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.

To me, hospitals are places run by doctors

I don't understand this. Hospitals are not run by doctors. You may want to think they are, but more than one person has said that this hasn't been the case for many years. Are you saying that you don't believe that?

They are not paid 'extra' at the moment it's just a very complex pay structure. It's not overtime it's part of their rota. Most drs do, do overtime but they don't get paid for it, unfortunatly because many posts are understaffed this is the only way that hospitals work. Goodwill (from most frontline NHS staff) is propping up most hospitals in the face of massive government cuts. However moral and conditions have taken a nosedive so it's getting harder to get people to give up their lives for 'love of the job'.
No Dr gets to control what unsociable hours they do so drs aren't incentivised to work more hours by the existing system.

None of this is obvious to outsiders

Well it is if you can read.

iwant the cost to see a GP isn't that high. It's free for 13 and under, beneficiaries and subsidised further for those on a low income. It's higher out of hours but ED and all hospital care is free.

People may think twice about making sure they are sick enough to warrant a GP appointment but is that a bad thing?

Prescription charges are around £2 per item. You pay in other ways in the UK.

Yes, I'd be happy to see a similar system to this in the UK.

It's pretty obvious to people who actually read up on something rather than just coming out with an opinion without knowing any facts. Have you watched the news in the last 20 years? Read a newspaper?

thanks to those who've supplied factual info.

will try to read again after pickup

YABU. I might have felt the same as you until working in the NHS. What I see day to day is far from how this Government would like us to view doctors' lifestyles.

"None of this is obvious to outsiders"

The only accurate statement you have made Miss Triggs. Yet you think you can start a thread about their presumed working conditions.

They make decisions every minute that could impact people's lives, get them sued, sacked or imprisioned even. No amount of money could compensate for that.

I support the strike

Oh come on! Don't play the 'outsiders' card - its hardly secret hidden info. I dont have any relatives or close friends in the nhs. I just read.

"Yes, it's self evidently silly. But it's how the NHS is run.

Agree it needs a complete overhaul. Millions were spent on a computer infrastructure that never worked. There are complex layers of management most of which could probably go. That would fund a lot of doctors, nurses and surrounding front line staff to provide a fully working 24/7 7/7 service."

that seems to be a way forward doesn't it? let's create a better simpler system.

a bit baffled by the abusive comments but it's AIBU after all!

It's a bit rich to start spouting bollocks your opinion on a subject you clearly haven't bothered to research even a tiny bit before proclaiming your bollocks opinion, then whine when people call you on your ignorance.

You're either a bit thick or a goady fucker. Or Jeremy Hunt. In which case both descriptors fit.

That's also self evidently easy. But management has got so bloated it would be verging on the impossible to untangle the unneeded jobs from the "place will fall apart without me" jobs. And you can't just dismantle the whole thing and start again, that would cost even more and cause chaos. So striking, trying to preserve doctors in the system, moving to more clinician led management (as here), slowly pruning the dead spend and reusing money more appropriately - seems to be a good solution to me.

I'm amazed by how much indemnity Drs pay. I'm a dentist and mine is eye watering but where in the 24/7 NHS did Jeremy Hunt account for a 5 session/week OOH GP having to pay £30,000 in indemnity fees?

That's just to be able to work. 24/7 my arse, if I had to find that before I could see a patient I'd fuck off to NZ as well.

*blueteapot,

thank you for your detailed reply. It is complicated!

under the current system, would an ambitious pre-own-family doctor not be incentivised to work far too many long anti-social hours because those pay better? So wouldn't it be better not to have that system?*

It is complicated, and I can understand how many would be unclear about how the current system works / the proposed changes - which is why we are trying to get the message out.

Under the current system the hospital comes up with rotas which are designed to meet the European Working Time Directive - a cap on doctors working hours as an effort to aid patient safety. Rotas are 'monitored' (ie we fill in sheets detailling our working hours) every 6 months to ensure they are 'compliant'. An individual can opt out of the EWTD but the vast majority wouldnt want to do so. The majority of doctors work extra unpaid hours to finish off work anyway / if things are very busy to ensure patient care isn't compromised. Apart from the occassional locum shift (which more often than not is instigated by medical HR ringing round last minute to put pressure on us to fill long term rota gaps) the majority of junior doctors wouldn't want to take on any work additional to the rota for extra pay.

'Banding' is worked out by analysing the rota to see how many of shifts cover out of hours work, and an extra percentage of base salary is paid according to this.

