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?

GraysAnalogy Sat 30-Apr-16 14:35:39
"No one is asking for more money, but they'd quite like to retain what they currently get. "

No doubt 'they' would !!!!!!

'They' probably think If it ain't broke - don't fix it

'They' probably think what the NHS needs is more of the same

In the sense that the Medics should get MORE and the patients might get the 'same' (although in reality probably even that is optimistic from the patients' point of view).

The BMA (....Opposing voices are dropping away ... reception ......poor ...)
should peer out of their bubble before it is too late - and make sure that they start noticing that they are approaching a world view event horizon which could
mean that the NHS in its current form may soon be unworkable.

Yes Jeremy, just as planned, an unworkable NHS. Well destroyed .

lanchester are you a manager? You speak such bollocky sentences that I really can't work out if you're trying to get a message across or just trying to use new wanky words that you learnt from a grown up.

Try not to get too excited about it. It's not like your tax will go down when the NHS is privatised.

A lot of Tory right wing tripe on here.

Shame the main MN thread on this topic is full of such utter rubbish and snidey comments from people with political or personal axes to grind.

Yes Himalaya and they'll be the first to complain when the whole caboodle goes tits up

Perhaps someone can better explain something that I am trying to put into words. A new contract won't increase the number of patients to the NHS/hospitals, so doctors workload isn't increased. The new contract will make it easier for hospitals to be able to afford to schedule doctors at the weekend. Hospitals aren't going to ask doctors to come in when they are not needed. Therefore its easier for a hospital to timetable doctors to work when they are needed. Surely this will mean patients will get treated best at the time when they need it and therefore will be less of a strain on the NHS and less work for doctors. Yes it means an adjustment for doctors but as we have no spare money isn't it a fair adjustment to ask doctors to make.

The argument I hear today is that its discrimination to ask women doctors to work at the weekend (without giving them shed loads of money). Huh? Don't they already work weekends in every other profession? Imagine a female soilder or police woman saying " sorry its discrimination to protect the public at the weekend, where's the money?". When women have to take time off work to go into hospital isn't that discrimination, because the appointment isn't when on the days they aren't working? Isn't it discrimination when mothers are considered parents but men are just baby sitters? Isn't it discrimination when mothers can't work at the weekend but fathers can?

Why is it ok for women doctors to work at weekends when money is thrown at them but discrimination when they are asked to do it in the same way as every other profession?

I'm really sorry, but multiple times it has been explained that juniors already work at weekends. It has also been pointed out, that without an increase in doctors numbers, you cannot have the same number of doctors on at all times without increasing hours, or decreasing their presence during the week. The busiest times of the week are Monday to Friday. The highest day for deaths is Wednesday. The changes required to make improved emergency and urgent care have to do with consultant cover, allied health professionals and social services to allow discharges. You are less likely to die on a Saturday or Sunday than any other day of the week. As explained in multiple posts on this thread junior doctors with weekends, nights, evenings etc. It is a government drive that hasn't been thought through or costed. In fact, in front of the public accounts committee it was made clear that the doh has no idea how many doctors are working out of hours, what it will cost for a seven day NHS, that they have not costed for this. Nor is the new money going to cover this, as the efficiency savings will rub this out. Plus, this is cost neutral. So staying on the current contract won't cost anymore (and would save money as the extra costs of implementation are currently being seen as massive by trusts, who don't have enough doctors to staff the rotas they have at the moment, let alone the new shift patterns that will see less in hours working -so less training time - and more out of hours than is necessary with no likely improvement as there is no evidence that junior doctor presence is the difference that needs to be made). plesse read the Cass report as it explains a lot of the problems with the proposed ways of working.

Shezadoc Sat 30-Apr-16 22:31:11

You usually make (wrong) but better argued points than that - it was full of contradictions.

For instance you are saying that no one has costed the new contract properly... then you say that the old contract will be cheaper.
How have you compared the new and old contract costings? A moist middle finger in the air perhaps - waved in the general direction of the patients?

Also, you have not even mentioned the oportunity cost of NOT having a full NHS Service.

Also, you have not mentioned the fact that at present there are gross inefficiencies in the NHS at present - e.g. underutilisation of fixed assets from friday afternoon until Monday morning EVERY WEEK OF EVERY MONTH OF EVERY YEAR .

typo correction:

Also, you have not even mentioned the opportunity cost of NOT having a full NHS Service seven days per week.

Female and male JDs currently work round the clock on weekdays and weekends.

