doctor strike

[JudyWilliams]

Bit of a rant. Has anyone else been moved three times because of the doctors
Strike? I'm booked in for ELCS originally today, then tomorrow, then Friday. Now Monday!

Slowly loosing hope! That and I'm now sofa/bed bound due to hip/back complications. I'm just wondering if anyone is in a similar situation.

[MissTriggs]

sorry, that sounded smug - I know this about the lies and the bad people because that is how we lost the public faith in the battle to save everyone from the consequences of man-made climate change... a few lies from well-meaning people who gave up trying to explain the complexities was all it took....(

[AyeAmarok]

So my gripe about the BMA story on banding is that they say "starting salary is £22,000" but that's only true if you are in podiatry or dermatology where you can work a 40 hour week. If you are in, say, paediatrics it's more likely to be, say £32,000 (which is fine by me but they should say so because I'm not stupid and I don't like being lied to).

I do agree with this. The "doctors only earn 22k" line is thrown about a shocking amount and is totally untrue. No FY1 junior doctor will only earn 22k in their first year, it's typically 30k, then it goes up in FY2.

If the JDs/BMA just came out and said "We are getting a pay cut, FY1 now earn 30k but this contract will mean they now only get (say) 26k for identical hours over a year" I think they would have got even more support.

Because that^^ is a bad enough erosion of terms. Most people don't need to hear what it is after tax, childcare, indemnity fees, yadda yadda yadda which only equates to £7 an hour take home pay and is less than the manager of Pret gets [Daily Mail sadface] That's when it feels like doctors think they're talking to idiots.

[LaurieMarlow]

Wow SinkingFeeling. If we need to look at where the Drs are losing the PR battle, that's it right there. Guess what - other professionals don't like being told they're inferior. Who'd have thought it?

[Leafygreentrees]

I think I have reached the point where i am beginning to not care what the general public think anymore. Sad but true - it has taken some time but I'm there now.

I have been told I shouldn't care about my pay, my hours, my training needs & my family. That i'm selfish, stupid, greedy, arrogant and out of touch with reality. I should patiently accept my profession being relentlessly portrayed in the media & by the government as bungling, uncaring and thoughtless.

During my 10+ yr career my terms & conditions have steadily been eroded. I have ever increasing responsibilities to patients, my employer and exponentially increasing statutory bodies. I have more responsibilities but a steadily decreasing control on my working life.

Friends & colleagues are leaving. The NHS is teetering on the brink of no return, finally doctors are saying enough.

I have supported and continue to support other professions during wage & conditions disputes & I am fed up of the relentless race to the bottom for wages, pensions and the like.

The government lies, twists and spins.What is happening now is a political choice and one that needs to be fought. Doctors are the only ones that can ultimately stand up for doctors and that is what is happening now. Finally

[parallax80]

Haha that's ok.

So, again I think you may be describing 2 different things.

Breaching the working time directive is a criminal offence, and breaches are managed by the Health & Safety Executive. I think the employer is technically liable for £5000 per offence and this goes to some part of the state (don't ask me where but presumably some HSE linked pot).

Separate to this, an employer can be keeping to WTD but not be paying correct banding for the job. So if they pay (for arguments sake) a 1B banding (1.4x basic) but when monitoring is done it turns out that it acutally meets the criteria for a 1A banding (1.5x basic) then the employer can be forced to upgrade everyone on that rota to the higher banding (with back payment if necessary). This can all be while the post is WTD compliant.

I have never met anyone who has been paid a bonus or "danger money" (I have no idea where Jez picked up this expression!) and the good old bad old days of yesteryear when we did a million hours on a 2A banding are long gone - they weren't WTD compliant and it was too expensive for trusts.

[LaurieMarlow]

Leafy green, I'm certainly not telling you you shouldnt care. Of course you should care about your own pay and conditions.

It's the degree to which the profession has convinced others to care is what's up for debate in my eyes.

[parallax80]

Re the starting salary, I also agree this is disingenuous. Most F1s are unbanded but by far the majority of F2 and upwards are on a 1B at least.

In fact, the money is probably the least troubling bit to me. (Though having grown up in a single parent family, comprehensive school etc etc perhaps my aspirations are more modest than some of my colleagues. Or to put it another way, I'm a massive skank and one of the attractions of my specialty is that I dont have to wear smart clothes to work.) FWIW I don't think I'm poorly paid for what I do currently, but I also have a big skill set and lots of responsibility, work lots of unpaid hours with unpredictable finishes and have to invest quite significantly in both time and money to ensure I am / stay adequately trained / skilled / up to date, so I'm equally not convinced I should have a pay cut.

[Peaceandloveeveryone]

paralax you are doing a much better pr job than our friend earlier. .