Out of hours work is currently covered by a skeleton 'on-call' team for each speciality. The governments proposal that evenings / saturdays become 'normal' working time would mean removal safe working time limits and stretching our current cohort of junior doctors even thinner to cover all the extra shifts it would generate (Afterall, 'normal' time has a full rather than a skeleton team).

Can you see how cutting pay and increasing hours is going to lead to huge compromises in patient safety and a massive increase in the ongoing recruitment crisis so making things even worse in the long term - the governments long term aim is for it to all fall apart so they can privatise. We need to save our NHS!

The issue is very simple. Money. Healthcare is extremely expensive and the fools in Westminster are trying to save money by cutting payroll expense. I am fed up of hearing how the NHS delivers the best value for money. Personally I don't think the focus should be on value for money but on providing the best possible care for our society.

It is not the way to go at all. The focus should be on all NHS front line providing excellent care. They need a fundamental rethink on shift work so employees can have some consistency. Doctors and nurses need to be paid fairly for the work they are expected to perform. If the care provided is not of an acceptable standard they need to find another career if further training does not fix the problem.

On the flip side I think the general public need to start being more aware of what it is they receive from the NHS. I am in the US and copays make you think twice about if you REALLY need to see the doctor. We already have a system in place to charge certain people for prescriptions and I think that should extended to doctor visits.

I would also charge anyone who isn't a UK resident an awful lot more. GBP3k for a CS is a joke. The true cost is much higher because healthcare provision is planned for the UK population. Someone coming in from abroad puts an additional strain on the system that wasn't accounted for so charging them cost price isn't an accurate reflection of the true cost. It isn't fair to the NHS or British citizens needing care when this happens. Increase the billing charge to GBP30k and make it a requirement that tourists come to the UK with medical insurance. I live in the US and no one I know comes to the US without a travel policy that covers them while they are here because we all know how expensive it is. If you can afford to visit the UK you can afford a travel policy that covers treatment.

Finally, we know we have a shortage of doctors and nurses. Given the sheer volume of sixth formers who are applying to medicine with strong grades, we should not have a shortage if the government had been radical with their approach to opening more or expanding existing medical schools. Quite frankly a student with 3B's at A'Level is just as capable of being a good doctor as one with 3A's.

OP - overall, you are not wrong in that your care has been below expectation but if these changes go through you are going to be dealing with far far worse standards of care than you are getting now.

misstriggs I think it is important to point out that junior doctors are paid extra for working antisocial hours currently but generally they have no say in which hours they work.
I'm currently working a 6 month "rolling rota" which means that every 2 months I have the majority of my long days, nights and weekends which is my "on call block". I don't get paid extra that month and I don't get to choose when I do these shifts. These shifts are allocated to each doctor and although swaps are possible, you can't just decide to do an extra week of nights because you get paid more. If they don't need you, you don't get paid extra. (Having said that, it doesn't stop most of us putting in extra hours here and there because the rotas are so tight. We certainly wouldn't expect to see any remuneration for these hours routinely- you can kiss those hours of your personal life goodbye).

I got married a few month ago and there was a hairy moment when I thought that I was going to be refused the time off for the wedding (not the honeymoon, I had to take that a couple of months later due to rota commitments) despite giving six months notice. This was because of the way the rota is structured and the fact that there is no room to cover if people need time off.

We already work long hours with little flexibility. We often don't get to choose when to take annual leave and you are lucky to get more than one week of annual leave at once- it has to fit with the pattern of the rota.

Many of us have families and responsibilities. We have entered into mortgages based upon our base salaries and the antisocial hours payments. This isn't seen as extra, this is part of our monthly income. To see that cut by up to a third would mean that I would have to uproot my family or think twice about my career choice.

I am in Scotland and so feel fortunate that I do not have to make these difficult decisions but I fully support my English colleagues in their endeavour to negotiate a contract which is above all, fair for doctors and safe for patients.

Nobody wants to strike but it has unfortunately become necessary.

To me, hospitals are places run by doctors

HAHAHAHAHAHA! Comedy gold, that. I work in a speciality with a reputation for bullying and undermining. No control if a bed for an elective surgical patient gets allocated to a patient with complex medical needs, even if the surgical patient has cancer. No control if the specialised unit gets closed down because the nursing staff are told they have to look after an additional bay of patients. My rota changes on a daily basis, sometimes I get no notice at all. I've worked shifts where my first toilet break is 13 hours into it. Get home after not falling asleep at the wheel to hear of a health secretary spreading lies and misinformation and accusing the profession of not working hard enough.

