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?

"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."

Lanchester are you reading what's being written? Paying doctors less for less hours would mean needing more doctors....we don't have more doctors and even if we did what is really needed is more doctors net, as in an increase of staffing. If two doctors were on at night for critical care, nurses on ICU wouldn't be having to make treatment decisions while they wait for the doctor who is stuck with a patient in A&E resus.

The reality is very different from the spin.

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

Nope, NHS worker. But I do think that if people want to do agency work they shouldn't be prevented from doing so. I also think that if a government holds a philosophy about market forces, they shouldn't be able to manipulate those forces with legislation to suit themselves.

I am a junior doctor, and would like to clarify that in the UK training jobs are only available within the NHS. This means that if a newly qualified doctor wishes to pursue a medical career in this country, they are effectively obliged to work for the NHS for at least 5 years (to become a GP), or 9-10 (to become a consultant). In fact part of the despair we are currently feeling comes from the fact that we effectively have a monopoly employer. The fact that we have so few options available to us is why many of my colleagues are seriously considering leaving the profession. If anyone has any genuine questions about the contract and why we are striking I will do my best to answer.

With regard to senior terms and conditions, the new contract will be out soon, I am told. As a consultant I am paid reasonably (£79,000 in year three), and the current maximum (reached after 15 years of being a consultant) is 101,000. Its a good wage, no doubt about it. For this I work four and a half days a week, 8 till 6,(those are my contracted hours, consultants aren't paid for lunchtime, and I will be in earlier if in theatre, and later if clinic is over-running) with a 1:8 rota for 24 hour on calls, and one in four weekends (we split our weekends for safety). I am wholly responsible ultimately for the care of those under my name, regardless of whether I or a member of my team has seen them. I undertake teaching of medical students, doctors in training, risk management (investigation of cases where things have gone wrong, we share this in my department), audit, research and share management responsibilities for the department. I am educational supervisor for at least one trainee. In my specialty we are often in on our on calls, for which I am paid 5% of my salary, because of the intensity and the frequency. I do not do private work (never wanted to, I saw my father do private work and we hardly saw him), in fact outside major urban centres there isn't that much available, and its actually really expensive to set up and get insurance for, quite frankly unless you are in certain areas (london being the main one) its often just not worth it.
The days when consultants in most specialties could just sit at home (or on the golf course) and actually just consult went out with james robertson justice.
Also I don't have any merit awards (awards given to those who have improved services / research / teaching), but those who have them have worked really hard for them. The new proposals are that these will be linked to the achievement of government targets (rather than excellence in and of itself) and will be time limited. They will be taken away from those who have them (they are pensionable, so big deal for those who have them). This is likely to be the biggest sticking point along with flattening of the pay scale to two points for consultants who are within the last few years, who will resign / retire early and take their current pensions, then come back to just work, without the rest of the stuff that makes our lives considerably more complicated.
So, that is what the current and potential future position for consultants is.

oh, and unsocial hours will be re-classified, and all consultants will be expected to work one in four weekends.
the recompense for these was a really complicated matrix, which quite frankly I could make head nor tail of.

"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."

That is not the truth in relation to number of junior doctors available. The report said as much. The report authors said it isn't. The publication it appeared in said it isn't. The only person that says it is is Jeremy Hunt. I therefore fear that you are either a tory staffer or suffering from some form of statistical blindness.

The government does not HATE to ensure patients are energetically investigated and treated 7 days per week (wtf does that even mean). If you have a bunion you don't need that checking at 3am on a Sunday morning. Stop being so stupid.

Jeremy Hunt does not have wide support. Not for this measure. All of the polls disagree with you.

You are, for want of better phrasing, making yourself look a tit.

With regard to ensuring investigations at the weekend, these are allied health professionals, also often in short supply, who provide these. Not doctors. They order the tests. This is something everyone wants. But you can't just expect people to do this extra work without being paid for it. And this will be what is asked of them if the Junior doctor contract goes through. And as it happens, the day most die is on a wednesday. No one is clear as to why more people who are admitted on saturday and sunday die within thirty days, but it may also have to do with the case mix rather than care. Fewer people die on saturday and sunday than any other day of the week. (the paper that jersey hunt keeps misquoting is where these figures are from.) this is highly unlikely to be affected by increasing junior doctor presence at the weekend.

the governments manifesto pledge was to provide a properly funded, properly staffed 7 day NHS, not to spread current resources more thinly to try to achieve this.

*HAVE not HATE - autocorrect

rachelrcrossley Wed 27-Apr-16 15:33:08
"In fact part of the despair we are currently feeling comes from the fact that we effectively have a monopoly employer.
The fact that we have so few options available to us is why many of my colleagues are seriously considering leaving the profession."

