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.

Anyway - this thread is about the juniors, and as far as I can tell, the consultants do support them and will step up when needed to keep things going and look after the patients.

Mrs Consultant - I know what you mean about on call nights, when that bleep goes off, I wake up swearing and I don't even have to do anything.

I'm another junior doc, mid 30s in Paediatrics/NICU. I wish we weren't striking, but I wish this government weren't hell-bent on destroying our NHS more.

I've been living overseas on a career break recently and was unfortunate enough to have a stillbirth while there. One of the single greatest things about our NHS is that you will never, ever get mail addressed to your dead son, six months after he died, asking for that 800 Euros for those genetics tests they ran. We have been incredibly fortunate that our insurance company have not only covered all the costs associated with this but have done so with compassion. Doesn't change the fact that we have to pay out and then claim back.

I've actually put my hours into the independent calculator - which is only partly accurate as the information we have is vague. If I do my current rota (a fairly standard 1:8 NICU covering days, nights, weekends both on the unit and transporting babies around the region/country), then I will see a 5% pay cut if I work full time. A peculiar quirk of the hours calculator means that if I were to work part-time (70%), I would see a pay cut of just over 10%, as the proportion of antisocial hours (of their total hours) is greater for those working less than full time.

The removal of safeguards is one of the scariest parts of the new contract. One of my previous rotas was downbanded following the outlawing of the worst rotas. No changes were made to the number of doctors, they were just told to go home earlier each day. Needless to say, they all ended up staying late in order to keep the patients safe - monitoring came and went and the trust had to pay and change the rota to make it compliant (by adding doctors to it). Needless to say, without that safeguard, nothing would have changed and doctors would have been more tired and less safe as time went on.

Yes sorry I got on to the consultant thing because of the obvious link between staff shortages and private practices

Anyway, fwiw, having thought about the responses,I would now support rejection of the" rebranding" of Saturdays provided there was transparent identification that the salaries are more like 30k up rather than 23k up and provided the protected pay issue was mentioned. it is not a pay cut for individuals it is a "degrading" of the salary bands

Not that my views will make a difference but felt I should mention it for the sake of the people who took trouble last night

I dont know if anyone has posted the costs of total healthcare expenditure in different countries but it is worth pointing out that the usa spends 8500 us dollars per capita or 17.7% gdp and the uk only 3400 us dollars or 9.4% GDP.

K, fact UK spends less is a testatment to how much better our system is though surely?

(Chat I'm so sorry about your still birth)

Yes exactly. I guess my view is the government are quite happy to piss off doctors, risk losing medical staff and other staff and run down the NHS because they oppose state run services. However market forces dictate a higher wage for medical staff and a worse service and more expense overall. Just because the Torys quite fancy their mates get a slice of that money is not a good reason to lose what we have.

The numbers just do not add up. So junior doctor numbers are not going to increase and we are going to work fewer hours. Yet there are going to be more doctors working evenings, overnight and weekend. Which can only mean the number of doctors on-shift on week days must be going to reduce. Which will impact on the services provided at present. I suggest all that will happen is a poorer services 7 days a week.

All this based on misinterpretation of figures (as Jeremy Hunt has been told by the authors of the study and report that he seems to base his "extra 15,000 deaths at weekends"). The government cannot even fully define what they mean by "7 day NHS" and how they are going to staff it (not just medical staff) without more staff or more money.

I also echo what Chat says here:
The removal of safeguards is one of the scariest parts of the new contract. One of my previous rotas was downbanded following the outlawing of the worst rotas. No changes were made to the number of doctors, they were just told to go home earlier each day. Needless to say, they all ended up staying late in order to keep the patients safe - monitoring came and went and the trust had to pay and change the rota to make it compliant (by adding doctors to it). Needless to say, without that safeguard, nothing would have changed and doctors would have been more tired and less safe as time went on

Exactly my experience. In one job I had nearly 1/3 of the posts were unfilled for various reasons. We stayed late, did extra nights, missed breaks and so on. We complained to the consultants. They were also concerned and went to management, who refused to hire long-term locums and only put out the "on-call" shifts to internal locums (i.e. the staff already working there). Did not address the problems of staff shortage during the day and the extra work this created. 1st monitoring period came and we failed- we too were told to "go home on time and take breaks". That couldn't happen most of the time, or at least not without leaving work undone, putting patients at risk or delaying discharges etc. We declined to do that and so failed monitoring a second time- when they had to up-band our rota. Then all of a sudden they managed to change the rota and when we failed a 3rd time suddenly all the posts were filled.

