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?

Midwives went on strike for the first time I think ever not that long ago. If Hunt tries to change pay and conditions for nurses/midwives I can see them striking.

For those asking about the safety aspect of today's strike:

I can't talk for all hospitals but I know that before I went on strike I met with the medical director, the clinical lead and my ward consultant team to find out what the plans for cover were.

The hospital started from a position of "let's cancel everything that's not an emergency" and then went on to put consultants to cover all the roles that were felt needed filled.

For my department that meant covering the medical on call and admission team, the arrest team, the medical wards and providing extra support to A&E. They also had a look at what the other departments would need so for example consultant anaesthetists were deployed to surgical wards to assist with sick patients.

For some of the consultants they're less commonly involved with procedures now than they used to be so they have put an anaesthetist on call for difficult venous access and lumbar punctures etc.

There are general surgeons, cardiologists and acute physicians seeing people directly in A&E in addition to the ED consultants. There are orthopaedic and plastic surgeons running the injury and trauma side of things.

Once these were filled they went on to see "what can we safely re-introduce?" Obviously we wanted to keep some cancer operations and 2 week wait clinics running and that's what was looked to next.

Every August when junior doctors move jobs the consultants and staff grade doctors do this whilst junior doctors are in induction, getting new ID badges etc.

There were significantly more staff and more highly qualified people today running our acute service today than there was on Christmas Day (when I was at work) or a standard weekend.

I am truly sorry for everyone who has had a clinic, an operation or procedure cancelled. I know that this is a horrible and scary time. I really never thought I would strike.

People have asked me what if someone dies? Obviously anyone dying is sad. Given the cover today I really don't think anyone would have died because of the strike but more because they were sick. I really do think the hospital is safe today and if you are sick please seek medical attention.

If things are so good today why do we need junior doctors? Well... Partly because whilst the consultants are doing all of the above they can't do anything else. Clinics, elective operations, paperwork and training all have to happen. Also the consultants will not go on forever and the supply needs to be replenished.

Once again, I am truly sorry for the disruption. I genuinely do think the contract poses a bigger risk than today's strike, which incidentally is 8-5 on both days, not 48h, junior doctors have been in from 5pm and all through the night yesterday and will do so again tonight.

RCN have no backbone at all hence why I left them 2 years ago. Every other union called for a strike over pensions, even as someone up thread said the midwives for the first time ever but RCN just lie down and take it.

I support the Junior Doctors for many reasons that have already been outlined but think in the end this government will crush them in the short term.

The fact that the Government cannot negotiate without having a threat of imposing a contract is appalling employee relations. It could also be seen as poor governance but not when it is fuelled by an agenda and philosophical standpoint to dismantle the NHS.

A decent employer considers the impact of any changes on working on it's staff - however there are many employers that aren't decent and they need to be taken to task by the legal framework if that is working. The contract has already been found to be unfair to female employees - I think it will also be found to be unfair in terms of Health and Safety legislation as well as a breach of contract. The request of Mark Porter to the government to return to the table without having a threat of imposing the contract would be seen as reasonable by any industrial relations professional.

So my prediction is that the contract will be imposed but will at some time in the future be successfully legally challenged. However the shabby way Junior Doctors are currently being treated by their employer will live long in their memory. We the public will be left with Doctors less motivated and engaged as they toil in an organisation that does not care for their well being - and guess what that will impact on the service the public receive.

The only solution to bring back any credibility for the government now is to quickly remove Jeremy Hunt from post and get back to the negotiating table with no threat of imposition of contract to ensure that genuine negotiating can take place.

Additional to all of this, which hasn't got any coverage, is the term being introduced to force JDs to offer their services to their employer if they want to do overtime:

"The 2016 contract sets a clear limit on weekly average hours of work in any setting at 56 hours (where a doctor has opted out of the Working Time Regulations). Doctors have a responsibility to ensure that when working any additional hours outside their work schedule those hours are safe and in line with the contractual limits that are binding on both the employer and the doctor.

Before undertaking additional locum work, doctors will need to offer their employer first refusal on any such locum work, and any such work will be paid in line with NHS terms and conditions. The employer must act reasonably, in accordance with guidance and respond to requests within rapid, defined timescales. Where employers do not wish to take up the offer of additional locum hours, they will still need to be informed of any additional work that doctors are doing to ensure that they are working safely. Employers can withhold permission if that is not the case."

So the Govt. will basically stop doctors doing locum work for agency rates, just as they've caped agency rates for nurses. Given that the Conservative Government runs on the principle of free market, it's convenient that they can bring in rules that stop public sector workers using their skills to gain money!

Dianablythe, as a consultant (currently on mat leave) I fully support the strike. My department is able to offer some elective work as well as fully cover emergencies with the juniors out, but this would be unsustainable in the long term for exactly the reasons you state.
There is minimal private practice in my area, and I don't do any. My husband doesn't earn much, so I am the breadwinner. I will be going back full time.
I have read through the whole thread, and think my head is starting to explode. I can understand the confusion of some as numbers and quotes are thrown around ( I find the training costs interesting as these presumably include salary, for which doctors work... And doctors train other doctors with a small amount in their salaries to recognise this, as do some nurses, midwives and allied health professionals).

