All the doctors I know are leaving. Are we going to be screwed for healthcare in 5 years time ?

[Gigihadr]

Our NHS now has some of the worst health outcomes out of 19 wealthy nations compared in an international study.
But in 2010 the NHS regularly ranked 1st or 2nd in most international studies.

The UK is under-doctored, we have a 3rd fewer doctors per 1000 people than Germany or Spain

Our government response to the doctors we have left has been to erode working conditions and pay, ensure they have record levels of inflation and rocketing student debt

They are moving to better paid, better resourced systems/employers (they are a competitive international commodity) and I can’t blame them for that.

AIBU to think we are utterly screwed? why are we just sitting back and watching this slow motion car crash ?

I feel so weird about this stuff. Middle aged people has been claiming the world is going to hell in a hand basket since time immemorial, and now I’m 40 I feel exactly the same way. But at the same time - has any society changed as much in a couple generations as ours? The numbers I read in the paper are presumably real? Even people I know who are quite jolly can get pretty apocalyptic about the future. I just don’t know.

I suggest that nurses who want to play doctor ought to go to medical school and become qualified, rather than furthering the government's plan to create a two tier healthcare service (because you can bet those with private healthcare aren't seeing nurses).

Lots of PA course want a science degree! There’s plenty of room for allied health professionals. But we have less bed space (by the way lack of bed space makes training more doctors extremely challenging as they are taught at the bedside) and the government were too slow to up numbers of training places until quite recently.

CNS-led services have excellent outcomes and high patient satisfaction, compared with their medical colleagues. Seriously, whether or not you actually intend to piss off everyone whom you consider subordinate and inferior to you, you’re coming across as a bit of a ducking aunt here.

they aren’t seeing junior docs either…. Except at night when you can see a non training house officer with minimal support no critical care outreach team in many private hospitals

We need to stop flogging a dead horse

the NHS needs to be replaced. It will take a huge amount of money and work but we have to look at non profit insurance based healthcare it will no longer be free at point of service

it will mean paying more and that doesn’t mean 1p on tax it will be considerably more for many

unfortunately parties use the NHS as a political football as they know how strongly many people feel about keeping the NHS

But they’re not playing doctor. They are utilising their skills in their specialty within their scope of practice. That is not playing doctor. You might not like the fact their scope of practice now includes prescribing and ordering x-rays, and indeed seemed unaware of that until just now, but there you go. The evidence backs the ANPs up for being able to do it and doing it well.

Theres plenty of stuff which doctors can do which nurses can’t. I don’t have any real knowledge of PAs, we don’t have any in our trust.

Out of interest (genuine question) who do you think is at fault for there not been more training places? Is this due to staffing or funding? The government or the deanery?

@Darhon

and the government were too slow to up numbers of training places until quite recently

Not helped by the BMA stance 15 years ago when they voted against new medical schools and not to increase the number of medical school training places.

https://www.bmj.com/content/337/bmj.a748

"to avoid “overproduction of doctors with limited career opportunities.”

So blatant self interest!

Umm people mainly see junior doctors. They are the ones often doing your surgery, your CPR, an intubation at 2am on a 6 month old. Who do you think those people are ? Consultants ? Not v often.
Junior doctors needs to go as a name. Foundation, SHO, Registrar etc would give more impression of seniority. Many people think junior doctors are still doing their degree.
Oh and the laughable idea that F1s are fully supervised is nuts. I know several who have been left over seeing several wards over night. The supervision is that there is a more senior colleague somewhere in the building. That F1, on £14.09 an hour could be the one starting the crash cart on you.

We need people to stop thinking that taxes are bad. You get what you pay for. Buy cheap, buy twice. You know, starve something of funds and wonder why it’s gone to shit in 13 years.

One thing I do do which traditionally has been considered a doctors role is NIPE examinations. The Emren study backs midwives up in their ability to do this, massive study which showed they were as clinically competent as the doctors, had a better bedside manner, improved satisfaction rates from parents and provided more health promotion information.