So you think that the BMA is not acting as a monopoly / oligopoly supplier?

You sound pretty hypocritical.

The taxpayer has funded the vast majority of the cost of your training.
The taxpayer pays you quite well as a JD compared to other young graduates.
The taxpayer (your fellow citizens - though mainly poorer than you - granted) require YOU to honour your part of the deal by turning up for work reliably -not just when you feel like it.

Despair? the rest of the population won't know whether to laugh at you or despise you for your unearned sense of entitlement.

Lanchester this sounds very personal to you. Have you suffered at the hands of the NHS? I assure you, when we're trying to keep someone alive at 3am nobody has any sense of any entitlement to anything. We are just a team of professionals trying to achieve the best outcome for our patient.

Ok, so the first strike in forty years is hardly showing up to work when you feel like it.
I appreciate that we are not going to change your mind, however for the record, doctors stay until the job is done every day. They are not recompensed for this. They turn up ill, as there is no one else to see their patients. They cover gaps in their rotas on a daily basis. Their professionalism has been pushed to the limits, and therefore they feel they have nothing else they can do to show how desperate they are. Work to rule is not possible if that means leaving a job half done. This strike has been possible as consultants and staff grade doctor are providing emergency care, otherwise it wouldn't happen.
And doctors pay tax and NI too. just for the record. They are also patients of the nhs, as are their families. And as you well know, this isn;t just talking about recent graduates.

But you know all this, and for others I am probably preaching to the converted.

I wish you well.

Shezadoc Wed 27-Apr-16 15:58:45
"With regard to ensuring investigations at the weekend, these are allied health professionals, also often in short supply, who provide these. Not doctors. They order the tests. This is something everyone wants. But you can't just expect people to do this extra work without being paid for it. "

There needs to be a new settlement in the NHS - a new social contract with the rest of society - whereby the population get more work out of the NHS for LESS staff rewards. The whole NHS rewards regime has now got out of kilter with the work rewards vast majority of the population who have to fund the NHS.

(Obviously fat cats / non-doms / user of overseas tax-havens etc etc are a disgrace to this country - and all that needs to be legislated against - but that is a different issue from what is being discussed here).

If NHS Staff want to set up their own health care facilities in competition with the new NHS then that could be allowed under some sort of licencing arrangement.
ALL COSTS would have to be covered by private sources - including staff training etc. Some of the costs of training received from the NHS could be recouped from the deserters.

Lanchester, I too feel that you have had a run in with

• a stupid dr
• or an arrogant dr
• or an entitled dr
• or a patronising dr
• or a dr who has an overwhelmingly naive sense of what life in the private sector is like
• or a dr who mistakes following protocol for being super clever.

But there will always be annoying people in every profession - none of the HCPs on this thread are like that?

I think it is very difficult to communicate well the differences between public sector and private sector problems, but people are making a good faith effort.

Sure, drs seem to have been fed extraordinary rubbish about what the rest of us earn (I'll say it again, lawyers earn between 30 and 40K on average unless they work in the city) but we have to educate them not shout at them.

Similarly, a dr's job seems to have particular stresses. It combines much of the stress of being a factory worker - they have remarkably little autonomy in both their fortnightly working regimes and their career patterns. Maybe for some neurologists some of the time it's a gilded cage - but for lots of them it's just a cage?

"whereby the population get more work out of the NHS for LESS staff rewards. The whole NHS rewards regime has now got out of kilter with the work rewards vast majority of the population who have to fund the NHS."
I'm really sorry, but what exactly do you think the rewards are? These are this years pay rates for those under agenda for change (basically non medical staff, but also doesn't include senior management e.g. CEO's, finance directors etc).

Band 1

Point 2 £15,251
Point 3 £15,516

Possible roles at band 1 - domestic support worker, housekeeping assistant, driver and nursery assistant.

Band 2

Point 2 £15,251
Point 3 £15,516
Point 4 £15,944
Point 5 £16,372
Point 6 £16,800
Point 7 £17,351
Point 8 £17,978

Possible roles at band 2 - domestic team leader, security officer, secretary/typist and healthcare assistant.

Band 3

Point 6 £16,800
Point 7 £17,351
Point 8 £17,978
Point 9 £18,152
Point 10 £18,653
Point 11 £19,217
Point 12 £19,655

Possible roles at band 3- emergency care assistant, clinical coding officer, support, time and recovery worker, estates officer and occupational therapy assistant.

Band 4

Point 11 £19,217
Point 12 £19,655
Point 13 £20,348
Point 14 £21,052
Point 15 £21,692
Point 16 £21,909
Point 17 £22,458

Possible roles at band 4 - assistant practitioner, audio visual technician, pharmacy technician, dental nurse and theatre support worker.

