Junior Doctors Strike

[Lanchester]

Do the Junior Doctors seriously think that they are still
respected for always putting the interest of their individual patient first?

the (main) issue JDs have with the new contract, is that it incentivises employers to schedule more hours per week. And this also leads to more erratic combinations of hours (not a straight fortnight of nights only, followed by a fortnight of days only, for example)?

Yep. And the substantial pay cut. And the expectation that they will cover all rota gaps as above. They also object to calling very early morning and very late evening shifts ordinary hours, along with some rather bizarre new definitions of basic contractual terms like 'night shifts', 'weekends', 'on-call' and 'working hours'.

Pausing - yes, that's it pretty much in a nutshell. But added to that the fact that, particularly in some specialities, there physically aren't the extra people to employ. My background is in paediatrics - it's family-friendly cause it has to be really - people who like children and babies tend to want to have their own! So we have a lot of part time people and often a lot of people on mat leave. It's also a speciality that people think is going to be a bit softer and fluffier than it actually is, so a lot of people who start in paeds realise that the hours are tough, the consultants are in all day and often all night and when babies die it's really upsetting, so a few people will drop out in the first few years and go and work in another speciality.

So we have gaps we can't fill because we physically don't have the people to fill them. Even if you open more med school spaces, a lot of those new doctors will not want to do paeds, and even if they do, for those starting medical school now it will be 10 years before they will be on the paeds registrar rota!

I fully support them

Thank you for explaining that, Meir and Sally.

Am I also right in thinking there has looooong been an issue with the fact that the number of consultant positions is vastly less than the number of posts required by the hospital at each more junior level. So there is an expectation that many (most?) JDs will not eventually become consultants?

I might have misunderstood that. But if it is the case, we have to recognise that a non-consultant position IS many people's career, not merely a (rather long) temporary training period. And make that career feasible long term, rather than something people are only able to do till they burn out or drop out.

(This would be a contrast to the profession someone mentioned upthread, where surely the vast majority of trainee solicitors on a two year trainee stint, would expect to become actual solicitors.)

Sorry, my post was unclear. The need to make the non-consultant positions attractive isn't primarily to be kind to the doctors, but because the employers need to fill these positions for their hospital to function.

If there were enough doctors, the new contract might theoretically reduce working hours So really what you're saying is that the NHS should employ more doctors and its a win win. But everytime I see a BMA rep on TV that is not what they say they are striking for. The Union appears to be striking because of saturday overtime and not large enough fines for hospitals getting JD to work to many hours.

If a hospital can't afford more doctors at weekend because the overtime is so expensive. But a new contract will 'apparently' force doctors to work longer because there isn't enough of them. Isn't the answer to bring in a new contract that means you can afford to employ more doctors at weekend because they won't cost as much?

The NHS is not perfect but it provides equal universal healthcare to all residents of the UK free at the point of and that is an amazing achievement.

I work in a medical speciality and we have patients from other eu countries, and not just the recent acsension countries, who have move to the UK on their doctor's advice for the healthcare as we have some of the best practice in the world.

I have also worked in other developed countries where if you can pay for your healthcare it is brilliant but if you can't then expect a basic level of provision but further medical investigations and treatment are severely rationed.

I found it difficult to work in a system knowing patients were fobbed off with painkillers to manage pain when their symptoms indicated they needed investigations for secondary tumours but they would not get them unless they paid to have them done privately.

Isn't the answer to bring in a new contract that means you can afford to employ more doctors at weekend because they won't cost as much?

I think that's a good idea. It would be a lot safer and address the patient safety issues. But there are finite resources so it would mean doctors being paid less - which no one seems keen on. Fair enough - but again does get back to the pay issue.

I also agree with you re: what the actual BMA reps are saying is the reasoning behind the strikes. It's quite different from what those on the picket lines are saying. So something is adrift.

The new contract wants to take away that protection though - so say the current rota is written for 8 doctors but we only have 6. The new rota may be written for 10 doctors, but we still only have 6. But now the hospital can say 'we know you've worked 48 hours this week, but we cannot employ enough doctors to fill this rota so your contract says you have to do 2 more 12 hour shifts to fill the gap'

OK, now I'm getting it.

No one wants the hospital not to cover the rota. But then the hospital should be doing whatever it takes to fill the vacancies.

This contract allows management to twiddle their thumbs on recruitment while simply demanding the existing staff do 60 hour-weeks. And as a bonus, lowers the employer's financial penalty in overtime costs.

Given the behaviour I've seen from employers in other sectors, this is a recipe for disaster. Because once the shift is covered, staff shortage drops off top spot as Most Urgent Problem. IME of the private sector, management doesn't act until it feels pain from the staff shortage (failed project, lost bid). I would hope there'd be a little more responsible behaviour in healthcare, though after Mid-Staffs I wouldn't like to rely on it.

Union appears to be striking because of saturday overtime and not large enough fines for hospitals getting JD to work to many hours.

That sounds exactly in agreement with employing more doctors, surely?

Urbanfox - if there were more doctors to employ, and more money to employ those doctors, we'd be much happier with the new contract. But there aren't loads of junior doctors sitting around at home with no jobs (or in the private sector, as private healthcare is very consultant led), in fact there are already too few junior doctors in some specialities. If we make more medical school places, that's still at least 5 years before those people even finish uni.

If Hunt was planning on giving the hospitals a big pot of cash to bring doctors from abroad to prop up the NHS that would be great too. But he's not, and even if he did, we'd have to make sure their English was good enough, make sure their training was compatible with ours and so on, so they couldn't just slot straight into the gaps.

