Junior Doctors Unemployment in August part 2

[PurpleFairyLights]

Following on from previous thread.

https://www.mumsnet.com/talk/am_i_being_unreasonable/5337022-junior-doctors-unemployment-in-august?utm_campaign=thread&utm_medium=share

You cant name change on a thread you’ve already posted on. It’s the case that so many people actually just disagree with OP, likely because it’s a troll thread posted to stir up arguments. Unfortunately, OP’s opinions are in the vast minority.

It’s funny to accuse people of bullying when OP and mums have been the ones consistently being rude to people.

As almost everyone has stated, there is no argument that UK grads should be prioritised. However, the initial arguement (that they should automatically get a training place: 12,000 med school places for 12,000 training places) is what people disagree with. OP has backtracked on this and twisted the argument several times to continue the thread (likely because it’s a troll post).

I very well remember this too as I was heavily pregnant at the time and terrified I would miss the interview and never have a chance of a training number. Wvery single junior Dr in the U.K. had to reapply to their own jobs for no apparent reason. We were indeed told that this was our only shot. If we wanted to re-enter we would have to go back to the bottom and repeat 5 years or get a staff grade job. I enquired what if I was sick or could not attend and was told tough luck there is no dispensation for that. You were also only allowed to apply to two deaneries so I had two shots at getting the training number and one was after my due date.

My specialty (which I chose for the love of it not because I could not get anything else) has always been unpopular so I figured I would likely get some kind of job and my plan if I had missed the interview (due date was on the day of my deanery interviews) was to try to get a staff grade job and eventually apply to be a consultant via that route. Of course lots of people were in that boat so it may not have been very easy. Many of my friends went abroad and didn’t come back. It didn’t feel like an option for me at that point in my life. I made it to the interview whilst having contractions, got my training number and had the baby the same night (she’s just off to uni but not to study medicine)

Had I missed that interview or not been awarded a number I would have been unemployed with no job to go back to after mat leave and a tiny baby. When I got pregnant (planned neatly for after my membership) there was no inkling at all that the system was about to change so drastically. It was a shocking debacle and a lot of us were scarred for life by that. The media did not care at all about it at the time as it was hard to explain to people who don’t understand medical careers

I absolutely do have sympathy with the plight of Drs who are facing unemployment therefore and I would support a change to the visa rules to put them back to what they were.

We always had a lot of IMGs when I was training because it’s an unpopular specialty but I think they could only be given the job if no British Drs had applied. There were still a lot of opportunities for them and many are excellent colleagues of mine to this bringing a lot of value to the NHS. We continue to get consultants in from overseas in my specialty right now as we have no U.K. applicants for many of our jobs

Where I part company with the OP and others on this thread is the vitriol towards BAPIO (British association of physicians of Indian origin) who as far as I (white British) am concerned is an organisation who do nothing but good and have exposed and campaigned against racism in the NHS and GMC for decades. I can’t understand why the repeated digs at them.

Individual IMGs and organisations that support them are not responsible for the U.K. government’s poor planning of the medical workforce. People who trained overseas prop up the NHS and have done for many decades and I welcome them with open arms where there are jobs that U.K. trained grads don’t want (and there still do appear to be). Half of my consultant colleagues are IMGs and for my whole career I have been in the minority as a U.K. trained person in my specialty. I am bloody glad that those Drs are here and this thread at times comes off as anti immigrant and xenophobic and that’s what people are reacting to.

No vitriol against BAPIO and no repeated digs. Legitimate questions though for their training arm to answer. Perhaps you can shed some light?

With the NHS being publicly funded, there needs to be clarity on how if at all training capacity is being reduced for doctors working in the NHS already (whether IMG or UKMG) when new IMGs enter the NHS workforce through the numerous BTA schemes available for new IMGs.

IMGs are of course valuable contributers to the NHS but at a time when doctors are facing unemployment, there is no need for BAPIO through their training arm to bring in new IMGs. Some of these courses cost each new IMG £30k plus. Their academy offers licencing exam exemptions and fast tracking into NHS posts for new IMGs who can afford the fees. These new IMGs need not be the best of the IMGs. Hence the merit argument is questionable. They have to be able to afford the exorbitant fees BAPIO's training arm charges.