So if those safeguards of monitoring and financial penalties for having unsafe rota's (which seems to be the only thing that makes the powers that be take any notice when it comes to doctors working hours) are removed, there will be absolutely nothing to stop or act as a disincentive to hospitals to ensure rota's are fair and safe. Moreover, there will be no mechanism to uncover unsafe rota's. Which I imagine is the reason that the government are removing the safeguards- they can promise a reduction in hours, knowing full well that there will be no way for this to be proven one way or the other and no mechanism for redress from the doctors.

I do understand ivy but think it is morally wrong

What feels morally wrong about having a mix of private and state healthcare going on is the reasons why someone would choose private over NHS. If we're all paying into a common pot for our healthcare, then it should be good enough for all of us. There's something wrong with a system where the poor have to pay into something that clearly isn't felt to be adequate by those rich enough to have the option of private healthcare. Given that our taxes are paying doctors' salaries, one would hope they haven't got oodles and oodles of time to work elsewhere, because all their available working hours should really be spent on the job they're paid to do - otherwise the public isn't getting its money's worth.

I realise this is far from being a watertight argument - but look at the alternative. Consultants (who do work hard for the NHS) being paid a great deal of money to provide healthcare that is, through no fault of their own, inadequate, then going to make a great deal of money delivering an adequate system to those who can pay for it. If we were looking at this in a different society, we would call it corruption. I've spent time in South Africa and that's the way we're going, to be honest.

However, what you have to also look at is that in an annual intake of 5000 at my firm they only expect 0.8 to make partner.

Would those 5000 all be people with the equivalent of a medical school qualification?

YANBU.

Work conditions in the private sector are an awful lot harder than they were 10, 20 years ago. As a lawyer, I don't get paid any overtime yet regularly work 20-40 hours over my "contractual hours" every week. This is absolutely expected and if I didn't do it I would be fired. And I don't have the job security or benefits, pension, etc. that NHS doctors have.

I really don't agree with the doctors striking.

because all their available working hours should really be spent on the job they're paid to do - otherwise the public isn't getting its money's worth.

Or their well paid private work subsidises their NHS salary.

Unless they are skiving off somehow, I'm pretty sure doctors can't do private work when the NHS is paying them to do NHS work.

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.

Equally though, most professionals have no idea what it is like to have to make life or death decisions on a daily basis, to work 32 hours shifts (yes I know doctors that have done this) and to have to study and train for often the best part of a decade before able to get a paying job. Nor do most people do a job where 60-70 hours a week is the norm, where maintaining a family or personal life is sometimes near impossible. This is all against a backdrop of increasing work loads as the NHS tries to increasingly expect less and less staff to manage more and more patients. And yes, as a nurse I'm seeing over-tired doctors making mistakes on a daily basis. It seems to me madness that pilots, lorry drivers etc have strictly limited working hours, but nurses and doctors don't. I'm supporting the doctors 100%.

This is absolutely expected and if I didn't do it I would be fired

Except while you might make a mistake because your employers have a culture of racking up the hours, there isn't any immediate danger that the mistake will kill somebody.

Equally, if you decide to leave the corporate world to set up a lentil weaving business, all power to you.

On the other hand I need there to be oncologists, paediatricians, obstetricians etc. etc.

Two interesting facts by the way about the NHS:

1. It is the third biggest employer in the world (behind the Chinese Army and the Indian National Railway I think).

1. Even if you were to close the NHS now, the cost of paying the pensions to all the NHS workers would be over one trillion pounds.

I'm afraid the NHS simply isn't sustainable - it worked back in the day when life expectancy was much lower and treatment options limited. With medical advancement, the cost is simply too high with the money available.

With medical advancement, the cost is simply too high with the money available.

That might be true, but then the government should come out and say "The NHS isn't sustainable - these are your options".

I think the government is trying to drive staff and patients towards private medicine so that we end up with a 2 tier system by default rather than by choice.