As a junior I worked the old and current rotas. There were times I could barely put one foot in front of the other, relying on adrenaline to get me through. Having to cycle through different shifts (day, twilight, long day, night) to get around the rules on shifts would have been impossible for my mental and physical health. I would not wish it on anyone.
The guardian role is interesting, but also relies on educational supervisors (of which I am one) having to deal with these exception reports first (to try to resolve the issue first) something that is not educational at all, and will require more time (paid for by whom? Taken away from patient time?) and then go to a guardian who will be paid at minimum one session a week (4 hours) and possibly have to have it as a full time job, whose job is to report to the board who employ them, and fine the trust. I can see this being used as a way to fund medical post grad education and trusts removing that money up front. It's not robust.
The pay issue is interesting, especially if you know who pays what. Trusts don't pay the basic salaries of those on training schemes, that money comes from a different body called health education england, whose budget is being cut (so their only option will be to decrease training numbers). Trusts pay for the hours over the basic pay (ie, basic pay covers 40 hours, juniors are contracted for an average of 48 to 56 per week). The current system of banding recognises not just the number of these hours, but how often these hours are outside of 8am till 7pm. The future system gives a pro rata increase for hours deemed unsociable, which has changed to decrease these hours, and therefore they will receive less pay overall. (Despite basic pay uplift). There is no such thing as overtime in medicine. You work your rota. But if there is work to be done at the end of the shift (ie a sick patient) then you stay. For free. This will need to be pre approved in the new contract, by a line manager. This will remove a lot of the goodwill doctors have, and is likely to increase the reports for staying over their shifts, increasing the work of the guardian.
The indirect discrimination against women is icing on the cake, in an age where this is supposed to be decreasing.
I understand some will still not support juniors, and I respect that. However this contract will not improve seven day services, it won't change the weekend affect (most patients die on a Wednesday) and it will cost a lot of money to implement and monitor (increase in consultant pay, etc). It's not cost neutral (when you consider othe factors, not just junior pay), it doesn't tackle any of the issues the government want to tackle, so why impose it?

That limit is on "average" hours per week?

Averaged over how many weeks?

This sounds very different from a hard limit of 56 hours per week. Does it mean a scheduler can keep adding hours in any given week, and kicking the supposed TOIL further and further down the line?

lougle it's common for both public and private sector employers to include contract terms that restrain employees from moonlighting where that could cause a conflict of interest. On the other hand, you'd expect such terms to be reasonable and for there to be a quid pro quo - if you don't want your employees moonlighting you need to pay them properly in the first place!

(Don't take this to mean that I don't support the JDs - they have my wholehearted support - I just think that it's not appropriate for the NHS to compete with agencies to employ their own staff.)

cant choose please ignore the politically motivate op is that you Jeremy? in reality most people support the JD's I'm behind them 100%.
When it comes down to who do I believe I'd trust a real doctor over a spin doctor any day. I don't trust Jeremy Cunt as far as I can throw him and as for his smug little grin my tv is in danger of having something thrown at it every time he's on.

Jeremy wants to privatise the nhs so he and his Tory cronies can take exceedingly well paid directorships with the private companies who'll be running what's left of the nhs if he gets his way.

MPs work 4.5 days a week, have longer holidays than school kids, massive expense accounts, huge pensions and voted themselves an 11% pay rise with no reduction in weekend pay because they DONT work weekends.

This idea of imposing a contract surely you can't call it a contract if it's imposed as acceptance is one of the four components required for it to be a contract and the JD's are definitely NOT accepting this contract.

I have a chronic health condition that requires hospital treatment fairly often. I've always found the JD's to be conscientious and hard working and will not have taken the decision to strike lightly.

As far as endangering patient safety yesterday and today wait until your doctor has worked seven nights in a row and is turn making life and death decisions.
If Jeremy defeats the JD's it'll be the nurses, consultants, radiographers etc he comes for next.

It's averaged over 16 weeks. So yes, the hard limit is different.

And they can include those on annual leave, study leave etc, so that changes the average too. It's averaged over everyone working that rota for 16 weeks, not individuals.

And they can include those on annual leave, study leave etc, so that changes the average too. It's averaged over everyone working that rota for 16 weeks, not individuals.

Wha...?!

So if I'm a JD and my colleague goes off on honeymoon, that counts as if my work hours are less?

I boggle.

Pausing - and that's the system the JD's want to keep! Imagine how much they fear the new contract if that's what they're willing to fight to keep.

I'm not sue how I feel about the first refusal clause in the new contract. I guess it's not really the big sticking point for me.

On the one hand there are a lot of companies who have one. I don't profess to know much about working in the city but I presume in lawyers can't just do hours for other firms.