I did an eight month post grad qualification in order to do this as part of which I had to do 40 supervised examinations, three essays and an OSCE. I turned up one day to do some exams with the paed to find a new SHO who’d never done one before. He nipped up to NNU to do one infront of a consultant who signed him off to do them. He returned to the ward and was unbelievably clueless. I don’t blame him, but to say he’d be better at it because he’s a doctor would be utter rubbish. Didn’t know how to turn the ophthalmoscope on, thought we’d take the babies away from the mums and into the office to do them, forgot to do reflexes, didn’t realise we needed to do sats monitoring, couldn’t undress a baby, very dodgy Barlow and Ortolini skills.

Not his fault as it was literally see one, do one, teach one. I made my excuses and left as I was learning nothing and was worried he didn’t know enough to correct me if I was doing it wrong. Learnt to much more from the much more skilled ANNPs.

No point having more medical students unless you have more speciality training places. And more doctors to train them - so few on wards some days they get little actual teaching.

@LeanIntoChaos you should have voted to strike and can still strike even if you voted against it. Staffing is unsafe and dangerous each and every day. This is the only way, the only way to encourage retention and stop this mass exodus of talented staff. Short term pain for long term improvement in the nhs. This is the only way the govt will listen that the nhs is broken.

Nobody's mentioned PFI. Had that not happened, there might be a tad more in the coffers.

Yet another Blair/Brown smoke and mirrors trick like QE and fiscal drag - announce massive increases in tax allowances and then implement them 5 years later. Brings more and more people into the tax net. Kerching!

In 1977 I was paid less than the full mandatory student grant after tax, ni and pension contributions. Around £120/month. To get that, I paid income tax at, shock horror, 33%. My salary was just under £2000 a year.

Putting the base rate of income tax up to 33% would raise a lot from PAYE, but would hurt a lot of people, and there'd be more for the NHS

One of my friends nearly died after being seen by the ANP at their GP practice. She had chest pain , the ANP told her she was young so must be anxiety/ panic attacks, didn’t do an ecg or any other tests. She called 111 and spoke to a GP because she still wasn’t happy . In A&E they told her she was having a heart attack…. Scary

The car crash has already happened - we now have the wreckage. Dh is a GP - and left the NHS in April. He was on £70,000 a year after being qualified for 25 years and numerous post grad qualifications and worked 70 hours plus a week. He was assaulted numerous times and we had our car and home vandalised. He now works overseas on a 6 month contract for £250K with accommodation and return 4 flights per term. Everyone left at his practice have an exit plan.

My daughter is coming to the end of F2 and is on her 6th placement - community mental health. She has done a great job over the last 2 years and has had brilliant feedback. She survived A&E over Winter. Today she walked out of work as her present role is untenable. She is a junior medic supposedly performing a medical role in community Mental health, doing ECGs, bloods, discharge letters etc. It’s ended up her regularly being the only doctor covering her base mental health ward and several others at the same time. She often has to refer those with severely escalating mental health problems into the main general hospital. She is making decisions of senior mental health clinicians. There aren’t many doctors in her area and this week 2 consultants and 2 registrars are off on A/L and sick leave. She has escalated the issues with staffing formally through several channels on several occasions and nothing has changed. It is unsafe for patients and herself. She basically says no one cares.
I’ve witnessed a resilient, competent and caring doctor reach breaking point (ironically in a mental health placement) and I’m upset and angry. She is going to Australia in September and I won’t blame her if she doesn’t come back, even if I will be devastated. The pay is ridiculous for the responsibility and yes, she’s worked with PAs who seem to amble around without a defined role, asking her to prescribe and order X-rays. She has to then review the patient, read notes etc as she can’t do those things without seeing them so it’s no help to her whatsoever The PAs have had the cheek to declare that they are basically the same as Foundation doctors in her presence.

I agree on PFI. Labour will need another way to approach it if they get in

@HaveYouHeardOfARoadAtlas there’s evidence in the US that PAs etc are more expensive and order more investigations so aren’t always cost effective.