Stopping - Consultants are currently paid for in slots of 4 hours called a Programmed Activity. So I am employed by my Trust on a 10PA contract. I do more hours than this actually but thats the nature of the work. Many trusts only have enough money for 10, 11 or 12 PA contracts which surgeons might take over 3 or 4 days often on a rota including oncall. It is no ones elses business what they do in the other days or evenings. Some do private practice. If you want the consultant to work more PAs you have to pay them to do so. If they want to do private practice they have to first offer to do another PA for their trust under the contract too. Our trust declines this usually as it cant afford to pay us for any more work. In a similar fashion we could work more at weekends but then they would either have to up my PAs or give me equivalent time off in the week. I am more useful and effective when everyone else is around so we only do oncall emergency work out of hours.

Dimple - have a look at the costs of total expenditure on healthcare by country. The NHS is very cheap in comparison. They spend more than double per person in the US for instance.

Also the doctors pension scheme entirely pays for itself and is in surplus.

Misstrigg

Do you also find it morally wrong for junior doctors to be paid for 40 hours per week for the NHS and then work extra hours for free, due to staff shortages and mangers placing further work upon them due to lack of funds - is it morally wrong to employ two junior doctors and then expect them to complete the work of three doctors for the price of two?

I've been reading the thread and feel I have to comment. I fully support the junior doctors in their strike action. I'm an A+E consultant although currently on mat leave as 2nd baby due on weds. The nhs is exceptionally stretched at the moment. I am supposed to work until 11pm on my late day however it commonly ends up being 1am sometimes 3am the next morning. Then I'm back in for 9am having dropped my daughter off at nursery before I arrive. At times it worries me that I am so tired that I could make a mistake which in A+E could mean life or death.
I don't earn over 100k as people seem to think consultants do. I also don't have any private practice. I see our juniors working so hard with no thanks when they stay late after their shift or go without a break. A+E has numerous vacancies in all posts from consultant to juniors and the new contract will deter more doctors from doing A+E . I worry about what the future holds for the nhs as we seem to be constantly stretched.

because all their available working hours should really be spent on the job they're paid to do - otherwise the public isn't getting its money's worth

Oh for goodness sake, I cannot believe that people actually think consultants/GPs and even junior doctors merrily swan off to do private work or slope off to the golf course! Of course all hours they are contracted for should be spent doing the job they are paid to do. And that is what happens.

Those doctors who do private work will be contracted part-time (whether than be 50%, 70% or whatever), leaving them free to do private work in the remainder of their time if they wish. Consultants are not able to bring private work into their NHS time. As it stands, there is no rule saying consultants may only work for the NHS and must work full-time. I doubt that any such rules could be enforced.

Beside this, junior doctors are not involved in this and so has no bearing on the current dispute.

Dimple

Thanks to those who answered my queries on costs.

So fellow Brits can you find approx £300-700 per month for health insurance? £30-80 for every gp appointment? Scan? I bloody couldn't! Even when I was working! My rents £450 for context. But that's where we're headed! Private health care people I'm disabled and have mh dx so not working and on benefits currently what happens to the likes of me in that system?

As for the ‘early retirement’ jibe those drs will have worked many more hours than most in other jobs before they retire. As pp have said if they even get to! I was also aware of several consultants who died before retiring. Some through suicide.

Pressure sores - pressure mattresses help but it's a circulatory issue. So even with a special mattress they need to move. Agree they should have to sign a waiver if ignoring medical advice. Fwiw having treated more than my fair share and seen the agony they cause you couldn't pay me £100,000 to suffer one!!

Maidofstars is right. This govt WANTS the collapse of the NHS so they can sell it at knock down price to cronies who's companies they have shares in! Again fwiw I don't think any MP's should be allowed to have any job or interests outside of govt while in govt. THEY'RE on £74,000 pa!

“From my perspective it means they are very good at what they do.” how fucking insulting! Plenty of very good drs in the NHS! I bet you don't reject a Dr for not being ‘very good at what they do’ if you or dc suddenly struck by eg appendicitis!

Chatenoeuf so sorry for your loss

I agree broadly with stopping

Hi Dimple,. It is worth reading mamadoc's posts to understand the reason why the drs don t agree with the contract on offer. Also blueteapot and jared and a poster with Thursday in the name.

You are right stopping it is corrupt.