to think the doctors' union could have handled things better

[MissTriggs]

I had not realised many of the stresses of the job until learning about the strike, and completely accept the need for better working conditions (which is practically the same thing as patient safety).

But why say a starting salary is X when it is XplusY for all except the minority who never do overtime? Why say it isn't about pay in the middle of a settlement negotiation that is about pay and only pay?

If they would walk out until there were enough social workers and social care beds, I would be on the streets with them. A strike targeted at a solvable problem would be one thing. But I don't think pay is their real problem - their real problem is not being resourced to do the job. I also think they have very naïve ideas indeed of what other people earn and indeed of the ability of other professionals to even stay in the workplace at all after having kids. It's particularly unfortunate when they say "I could leave and work in the city" (the naivety of that remark would mean they wouldn't get an interview).

In short, I feel like the Gov. and the BMI have been playing a dispute game with each other in London that misses the point of what's really wrong. I feel the BMI is trying to equate "back our strike" with "back the NHS" and I just don't accept it. I think they need to protest better, smarter, more honestly.

And £200,000 at 36 equates to no national pay scale I've ever seen! Must be locumming, or working in the private sector wholly or partially.

I find that very hard to believe, if he's purely NHS, *Celticlassie'! My DH is a very senior NHS consultant and is nowhere near that figure! Although, when we return to Australia in a year or so, he'll be on double that in the public system.
The junior drs aren't asking for more money, they simply don't want to lose what they've already signed contracts for and I don't blame them one bit.

I expect that any doctor on £200 grand is a consultant and also involved in private practice alongside his NHS work. Taking a look on the recruiting page of the BMJ a speciality doctor is on £37-69K, consultants on £75-101K

It is ludicrous to say every strike or dispute is about money.
There are plenty of disputes and strikes about unfair changes to conditions or to improve conditions.
Hunt has handled this badly. He is trying to play the hard man to advance his career. I understood that a compromise was reached before this or the last strike but he personally vetoed it.

I have to say, when I see public comment like this (from the OP and the people who agree with her) I do feel a bit of shadenfreude...when it all falls apart people will get the health service they deserve. Why should I put any energy into saving it when you get attacked for trying to do so? But ultimately it's because the people who really, really need it are the ones with very little voice and someone has to fight to retain it for them. Anyone ever looked at the outcomes for people with serious mental disorders in privatised systems?

Miss Triggs has history for posting ill informed shite on threads about junior Drs . I actually can't bring myself to read it any more - if you don't know your BMI from the BMA it's clearly time for bed

Funny, I dont see any Cons here defending the Govt on this one.

200,000 at 36? Not as a permanent NHS doctor they're not. They've either gone private (traitor). Or they're charging through the nose locum rates.

I can assure you that, as a consultant of quite some years, working more than full time in an acute speciality, that I earn considerably less than half of that. But then I'm far too busy looking after my patients, and training my juniors, to have any time to do private work...quite apart from having an ethical problem with charging worried parents.

Most private systems pay doctors more than the NHS does. And yet most doctors are fighting to save the NHS. Which would seem odd, except...I hate the thought of having to ask a parent about whether their child has the appropriate health insurance/credit card before treating them. I have colleagues who once worked in such systems, or where the family would have to sell a goat to buy the kit. They are the biggest fans of the NHS I have ever known.

Money was part of the issue, certainly, not the only one. Far from it.

Jeremy Hunt has knowingly misrepresented figures about hospital deaths at weekends- either that or he is so inept that he cannot understand the statistics for himself. The authors of the papers from which he so often quotes and the editor of the journal which published the papers, the BMJ, have both written to Mr Hunt to explain that he has misrepresented the statistics, and the cause for any discrepancy is highly likely to be multifactorial. However, his assertions have caused fear among some patients, leading them to refuse admission over weekends or delay seeking help, thus being more unwell when they do eventually seek help. All of this has caused much anger within the profession.

