocal about the dismantling of the NHS for a while - certainly lots of twitter campaigns etc. Lots of doctors wanted to take action when the first real signs of privatisation started to appear. However legally strikes etc can only be about T&Cs not the fact we can see the organisation we believe in being badly damaged.

A few docs have stood for parliament based on local healthcare issues etc. We do stand with others despite what many will think.

I work in acute medicine. That means if you are acutely sick with a medical condition you come through my unit. IN the 6 years I have been a consultant our admission numbers have gone up from 800 a month to about 2000 a month - despite us putting loads of pathways in place to keep well people out of hospital. What we are seeing essentially is sicker patients coming to our doors in massive numbers.

I benefited from the original New Deal in 2000 - prior to this I was on a 1 in 4 rota where you worked 8am till 12 the next day, then 3 days 8-5 (but actually worked till work finished). If you did the weekend (sat 8 am till monday 10am) you did get to bed on monday morning. We got paid additional duty hours - essentially 50% of a regular hourly rate - for work we did - so at 2 am on Sunday I was earning a lower hourly rate than the cleaner. The New Deal tried to put the antisocial aspect of work into categories rather than paying per hour - so more salaried & definitely massively improved working conditions for my group. The most obvious benefit for me was that I didn't get palpitations thinking about work on a sunday night, and was no longer so exhausted I walked into things.

I don't think juniors dispute that the current contract arrangements may not be ideal - its the nature of the lies from the beloved Jeremy Hunt. There's lots of misinformation:

1. the weekend mortality crap he is spouting is incorrect. Either he hasn't read the source data, doesn't have the skill to understand it or is deliberately lying. Bottom line is that the raw data is less deaths on the weekend, and given that we don't do any routine stuff (like come in for low risk routine tests) at weekend you have to be ill to get in. The paper they keep quoting even says this clearly

2. doctors opt out of weekends. This comes from the 2003 consultant contract (most of us aren't on it). Juniors do not opt out of weekends - in fact they generally can't complete their training without working tons of weekends and nights. They are not even asking to get out of weekends - they are hugely offended at the suggestion they are not committed to a safe NHS.

I'm currently 24 weeks pregnant & have SPD. My shifts mean being on my feet. I knew I wouldn't be able to work a 12 day stretch of haring round the ED - but I didn't opt out, I swapped so I brought the days earlier in my pregnancy (god, the smells and sickness) & split them so I only worked saturday or sunday but not both i.e. no more than 6 days in a row. I am really bloody offended that the right honorable Jeremy thinks I don't work at weekends

3. That any public sector service can be run to a high standard with the levels of cuts all are experiencing.Then, turn on the staff and try to blame them, villify them & tell them to work harder but be surprised that they don't respond well to that.

I was at work and unable to leave the day (no alternative cover) my mother in law died, so couldn't support my heartbroken husband. My life is planned around delivering out of hours care & i can see our great NHS trickling away. I have friends in the Police, Teaching etc in a similar boat.

I think we have a responsibility to try and balance the information out there sot he public can make their own minds up. It's been hard to engage the press though. I do think there are advantages to working in the NHS - certainly I work with some amazing compassionate people so when my Mum died they covered her last 2 weeks in the hospice so I could be with her. A lot of people don't get that. I don't get freebies or perks, but the sonographer let me have my scan pic for free. I know how to get through the system.

However I could have earned more in many other walks of life - I do this because I love my job. My fear is that I wont be able to keep loving it if we abuse our workforce, end up unable to recruit to acute specialities & the whole caboodle comes falling down.

I am actually 100% certain that I would personally profit from a privatised health service - my skillset (medical and management) means I could earn a shedload more if I wished to do that.

However for the sake of my 91 year old Dad, my nephew with aspergers, my fried with cancer (I can go on) I do not want to see the changes this government proposes. And a part of this is valuing the massive skillsets of all the staff to deliver the care.

That is a great post madsaz

Ava- more like 38 than 28 to become a consultant or 10+ years of service as a 'junior Dr'. Registrars, who appear pretty senior to the layman, are still 'junior Drs'

Does the salary jump then?
It does a bit. I think starting base pay is about £70000 full time. Remember this is after at least 10 years in the career though plus a lot of extra study and post grad qualifications
I used to think I'd be really well off as a consultant but after higher rate tax and loss of child benefit we do fine (non dr DH) but not in a private education, skiing holidays, huge house league

Hours- most people are on a full shift system these days so shouldn't be doing more than 12h at a time.
And there are rules about the number of days straight you can work without a break (used to be 14, not sure if it is now). My juniors get a day off after working a weekend so 7 in a row or 7 night shifts on a row.

