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 never think these bun fights we have between different professions really get us anywhere (and being from a family of doctors and lawyers I know both sides). Teenagers pick careers for a variety of reasons but pay certainly comes into it and of course if they are bright enough to get the exams to be doctors and lawyers (most people aren't) or have the skills to be the next Beckham or opera singer or whatever.

At the end of the day when there is a shortage of the right people pay goes up in countries which can afford that in both private and state sectors.

We all operate within the law. It is a very common argument pulled out that we could get XYZ extra money if we did ABC - well yes and we are trying in all kinds of areas. However if personal tax gets too high then you recover less tax so it is not always a simple solution. You could confiscate my house and give the money to the NHS for example but that would deter people from working if property were then confiscated so we have to work within the system and something that people and companies feel is reasonable. I am certainly not against changing tax laws to straighten out our very complex tax system. I would abolish all tax relief on all pensions. I would also cut the foreign aid budget entirely and much else.

As for all those boys in my sons' sixth form who want to become doctors they are not yet put off. It is a relatively stable career with pay still which is higher than many other things that they might otherwise do. Whether that will change remains to be seen.

Stopping

No-one is asking for a pay rise. Junior Drs are just asking not to have a pay cut. We've had a pay freeze for 5 years and we never complained. He is not needing to find extra money to pay us.

'What about the nurses?'- they will be next when Hunt has renegotiated Drs contracts he will then do the same to other NHS staff.

The current juniors will have pay protection. They are not striking for themselves. They are doing it for future colleagues, medical, nursing and the rest and for patient safety.

Starting salary 1st year is 22,000 for a 40hr week. There is a 0-50% supplement paid for out of hours work beyond that in some jobs. That is a fact not a lie. You can google the pay scales very easily yourself.
Over the next 10-15 years it goes up gradually like most jobs with experience and training.
Starting salary for a consultant with a degree, very often a research qualification eg PhD or MD, 10+ years post qualification experience is 75,000 full time.
In comparison to similar careers it is not that much.
What do you reckon those City lawyers earn? Or indeed your BIL.

You seem very resentful.
I live a very ordinary life.
I live in a terraced house on a mixed estate 'in close proximity to social housing, as the estate agent put it and I drive a 2nd hand Ford Fiesta, I send my kids to the local primary.
I do no private work. I work in a shortage specialty looking after people with chronic mental illness. I get verbally abused on a regular basis and yesterday slapped and kicked by a patient. I still love my job and it will give me great pleasure to make that person better.

So shoot me if i don't think I deserve a pay cut.

You appear to want NHS staff to pay for the NHS by accepting lower pay.
We already do that. We accept lower pay than we could get in another comparable job, in the private sector and abroad. There is a limit.

I have suggested what should happen. Taxes should rise. I am happy to pay my tax as a higher earner and happy to pay more. It's just I would like that shared amongst all the high earning people including the lawyers and bankers rather than just me take the hit.
Scandinavia does have great healthcare and they pay more for it.

Shorter wait times did used to be an advantage of going private but now NHS wait times are much better. Cancer referrals are seen very quickly. There is a longer wait for non urgent stuff but I think the target is something like 18 weeks which is not outrageous (used to be up to 2 yrs for hip replacement which was wrong).
You would need a lot more senior Drs to see everything within a few days so the compromise is that less urgent stuff waits.

I cannot comment on whether your particular private consultant ordered unnecessary tests but overall it is a fact that in a system where it is pay per item of course there is an incentive to order unnecessary stuff. That is why US care costs so much.

It is a teeny tiny bit ironic isn't it that you are presumably rich enough to afford private healthcare but you want Drs paid less. You don't think Drs should do private work presumably unless it is to see you.

I dont think a decision about whether or not the junior docs should strike can be made on the basis of whether or not they work harder/are more stressed/ better paid than those in the city. Jeremy Hunt is playing a political game where he pretends he is improving the NHS by making it a 24 hour service etc and slagging off lazy doctors, He hopes to ecourage the general public to harden their attitudes against medical staff . Pople who dont work in the NHS cant really understand what its like to be on the coal face of the NHS any more than people in the NHS can understand the real pressures of working in the private sector.
He knows what he is doing will tip an already crumbling service over the edge. He wants the NHS privatised and dosnt want the blame for that. So all these tit for tat arguments are exactly what he wants to happen. We need the lawyers in the city. People have to decide whether they want the NHS in its current form or whether they wish to pay for what may be a better service in the long run but will be much more expensive to manage and much ore divisive in who gets what treatment. I work in mental health which is at the bottm of the pile for funding at the moment but would definately be a 2 tier system with privatisation ,esp for those with long term conditions.
IMO the docs are not so much fighting for themselves but for the preservation of the NHS

We DO pay for our own training. We pay tuition fees same as anyone else.