Mr Hunt says he wants a "7 day NHS". First the government need to define what exactly that means AND then show us the plans to properly resource and staff it. It is not just junior doctors that would be needed- we'd need everything from more Dr's, nurses, allied health professions, radiology, lab staff to admin, medical records, porters, secretaries, cleaners and so on. We'd need more physical resources- for example, more beds, greater lab capacity, potentially more diagnostic equipment in some places. We'd also need to have a properly resourced and functioning social care system which would allow us to discharge patients safely and allow steady patient flow.

Pilot study in our area show very low uptake of Saturday afternoon/any time on Sunday GP appointments and similar for out-patient clinics. Non-attendance was high. So we also need to look carefully into what we need from this "24 hour NHS".

Add into all this the actual problems with the proposed contract for junior Dr's, which Hunt just does not acknowledge.

1. Given there are not going to be any more junior doctors at present AND he wants more of them working evenings, nights and weekends AND we are allegedly going to be working fewer hours overall, I would like to ask what Mr Hunt thinks is going to happen to the service in the current "routine week"? He is just spreading the same resource thinner, if more evenly, over 7 days- at a time where most rota's have significant gaps due to unfilled vacancies (sometimes filled with expensive locums). It is going to cause chaos and most likely a poorer service all round.

2. He states that the change in contract will lead to working fewer hours. But then attempts to remove the monitoring process which ensures hospital's which are over-working junior Dr's are identified and forced to make changes. If he is so sure that his changes will lead to fewer hours, why is he removing the monitoring process? He can promise anything he likes if he removes the safeguards and methods of identifying those areas who are not playing by the rules.

3. Bear in mind that many specialities are having recruitment and retention issues as it is. GP, Emergency medicine and psychiatry are the worst hit at the moment but in a number of regions even core medical training (i.e. hospital physicians before specialism into cardiology, respiratory, GI etc) are not filling their training posts fully. Do people actually realise that in some specialities in some area's that the recruitment into training posts is only at around 75% of those required. This is worrying- and makes point 1 above even more difficult to achieve as there are significant number of vacancies in many regions. Add in making pay and conditions worse and I can't see recruitment problem resolving.

4. removing pay progression for those who take time out of clinical work to do research (though many will do locum shifts to keep their "hand in") and those who change specialty, as well as those taking part in parental leave is also muddle-headed to me. We need Dr's to go into research, for instance- to make it financially difficult for them to do so (they usually take a pay cut to take on a research post anyway) is very short-sighted and damaging.

The NHS relies on good-will of staff. Most of us (and not just Dr's) work far more hours than they are rota'd for, without much complaint or over-time pay/time back in lieu. The various upheavals, stretching of resources and so on have taken it's toll on the good will. I fear this may be the breaking point- many junior dr's have not entirely trusted NHS trusts (due to issues with pay and conditions over recent years) for a while now. This row has led to complete breakdown of trust in NHS in England and in the government- relations are toxic now. Morale is as low as I have ever known it.

I don't work in England any more, but I do have many friends who do. The anger and dismay is real and palpable. Many are seriously looking into alternative locations and so on. Of course not every Dr will move or go into private practice or leave the profession and it would be ridiculous to suggest they would. But given the recruitment and retention issues and many unfilled vacancies if even 5% moved abroad/left the NHS for private work or a non-medical job (or to work as a locum) the NHS would be in dire straits.

I generally lurk more than I post on mumsnet and I'm consistently amazed on these forums how rarely (if ever) it is mentioned how much junior doctors need to do outside their working hours to progress in their careers. And I don't mean the letter writing and notes and other admin that they often write at the end of a shift after the official time to leave.
Despite morale dipping to alarmingly low levels when you apply for more senior positions within the junior doctor range (CT2, registrar etc) it is still an extremely competitive business, especially in London. So doctors need to do a whole raft of activities to gain ' points' on the standardised systems to even be considered for a job. This includes:
-Intensive study for exams to gain membership to royal colleges oh and pay exorbitant fees for these exams out their own pocket. Yes there are plenty exams to do every step of the way of specialisation even years after qualifying.
-Spend time doing audits and ticking off portfolio checklists - which incidentally are a good thing and a useful process to help them improve and develop but less so when the criteria change and the goalposts move just when you are coming to the end of the cycle!
-This is in addition to desperately trying to get published and putting your name on research papers which require er, time consuming research.
Having a hobby or simply seeing ones own family in a relaxed manner becomes a challenge.
So in addition to extended hours meaning more tired doctors without any diminishing responsibility for patient care and safety, when are they supposed to complete all these other necessary aspects of their job ?? And to add insult to injury less pay how can they afford to outsource all those mundane day to day things that they have no time to do themselves ?

