to wish doctors weren't going on strike

[MissTriggs]

After 5 months of misdiagnoses, being sent to the wrong person, explaining why suggestions weren't helpful, holding my GP's hand and fighting to get to the right person I'm now booked in to have the test I need on 2nd December, the day after the strike.

If my test was on 1st December I'd be pretty upset

I then read a post on here from a junior doctor claiming s/he could make more money "as a manager at Greggs" and that tipped me over the edge.

I saw lots of posts from doctors saying they already work weekends but it turns out they get paid extra for this at present.

I think doctors have no idea what it is to work in a job where you can be sacked easily, where you don't know whether work is coming in from day to day, where your employers have no interest in getting you back to work after a career break and where you either have no pension or the value of your pension can fall from year to year and be worth nothing.
I also think they don't realise that, whilst a generation ago doctors might have been unusual in working antisocial hours, nowadays all professionals are expected to be available all the time.

I might be wrong, but I don't think I'm being unreasonable here.

I support the strike. There is nothing else our junior doctors can do to show that what they are being subjected to is not acceptable.

But we don't live in a 5 day a week society anymore and we have to adjust.

But changing existing contracts is not the way to do it.

There needs to be out of hours provision for emergencies, but that doesn't translate into there being a need for a local surgeries to provide a fully staffed 24/7 GP service. You are right that many NHS services can't meet demands, but it's not clear what a '24/7 NHS' means. (Although it is short and snappy).

Ok so local surgeries maybe don't need to be 24/7. But if people who get admitted to hospital outside of business hours don't get the same access to labs, X Ray's or as simple as someone being able to access their records then it's always going to impact negatively on the system surely?

Want2bSupermum

very interesting point about advantages of dealing with educated/polite clients. I would accept that. though doctors don't tend to mention the interaction with vulnerable patients as the downside....?

so Merry you think the focus should be on getting the weekdays right?

Very good point gasman. Why indeed would there need to be pay protection if this was a pay rise....

I am also a bit sceptical that the NHS needs to run in exactly the same way at night and the weekend as in the daytime. It needs to be fit for purpose to manage emergencies but it stands to reason you don't need as many Drs at 3am in the morning as 3pm in the afternoon. Even sick patients do sleep.

The vast majority of Hospital inpatients and attendees at GP surgeries are old people. People over 65 are using up most NHS resources it's just a fact. The people reading this thread are in general not the target audience.

So whilst you might all think it would be lovely and convenient to go to the GP on a Saturday or Sunday and not take a day off it in fact makes not a blind bit of difference to most of the clientele as they are retired. It's actually easier for them on a weekday as the buses are running. The NHS needs to be set up for the frail old people who are actually it's majority users and increasingly so as the population ages.

Well here in the US they are providing excellent out of hours coverage. When I call my obn I first speak to a doctor in Israel and they triage me. If needed the doctor on call will phone me back and give instructions about what to do or will call in a script to the local 24 hour pharmacy. It is extremely efficient.

My GP and the paediatrician we use has hours from 7am-10pm Monday-Friday and 7am-7pm on Saturday. That doesn't mean all the doctors work those hours daily! They operate on a shift basis either starting at 7am or 3pm. A couple of the doctors in the group work 12 hours shifts so they can compress their hours. A mother in DD's class at school works the Saturday shift and then 3 morning shifts. Her DH is an ER doctor and he works 3 nights a week that are 12 hours. Both are considered FT with 36 hours a week and sometimes they will do extra shifts if needed. They have consistent shifts and leave on time unless there is a major catastrophe.

But the people who do get admitted on the weekend need the same support as people admitted during the week surely!!

But we don't live in a 5 day a week society anymore and we have to adjust.

If you fall ill at the weekend or at 2am you will get any treatment you need at that time if it can't wait. Or are you suggesting GPs stay open 24/7 so people can make midnight appointments for non urgent care? . Perhaps get prescriptions for free slimming world classes as suggested in s previous thread on here

I digress from the OPs point but couldn't let that one go I'm afraid!

Haven't read the whole thread but I do fully support the junior doctors. They should be adequately and fairly paid for the work they do and we need to ensure that those we train are encouraged to stay within the NHS. If we take emergency care doctors as an example, we currently have around 1850 trained EM doctors (consultants and registrars in their last few years of training). In the last 5 years, 510 trainees and 110 consultants have emigrated to Australia and New Zealand - about a third of the workforce. Every year, this group of lost doctors could have seen around 1.5 million patients - or about 50 million over the course of their working lives. Each of these doctors cost around half a million pounds to train, and they now pay taxes to a different government. We must not give them further reason to leave.