Don't you think that it is unethical to charge vast amounts to new IMGs when BAPIO and their academies are well aware of the shortage of training posts in the UK for UKMGs and those IMGs already working in the NHS?

What do you make of the conflict of interests in promoting these expensive courses abroad, especially when BAPIO are central and highly influential in NHS workforce planning?

Could you perhaps explain how much the NHS is being charged by BAPIO's training arm for each new IMG being recruited this way? Don't you think recruiting these new IMGs is unnecessary at a time when there are tens and thousands of doctors, including IMGs already working in the NHS who are ready and available to take these jobs?

BAPIO's training arm charging the NHS, a publicly funded institution, a lot of money for new IMGs undermines a lot of the good work done by BAPIO in relation to discrimination and race and is therefore not supported by many of its members. Why keep using the sponsorship route to perpetuate these schemes?

Why not put effort into pressuring the GMC or the powers that be to pause PLAB to help other countless IMGs unaware of the recruitment issues in the NHS before they incur wasted expenditure coming to the UK. I know it may not help its business arm in promoting their courses but surely it's ethical and would be good work for BAPIO to help raise awareness amongst new IMGs so they don't incur wasted expenditure on PLAB if there are not enough posts this summer? Why keep promoting these courses?

How is it with BAPIO at the heart of workforce planning have UK medics (IMG and UKMGs) come to miss out on speciality training posts? Surely the good work that BAPIO should be doing should extend beyond discrimination and racism to alerting politicians and others in workforce planning to supporting UKMG and IMG doctors already working in the NHS get training posts before their training arm offers training capacity to new IMGs who haven't spent a day in the NHS?

Wouldn't you also agree that it would make sense for BAPIO to put as much effort back in India to pressure India to increase training capacity for their million or so doctors graduating from medical colleges each year instead of accomodating many of them in the NHS through their sponsorship certificate? After all, BAPIO's leadership has enough influence in India to do this successfully.

Anyone who is a taxpayer and uses the NHS would be interested in the answers to these questions. No vitriol. Criticism yes as there is no clarification on any of this. Would also be interested in why BAPIO, as an organisation heavily involved in workforce planning over the decades, has despite all the good work done in safeguarding IMGs from racism and discrimination seems to not have factored in the interests of doctors , including IMGs, already working here, in securing training posts?

NHS users would be interested in how BAPIO and their training academies think a new IMG doctor paying their academy huge amounts for their courses and who hasn't yet worked in the NHS should qualify for training capacity and mentoring from NHS doctors ahead of the domestic NHS workforce.

What guarantees are there for patients that these doctors who have yet to work in the NHS are indeed better doctors than the experienced NHS doctors facing unemployment? Also having to train up new IMGS doctors when there are trained NHS medics facing unemployment who could do these jobs is an absolute waste of taxpayer money!

@BlueGreenPanda d.” However, the initial arguement (that they should automatically get a training place: 12,000 med school places for 12,000 training places)”

That was never the proposal. Priority for UK grads ready to move on. Not guaranteed, not a job for life, not whatever job they want.

This has ‘guarantee’ claim has been corrected 10+ times over the last threads. It was never made. Yet posters keep claiming it has. Why?

W0tnow not correct. One poster said on a number of occasions: 12,000 training places 12,000 med school grads. The maths is simple.

That equates clearly to no filtering being required. That's precisely where the discussion about quality of education, prior achievement etc came from.

If you trawl back over the related threads you'll see it clearly, on a repeat basis.

It was almost a catchphrase of the poster in question.

And just to pre-empt any unreasonable demand which is about to fly my way: no, I'm absolutely not going to trawl myself. I'm 100% clear those posts were there and equally clear that now there's been a very significant rowing back from that completely unrealistic position.

And just to do a bit of repetition myself: Wes Streeting is not increasing the number of consultant posts - so watch out for the same sort of culling as there's always been. Plus ca change.

No, what was stated (repeatedly) was x amount of grads, x amount of training places, x amount of applications.