There is mon to fri 9 to 5 basic hrs or in- hrs, on top of which is rota- ed in the on call or out of hrs rota so for example you could be on call this week on a Tuesday 9 am to 9.30 pm and the weekend Fri 9 am to 9.30 pm, sat 9 am to 9 30 pm , sun 9 am to 9.30 pm on top of your basic hrs 9 to 5 each day. The weekend and on call shifts days are emergency care and are full on exhausting days. There is a baton bleep for emergency shift work within each specialty on call which the doctors pass to each other at 9 am and 9 pm to ensure round the clock safe cover.
Routine care mon to fri is generally covered by a team and is less fast paced covering one ward area and clinics etc. whereas weekend care covers all ward areas and the AE admissions for that specialty and all incoming patients.
It's like two separate working patterns which we split between.
jeremy wants to make the on call shift on a sat,( one of the busiest shifts) , the same pay and rota as a routine day. No doubt at a later point, all days and nights will lose their extra pay and this is the reason why it is so important and the BMA are fighting this for us... We would not be able to cope with too many more weekend and on call shifts because of the different work pattern, and this on call shift pattern is currently regulated..but we fear this regulation is going to be lost. Because of recruitment issues, we are constantly under pressure to work extra twelve HR shifts on top of both our basic hrs and our on call shifts.
Jeremy wants ' all days to be the same' and actually we don't think he understands anything about hospital work and he hasn't even said which seven day services he wants to introduce..because we already have the emergency work covered.
It is also insulting for such an ignorant and arrogant person to change our work patterns and pay without understanding anything about what the work is like. We can get through a twelve hr intense shift without food and drink, because it doesn't go on forever ... But we are strained by these demands and there is not much slack so if our shifts are messed about with, it can tip us over the edge into exhaustion and fatigue and longer term burnout.

Actually thought I made it clear that the department of health has not thought through the costs of implementing the contract. Trusts are having to, however, and the health services journal has been reporting their disquiet at the cost involved in changing rotas, monitoring, having different staff on the same rota on different contracts, the cost of the guardian role etc.
As far as opportunity costs go, we have again covered this before. Equipment and space are it independent of people, and availability of people to run lists, run machines etc is important. Plus, even on current contract rules many hospitals manage to have Saturday elective work. The bed availability restricts in patient work, and this is a major problem on a daily basis in the NHS with operations being cancelled every day. We cannot operate on patients if we have nowhere to put them afterwards.
As for savings in the NHS, I see you don't mention the massive cost of the private finance initiative, the recent reorganisation of the NHS (which involved firing and the-hiring staff once they had their redundancy packages - not clinical staff), or the massive failings of the IT project.
I appreciate you feel my arguments are wrong, just as I cannot work out why you cannot ever acknowledge even some of the points put to you - and cherry pick items to respond to. I don't really understand your motivation, apart from just really disliking th NHS in general. It's sad you can't see that, whilst mistakes are made, (as they are in any system), in general the NHS works well for those who use it. And I have used it, requiring treatment that I would not have been insured for by any policy.
A fully staffed NHS seven days a week requires no ecpeople than we have and quite frankly we don't have enough now. These dont grow on trees, nor are they easily importable (despite other opinions, if they were we wouldn't have the rota gaps we currently have).

Typo, equipment and space are not independent of

A fully staffed NHS requires more people

You have both made things very clear and thank you for doing so. I hope the NHS will continue but J*unt is hell bent on destroying it so the future is looking grim to me

Thankyou

Nobody has explained yet where the extra beds, porters, cleaners, kitchen staff, phlebotomists, theatres teams and so on are going to come from.

It's so narrow minded to think that all we need is a few extra doctors on duty each day. If they concentrated on the real issues then the NHS would be a lot better off.

For instance, if a patient becomes fit for a ward and is on ICU, we have to wait for a bed to become available. But once a patient is ward-fit, if they are nursed near to patients of the opposite sex, we get fined because the government decided patients shouldn't have to be near patients of the opposite sex. Except that we have no choice because there is nowhere to move the patient to. We still get fined even though we have declared the patient fit to leave our unit.

Jeremy Hunt hasn't thought through the practicalities of any of this. The trouble is is gone too far now and it's too high profile for him to back down.

Currently there are not enough phlebotomist so on sat and sun.. A lot of JDs time is wasted taking these bloods when they should be doing other things. If current provision isn't enough, how will it magically change?
Listening, and negotiating should have been done properly from the start from people who know how hospitals work.
One reason for the strike is that if the smith it's the fan and services deteriorate from this contract imposition and Drs are even more stretched per on call emergency care shift than now, and even more tired, and human error occurs in worst case scenario someone died.....will we be able to incriminate JH or DC ??
No, the Drs themselves will be blamed , and under new law possibly prosecuted and imprisoned.