We are required to work in the NHS for 1 year minimum to get full registration. In order to complete training a further 10-15 years NHS service as a junior Dr is required. You cannot do private work in that time. You can emigrate if you want to or quit this being a free country. In practice the vast majority of Drs would then work the rest of their career in the NHS.

Goodpost mamadoc. However I do agree with some of your last post too Stopping. Looking again I think that 2bn surplus figure was prior to the lastest round of renegotiated pensions so I imagine its more in balance now and I do appreciate that argument want2be and its interesting to hear your views on it.

For what its worth whilst I absolutely support the JD strike I voted against the last pension strike although it did go ahead. I would have been excused anyway as I do emergency work but would have broken the strike as did many doctors. Whilst I am participating in this arguing about whether lawyers doctors or city bankers should get paid more I also was well aware I was the highest paid person out of both staff and patients on the ward and I could not personally consider striking for that when I had people struggling to pay for food on benefits through no fault of their own. I guess that is where the ambivalence MissTriggs sense kicks in.
This however does feel different. It is of course about terms and conditions and pay too but it does systemically have consequences to the care that can be provided in the future.

I have NEVER said I want more money.
I have repeatedly acknowledged on this thread that I am paid fairly and have a good pension.
I have just declined to agree that my pay should be cut and we should go for a communist system where all NHS workers are paid the same.

Surprise, surprise not all Drs are the same. Some do private practice and some don't. It is a financial struggle often in junior years where pay is no so good, hours are long and training costs are high. It is usually not when you are senior.

Just out of interest whant2be, if the current NHS employees are paying the pension outgoings now, who will pay in the future if the NHS was privatised and our contributions started to go to a private scheme not the government one?

I don't think it's of much use to compare professions- it's apples and oranges. There are some medical jobs which are not too busy, others (most) which are very busy. Likewise for city jobs. I've just finished a night shift. I stayed late to help sort out a very ill patient, and to help one of my more junior colleagues debrief after an upsetting case. I love medicine, its really not something you can do just for the money. Irish doctors are leaving in their droves due to awful working conditions. We just need to look across the sea for an example of what happens when you completely disregard the working conditions and terms for a group of professionals. Morale amongst Irish doctors was incredibly low when I left, and the constant media reports of us being over paid, underworked, lazy was a major factor in that. I can see things going the same way here already.

Yes, I never much see the point in comparing lawyers and doctors although many many bright teenagers choose between the two careers even now - they are the most popular stands perhaps with dentistry and accountancy at plenty of our local schools on careers nights. There is more consistency of higher pay in medicine than law as some lawyers are on very little indeed for life on legal aid. Other lawyers get to earn quite a bit and even up to £40k in their training years although they receive no over time at all and will often work 7 days a week for that.

The market will decide this - if JD withdraw labour because they don't want a pay cut that might mean a better deal is offered but we have to remember the people spoke and I with many others voted Tory and want a much smaller state, huge cuts and lower taxes and most of all to cut the deficit and after that the national debt. The Government has rather a large mandate here.

kittle If they dismantle the NHS the pension would be closed. The pension would then start again under the new private company. When it comes to your retirement they would probably purchase an annuity to provide the payment of the pension. If there is a shortfall it's normally the new entity that picks up 100% of the cost. I would expect with reasonable negotiations the government would probably end up picking up at least their portion of any shortfall but knowing just how bad they are at these things they would probably pick up 100% of any shortfall.

As a private company you can be sure they will stop the pension benefit. It's just too expensive to have final salary schemes.

Dr or lawyer was my choice at 6th form too.
I chose because of job satisfaction not pay (albeit I had a romanticised idea of doctoring)
I doubt any normal teenager is thinking about pension arrangements when deciding.

Some good people will always want to do medicine for the love of it whatever the pay but you will lose many others if pay is seriously eroded compared to other jobs that bright young people consider.

And pension arrangements will change over time. My brother's (NHS consultant) when he started was final salary and now is average over life earnings. In fact he';s been told to earn as little as possible from the NHS between now and retirement at 55 because he's up against the Government's new upper cap on the total amount or value of a pension which is allowed without confiscatory 55% tax applied to the sum of the fund or something of that nature. Meanwhile I lawyer just about have no pension and will work until I die which could be 30 more years than my brother does (although I am sure he will continue with non NHS work at 55 or whatever the age is).

I am sure NHS consultants' retirement ages will move towards 70 like the rest of the country before too long however.

Well the government do have a majority but it is tiny so I probably wouldnt call it a large mandate though yes, it is a mandate. I think the polls also show that on individual issues a majority want to maintain the NHS. So an understandable ambivalence in the part of the electorate too.

Ok so you want lower taxes and a smaller state and apparently this is the majority view.