I agree with you about the blurring of roles and I feel that it's to get Drs on the cheap. Many nurses now prescribe, do minor surgery and order investigations. It's a cost saving exercise although I quite like having more autonomy.

[Runningwithacheesegrater]

JDs currently have to be monitored twice a year to ensure the maximum hours and rest breaks are adhered to. For monitoring to be count 75% of the monitored cohort must successfully complete monitoring. If found to be in breach then two things can happen (although rarely, I've only known of upbanding to happen once in my 10+ years). The HSE can fine the trust £5000 per breach and/or the whole cohort of JDs monitored get their pay uplifted to the correct pay band reflecting their actual hours worked, until the factors causing the overwork such as rota gaps are rectified and monitoring shows that work being done is back to the original intended levels.

This is potentially huge for the trust and rarely happens, but the threat of it is enough at times to keep trusts in check from overworking their doctors. The reality of monitoring is during monitoring week, there is pressure on the monitored doctors to leave at five and dump a whole load of work on the already overstretched on call team. If you breach, there will be a curt e-mail to your boss insisting they have a word with you. And diary cards often go missing so the whole exercise is repeated again and again and again.

Breaches are inevitable in medicine, you can't leave when you are the only one around to administer clotting factors to an actively bleeding patient - so there is quite a high treshold for breaching as a cohort before the fines kick in.

I think I need to leave this thread now, I'm tired and am looking at a 12 day working stretch ahead of me. Good night all.

[AyeAmarok]

I agree Parallax completely (at least I agree from your FWIW onwards; I very much doubt you're a massive skank! ).

I think that if the JD's case was laid out in the media/social networks the way you have just put it, then there wouldn't be a single person (bar Hunt) that didn't agree with you.

[stitch10yearson]

Each time the monitoring is done, I have sent a form in. Yet each time i have heard back that zero percent of forms were recieved and therefore this times monitoring doesnt count. And that leaves me thinking that the email system functions in odd ways.

[stitch10yearson]

Peppatax, why do you think it odd that doctors would strike because they are concerned about patient safety?
Industrial action is a last resort. The whole thing may have only come to the light of the public in recent months but the talks about the contract have been going on for at least three years.

[gonetoseeamanaboutadog]

Don't try that divide and conquer bulkshit. The vast majority of us support out doctor colleagues.

Grow up! The element of responsibility was the topic of conversation

[ginghamcricketbox]

I will just put this here . Stop with the Save our NHS bollocks, it is not your NHS it is everyones.

[peppatax]

Nice to see parallax is taking the time to actually explain rather than the torrent of abuse from a PP

[peppatax]

stitch it may well be that the talks have been going on for however long and that industrial action is the last resort but how can you expect the public to support and understand when the JDs are going against everything that they say is key to their argument. It might be that the NHS is running better on strike days because of the absence of poor, overworked doctors who spend their days saving people's lives at the expense of their own. It might be that there are people who have died on strike days due to the absence of 'normal' service. It's hard for the public to get appropriate knowledge about this when the media is full of pictures of the 'heros' on strike with some pretty wanky posters.

[Onthedowns]

Does everyone think this is just limited to doctors? My son is currently in SCBU and the nurses know the government are coming for them next. I work in the police and have the same treatment, sick to death of the argument being brought back to just salary it's very ignorant to assume that's the only reason. I would happily pay an increase in NI to cover the NHS and the vast amount of people that I speak to would. I would happily pay more to support the staff looking after my son for the past 2 weeks. When the NHS is slowly eroded and privatised and people need to pay on point of access it will be interesting to see the difference in opinion then

[jacks11]

The part which concerns me most is that the numbers coming out of Hunt and the DoH don't add up. That and the removal of the current safeguards on working hours to be replaced with a "guardian" which, from the little information we have been given, has a very limited role and few powers.

There aren't going to be more Dr's and we are all going to be working more evenings/weekends/nights whilst simultaneously working less hours per week overall. This does not make sense.

This will only be possible by reducing the Dr's working during the "normal" hours Mon-Fri. This will inevitably have an impact on the service during those "normal hours" as there will be fewer junior doctors available. This will impact on wards, outpatient clinics and elective surgery as the same workforce will simply be stretched thinner over the 7 days. Add in to this that most rota's are working with unfilled posts (and in certain specialties the number of unfilled posts is getting worse each year) meaning those on the rota are already having to pick up the slack. There is very little 'fat" on most rota's, so much so that one person going off sick can cause problems- stretching that even further is going to be very difficult to achieve.

In addition, the safeguards re working hours has been diluted. The cynic in me says this is so Hunt can say Dr's are working less hours overall and has effectively removed the process through which this could be disproved

The impact of these two measures is going to have a negative impact on care for patients and the BMA needs to communicate this far more effectively.