Or to give another example: two sets of offices. One is on a top level floor, carpeted, air-conditioned with desks, comfortable chairs, working computers, a water machine and fully stocked kitchen. The other used to be a storage cupboard, 2 chairs shared between 15 people and a computer that frequently breaks down (which the team were moved to without any notice). One office is for management, the other for a team of surgeons. Match the offices to the teams.

ScottishLady I organised my wedding around the rota I was sent from my next trust - picked the date to coincide with the end of the block of nights (so had the weekend off and could book two weeks of leave in the day shifts following). When I arrived at the trust they'd had a rebranding exercise, reorganised all the shifts - without letting anyone know! - and I was working the weekend of my wedding. Until pretty much the Monday before I was going to have to get married as planned then pitch up for a night shift in my wedding dress! Thankfully at the last minute one of my colleagues managed to convince HR to let us swap a chunk of weeks so I could take my (already booked and approved) leave :)

You're either a bit thick or a goady fucker

I'm think both purple

Rebanding- autocorrected to rebranding. That was another huge waste of money, changing the NHS logo

from my understanding, they are worried about patient safety. The safeguards for working hours are going to be removed by the new contract. I would rather the doctor looking after me/doing my op wasn't completely shattered.

I worked in the NHS before the hours were capped and my God how more people didn't die was more by luck rather than anything else.

A House Office as they were called at the time, could easily start shift at 9am for rounds (In reality s/he would have been in a few hours earlier to check notes, learn what new patients had been admitted/ chase blood results etc)

Following rounds they would have piles and piles of paperwork to fill, more results and test to chase.

In the mean time people like me (ex-Nurse) would be bleeping them constantly to come and fill in discharge notes/prescribe discharge meds so that we could get them to pharmacy, because we were getting shouted at by Bed Managers, who were getting pressure from A&E/ ITU etc.

If this was also one of there on call days they would also be getting bleeped to review new patients, fill in their prescription sheets, order their tests, re-cannulate difficult patients, pass catheters, take arterial bloods, speak to families etc. (Yes Nurses can and do, do these things but if for what ever reason you can't and the local Nurse 'wizard' ie: one who always succeeded one of my colleagues could pass an NG tube on anyone, another get blood from a stone, you first had to call the HO even though you knew they had less experience than you)

At some time between 5 and 7 they would then take over from the teams who weren't on call. (at the time we had 4 general medical teams caring for 120 patients) so one HO was the first point of contact for any of the Nursing staff when any of those patients needed any medical rather than nursing care.

Even on a 'good' night most would be lucky to grab 2-3 hours sleep and as they couldn't leave the hospital this would be in a on call room which were usually small, airless and never ever quiet. If very luck there might be half decent showers and then start again. If it was their weekend on call this could carry on from Friday 5pm until Monday 9am, when they would still be expected to work their 'normal' day.

It wasn't unusual to find HO's crying with tiredness; terrified that they were going to make a mistake and shaky from the amount of caffeine they'd consumed.

While its not hugely better now it is better, we as a people should be supporting improvement, and if they have to strike to get it, so be it.

Hic It's a horribly common tale, isn't it!

My maid of honour who works in the private sector said "Don't you get 'major life event leave'?" ... No!

My husband (also not a medic) said "They have to give you the time off, it's your wedding!" ... No!

Yabvvvvvu! Doctors already work seven days, I've done night shifts where doctors have been around from 6am - midnight five or six days in a row, they're dead on their feet and making silly mistakes through tiredness and they want to make their working conditions worse??? Be glad they are going on strike they are fighting to make the NHS safer for YOU!!!

To me, hospitals are places run by doctors

How naive and how very silly. If doctors, or even nurses, were doing what needed to be done to manage the several thousand people that a large Acute Trust employs, manage the budget within the constraints that the government is constantly making, manage the commissioners (who pay the Hospital to provide the services), manage the endless cut backs that are demanded by the government, manage the little resources that they have and, on top of that, have to deal with the more childish members of the frontline who constantly complain to them and blame them for everything.....then they wouldn't ever have time to deal with the patients.

There is bad management in the NHS - just as there is bad management in all areas of work. However, many managers (and despite what people might think the NHS is actually under-managed) are doing the best they can to ensure that the front-line - the nurses and doctors that everyone loves so much - are protected as much as possible from the crap that they are having to deal with everyday.

The average length of time that a Chief Exec of a hospital stays in post is round about 2 years. That's 2 years of absolute, utter shit poured on them by everyone.