my idea of them handling negotiations with mr hunt would be that each member of the union lines up and then takes it turns to kick him in the balls.

Given Wales and Scotland are saying no it's not like they all even have to emigrate.

The removing of fines for hospitals making staff go beyond maximum hours is my main concern in the change, the new contract seems to be such a backward step that way.

I have become disillusioned with the increasingly arrogant stance of the junior doctors and the BMA during this very long dispute, and I support Jeremy Hunt's latest action. I understand that part of the dispute is about 'persuading' the more experienced doctors to do their share at evenings and weekends.

My experience of hospitals is limited; I was wrongly diagnosed with a tension headache by a hospital doctor; it was correctly diagnosed by my GP as a brain haemorrhage three days later. During my subsequent stay on the ward I saw a lot of work being done by the nursing staff, of all ranks, and little by doctors, junior or otherwise. They may have been elsewhere, I don't know.

This dispute is about money; it seems impossible to identify exactly who earns what. The only junior doctor I know is earning £55,000 after four years, and her mother thinks it is far too little; I have no idea how representative that is.

One thing I genuinely don't understand is why it is necessary for the shifts to be so long, 12 hours at least I believe, for all medical staff. I have more sympathy with the nurses than I do with the doctors.

This government wants to remove any and all power from workers and give it all to employers. They know they can't go as far as they would like, but they now there are enough aspirant "strivers" who will keep on supporting the very people who keep kicking them in the teeth (like tearful woman on Question Time who voted Tory and then worried about tax credits). They are filthy liars about their support for the NHS. Under the circumstances, the doctors and BMA have done quite well.

Great post Hefzi. I support the JD cause, in the sense that I don't think anyone's pay and conditions should be made worse.

But I am sick of the medical staffing body behaving like this is first time this has happened to anyone; nursing ratios have been massively hit, admin staff slashed to the bone, support staff downgraded and diminished, pensions reduced and contributions raised, all over the last 5 years. medical staff have been untouchable until now. I don't think this should be happening; BUT it's only the same as has hit everyone else in recent years.

With respect to the doctor supposedly earning £200k on the NHS. This would be easy to confirm for the person who knows him; all public bodies with staff earning more than the prime minister are required to disclose this in their annual report. All hospitals are also required to disclose any staff who earn more than the Chief Executive, and £200k is almost certainly more than the CEO (unless it's Guys or maybe UCLH).

Most senior consultants earn around £100k, potentially with clinical excellence awards on top. I once worked with someone earning £165k; that was because she was paid for 16PAs plus 2APAs, this is unusual, most consultants are paid for 10 PAs plus one APA (a PA is basically a 4 hour session, it's a bit more complicated than that but that'll do for a simple explanation).

When dsis was a junior doctor, she worked around 9-5 during the weeks. Well, that was the official time. In reality she didn't often go home before 7.

Then every 3rd weekend she was on call. That was on call 24/7. She had a room in the accommodation attached to the hospital. So she'd be on duty 8-8 during the day. Then first on call for one of two shifts 8pm-2am, or 2am-8am, and second on call for the other making life changing decisions on people's care. Do you fancy having your life dependent on someone who has had that amount of sleep for 48 hours?

In real terms that meant there were nights where she didn't get more than an hour sleep at a go, for two nights running. I saw her after one weekend. I wouldn't have let her have control of a hamster, and she survives fairly well on little sleep. She then had to do a full week's work after that.
They changed the rules for junior doctors shortly after and imo for the better and much safer for the rest of us who need them.

it's the lack of logic that disappoints.

