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?

My sibling is also an NHS consultant but I don't want to disclose too much for the sake of their confidentiality but I know a lot of consultants who make an awful lot of money and they are not by any means only exclusively doing private work.

There is nothing to stop people moving once they are a consultant to areas with high pay and more private work surely. I moved from the NE to within the M25 for higher pay, better prospects and work and yes it's very hard being away from all family when you have small children but it a choice and a choice some doctors can make too. My doctor sibling has moved too for work and career within the UK. They have a merit award, silver I think it is or may be gold but I think silver and that is higher NHS pay. In fact they were saying that older doctors are trying to do less and less work as NHS pensions are so very generous that any extra money can mean a huge penalty on a pension because they are up against the upper cap for pensions savings. So I suppose the question is whether doctors in their 30s will ever get the same deals as doctors in their 40s have now. I still think if you hang on a few years and never go part time or end up doing most of the domestic dross at home because you're married to a sexist man etc medicine can be more lucrative than a good few other career paths.

Ooh, and whilst we are clearing the ground, may I ask my lovely fellow posters to avoid the phrase "race to the bottom".

As those of us at that "bottom" don't like to think of ourselves that way.
All good.

The government is trying to do away with merit awards currently. They are not awarding any at present. Silver and gold awards are very rare and are awarded through National Competition so you have to be one of the best in your field to get one. I always thought it was a bit of a racket and supported their being got rid of but it is the only way (pay wise) you can get recognised for being good at your job at the moment. It has started to bother me a teeny tiny bit if I'm honest that I get paid the same as people who put in way less effort and aren't as good. (Then I put that thought firmly out of my mind and remind myself that jealously is unattractive)

The only way to make extra money out of the NHS is to work hard as far as I can see. Drs who get paid very high salaries are doing a lot of out of hours work. I get a 1% supplement for my on call work because it's not very hard whereas my anaesthetist colleague gets paid an extra session so 10% more I guess but I'm largely giving phone advice whilst he is largely on site working.

Moving area will not get you more NHS pay (apart from the London weighting) as its a National Contract. All Drs the same grade and same years of experience (regardless of specialty) get the same pay.
Granted it might get you more private work but not more NHS pay.
The only way to get more NHS pay is to serve a long time, do a lot of hours or possibly win a merit award in competition.

Re the 20% pay cut - DH had pretty much that when he changed jobs because a fixed contract came to an end. Actual salary was a bit less but new company made no pension contributions at all so it was a big drop as he had to make up the shortfall.

The pension scheme is a bit worse now than it used to be too in that it's career average rather than final salary which of course will be lower especially if you've taken mat leave or worked part time.

It's still a good deal but it's another example of how things are not quite so rosy in the medical garden as they used to be. Drs in their 50s and 60s retiring now did have it a bit better than new consultants today.

No, certainly not going avoid using "race to the bottom" where it's appropriate. It's an accurate, succinct description of what can happen when underbidding arises.

What makes you uncomfortable about it?

(And come to that, what makes you say you're "at the bottom"?)

Two wrongs I guess I would say the difference is that there was some clement of choice for your DH.
I'm sure it wasn't an easy choice but possibly there were other companies who would pay more if he was prepared to wait for an opportunity or move or commute. He chose to accept a job with another company with worse T&Cs and I assume it felt he didn't have much choice at the time but he did have some. Presumably the job was also not identical.

Junior Drs are going to get a 20% pay cut for doing the same or a harder job. There is no choice at all apart from to leave medicine or leave the UK. They can't go and get another job as the National Contract will be imposed everywhere. Their only way to protest the change is industrial action.

(Should add for those who haven't come across the phrase, that race to the bottom usually refers to a situation where underbidding is causing cuts in standards and safety. It can occur in any unfettered market, and is why minimum wage, building regs and H&S legislation are so important - they put a floor to how far underbidding can take standards down.)

hi Pausing thanks for asking.

When I starting thinking and posting about this issue (back when I knew a lot less because I hadn't met the lovely Drs on here) I posted about my own working life and conditions and got several replies saying
"Oh, so just because your working life is shit ours should be too"
and
"It's not a race to the bottom you know".