You can't have the same or better service for less money. That is what Hunt is trying to do. He is trying to make NHS workers pay for tax cuts by having their pay cut and yet provide a full 24-7 elective service. He wants to have his cake and eat it.

If we don't accept providing the same service for less then either there will be no state funded healthcare or it will be rationed.

The public don't usually seem to want the NHS dismantled or rationed. No political party ever says they will do that as it is electoral suicide.

Wake up and smell the coffee Great British public. Great healthcare costs money. If you want a good service you pay for it either in taxes or insurance.

The NHS is a very efficient and equitable way to provide healthcare. It creates economies of scale, disseminates good practice and prioritises on need not ability to pay.

You're gonna miss it when it's gone.

Most of you will probably be OK to pay but my poor patients with chronic mental illness will miss it more though. I guess there will still be some state funded care for them of a very basic level.

The government has fuck all mandate on this. What a bare faced lie

Some surgical careers are a bit like sportsmen though.

Orthopaedics for example is heavy physical work. You need to stand under hot theatre lights, in heavy clothing including a lead vest for the X-rays for many hours at a time.

I'm not sure I want a 70yr old surgeon. They do tend to retire a bit earlier than medics on their private earnings and that's probably for the best.

The pension is being gradually chipped away at. It has gone from final salary to career average and contributions have been increased. I expect it will go at some point.

I'm ok with that. I won't strike about that.

People do find it hard to believe this strike is not all about money but it isn't. It is at least as much about safety, recruitment and the ultimate future of the NHS.

Want2be. I was thinking more about those already retired. Please excuse me on this one as I may be muddled but my understanding is that the nhs pension is an unfunded(?) one so there is no pension pot of old members contributions sitting around. Current members pay in to general government funds and the government pays out. Would they just carry on paying? Would they buy a pot -huge surely?

it may already have been said but doctors have to pay tuition fees for 4 or 5 years depending on whether they do a 5 or 6 year degree plus they have their living expenses to pay for (5 or 6 years) when they are studying. This makes their degree twice as expensive as another. Im sure if their pay is further cut it will mean fewer will want to pursue this as a career. There are alternative careers.

So the retired made contributions throughout their time working but those contributions were based on lower life expectancy and some will have final salary plans so payment during retirement is higher than under the current system. From a cash perspective contributions being made today are greater than payments made to those currently retired.

However you have two big issues, namely the NHS has historically been much smaller employee wise and salaries were also lower for many of those who are currently in retirement.

If NHS employees were moved into a new private entity the current pension scheme, by default due to the entity ceasing to exist, would be closed. This means no new contributions. A new pension plan would be opened with the new entity and contributions made there. Now you can transfer plan assets but because of the liability involved no one in the private world does this. You want to contain your risk and any final salary pension scheme is a huge risk. Keeping the plans separate does this and make any changes to the plan easier to administer.

But I thought there were no plan assets to the NHS scheme?

As described here?www.nhsbsa.nhs.uk/3416.aspx

deo you're right, the people did speak remind me again about this 'rather large mandate' you refer to?

The Tories would have got in under first past the post or any other system and have as much mandate as most other Governments including many Labour Governments.

I certainly agree with cuts and I have been against protecting the old, education and most of the NHS from cuts which the current Government is doing. If doctor pay is cut you may find fewer students pick medicine so that eventually will mean if we cannot import good doctors from abroad that pay will have to go back up again.

You used to draw a pension for 3 years when state pension first came out and then die. Now you might draw it for 30 years which is a huge issue for the NHS. My father was forced out of the NHS against his will at 63 - the very very oldest they would allow him as a consultant to work and he wanted to carry on. He could have gone earlier had he chosen. That seems wrong to me as today's 70 year olds as are fit as 60 year olds of 40 years ago.

So the webpage is confusing because it's in accounting speak.

'Employers and employees pay contributions based on a percentage of pensionable pay. Every four years the Government Actuary conducts a full actuarial review and recommends contribution rates in their Valuation report to the Secretary of State for Health. This is based on the use of a ‘notional fund’ as if all income from the start of the NHS Pension Scheme had been invested. As a result the Scheme is unfunded as there is no actual asset for a ‘pension fund’ on the balance sheet of the pension scheme.'

Translated what the means is the plan doesn't have enough cash to pay all future pension claims as it stands right now. The extent of the gap in funding is not given but it's know to be quite large. When they talk about the plan assets they are talking about the position on the balance sheet.

That seems wrong to me as today's 70 year olds as are fit as 60 year olds of 40 years ago.

I certainly wouldn't want a 70 year old surgeon scrubbing in for a 10 hour op on me! I wouldn't want a 70 year old JD looking after 100 medical patients scattered round a large hospital for 24 hours solid. I wouldn't want a 70year old nurse trying to mobilise me in an HDU on their own perhaps that's ageist but it's a fact!