As I said I’ve worked with some fab ANPs. But I’ve also worked with plenty of ANPs and PAs who think they’re registrar equivalent and complain that they’re on the ward round rather than clerking or going to clinic etc. This is dependent on the individual but I’ve spoken to many ACPs who told me that the advanced practice masters does not go into the same level of depth as medical school (2 years vs 5). Doctors after medical school then do even more further study, exams and regular teaching to further advance their skills in more formal training that can last over a decade for some.

The ANPs on this thread sound great and obviously practice in a small scope in specialised areas which is where they can be well utilised.

As an SHO I’ve been denied opportunities to do procedures because the consultant wants the PA to do them and me to go and see the sick patient in bed 12. So I’m struggling to meet my basic competencies. There is NO need from a training point of view for a PA to be able to do a lumbar puncture but as a med reg I must be able to do one out of hours.

We are the trainees and should be progressing towards becoming consultants, we should be prioritised for learning opportunities as have rigorous portfolio requirements to meet each year. But some departments use junior doctor as pure service provision and training opportunities go to PAs or ACPs who are not in training (they are formally already trained) and should be helping with service provision.

This isn’t said by doctors in front of colleagues. Personally I have worked with great ACPs this year I’ve really liked them and learned from them. They never try to steal procedures etc and I value their advice. But like all junior doctors I’ve had bad experiences in other departments but mainly with PAs. I appreciate ACPs have lots of experience in their own areas as nurses beforehand.

Personally very happy to work with ACPs. I’ve seen very variable PAs many of whom think they’re registrar equivalent after only a couple of years 9-5 working.

The car has indeed been progressively demolished and nobody minded. Doctors are not striking because they think the Health Secretary or Prime Minister will do the right thing, but because things are already intolerable. The UK pretends it's a low tax high service country when that's just propaganda. Replacing state funded treatment with private insurance is the road map of choice, and the better HCPs will escape before the less good ones. It will get to a point where nobody would choose state funded treatment if they didn't have to.

I am a midwife, and I do the student placements in our unit. The current response to the lack of staff is to push more and more students through. We have seen our numbers explode, but it means they don't get the placements they used to, don't get to work with one mentor, no continuity and they fight to get the numbers they need to qualify. We no longer mentor students, we are assessors who are expected to sign off students based on the feedback they get from supervisors they may have o ly done 16 hours with. They then get to qualify, and start off as NQMs without the support from the experienced midwives as they've all left, and then they burn out and leave too. To be replaced by more NQMs. Repeat cycle.

I am terrified for the future of the NHS and if any of my family need healthcare.

That’s rubbish but remarkably similar to DD’s tale of visiting a&e twice and the gp once with bad chest pain. Saw doctors each time, ecg were done and were fine so told it was anxiety. It was multiple pulmonary embolisms, finally diagnosed by an ANP. Scary. She could have died.

or the times over seven years I took her back and forth to the GP so many times with sickness, nausea, losing weight, anaemia, low vit d. They prescribe iron, prescribed vit d, said nausea and sickness one of those th8ngs. After seven years I asked them to test for coeliac disease and sure enough she has coeliac disease.

or me - back and forth from the GP for years with ankle issues, SI joint issues, bladder issues. 5 years of being under an orthopedic consultant and numerous ankle surgery. All of which are unsuccessful and consultant admits he doesn’t know what’s wrong with me. Ten years of high dose antibiotics for my bladder under the care of a specialist consultant in London. Went to see an osteopath and within five mins of examining me said he thought I have Ehler Danlos Syndrome. He could tell straight away from my ligaments Which makes sense seeing as close relatives have it, my knees and elbows bend backwards. Maybe i should have realised myself but I’d have thought after five years of examining my ankle maybe the orthopaedic surgeon would have picked it up.

point is people miss stuff, regardless of their job title.

@Medstudent12 @Shortkiwi this all needs to be shouted so loudly so the public hear. It's so ridiculous the way doctors are being treated, like cannon fodder.
To be trained you need training. By consultants. And ACPs who are experts in their fields.

OK, but as a nurse I heard stories like that from patients nearly every day of my working life - but about GPs or hospital doctors. So many cancers missed while they might have still been curable.

in what way are Norway, Denmark and Switzerland “inward looking”? Is this based on your actual experience of living and working in these countries?