The problems with really long hours used to be due to an 'on call' system where you are available to be called but not supposed to be working all that time. You get paid less than normal because you are not supposed to be working constantly but in reality you are up all night and you still have to do your normal work the next day. That is how you can wind up so tired you walk into walls. The worry is that if hours restrictions and penalties for exceeding the restrictions are removed we will go back to this situation

the worst bit about work before EWTD was the compassion fatigue. I once shouted at an old man for complaining that I was finding it so hard to take blood from him.

It was 2 am, all his veins were stuffed, I was taking blood out of his little finger. He was also riddled with cancer and blood clots, lonely and terrified and was only looking for some kindness. I was so tired I viewed him as the barrier to me getting 30 minutes sleep. I told him that the sooner he let me do it the sooner we would both be happy.

Still haunts me. Don't want to ever see a return to those hours - even accepting that shifts mean less continuity (we can work hard on our communication and teamwork). If we don't treat the staff with compassion they have no compassion for others & that is not the future we want.

The junior doctors are a soft target and not really what the DoH is after. Yes they want to cut our pay for working unsocial hours but what they are really after is redefining plain time working for all the NHS. It says so as much in their parliamentary briefing paper. So once they have managed to impose those hours on the junior docs it will be nurses, physios and everyone else on AfC next, as well as the consultants. That is a massive pay cut for ALL NHS staff, on top of the pay freezes that we have had since time immemorial.

And it is exactly contrary to the aim of a 24-7 NHS!

You can say that 9pm Saturday is the same as 9am Monday but no-one really believes that.

If you remove incentives to work out of normal hours less staff will be willing to do it. They will gravitate to clinic based, non acute work and care out of hours will get worse.

And yet Hunt argues that the changes are going to reduce weekend mortality???

Makes no sense to me.

Reading threads like this, I fear that most non-medics aren't on our side.

I have heard that we will never have the general public's support, as they see doctors as well paid, and that other public employees have had pay cuts.

Is this true?

No I don't think many non-medics have much sympathy

Nor did non-teachers support the teachers striking

We are well paid and I guess it does come across as carping about pay (that woman who wrote the open letter did us no favours)

It isn't about pay so much as safeguards against long hours, fair reward for antisocial hours to stop the stampede away from acute specialties and discrimination in pay progression against those who take mat leave, are sick or work part time

However those are hard, technical issues to understand from the outside so I expect no sympathy. Hunt is succeeding in painting Drs as work shy, not bothered to do weekends and nights

This reminds me of the MMC debacle which had a devastating effect on juniors at the time but was not understood at all by anyone outside the profession. There was a half hearted 'strike'/ work to rule at the time which had no effect whatsoever.

I think any strike will be s bad PR move but anything less will not work. I expect the government to win this.

I fear you are right mamadoc

I am a fy2, and likely won't be able to afford to train if the new contract is brought in once I have paid for childcare.

I don't want to move abroad, my dc are settled and I have family nearby.

I'm thinking of alternative careers. Childminding looks pretty attractive.

/Another rant.

It is fairly concerning that most on mumsnet, a fairly educated non-DM place, don't see the underlying issues. It makes me feel that the junior doctors - and the NHS as a whole - is a bit doomed tbh.

I am less surprised by HR types like Follyfoot, I've met a fair few of them. They generally see the workforce as cattle, and feel they can divide the economics of healthcare from the human element which actually can't be done in a moral fashion or at least not in non-private healthcare.
I got a Band 3 payment for a job I did once, Follyfoot. The extra money was useful, I paid a chunk off my student loan (I was a lot more junior then). Probably didn't quite compensate for the kidney infection I was hospitalised with after I went without fluid/food as the sole doctor covering six medical wards for 36 hours straight one weekend. One of the other juniors had given an accidental insulin OD to a patient on their 30th hour the previous weekend. She attempted suicide the following week, survived it, but left medicine. That trust needed a harsh financial penalty to change conditions, and change them it did after having to pay a rota of doctors Band 3 for 6 months. Your argument is akin to saying the NHS should not have to compensate patients financially if they screw-up because its just taking the money away from other patients, after all...