Which I found rather insulting.
Maybe it was just my unfamiliarity with the phrase? or that I was posting in ignorance then so was getting testy responses?
But the posts were about me. I don't have a firm, a profession even to hide behind. This is the life I have carved out for myself. It's flawed (DH has a career average pension) but I have offered a service that combines a price and quality my old firm's clients very rarely got.

As I say, I was innocent of the phrase until I heard it used against me and what I do.

Medicine is no longer a profession and a calling, serving patients’ needs. It is a business where the employees union wants to negotiate pay and conditions like any other job and will withdraw their labor to get it. Fair enough, but that will ultimately lead to the privatisation of the NHS and doctors can fend for themselves as to what salary they command.

The BMA could destroy the NHS, which might very well be their intention. It would do doctors to remember a bit of history. When Nye Bevan was creating the NHS the BMA described him as "a complete and uncontrolled dictator, a medical Führer". Seems similar to how the BMA are treating Hunt today.

Bevan was then forced to ... "I stuffed their mouths with gold." Seems similar to what the BMA want today. Is that what we want to do now?

In 1948 the annual cost of the NHS per head, per lifetime, was £200. Now, that figure has risen by more than 1000 per cent to over £2,000.

My relative who has the silver merit award is pretty good. I was just using that as an example of how some consultants can get higher pay although getting an award like that is a huge problem now because of the pensions cap. Some doctors are having to reduce their hours and income because they will have too much pensionable income and be right up against the upper cap so I suspect the legal changes to pensions to introduce that cap would have meant the career average pension change has not made a difference because final salary if it's a high salary can mean you are up against the cap and have to go into retirement or part time work early. This is not something lawyers like I am have to worry about as we have no pension and will work until we die.

I know my relative has had a lot of different choices - the expert witness work, the commuting at least once a month to London for very long (and I mean very long) days without a break of work outside the NHS and was offered a job in a privae sector company about 10 years ago too at very very high pay but decided to stick with the NHS for early semi retirement, pension and I suppose security. Loads of choices . I am not saying every consultant has the same choices. I live in the SE now so there are loads of private doctors but I am from the NE of England and even there my father did an awful lot of private work. He gave up part of his NHS salary at one stage so he could see private patients from about 1.30 to 9.30pm without a break twice a week at our house, that kind of thing. Very hard work but extra income. He lectured. He went on TV, all sorts.

I certainly agree that anyone faced with a pay cut is not going to be happy and we shall just have to see what happens. What I earn is entirely up int he air year by year, sometimes half of the year before, sometimes up, sometimes right down. It is the risk you take but I don't have the risk of working for the state and we all know as sixth formers choosing between say law and medicine what the pros and cons are.

Hmm. But we have an ageing population with more complex health needs, coupled with very expensive technology and drugs (particularly for cancers and things like MS). It's not all doctor's salaries, Urban.

Oh urban. These are some very tired, hackneyed arguments.

No longer a profession, a calling- being a vocation and caring about patients does not preclude having employment rights. I guess you work for free at whatever you do.

Drs do not want the NHS to be privatised because it would be bad for patients although they would likely be paid more if the NHS were privatised. They certainly get more in the private sector in the UK and in privatised systems elsewhere in the world. How will junior Drs having the same pay and conditions they currently have rather than worse ones force the NHS to be privatised?

I should have thought most things cost quite a lot more now than they did in 1948. It would be patently ridiculous to think they should cost exactly the same. What proportion of that cost is Drs salaries as opposed to all the other people's salaries, buildings, equipment, drugs, lighting, heating, insurance, legal fees etc, etc. Don't you think you get quite a lot more service from the NHS than people did in 1948.

It is also a bit ridiculous to castigate today's Drs for what some other Drs did in 1948. Like blaming today's German government for the holocaust. All Drs I know today are wholeheartedly in support of the NHS and not out of self interest.

They have a little interview section in the BMJ with prominent Drs and one of the Qs is 'who was the best health secretary?' Pretty much 100% of respondents say Bevan to the extent that it is quite boring. I surmise therefore that most Drs today think the NHS is a genius idea

MissTrggs
Podiatry is not a medical specialty but an entirely different degree !!