Finally, for those saying it's all about the money. Really, genuinely, it is not about the money. Of course pay is a concern- junior doctors are not arguing for more pay- but nor do we want a pay cut. And yes, current pay will be protected but it will effectively be a pay cut in the long-term and for those coming up through the ranks in the future. The thing is, it's also this change to pay which is allowing the changes that junior dr's are worried about- if it costs less to have us working nights/weekends then employers will be more likely to do so.

[jacks11]

sorry that should be not all about the money

[jacks11]

Also, in reply to MrsTriggs - the monitoring/banding thing is complicated and I think you haven't got it quite right. There is no "bonus" for working longer hours, the banding supplement is altered to reflect the hours actually worked where these do not match the expected hours according to the rota. The fine is for breaching the EWTD.

Junior Dr's get base pay + a banding supplement depending on number weekends/nights worked and intensity of that work. This supplement can range from unbanded (0% supplement) to Band 3 (100% supplement). Reality is most posts at FY2 and above attract a supplement of 40-50%.

Junior Dr pay comes from 2 sources- part funded by NHS education (from the relevant organisation for England, Scotland, Wales or NI) as junior doctors are (to a greater or lesser extent) still in training. The NHS Trust pays a proportion- usually equivalent to the "out of hours" supplement. This arrangement was made to reflect the fact the NHS Trusts are providing "on the job training". As part of this agreement, the trusts must provide appropriate learning opportunities (i.e. the junior dr's in the trust are not simply there for "service provision"- although clearly this is a large proportion of their duties) and appropriate rota's.

Junior Dr's are "monitored" at least twice per year. During this "monitoring" period the doctors on each different rota are asked to record their working hours (and whether they achieved breaks) during a 2 week period. The data is collated- to "fail" the monitoring more than 75% of the Dr's on the rota have to have breached the maximum hours for that particular banding (these numbers will include those Dr's on annual or study leave, those on post-night "zero hours" days and so on).

If this happens, then the post must be rebanded to reflect the actual hours worked- so it could go from a 40 to a 50% banding. Pay would be backdated to the time each Dr started on the rota which had breached and would continue to be paid at the higher rate until the cause for the breach has been addressed (could be change of rota, filling a vacancy and so on). Once the trust feels it has addressed this, the rota will be re-monitored and if it is compliant (i.e. 75% or more of the dr's on the rota work the hours expected and get their breaks) then the rota will be down-banded. In no way is that a "bonus" or "danger money"- it is acchange to pay to reflect the actual working hours.

The "fine" is a separate matter. If the EWTD is breached, then the trust must pay a fine (not to the Junior Dr's). I think it is £5000 per trainee on the rota that has breached EWTD, but I could be wrong.

These rules were brought in because the relatively high cost to the Trusts for not ensuring the rota's they asked junior doctors to work were fair/paid appropriately seemed to be the one thing that ensured they played fair. Before this the rules were frequently flouted, as there was no significant disincentive to do so- in fact the financial incentive was to do the opposite.

As it is, the monitoring process is often manipulated. But at least it is something. The proposed guardian sounds even more watered down and ineffectual.

I have worked in departments where in the run up to monitoring all sorts of things are put in place to ensure there are more doctors around (so more likely to get achieve breaks and finish on time) or someone is sent round to try and make sure we are leaving on time. As soon as monitoring is over, everything goes back to normal. Monitoring forms are frequently lost/ allegedly not returned (a minimum of 75% of doctors on the rota must return forms for the process to be deemed valid)- so the process has to be repeated at a later date. Although, if the rota is compliant these problems never seem to occur. We got round this by collecting all the forms together, photocopying them all and then handing them in together, asking for note of receipt. When the forms were "lost" we were able to supply a copy. Strangely enough, the number of "lost" or "not returned" forms dropped dramatically and a few more rota's breached.

One post where we did 24 hour resident on-call (only supposed to be called out during the night for emergencies, but available and on-site for the full 24 hours, plus doing a normal 8 hour shift the next day), the nurses were all told that we were being monitored and only to call us in an emergency and had to record why they had phoned us. They were told the reasons we were called would be scrutinised. Out with the monitoring period this was never done. At this time, there were 2 vacant posts on the rota so lots of cross-covering was going on. We failed that monitoring period anyway, so management changed the on-call process- overnight calls were filtered through a senior charge nurse who decided whether the Dr could be called. They also employed a temporary locum to fill one of the vacant posts. We (only just) passed the second monitoring process, but within a week the new process for filtered calls was abandoned as being "impractical" and the locum's short-term contract was not renewed after their initial three weeks.