The following is not scaremongering.

• The government's aim is not to provide a safer NHS, for patients or for doctors or nurses or any PAM.
• It is not even to provide a situation where you have busy little bee cheap NHS workers seven days out of seven so people can have varicose vein ops on a Sunday or ENT appointments on a Saturday for little Tommy to prevent you taking time off from your 9-5 Mon-Fri schedule. This is not the utopia you're heading for.

The government's aim is to privatise the NHS. Jeremy Hunt, the current health minister, actually wrote a manifesto on how to strip the NHS down and sell it off. He is attempting to move the medical workforce to a lower paid hard worked junior doctor system (as in the US) and a higher paid specialist consultant population (paid directly by you, not taxes).
The ultimate result is that you won't be paying less, you'll be paying more at least if you want private healthcare. And you will want private healthcare because the state healthcare will be a scary place. Of course, if you have a good safe job which you're guaranteed to keep, many who work will have most healthcare expenses covered by their companies (up to a certain deductible). Those on a low income or benefits will be queuing for hours for their insulin, turned away to second tier hospitals in an emergency, and denied life-altering/prolonging treatment if they cannot pay. General medicine / old age medicine / community psych will be undervalued and underfunded as the people who use these services most don't tend to have private healthcare. (Jeremy by the way is also trying to shorten training time so your doctors will be less well trained, a point that is missing quite often).

In the current system, doctors are paid well. We are afraid to say that, but we shouldn't be. A first year junior doctor does start out on a derisory amount for the amount of education, responsibility and work they put in. It quickly rises as they rise through the ranks, and for most of their career they are paid well. They earn it.

I'm not a junior doctor. I'm a first year consultant and I am happy with the remuneration I get - I'm not asking for more. I don't want to be paid by private insurance and patients that can afford it. I earn 78000ish gross pa/3900 net a month if you're particularly interested. I pay £1400 in tax a month, 900 in pension contributions and about 270 in national insurance. My ultimate pension has been reduced massively by government compared to previous years, but that argument is over and done with. What people seem afraid to say is that we are worth the amount we are paid. Other professions work late and work hard. Some are paid to a similar level to doctors and I suspect they earn it too. Many aren't that should be. But that doesn't mean I'm not worth the money I'm paid. The scale of decisions I make in my day to day job and the scale of risk I assume are matched by no other profession. I do my job well, I love it, it's the most interesting and rewarding job in the world (I think) but hell yes, if you tried to reduce my salary by 30%, I'm going to complain, I'm going to fight, I'm going to find another country that will pay me what I'm worth, or ultimately - I'll just stop doing it.

If you think doctors are paid too well for an easy job, then why don't more do it?

• The five years of medical school? (with associated debt)
• The minimum nine (often more) years of training as a junior doctor, in which you can be moved every six months, with hours commuting distance from your base (that's fun after night shifts). Nights, long days, the impact on family life - any kind of a life really.
• the constant assessments, the thousands that are paid out every year on exam fees, course fees (necessary to show progression and learning), malpractice fees (we have to fund these ourselves) and registration fees with the GMC (yes, we actually pay for the body that allows people to make complaints against us). Also BMA (union fees, which are more than they're worth to be honest).
• the constant training to comply with hospital policies that has to be done in our own time, pressure to meet targets, pressure to balance the care you want to give to your patients with the time and budget constraints that the Trust sets on you. The increasing demands from a patient population who want to live high risk lives but never die...

The perks are firstly, the patients, the positive impact you can have on their lives - and yes, the pay.

To criticise juniors for daring to protest, and daring to consider striking for proposed increase in their hours (and yes, reduction in their pay) is short-sighted to say the least. They are concerned about their livelihood, of course, but for many, the big concern is the future of UK healthcare.

/Rant over.

P.S. If all you took away from that was an overwhelming sense of indignation that doctors should feel they have the right to a high level of pay when other deserving professions don't even approach the same level, then you have completely missed the point. You'll miss that free care when it's gone.

You see straighttalker I don't think the majority of the British public really believe that the NHS will get privatised, or rather they can't imagine a different system where they will have to pay for everything from the canulla to the £100 a day antibiotics. It's fucking ironic that it's the doctors that are shouting about trying to save the NHS when in every country where healthcare is privatised doctors do very well out of it financially and patients don't.