OOPS!
Thanks!

Orthopedics is maybe what MissTriggs was after?

Me: Order, order
Lanchester: ahem...
Me: oops, sorry - but does anyone NOT agree with anything Mamadoc says below? Being that we are nearly at 1000 posts and all.
I shall put alphabetic letters before each of her points to make myself feel more important.

1
A In my view we do not need a 24-7 elective service ie routine clinics on Saturday nights
B We do need a very good 24-7 emergency service.
C We could improve GP out of hours services which are a joke in many parts of the country especially rural areas.
D We need more access to scans and investigations for inpatients and A&E at weekends but we'd need more staff at all grades not just Drs for that
E We need much, much more social care and hospital at home type services to keep elderly people out of hospital and discharge them safely.
F We need more physics, OTs, geriatricians, dietitians and care staff around the clock in community settings. That is a big culture shift and very expensive. We'd probably need to close wards to afford it and that wouldn't go down well.

G Most people who use the NHS are elderly, frail with multiple conditions not the people posting on this thread. The NHS is for them mostly it's not actually for the convenience of working people who'd appreciate a Saturday appt.

2. does this strike help that? A Sort of a bit B Certainly making junior Drs work longer, more antisocial hours for less money will not improve the NHS and it may well make it worse by having more tired junior Drs and by putting drs off doing A&E"

LOL no I thought the podiatrist was a Dr.

Have we got time for my long story about the turf war between the physio, the podiatrist, the osteo and the specialist GP over my son's wonky lower body?

No... thought not, but now I know the podiatrist is not truly "one of us" that explains a LOT thank you . It's all so interesting.

Miss Triggs I apologise if i used the phrase wrong- I meant in terms of pay and conditions- so when people say that cleaners have tough working conditions the answer should be to improve their working conditions not make everyone else have worse conditions. I didn't mean it to refer to the type of job.

a generation ago - ten years ago - we couldn't have expected to be worrying about applying it to alternative legal practitioners :)

I suppose "two wrongs don't make a right" is better.

Nottsmove, I think you used it fine, and I understood exactly what you meant.

Thanks for explaining, MissTriggs. Yes, I think it's just that you weren't familiar with the phrase. It's certainly not intended to be insulting.

For those saying NHS costs are a lot. I just got a pet insurance quote for a healthy 5y old cocker spaniel. Covers up to £12k vet bills/ year.

But there's a £100 excess, and it's going to be £1000/year. And they can increase this as time goes on.

I think I'm going to have to be my own devils advocate

Why is Jeremy Hunt and the Tory government picking a big fight with the BMA over junior Drs pay?
It will not save him much money certainly in the short term as he's promised pay protection and not in the long term either as junior dr pay is just a tiny bit of the NHS budget

It can't be for the reason he says that it will enable a 24-7 NHS or prevent deaths at weekends as neither of these problems would remotely be solved just by having more junior Drs on at weekends (and less on the rest of the week QED as there are the same number of Drs)

It only makes sense to me if he's started with the easy target and is then going to move on to the consultant contract which is currently under negotiation and to Agenda For Change which is the contract for all other NHS staff. If he imposed Saturday is the new Monday on ALL staff he might save some significant money and get more people working on a Saturday. He would be able to argue that junior Drs are already doing it so it's fair. If he thinks the BMA are a problem he wants to try going up against Unite.

Would it significantly improve the NHS to get more people overall working on Saturdays for less pay? Maybe, maybe if they used some of the money saved on overtime to employ more staff otherwise the current ones will just be stretched thinner.

I still think there are far better things we should be doing that would have a really radical impact on reducing cots and improving the service ie moving from hospital based to community based medicine.

I think the Tory government ultimately does want to privatise the NHS. It costs a huge percentage of the tax take and they are in favour of a small state so it makes sense to them.
Privatising the NHS will not ultimately save money BTW it will cost more money because of private sector profits and loss of collective bargaining power but it will shift the cost from the government to individuals and employers via compulsory insurance. This will increase inequality and that is something I am against.

I am not sure how this dispute relates to the privatisation agenda but maybe someone else can figure that out.