Band 5

Point 16 £21,909
Point 17 £22,458
Point 18 £23,363
Point 19 £24,304
Point 20 £25,298
Point 21 £26,302
Point 22 £27,361
Point 23 £28,462

Possible roles at band 5 (includes newly qualified professionals) - operating department practitioner (ODP), midwife, podiatrist, adult nurse, diagnostic radiographer, practice manager and ICT test analyst)

Band 6

Point 21 £26,302
Point 22 £27,361
Point 23 £28,462
Point 24 £29,333
Point 25 £30,357
Point 26 £31,383
Point 27 £32,407
Point 28 £33,560
Point 29 £35,225

Possible roles at band 6 - school nurse, health visitor, senior paramedic, health records officer, clinical psychology trainee and biomedical scientist.

Band 7

Point 26 £31,383
Point 27 £32,407
Point 28 £33,560
Point 29 £35,225
Point 30 £36,250
Point 31 £37,403
Point 32 £38,683
Point 33 £40,028
Point 34 £41,373

Possible roles at band 7 - communications manager, estates manager, high intensity therapist, advanced speech and language therapist and theatre team leader (ODP).

Band 8a

Point 33 £40,028
Point 34 £41,373
Point 35 £43,038
Point 36 £44,703
Point 37 £46,625
Point 38 £48,034

Possible roles at band 8a - consultant prosthetist/orthotist, dental laboratory manager, project and programme management, modern matron (nursing) and nurse consultant (children's nursing).

Band 8b

Point 37 £46,625
Point 38 £48,034
Point 39 £50,467
Point 40 £53,285
Point 41 £56,104
Point 42 £57,640

Possible roles at band 8b - strategic management, head of education and training, clinical physiology service manager and head orthoptist.

Band 8c

Point 41 £56,104
Point 42 £57,640
Point 43 £59,606
Point 44 £62,397
Point 45 £66,582
Point 46 £68,484

Possible roles at band 8c - head of human resources, consultant clinical scientist (molecular genetics/cytogenetics) and consultant paramedic.

Band 8d

Point 45 £66,582
Point 46 £68,484
Point 47 £71,338
Point 48 £74,825
Point 49 £78,629
Point 50 £82,434

Possible roles at band 8d include estates manager, chief nurse and chief finance manager

Band 9

Point 49 £78,629
Point 50 £82,434
Point 51 £86,390
Point 52 £90,537
Point 53 £94,883
Point 54 £99,437

Possible roles at band 9 include consultant psychologist, consultant podiatric surgeon, chief finance manager and director of estates and facilities

High cost area supplements

Area Level (1 April 2016)
Inner London 20% of basic salary, subject to a minimum payment of £4,158 and a maximum payment of £6,405
Outer London 15% of basic salary, subject to a minimum payment of £3,518 and a maximum payment of £4,483
Fringe
5% of basic salary, subject to a minimum payment of £961 and a maximum payment of £1,665

have been trying to copy and paste current pay scales for doctors, but will have to put in link instead
www.nhsemployers.org/~/media/Employers/Documents/Need%20to%20know/Pay%20Circular%20MD%201%20%202016%20general%20uplift%20finaldoc.pdf

I think Lanchester didn't get into med school.

MissTriggs Wed 27-Apr-16 16:24:35

you are not far wrong - my concerns about the sense of entitlement amongst some NHS staff is indeed based on observation (personal and media) and experience.

I actually support the idea of healthcare free at the point of delivery

BUT there have been too many large scale NHS scandals in the news over recent years,

and also on an everyday level less publicly recognised

• but privately awful - NHS failings in what must be millions of other cases.

It seems that the NHS is in fact too big to manage.

The word 'professional'
has become fairly meaningless in the context of the modern NHS - evidenced for example by the fact that the doctors union the BMA has withdrawn emergency care during the current strike by JDs (according to themselves).

There is a culture of denial and cover-up in the NHS with staff at all levels afraid to speak out e.g. about negligence that has injured patients.

There is a failure to bother about informing patients or obtaining their properly informed consent. This is not rare even though it s probably illegal.
This failing applies even to the extent of not consulting with relatives when some doctor somewhere decides to put a patient on some route to death like the (supposedly now defunct) 'Liverpool pathway'.

Nurses will falsify medical notes if it suits them to avoid a disciplinary matter.

Whitle blowers are persecuted career wise.

Many doctors just feel worn down within a system that they feel powerless to change.

Divide the NHS up into more manageable units.

Reduce staff salaries and benefits to a level where more staff can be employed.

Train more staff asap.

Stop stealing overseas doctors from poor countries.

Lets have personal accountability -

STOP the medical defence union preventing justice for patients.

STOP the practice of asking managers to leave quietly with a good reference even if they have been found to have been stealing large sums of money from the NHS.