[peppatax]

I am not sure what people expect to happen though - current public service models largely don't do what they should and it's often a legacy of several Governments being slow to react or not being proactive. 'Free healthcare for all' sounds great but in today's world it is far too open to abuse. Not just the health tourists but all of us. The NHS will always be overstretched when people continually make poor lifestyle choices because they know if they get sick or need medical attention it won't cost them a penny because they've paid tax/NI so they're 'entitled' to it. I would rather pay the same tax/NI and pay for healthcare insurance that provides a better service and means I take responsibility for my own health.

[peppatax]

Not to mention the people that wil take their children to A&E for a headache or cut finger!

[ginpig]

Aside form the contract debate, it is really interesting to hear of others experience of hours monitoring and what happens when your rota is found to be non-compliant.

I am aware of a similar situation at the moment- hadn't been monitored in 21 months, lots of mission creep, JD's repeatedly telling management that rota was becoming unsustainable and finally requested that they be monitored. All set up, good to go, 10 days in (it lasts for a peroid of 14 days) and after the 3rd clear breach (a 4th would make the rota non-compliant and trigger the pyment of penalties) HR cancel the exercise. Absolutely scandalous. This is now in the hands of the BMA.

My fear is- if this monitoring system is replaced with a trust appointed Guardian, the ability to make change to frankly dangerous rotas will be almost non-existent.

[jacks11]

Peppa, I see your point.

I think a fundamental problem with this "7 day NHS" mantra from the government (apart from the fact there is a 7 day NHS, just not a 7 day NHS for elective things) is that they haven't actually defined what they mean, how they are going to achieve this nor how they plan to fund it. Where are the extra beds for all this elective work that is being proposed? How are we going to staff it all (not just Dr's and nurses, but physic's, OT's, radiographers, laboratory staff, theatre staff, admin staff, porters and so on will all be needed)? And where are all the social services to support patients on discharge- from care packages for the elderly to community rehab (e.g. physio follow up post op)- going to materialise from?

I'm not even sure the public really want it- many will say they do, but in my experience they often like the idea of it more than the reality.

In our region we did a trial of running some clinics at the weekend (partly as an initiative to reduce waiting times). It proved an almost complete waste of time- the first few weeks the DNA (did not attend rate) was about 65%. We then arranged for patients to be called on the Thurs/Friday before their appointment asking if they were intending to come, nearly everyone said yes, and those that did not were removed from the list and re-allocated (there are specific instructions on all appointment letters regarding how to reschedule if you are unable to attend of the specified date, but these are often ignored) . Our DNA rate fell by just over 5%. When patients were contacted to ask why they had not attended the common response was along the lines of "it's my day off, I had other things to do" or "I forgot".

My friend is a GP. Her practice did a trial of opening on Saturday until 3pm and late night opening until 8:30pm Tues, Wed, Thurs with Thursday being a drop in clinic. Again, hardly worth their while. Many of the patients who came during extended hours/weekends could have come at other times. The DNA rate was also high- especially at the weekend. Some days it was hovering around 50%, but on a number occasions it was well above this. So they stopped after 8 weeks- it wasn't cost-effective.

Data from our area, and I don't suppose we are vastly different from others, is that approximately 20% of GP appointments and 23% of hospital appointments are missed.

[jacks11]

Gin

we have had all sorts of fun and games over the years. As you know, the trust must provide the junior Dr's with the results within a set time frame (I think it is 15 working days from memory)- 2 months later they would not give us the information. After a lot of complaint, they informed us the data had not been analysed due to "staff shortages". We go the BMA involved and after much hassling, we got the result 12 weeks after the monitoring process ended. We had failed and automatically got up-banded (we had horrendous rota gaps- 25% vacancies meaning at times there were only 3 junior doctor, including the senior reg, to cover the in-patient dept of 6 separate areas including 2 emergency services and an elective theatre list). They couldn't argue they could make changes to make it compliant due to the systemic problems so agreed to up-band us. I think they were hoping if they didn't provide the results, we wouldn't ask.

I have had a previous post where the results were not given to us, when we asked after a few weeks we were told we had passed. We were sure we hadn't so asked for a breakdown of the results- they had somehow averaged the hours over 18 days instead of 14 (as there are 14 days in 2 weeks)! Obviously, we had failed and they had to go through the rigmarole of re-monitoring. A friend was not told the results at all, and when they asked several weeks later were told they had failed- when they asked why they had not been told immediately, it was implied that they would only be told if they asked. And if they didn't ask, then management would assume they were fine with working practices and would not make any changes. Despite they have a contractual obligation to provide the results to their junior doctors.

This guardian proposal worries me because, however easily manipulated the current system is, at least we can ask for monitoring and have a contractual right to do so and to have the results of this supplied within a given timeframe. With this guardian we will have no such rights and they appear to have a very limited remit and no real power to enforce change nor provide any significant disincentive to trusts who are flouting the rules (the only thing that seems to keep many Trusts in check in any way is the threat of financial penalties hitting their budgets).