I'm not overly inclined to locum anyway, I do enough hours as it is! The only locums I do are internal when I know they're desperate or occasionally for the local hospice when they're short. I do that because it's good for my skills upkeep and nice to keep the contacts and I quite enjoy it. I presume most people are similar, keeping contacts and keeping up skills.

I don't know how far they'd push that though. If there's a vacant F1 job would I have to do that in preference to anything external? What about a surgical job? I did so surgery as an F2 but not since, I suppose I'd be qualified...

No one knows how first refusal would work, or wether it would work. The newest health services journal (the journal for managers) article focuses on trusts saying the contract isn't workable. So if they feel like that we are not alone

I just think it's fundamentally unfair that signing a contract for x hours per week of your time for a corresponding amount of pay restricts your freedom for the other hours of your week.

The line about 'ensuring safety' is complete bull because if you are safe to work an extra 12 hours for your own Trust, you're safe to work it for another Trust.

Most professional people in salaried jobs are restricted from working in similar roles for competing organisations. Whether the NHS could actually function without doctors doing this is another question though. Also, unlike most professionals in the private sector, doctors are significantly underpaid in relation to their skill level and the scarcity of those skills - which makes wanting to moonlight rather more understandable.

Someone(Scouselass?) has already asked this but no-one answered it:
How does paying Saturday overtime at unchanged rates make the contract "SAFE" for patients ?

JDs are being manipulated by SENIOR doctors' interests - who fear their feather bedded conditions and pay will be opened to public scrutiny and reform next.

As someone who has been in hospital a number of times I can point out that it is a big LIE for JDs to say
that there is the same medical doctors activity in hospitals at the weekend as during the week.

The truth is that the weekend wind-down actually has an detrimental effect on patient care from early FRIDAY until Monday morning.

The government HAS to ensure that patients are energetically investigated and treated 7 days per week.

Jeremy Hunt has WIDE SUPPORT in the country for trying to reform the NHS for the benefit of patients.

Yes, you have a point there. It wouldn't look good for a well known solicitor from firm A to take cases for firm B.

Back to the strike: I do think it's a shame that the public are being told doctors are greedy. The doctors I work with are stretched to breaking point as it is. I worked a night shift last week and a new doctor to our area said 'Is it always this busy?' He then listed 6 patients with critical situations on our clinical area, he had 2 patients to see in A&E resuscitation, and was also needed elsewhere. He didn't know where to start and no matter where he started he had to balance the risk elsewhere. That's the reality. One junior doctor taking responsibility for critical care across a whole hospital, with a Consultant the doctor can call for advice.

If doctors are stretched to breaking point then they need to be paid less for working less hours
and the funds released need to be used on employing more doctors.
(and training up even more nurses to take over some functions from JDs - as has been the trend for a while)
Many junior doctors seem pretty ignorant anyway.
When I was in hospital one junior registrar was insisting that "it is not advisable to have MRIs because of the serious ionising radiation risk" (obviously wrong) - The rest of her time she spent telling off a very nice German Junior Registrar who was trying to help - telling her that "these are my patients, not yours".
She also ignored abnormal test results because it would have meant her pointing out an earlier mistake to another doctor.
She was the senior doctor available for a number of hours on that acute ward !
That was in a midlands teaching hospital -
Standards seem very variable amongst junior doctors at present !

Also, unlike most professionals in the private sector, doctors are significantly underpaid in relation to their skill level

This may be true for junior doctors but certainly not for consultants, whether private or NHS alone.

This may be true for junior doctors but certainly not for consultants

Consultants aren't on strike ... But FWIW, if the NHS is losing doctors, and struggling to recruit, then they are paying under the market rate. This is certainly true of GPs and probably also true of consultants in some specialities. Doctors in private practice may earn £££, but the majority of doctors won't work privately, and those on NHS salaries (even at the upper end of the consultants' payscale) are not that highly rewarded in comparison to senior managers in industry or the city.

One junior doctor taking responsibility for critical care across a whole hospital, with a Consultant the doctor can call for advice.

And some people want us to believe that these doctors are overpaid and only in it for the money...

Lougle 11:30

"So the Govt. will basically stop doctors doing locum work for agency rates, just as they've caped agency rates for nurses. Given that the Conservative Government runs on the principle of free market, it's convenient that they can bring in rules that stop public sector workers using their skills to gain money!"

So you are a kind of (caring public sector - natch) " privateer" ?

Saturday pay is what the government is focusing on. The contract disagreement is about much more than that (see above).
Total hours are also not the only thing to consider, it is also when those hours are and the subsequent toll that takes on the ability to function and make key decisions.
I am sorry to anyone who has had bad experiences of doctors within the NHS, all I can say is that, like every other walk of life, the average are good, the exceptional are amazing and those that need improvement are still present. Hopefully the current training system will catch those people and improve it. Carrying out more work out of hours is, however, not going to improve this at as it decreases the amount of direct supervision time.