And PLEASE .....NHS Staff STOP COMPLAINING about how hard done by you are.

You maybe all deserve a year off unpaid sabbatical to recharge your batteries maybe doing something like working at an actual coal face somewhere (probably would have to be outside the uk - obvs as feew actual coal mines left in the UK)
or if you want to stay in the UK for the whole year...howabout maybe doing something like working in a wet and noisy non-unionised factory on 13 hour nightshifts at +1 degree centigrade ... at national minimum wage
... but don't worry because by 2020 Georgy Porgy 'wer'e all in it together' Osborne
says that will be a 'living wage 'of a whole £10 per hour
(..... please make your own pension arrangements - limited offer - other terms and conditions apply .....)

Don't all rush at once NHS Staff !

That doesn't help Simon, it really doesn't.

WhoTheFuckIsSimon Wed 27-Apr-16 17:10:10

"I think Lanchester didn't get into med school. grin"

You need to think a bit more seriously about what Lanchester has said about the way the NHS is failing patients.

I am not a doctor, but then neither are about 99% of the population.. oh sorry are you saying that only NHS staff are in a position to comment about the NHS?

Idiot !

NHS rewards? What does that even mean?

Do you mean getting paid a wage for doing the job you're trained to do? Or do you mean rewards like perks?

Reduce staff salaries and benefits to a level where more staff can be employed.

How does that work? Incentivise the recruitment of new staff by offering lower wages? And what benefits? My DP pays to park at his place of work and buys the tea and coffee for the meetings he holds.

oh and training expenses - £585 per year from deanery when i was a reg two years ago. Didn't come near to the costs of the courses and exams I needed to take. (might cover one course?)
training on the job is done as part of service so very difficult to pick apart, given by those who are in jobs already (as previously said). We ran some study days for our colleagues, giving our time free, (as did the people who kindly came to talk), and a nominal cost for food and materials was asked for. (about 20 pounds).
Plus money to GMC, indemnity, union (yep paid into the BMA!), royal college fees, fees as diplomate to another college, cost of travel to and from different places of work over the years (I got travel costs for one year out of ten), over which I had no choice. I could go on but actually I'm beginning to sound a wee bit pathetic even to myself.

I love my job and couldn't imagine doing anything else, anywhere else. I paid these at the time (and still do!)as part of the price for doing my job, although a bit more savvy about reclaiming tax these days.

no one has it easy or perfect. I would imagine most of us have very weird ideas about what happens in different professions ( I admit to being pretty clueless about jobs outside the nhs). It is hard to see things from other's points of view, but sometimes it helps to know where others are coming from. It doesn't mean your views are any less valid, but its very hard to not have an emotional reaction when you feel that something you love is being attacked by someone who just doesn't seem to get it. Not everyone can agree though.

Not at all Lanchester. Remember im the poster you wrote a lengthy post about the other day accusing me of being a greedy doctor. You then totally ignored my response pointing out im not a doctor.

I think Lanchester needs to think a bit more seriously about why the nhs is failing patients. Because currently nothing they're saying makes sense and shows a lack of understanding. Cutting wages and pensions even further, worsening working conditions is not going to help the recruitment crisis. And then the nhs falls apart.

Sidge Wed 27-Apr-16 17:26:08
"Reduce staff salaries and benefits to a level where more staff can be employed.
How does that work?"

ok, so if the country wants more / improved NHS care, some of the following might achieve that,
and the greater staff numbers option might also de-stress NHS Staff.

1. increase efficiency of staff work methods - e.g. better protocols
2. get staff to work more quickly
3. make sickness benefits less generous so as to reduce (currently high) sickness levels
4. INCREASE THE NUMBER OF NHS STAFF (already 1.3million though) by
   • reducing staff salaries (or by points 5 through 10 below) so that more staff can be employed at the same overall cost,
   • or by INCREASING TAXATION so that more staff can be employed at the same or raised overall cost,
5. Reduce paid study leave and any unnecessary travel / secondments etc.
6. reduce the generous parental leave to uk industry standards
7. make the NHS pension scheme a defined contribution scheme - (so no more minimum retirement age at 55 for band 8 nurses with pension pots of £1.2 million), and pause pensions if people return to work on 'non nhs contracts' having retired for examople maybe at 55 claiming full pensions.
8. make part time working less readily agreed to and less affordable for staff 9)make early retirement conditions stricter and less affordable for staff
9. stop giving a boost to normal pensions if people retire on health grounds.

Very approximately:
Total Number of NHS Staff affordable = Tax receipts allocated to NHS salaries / Average NHS salary

Part time working / early retirement are both a waste of resources.

Under use of hospital facilities is also an under use of facilities.

7 day working might enable greater use of fewer facilities and other facilities might be ableto be sold off to raise one-off funds for training new staff.