On a different but related note, I see the normal NHS manager-bashing has snuck in. Funny how no-one on Mumsnet pays a blind bit of notice to the Daily Fail, except on this one issue where their word is gospel apparently. The Kings' Fund offer the following analysis:

1. Best estimates suggest that the NHS spends roughly £8 billion of its £100 billion budget on management and administration. According to the Office for National Statistics, the proportion of managers in the UK workforce as a whole in June 2010 was 15.4 per cent. For the NHS is it 4.8%. In other words, the NHS has a managerial workforce that is one-third the size of that across the economy as a whole.

2. The NHS in England is a £100 billion-a-year-plus business. It sees 1 million patients every 36 hours, spending nearly £2 billion a week. Aside from the banks, the only companies with a larger turnover in the FTSE 100 are the two global oil giants Shell and BP. If the NHS were a country it would be around the thirtieth largest in the world. If anything, our analysis seems to suggest that the NHS, particularly given the complexity of health care, is under- rather than over-managed.

Leading clinicians have sent an open letter about the issue to support NHS Managers, a excerpt of which is below:

"In our experience, NHS managers are as dedicated to the service as any other group of staff. We find it regrettable, therefore, that they are so often the subject of ill judged criticism and made scapegoats when concerns arise. This is both unfair and damaging to the interests of patients since successful joint working between managerial and clinical staff is an essential ingredient of good care".

Anyway, rant over....

I think the focus should be on recognising that sometimes to procure a service you have to spend money.

But the people who do get admitted on the weekend need the same support as people admitted during the week surely!!

Yes, and that costs money. the government can fiddle around with schedules and pay deals as much as they want, but with no more money spent the service will not improve.

But if you get admitted to hospital on the weekend you don't get the same level of care as if you are admitted at 9am on a weekday.

Because the infrastructure is not available.

Junior doctors don't work for GPs. But when A&E is full on a weekend because out of hours is frankly crap tucks puts more pressure on our junior doctors.

poorbuthappy

But patients who are acute admissions and patients already admitted to the wards DO have access to blood tests, x-rays in the evenings, overnight and at weekends. They are routinely available and there is absolutely no problem in doing this. If CT or MRI scans are needed, whether than be 1pm on a Saturday or 2am on a Sunday morning it can and will be done.

I just cannot understand why there is a perception that patients would be admitted to hospital but could not even have routine bloods or x-rays done.

Our hospitals do have access to the medications prescribed by GPs, most recent investigations (blood tests, x-rays, scans etc) and the most recent clinical letters from specialists to GP and vice-versa via on-line systems.

But it's the extra pressure of people who need a GP service at 3am but it's not available which makes doctors more stretched.

Otherwise are we saying the system is working ok?

If you are an emergency admission at 3pm on a Saturday you will get exactly the same care as you would at 3pm on s Wednesday! If you need a scan you'll get it, if you need surgery you'll get it, if you need transferred you'll get it. If it can wait till Monday when there is a full quota of staff it can wait therefore it's not urgent

Saying that, there are areas where it's best to have an MI during working hours but that's a geographical issue rather than a staffing one. I believe (where I am based) that will be changing soon no thanks to cockwomble hunt I should add

So the system works yes?

do what your really saying is it's inconvenient that it's not a 24/7 fully functioning service? That's different. Opening times are not the issue here

I wish they didn't need to strike but this government are attacking our wonderful NHS. Its one thing we should be proud of.
All the staff where I am are living saints.
A and E were full of people with colds yet they were treated with dignity and respect. True professionals.

Why would you need a GP appointment at 3am? If it is an accident or an emergency go to A&he, otherwise use a bit of common sense and wait until the morning

The system actually works better for the acutely ill than it does for planned care IME.

Yes, they do and on the whole they get it. Don't let Jeremy Hunt tell you otherwise.

If you break your leg at the weekend it will get xrayed and plastered or operated on just as fast as on a weekday.
If your child is sick they will see a paediatrician just as fast as on a weekday
If you give birth at any time you'll have the same access to pain relief and emergency CSection round the clock.
If you are admitted to hospital as an emergency the system is the same weekday or weekend at our hospital you will see a 'junior dr' (but likely to include a registrar with 6-10 years experience ) on the spot and a consultant on the 'post take ward round' within 24 hrs max often 12 hrs.