At no point has anyone advocated for guaranteed jobs. Not once.

Well no, I won’t ask you to trawl back because you won’t find a post that supports your assertion.

And anyway, numerous posters yesterday have clarified that no one was advocating such an ironclad guarantee. No one is walking back from anything. You’re just choosing to ignore words clearly written on a screen.

Well if it’s all the same to you W0tnow I might opt to ignore words written on a screen when they’re emphatically incorrect.

It was a refrain. A slightly irritating refrain since it was so obviously flawed.

It’s good to see the rowing back. Not that it matters two hoots what people on MN say. MN simply isn’t a forum whose threads are discussed in meetings by those responsible for policy at the DoH.

Righto then.

The refrain that UK graduates should have jobs at the expense of candidates who are, by the usual metrics, better qualified has been incessant.

E.g. mumsneedwine: "No one is saying IMGs won’t have jobs. They will get the ones left after current UK staff, as they DO IN EVERY OTHER (apparently racist) COUNTRY IN THE WHOLE WIDE WORLD.!"

Given the oversupply of British graduates relative to speciality training posts, this would mean that there would be a complete absence of foreign graduates after ST1 regardless of ability.

They fail to understand the process behind ARCP and its relevance to career progression but this is clearly only a part of their problem.

They are advocating that Brits get all of the training jobs. Can you explain why you think this is any better?

@Marchesman how do you feel about the role of PAs? Only bringing this up as I recall you being critical about their use in the NHS. I think you agreed with me on various points of concern raised and the potential for them exceeding their scope. Do you still agree? Don't understand why you haven't taken issue with some on here who seem to think PAs are better qualified to treat patients than doctors but happy to support them with the rest of their points.

I think PAs were a terrible idea for all sorts of reasons. Most concerning, as you say, is that they are used in situations that require training that they don't have. Ward clerks, ECG technicians, phlebotomists, digital technology, and nurses had already relieved junior doctors of most of the stuff that could be safely offloaded. After inventing specialist nurses, I can't see the point of adding into the mix the PA, if not to fool the general public into thinking that they are being seen by a doctor.

As far as this thread goes, I think I have in general addressed the point, rather than the person who raised it. If some people's experience of PAs has been positive I can't argue with that.

I am afraid we haven't had a positive experience with a PA hence my concerns.

My DC was seen by one. We were told by the hospital staff (including the nurses that day) that there wasn't a long wait as there were 2 doctors seeing patients. In fact, there was just the consultant and his PA. The staff thought the PA was a doctor.

Although she was lovely, she couldn't answer a lot of the questions relating to my DC's condition so we asked if the consultant we saw the first time was around. She then went to get him. I did think, at the time, what the point was of having someone with limited knowledge seeing patients without supervision. We were left waiting in the consultation room until the consultant had finished seeing another patient. He then came in and answered our queries. However, in the time spent finishing my DC's consultation, a doctor, instead of this PA, could have seen at least a couple of patients. What a waste of time for all the other people kept waiting while we all finished the consultation.

PAs are an expensive mistake the NHS is making and to be honest, given all the issues, PA courses should be paused. In addition to the issues of PAs acting beyond their scope and the discussion of PA salaries, there is the serious issue of potential negligence claims and the cost to the NHS and the patients affected. It is the case that some patients who are diagnosed and treated by PAs think that these PAs are doctors so have been unintentionally misled.

The NHS paid out £2.8 billion in negligence claims in the financial year 2023/24 (that's the official NHS figure).

The vast majority of claims are against doctors not PAs (of course it's fair to say that since the latter are supposed to be supervised by the former, there's not necessarily a clear line in all legal proceedings as to who made the 'actual' error, where a PA is involved).

This is a huge sum though, which is why it can be extremely provocative when assertions are made that UK medical education produces uniformly excellent doctors. (There's no evidence that more claims are against IMGs than against UK MGs (again, the legal process may disguise which group tends to be more at fault in successful claims, since it's usually the NHS Trust which is sued)).