Fully agree it's a disgrace
Sil is a jd and shortly emigrating as are half her jd friends/ working endless hours for what equates to nmw and huge levels of life and death responsibility at end 12-14 hour shifts is funnily enough wearing thin

Reading threads like this, I fear that most non-medics aren't on our side

I'm a non-medic. I want a well-qualified, well-rested, well-paid workforce in my beloved NHS.

It's very difficult to get a proper understanding of the facts when there is so much contradictory information out there as this thread proves.

I wonder how many doctors voted Tory?

If doctors strike you will totally lose my sympathy and support.

Apologies for disjointed post but reflects my state of mind about what's happening to the NHS. The whole country actually ...

I did not vote Tory and I can't believe that many NHS workers did (turkeys voting for Christmas if so)

I will never strike. I can't do that to my patients. Last time a strike came up it was to not do any non-emergency work and it was a bit of a joke. It had no impact at all.

I do think that of Hunt succeeds in cutting the Drs out of hours payments he will then have a stronger argument to cut nurses, OTs and all
other NHS workers pay (well look drs don't get any extra for Saturday's...)

jacks long term locums usually get paid pretty much the same as ad hoc. Most middle grades that are locums get paid nearly double and a lot more than that if PLC than those on training posts. I know of several who have come off training because of the pay.

Will you support your juniors though if they strike mamadoc? Only junior doctors in England will be balloted and the view is if the strike goes ahead then all elective work stops and emergency cover is provided by the consultants. Patients should not and will not ever be left in a position without medical cover, but all elective clinic and procedures will be cancelled.

For a lot of us, the new contract will mean having to give medicine up, the cut in salary accompanied by the increase in antisocial hours will make it financially not viable to work once you factor in the cost of childcare. I also refuse to put myself in the position of jeopardising patients and myself through exhaustion. So if push comes to shove, yes I will strike. Because the other alternative is to quietly resign. So the NHS either loses me for the duration of the strike, or for good.

I am neither encouraging nor discouraging my juniors from striking.

The issue about non urgent work is where the boundary is on that. OK we can cancel some clinics but actually not all. Are the rapid access chest pain clinic or the TIA clinic non urgent? What about the inpatients?

My juniors are only involved in ward work not in clinics or community so I can't see what there is in their job descriptions that is non urgent. The patients will still be on the ward and someone will need to look after them. If they go on strike then I will do it and I will have to cancel my outpatient and community work to do so. Plus there is only one of me and 3 of them so with the best will in the world service will not be as good as usual.

Nonetheless I don't question their right to strike. Privately I doubt it will work and will backfire re public perception but I don't say so to them.

Two Drs on the thread have now said they wouldn't be able to afford to go on if the contract is changed. I realise that this is very scary stuff and I remember feeling this way about MMC so I say this gently but after however many years of med school and post grad work would people really give that up? We don't know the actual facts and figures yet it seems premature to me to say that and possibly unhelpful in speaking to the general public as they may perceive we are over reacting or scaremongering (I realise this is not the intention)

I am not a young junior mamadoc. I was there during the MMC/MTAS debacle. We are a two doctor family. Increased weekend work beyond what we are already doing will not be sustainable for us. Both financially and in terms of what is fair to the children.

And what will I have to look forward to if the contract is forced through? Being a consultant on a contract with almost certainly worse terms than the current consultant contract?

FWIW I remember SHO days where it is just a single SHO on the ward, sometimes with an F1. Consultants will cope. Especially if they use an all hands on deck approach. I am aware that not all Consultants will want to do it though.

I will support the juniors if they strike. They are mainly ward based - locally our consultant and nurse practitioner group will make sure urgent care is delivered while wearing big badges explaining our support - our acute patients will be safe though.

Routine paperwork etc won't get done - or we will dictate letters etc for secretaries to do later. I would guess elective surgery will be cancelled but urgent not and some consultants will cancel clinics to keep wards safe.

Patients may be inconvenienced but not harmed. The NHS paperwork juggernaut will be harmed around processes and pathways but we would never turn a patient in need away.

Doctors and other care workers tolerate a lot of stuff from a sense of vocation but still deserve the same right to protest as any other workers. I am sorry some of the public think doctors who strike lose credibility - but I wonder what those individuals would be willing to tolerate without protest for themselves?