However:

If you need a scan to find out what is wrong with you or an operation or procedure but it is not so urgent that it's needed that day then you will probably wait until Monday.
If you are already admitted to hospital and you are no longer acutely unwell the routine 'ward round' will not take place at a weekend. Only the newly admitted and sick patients will be seen.
The physio will not come round routinely either and the OT, dietician and SALT won't be doing routine assessments at the weekend either.

Not having these routine things done at weekends will cause some delays and some people to stay in hospital a bit longer but no-one is endangered.
It would be more efficient to have this stuff operate at weekday levels all weekend but it would cost an awful lot to get extra staff to do this (or reduce staffing at weekdays but this won't help overall productivity) and the great British public voted in a Tory government who are certainly not going to increase NHS funding.

You can't have a 24-7 service in the truest sense (same standards at all times) without paying a huge amount. Plus it would not be sensible. It makes sense to staff it to demand.
In a 24 hr Tesco they don't have all the tills and the cafe and fish counter open at all times just so you can get the exact same service at 3am. They have less staff in recognition that most people just want basic emergency stuff at that time.

It was shit in the 1980s................all I wanted after 48h without any sleep was for patients to go away. It was the worst time of my life in obsterics working one in two ie every day Mon to Fri+ every other night + every other weekend when continuous duty period was from Friday am to Monday pm. Patients regularly came to harm because we were so sleep deprived.

We must not go back to that and nor do I believe we should go back to sending small boys up chimneys. This generation must stand firm most of our generation of doctors are v supportive including my old codger husband (retired Consultant Surgeon) who went on strike in 1975.

Do remember these are very bright professionals who are in global demand. They have an enormous sense of vocation and duty. Talk to them as individuals if you doubt that.

People who are admitted at the weekend generally get the same medical care as those admitted during the week, there are now targets about how quickly you should get a senior (consuktant) review. The vast majority if hospitals achieve these.

What they don't get is access too diagnostics eg. MRI. The people who limit that aren't doctors but other groups of health professionals and in many cases there aren't enough to of them to cover operating equipment 7days a week....

I think mamadoc has a good point - should we really be aspiring to run elective care 7days a week. That is a big increase in capacity and should cost more (although as the junior contract debacle shows JH is trying to do it within the same pay envelope)the NHS budget is shrinking can we really expect an extra 40% of work for no additional money. It sounds like a crazy notion to me....

Anecdotally I,, not sure the oubkic want it either -my hospital does elective work at the weekend eg.MRI scans as we have big outpatient waiting lists but the Dna rate (when patients inexplicably don't turn up) is much higher at weekends than during the week..... The GP Sunday data supports my crude observation.

As a senior clinician I would much rather try to sort out urgent care (as I acknowledge there are gaps) within the existing funding system than try to introduce a whole scale increase im elective capacity which I think quite honestly is unachievable.

Even the private sector wouldn't hope to increase output by 40% during a time of reducing budgets with a fixed staffing quota..... (As you can't magic up trained doctors). Those who entered medical school in August 2015 won't be entering my specialty (anaesthetics) as consultants until August 2030 assuming they have an average passage through training... So don't have more than the average mat leave/ number of attempts to sit exams etc....

But it's the extra pressure of people who need a GP service at 3am but it's not available which makes doctors more stretched

It's not that simple though. People do have access to a GP service at 3am- it's called the out of hours GP service and is accessed via NHS 24. It makes no sense to have lots of surgeries open at 3am. I know that NHS 24 is not perfect.

The problem with GP appointments is not as simple as "longer hours"- when there is a national shortage of GPs you cannot simply magic up extra GPs to work extra hours. So you could have more GPs working weekends/nights, but that simply means less GPs working during routine working hours. Unless, of course, you can magically increase the number of GPs.

People are attending A&E for a variety of causes- some of which are due to difficulty in getting GP appointments (and in some cases unwillingness to wait when they could do so perfectly safely). Other problems are an increasing ageing population who are living longer and with multiple co-morbidities and complex health and care needs. Added into this mix is the increased stress on the social care system- again increasing demand due to growing elderly population with multiple co-morbidities and frailty at a time of cuts in resources. This means community support services are stretched and unable to provide as much support which may allow the patient to be managed at home, thus causing the patient to require hospital admission.

Additional pressures are then put on hospitals due to these admissions. In turn, problems with social care can cause problems with getting the patient home from hospital due to lack of community resources. This causes congestion within the hospital. It is a vicious circle.