I question the strike in the mildest terms.

I'm then met with mindless rhetoric, told I "have form" (you mean I dared ask twice?)

But the facts are the facts. The BMA even seems to have reached a similar conclusion to mine given that it made a last minute offer to reduce the weekday pay demand in return for compromise on the Saturdays issue. So all I'm suggesting is that they should have offered this sooner.

I understand that tempers run high. I spent a lot of a couple of years campaigning to get the Climate Change Act through a few years ago. Some of my fellow campaigners called anyone who expressed doubt a "climate change denier" (which is a mindbogglingly offensive term) but I found I got much better responses when I listened respectfully and answered questions carefully.

I'll give any NHS professional who isn't getting enough sleep a "Free pass" for being bad tempered but not random posters on mumsnet who fail to address the question and just hurl abuse.

This is what I suspect the Gov's strategy is.

1. give up on making conditions better (which is what is needed but is harder for the public to understand in detail)
2. divert protests into argument about pay
3. rely on human nature (people who've only worked for one organisation are likely to have confused notions of what is a "good" salary and to think they are entitled to more than they have/that the grass is greener,etc)
4. allow the tabloids to focus in on the desire for money that is a result, not a cause, of how negotiations have gone.
5. shift public focus -and cleverly even the Union focus - away from conditions on to trying to keep unreasonable sums of money for working hours that they simply should never work in the first place.
6. Win.

This is definetly a matter of Tory policy and theory. They want to destroy the NHS and privatise it, we will all suffer. If Dr's have their pay and conditions eroded, council workers, civil servants and govt employees will be next. and after that private companies will have a low pay benchmark to to justify paying their workers less.

The rich will get richer and the poor poorer.

howaboutthisone You are so right. They have already begun the process of destroying the rest of the public sector. There are plans to tear up the terms and conditions of public sector workers so that they can lay hundreds of thousand of them off on the cheap. Then, as you say, the private sector can step in.

I completely support the junior doctors and I hope the don't give up. We need them to win.

I fully support the BMA and junior doctors in their strike. I think the NHS has underfunded for a long time. Living abroad and marrying a Dane has opened my eyes to just how underfunded the NHS is. It isn't offering value for money, it is shortchanging our society. I am a firm believer in 'Health is Wealth' and to achieve this it does cost money. We have had one stupid policy decision after another which have compounded funding issues.

The care we have received here in the US and the care my IL's have received in Denmark is of a much higher standard compared with the care my family have received in the UK under the NHS. The major difference between the three systems is money made available. The Danish doctors are not working the hours the British doctors are expected to work. Some American doctors are working insane hours but they get paid enough that they can cover their costs. As an example, my obn has two children. She and her DH earn enough to have two nannies. It sounds extravagant but when you are each working 70 hours a week Monday - Friday year round and need 80 hours of care/housekeeping year round, you need to have two people because working with children is exhausting and it gives you coverage if one is sick or on holiday. From what I have observed I think the working conditions in Danish and American healthcare centers create a much more positive environment for all. I also think the quality of care is better because the staff are not as tired/overworked.

Personally, my productivity starts to diminish when I work more than 55 hours a week on a long term basis. Given the negotiations are covering working hours, I think a goal of 50 hours a week all year round should be the maximum working hours. Hours should also be 24/7, and a supplement paid to cover childcare costs. I have said it before on here and everyone laughs but the hospital I have used to deliver my DC has a 24/7 daycare open every single day of the year. It is an amazing benefit for all staff in that it gives them an option of working unsocial hours.

Goblin. Be under no illusions, they're coming for the nurses (and every other NHS worker) next. That's why nurses are completely behind the drs actions.

And in continuation of that sentiment GirlsTimesThree, statements like 'I have more sympathy with nurses' rankle as they imply that doctors have no sympathy with nurses when many do. Hefzi makes excellent points but doctors are not just fighting selfishly, without the money to provide appropriate pay and conditions for all the workers the NHS will, and in some cases, is already falling apart at the seams.