Just5mins, are you sure your not a Tory spin doctor ?
Nurses are much less inclined to do hands on care than their non-degree qualified peers of 20 or 30 years ago.
Utter rubbish. They're far more qualified in many ways than a degree meaning they do far more hands on. They can prescribe, book and read X-rays, treat and discharge, suture as well as perform small procedures.
only themselves to blame.
Problem is there is some truth in this, due to poor lifestyle choices in fags, alcohol and food.
The joke that did the rounds in the NHS section where I worked was that the only reason the 'poor' didn't get scurvy was due to a diet heavy in chips.
[quote=Drac ]Nurses are much less inclined to do hands on care than their non-degree qualified peers of 20 or 30 years ago.
Utter rubbish. They're far more qualified in many ways than a degree meaning they do far more hands on. They can prescribe, book and read X-rays, treat and discharge, suture as well as perform small procedures.
This^
My wife is a "dinosaur" midwife with no degree but she has 20+ years experience. She has been told she will not get any career progression as she has no degree. (good staff motivation)
Yet the young un's coming through have the bit of papper saying they are "better" than my wife. Some of them are getting promoted with their head full of nonsense out of books and lectures with no practical sense of how to actually do things on the ward when it comes to the crunch.
My wife is a "dinosaur" midwife with no degree but she has 20+ years experience. She has been told she will not get any career progression as she has no degree. (good staff motivation)Yet the young un's coming through have the bit of papper saying they are "better" than my wife. Some of them are getting promoted with their head full of nonsense out of books and lectures with no practical sense of how to actually do things on the ward when it comes to the crunch.
bruneep - a very good friend of mine was a nurse for 30 years and learnt very much 'hands on'. She is critical of needing a degree for nursing and would agree with your thoughts.
My biggest gripe about both nurses and doctors is the lack of observational skills - tear your head away from the screen and watch the patient walk through your door, also look at them when they're talking with you.
Seriously? Coming back to this thread is like picking a scab. I know I shouldn't but I do. It just makes me angry.
My wife is an emergency nurse practitioner. She's also dual adult/paediatric qualified. That's extra nice as she now has to pay two sets of registration fees every year just to work. She has spent a lot of her life studying to be as qualified as she is. She has also spent 12 years working her arse off in emergency departments, walk in centres, gp surgeries etc. She is a band 7 at the moment, and earns a respectable amount of money. She bloody well earns it though. She does indeed sit on her arse doing paperwork. At home. After a 12 hour shift often spent doing things other than her actual job because the dept is so short staffed. Comes home exhausted day after day.
I'm a trained nurse and I got out of it a long time ago, there's no way I could put up with what she does.
Maybe that's the problem, I actually know what happens rather than basing my opinion on what the media tells me or what I think I know.
"Normal" hours for those on the Agenda for Change contract (which I believe includes nurses and other allied health professionals) are 6am-8pm on weekdays. Saturdays and evenings/nights attract a 30-50% premium. Sundays and bank holidays attract a 60-100% premium.
Many thanks.
So the 'evening' definition for the Doctors will be the same as Nurses etc, but Doctors wont get extra for Saturdays? (Although I'm sure I heard there was an offer of some kind of premium for Saturdays?)
the dr wanted that premium [ in return for a lower salary so it was cost neutral] but the Govt refused
Yup there was no offer that was part of what the BMA wanted to negotiate, Hunt refused then lied saying 20 Chief Execs agreed he should implement his initial proposal.
My biggest gripe about both nurses and doctors is the lack of observational skills - tear your head away from the screen and watch the patient walk through your door, also look at them when they're talking with you.
Do a volunteer shift in A&E and you'll see how nonsensical that comment is.
The new offer, which Sir David’s letter said would see the majority of junior doctors who work Saturdays getting a premium rate, was sent late on Tuesday.However, the BMA, which was given until 3pm to reply, appeared to reject the deal
Seems to be two different versions.
Ah my mistake. Hmmm! Set a short deadline that old trick.
The lies about the chief executives' supposed support for imposition are just such a perfect symptom... A transparent lie that started to be refuted literally within hours and which he knew would never hold water but he just crashes on anyway.
But you can also see the wider problem here too- the inevitable response is being reported most places as "chiefs withdraw support" rather than "chiefs never supported this in the first place"
[quote=Northwind spake unto the masses, saying]The lies about the supposed support for imposition are just such a perfect symptom... A transparent lie that started to be refuted literally within hours and which he knew would never hold water but he just crashes on anyway.
It only had to last until his Commons announcement, which it did. Liar.
Nurses are much less inclined to do hands on care than their non-degree qualified peers of 20 or 30 years ago.
Utter, utter tosh.
I've just received the letter setting out the terms of the contract and have been doing some number crunching based on my best guess on how the new contract works (it's a lot more complex than my current one!).