Now do you start to see? This is life and death for patients, and of crucial importance for Drs. Why should we put patients at risk? Why should we put ourselves at risk? This is why Drs will leave a career they love.

Shit hits the fan, not the smith ( who is he anyway?)

Himalayanrock Sun 01-May-16 09:09:51
Jeremy Hunt has to start somewhere with efficiency reform as indeed the financial shi* has now hit the fan.

It's not really that the taxpayer will not fund the NHS more -
If the tyaxpayer / government can be assured that HCP's are willing to reform working practices and attitudes, then the tax payer will provide funding as necessary - perhaps from direct taxation transfers - or perhaps through an insurance based NHS.
Rather, the problem now is that the taxpayers are very unhappy about the amount of money that has been already been swilled into the NHS over the past 15 years, which instead of bringing Patient Outcomes up to Western European norms, has been diverted into (particularly doctors - e.g. GPs) OVERALL payments from the NHS (including benefits that have already been discussed on this thread Defined Benefit Pensions - allowed to go part time - then fleece the NHS for locum cover payments - retire early on generous pensions - good sickness / maternity / training etc)
Now do you start to see? This is life and death for patients, and of crucial importance for patients. Why should we put patients at risk? Why should we put ourselves at risk? This is why Drs should leave a career they love if they love money more
Those ex- doctors can probably genuinely then say to the people who trained them '"I'm sorry ... it's not you - it's me !"

Good riddance to those doctors if they are holding back an efficient NHS, perhaps they can repay their squandered training costs to the public by becoming "world class" civil engineers or marine engineers (about a decade training in each case though probably - and this time the taxpayer will not fund that training.)

Some other poster on here:
thought she would have no problem doing a science PhD if she had good enough 'A' levels to do a Medical training.

But I would say that There's not much difficult to understand in medical books, but there's not much that isn't difficult to understand in for example Bsc / Msc/ PhD Chemistry literature.
Hopefully the Medics transferring careers will be able to cope with their new jobs.
Their annual appraisals will need to be good to get to the top quickly - or they may feel that work is a drudgery for them again.

Bullshit

lougle Sun 01-May-16 02:53:35

Nobody has explained yet where the extra beds, porters, cleaners, kitchen staff, phlebotomists, theatres teams and so on are going to come from.

Lougle - more money will be spent by the population on health care - IF and WHEN - they feel that they are getting a fair value service.
Private health care in the UK at the moment is sometimes a creaming off 'cherry picking' process and can sometimes be parasitic upon the NHS -
However, sometimes it has been integrated effectively with the NHS - giving patients more choice and quicker treatment.

So Public / Private what does it actually matter so long as patients get efficient and effective healthcare provision?

We cannot all sit back and do nothing to reform the healthcare system in the UK
The NHS Staff seem to say well we need more money.
but that prescribed treatment plan of more of the same hasn't worked, and it will not work.
Jeremy Hunt is starting to challenge the working practices and expectations of entitlement within the NHS.
Ironically perhaps he is the one who will actually be able to rescue the NHS from its current 'too often not fit for purpose' status.

PortiaCastis Sun 01-May-16 11:24:16

"Bullshit"

PC - That comment seems a bit complacent !

Anyone else find they are just scrolling past lanchester's posts now? Gotta love the settings which allow you to spot them quickly. Thank you to all the medics and allied HCPs who have patiently explained how the current NHS set up works in practice & the risks from Hunt's proposals. The links have also been highlighting too - I was quite surprised at the basic JD salary scales, especially Registrars etc. I had always assumed they were higher.

You talk blithely about taxpayers and what we would like etc. Can't you just say it's what you want. I'm a taxpayer, and I don't agree with you, you aren't speaking for me, and you aren't speaking for a lot of other taxpayers as evidenced by this thread.

hi Schezadoc, thanks for your reply below to an early post of mine explaining the short term nature of women's careers in the profession which advocates claim drs will do instead:

"I think it is really sad that the partner in you law firm thinks this way. I am fully appreciative of the changes the NHS has made to allow for women to continue with their careers. It's not just women"

I agree with you entirely. the only reason I raise the point is that I think that to build trust and support, Drs need to force the BMA to stop Ill- informed comparisons with these other professions. There is as much need for drs to understand how it is for the rest of us as there is for us to learn from them. Otherwise you may get polite lip service support but the general election result will tell the true story.

To try to give a positive example, I had absolutely no idea how little control drs have over the structure of their working week until I thought carefully about posters' testimony on this site.

I suppose the problem is this. It is easy for the public to spot the fallacies in the BMA's argument when it either lies or makes silly comparisons. This can effect our trust in other things it says about stuff which it really does understand.

PS Glad to hear there was no disruption in hospitals and afterwards