Instead, what's happening is that a lot of our doctors are thinking 'This contract is awful' and even more are thinking 'I work my arse off, I go above and beyond for my patients but the public think we are lazy and money grabbing and just want weekends off, the media are trawling our Facebook accounts and slagging us off for daring to have a mortgage, go on holiday, do voluntary work abroad and sometimes drink champagne when we have something to celebrate. I don't want to be a part of this any more'

These doctors are quitting medicine. Or they're going to work abroad. Decreasing further the amount of people who'll be left to fill the gaps. Which will make those still in the NHS more knackered, more disillusioned and more likely to leave.

And Sally, again to be clear, would you still be happy with there being more doctors and the vacancies being filled, if that meant less money in your take-home pay.

(But you'd be working lower hours and having more predictability.)

(Less money because you wouldn't be doing the extra shifts, I mean.)

"www.foundationprogramme.nhs.uk/index.asp?page=home/keydocs#fpar

Scroll down to Foundation Programme Annual Report, see Career Destination Report 2015. Relevant page is page 4 Table 4. Only half go on to Specialty Training in the UK. It was over about 70% three years ago, and even higher before that."

I can't promise to support you but I do promise to promise to read it

hundreds of posts in, finding a way to train more doctors remains the solution..

how to make that happen?

The new contract seems unfair to me.

To recap, Jeremy Hunt has proposed a “seven-day NHS” and to pay junior doctors' an increase by 13.5% on average, but with no unsocial hours to be paid on a Saturday and extra premiums for night shifts and Sundays to be be lower than what is currently paid.

So if that's the case I hope the doctors' will stick to their guns and won't be pushed around by Mr Hunt.

I fully support the JD, always have, always will.

Wish the nurses would come out as well.

Sally, what you are describing would be true if there weren't safeguards against forcing JD from working all these extra hours. Yes in exceptional circumstances but not as routine and as we know doctors are quite able to speak up if this is abused.

I have never seen any coverage in the media putting doctors down in the way you describe. In fact quite the opposite, I would say the coverage has been very bias in the doctors favour.

Has anyone mentioned how much money the NHS wastes on health tourism that it is never able to recoup. Would doctors support proof of nationality or insurance before treatment, I seem to remember they were against it? What about charging people for missed appointments? Again I remember a lot of people against it. The NHS needs more money, maybe it should allow consideration of options to raise more.

Pausing - yes, if we worked fewer hours and those hours we worked were predictable, of course we would be happy to be paid less - in fact some of us do - as a very junior doctor I did 4 months general practice, I could only work when there were enough people to supervise me so I worked 9-5ish with no on calls. For that 4 months I was on basic pay.

When I worked in anaesthetics, 2 of my colleagues had chosen to come out of training - they worked 8-5, they did predictable lists, they didn't do on calls, they got basic pay. It suited them, they preferred the lifestyle, and it suited the trust, in that job there were already enough people to do all the emergency stuff, these doctors doing the shifts they did meant the trust could offer more elective procedures.

However, the job I do now (intensive care transport) is entirely emergency work. I work loads of nights and weekends. I'm often busy all night. I often finish late. I may not get a break at all. Sometimes if we have a gap in the rota, one of us has to work extra to fill that gap and get paid extra for it or have time off in lieu when there are more people around. I'd love it if there were no gaps in the rota, I'd rather work my allocated hours and then have my allocated days off than work my allocated days and a bit more and get a bit more money.

I wouldn't be happy to be paid considerably less for my normal working hours though, as I think that what I'm paid reflects the intensity of my shifts - my workload at night and on weekends is greater than some other specialities and, as we have the same number of doctors regardless of the time of day or day of the week, I do proportionally more out of hours work than some other specialities.

Urbanfox - those safeguards exist now, but that's one of the main things that's wrong with the new contract, it takes those safeguards away.

And as for the media stuff - an example for you...

www.thesun.co.uk/sol/homepage/news/6850988/Luxury-lifestyles-of-junior-doctor-strike-leaders.html

www.dailymail.co.uk/news/article-3392513/Facebook-photos-junior-doctors-leaders-enjoying-jet-set-lives-lavish-parties-despite-complaining-new-contracts-NHS-strike-row.html

The lad posing by a helicopter - that picture was taken whilst he was a student doing some work experience abroad - he was staying with one of the doctors he was doing the work experience with, he'd done lots of free babysitting for the family and the helicopter trip was a thank you gift

The girl with the elephant - that picture was taken whilst she was a student doing some self-funded voluntary work.

Jet-set lives...

those safeguards exist now, but that's one of the main things that's wrong with the new contract, it takes those safeguards away.

Just picking that out, as it's now a long thread and newcomers may be skimming.

Has anyone mentioned how much money the NHS wastes on health tourism that it is never able to recoup.

The sums are relatively small, and it would require a move to a social insurance type system, with a larger bureaucracy dedicated to chasing payments, in order to recoup them. Employing accounts clerks costs money.

Would doctors support proof of nationality or insurance before treatment, I seem to remember they were against it?

The doctors were against being expected to police it. Why would you expect a profession that is already in short supply to spend time that could be spent treating patients instead checking paperwork? It's perfectly possible to check entitlement but it requires administrators - try booking into a French hospital one day; you will need to pass through an office where ranks of admin clerks are employed solely to check people's insurance documents and issue stickers that are used to trace payments through the system.

The NHS needs more money, maybe it should allow consideration of options to raise more.

The option used in most developed countries is taxation. The NHS is underfunded by somewhere between 15 and 25% compared with other European healthcare systems.

Thanks for answering my question about being willing to accept less pay for fewer, more predictable hours.

And also the one about roles like those anaesthetists who are no longer looking to climb, but to continue to doing the same job - that needs to be done - predictably and for basic pay.