None of this says much because of the qualifications made, except perhaps that £2.8 billion is a lot of money/ a lot of negligence/ a lot of mistakes. The NHS doesn't pay out unless it absolutely has to. And that the size of the bill (and what it implies about sub standard care) underlines the need for a merit based approach at all stages rather than a 'Oh you're a UK medical school graduate so you must be competent no question' one.

On the official statistics though, it does seem unfair to point the finger at PAs being disproportionately to blame for the claims.

Possibly also worth noting that these are the payouts only for those who have the determination and financial resources to go the whole mile. Lots of potential claimants don't claim because they just don't have the energy; lots of potential claimants can't claim - even if they have the energy - due to the dire state of Legal Aid.

Where have I pointed 'the finger at PAs being disproportionately to blame for the claims?'

Please don't twist words. If you support the use of PAs that's fine if that's your opinion. Unfortunately, I don't agree with their use regardless of the unemployment issues which have been the subject of this thread. My opinion comes from an NHS patient's perspective. Too many issues with potential scope creep and the public thinking that a PA is a doctor. Naturally there would be more cases of negligence against doctors than PAs given the number of doctors far exceeds the number of PAs. PAs are supposed to be supervised so more than likely, any mistakes and claims that follow affect the supervising doctor as well as the PA.

Given the current issues concerning the use of PAs, there should be a pause in the training and recruitment of any new PAs into the NHS.

OneMorePiece you mentioned negligence claims in relation to PAs and I gave a few facts and figures along with qualifications. No words quoted, no words 'twisted'. Merely pursuing a train of thought that you'd introduced. Not even in response to you in particular, just general info about negligence claims.

If you'd pause for a second to take breath, you'll see that I took time out to caveat the statistics. And stressed that I'd done so. No need for you to repeat what I said in order to make it your own.

There's an almost surreal level of over reaction by certain posters on this thread.

@OneMorePiece Unfortunately this is the direction of travel of the NHS. The current "plan" is to replace acute hospital investigation and treatment with "neighbourhood health services" - nurses, presumably others, and remote decision makers. NHS staffing has increased in the last few years while productivity has decreased: In my experience, 20% of a senior doctor's time is unproductive, and countless employees are total waste of space. Instead of addressing that, W. Streeting et al. are going down the hospital doctor avoidance route - again. It is absolutely insane.

@Sevillian Agreed, absolutely. I used to review complaints on behalf of the Healthcare Commission for which Trusts had refused to accept responsibility despite being pretty obviously at fault. At that time entry to medicine was still competitive. Worse still, sadly I would say that mistakes, more often than not, are not recognised as such and don't generate complaints. The £2.8 billion is the tip of the iceberg.

No overreaction. No desire to 'make it my own' either. You can own whatever you mean if that makes you happy!

No need for you to say 'If you'd pause for a second to take breath..' Also no need for 'There's an almost surreal level of over reaction by certain posters on this thread....'

Do calm down. It's Sunday night after all. You don't have to be on edge.

Is this really the best you can do by way of a dialogue OneMorepiece?

Absolutely the tip Marchesman. So many factors colliding to suppress claims and cost.

Yes, I am aware. As a patient, I have been adversely affected by some of the issues affecting the NHS. I have been following the updates and am hoping things will improve.

There just seems to be too many roles within the NHS increasing the burden on those supervising. The depth of the knowledge and skills some of the staff, in the newly created roles, have is not adequate to deal with patients whose conditions have become complicated due to, for eg, the long delays in getting an appointment. When those staff members make mistakes or refer the cases on to the consultant or a senior doctor because they don't know how to progress it, it adds to the doctors' workload and is a waste of NHS time, money and resources. Just imagine what it's like for a patient to see someone with limited knowledge and skills after waiting so long for an appointment. Consultants should be training young doctors instead of PAs and they should be supported to do this properly. That's my opinion. Of course, others might have a different opinion on this.

Not my style Sevillian although there is a lot I could say about you.

If you think insults work on me, you are wasting your time. Really surprised how much time you have invested in this thread. You know there are many other threads on Mumsnet. You could always explore them if enjoy having a war of words with posters.

I'll stick to those subjects I'm vaguely interested in OneMorePiece.

You're free to say what you like, within the guidelines of course.