I believe that I will personally be losing £1500 PA in the first year after imposition, and losing £4000 PA in the second (after which I hope I will be able to escape!). Interestingly, the old offer made in November was actually better financially for me - I would have lost £1200 in the first year but gained £4000 in the second.
It would seem that those in less than full time jobs (mainly women) will stand to lose a significant amount as they won't go up the pay scales as quickly as before.
Doctors taking time out to do academic degrees will also lose, as they will not go up any pay scales whilst doing research (even though most still work in clinical medicine during their research) and will only gain the bonus for academics once they have actually submitted and passed their degree, rather than when they return to work.
£4k!
Shame on Hunt, how can he keep his job after so many lies?
Shame on Hunt, how can he keep his job after so many lies?
More than likely get promoted; or put more time into his directorship interests as a lot of healthcare companies are going to have a business boom.
Shame on Hunt, how can he keep his job after so many lies?
You think he's employed to tell the truth?
Probably already covered, but I saw something in the press somewhere about Hunt's mother and aunt being board members of a big private healthcare company. I assumed they were getting muddled up with Teresa May and G4S, but it makes you wonder...
He wouldn't be the first politician to make the most of contacts made during his time as health secretary...
[url= http://www.independent.co.uk/news/business/news/former-minister-patricia-hewitt-joins-bupa-board-8656475.html ]Patricia Hewitt joins BUPA board[/url]
[url= http://www.donotlink.com/i9bw ]Andrew Lansley is private advisor for drug firm[/url]
No, I don't doubt it. Didn't they used to at least have the decency (relative to the current lot, not by normal standards) to wait until they'd left politics.
As doctors pretty much sat at the top of everything, they were the targets to knock out as a first pass, and that's been concluded- its really pretty much all over for any other public service now, as these tactics have been so effective.I wonder who'll be next.
Teachers? Possibly. Though it might be that there's not a lot they can sell off and make money from in teaching.
.....Police?
I'm waiting to see the media campaign begin, and soon, to start gently chipping away at whoever is next in their sights.
They have already done the Police with the usual nonsense spin..such as them having outdated pensions not looked at for decades (They were looked at and revised in 2006 moving from a 30yr 'career' to a 35 yr one) The Police Pensions Act was an existing act of parliament that prevented the Police from getting shafted...so they removed it from the statute books.
The Fire Brigade, led by those donkeys at the FBU (remember the last fire strike in 2002 when their leader, Andy Gilcrist went on expensive meals while his members stood on picket lines not getting paid ? http://www.telegraph.co.uk/news/uknews/1424741/It-seems-that-the-FBU-leaders-817-curry-was-just-for-starters.html ) have also failed miserably at battling the Govt (Should have joined forces with the Police Federation and gone on the Public Safety ticket rather than going solo and only talking Fires)
The Armed Forces have also had a good seeing to but that is going somewhat tits up for those idiot at Westminster. They want to cut regular forces and double reservists...problem being that they are failing to get feet in boots for new reservists. http://www.****/news/article-3139817/Army-fails-attract-30-000-reservists-ministers-wanted-boost-military-amid-huge-cuts-number-time-troops.html
I sincerely hope that the NHS will be the straw that breaks the British Publics back and that they will get up off their arses and get more involved. The year 2020 is a long time away
I havent read all the pages so forgive me if my question has been answered elsewhere.
but can anyone explain Labours position on the proposed contract?
I mean if the doctors hope to take on the government to get a better deal, then would Labour be looking to set up a new deal if they get in to power in the next election.
Considering the NHS is a labour favourite, I am surprised I havent heard more from them.
I have been out the country for a bit, so not totally up to date
their position is to sit back and let the tories show their nasty side.
I'm sure they'll come to its rescue next time they're in power 😆
Labour's position- Corbyn's response.
"Jeremy Hunt's decision to impose a contract on junior doctors is provocative and damaging. Rather than helping to resolve this difficult dispute, his action will only inflame it.
The BMA has continued to table proposals to settle the dispute. The fact that the Health Secretary is now simply trying to impose his will rather than negotiate, demonstrates a lack of confidence in his own arguments.
We need to recognise the huge contribution junior doctors make and the years of training they go through to look after us. These are people dedicated to our health and our NHS.
Patients, doctors, the BMA and the public want an agreed settlement. What is now keeping this dispute going are the actions of the Secretary of State himself.
More strikes now look likely. If that happens, it will be clear that the blame lies with the government, not the doctors.
Even at this late stage, I appeal to Jeremy Hunt to go back and negotiate with the BMA.
This government is reckless with our NHS and is now prepared to put patient care at risk in the service of its self-defeating austerity programme."
But he's so crazy he's not even in favour of setting the world on fire, so don't listen to him
I believe that I will personally be losing £1500 PA in the first year after imposition, and losing £4000 PA in the second
It doesn't seem to have even crossed your mind that you're overpaid - entitlement syndrome?
Has it crossed your mind that he earns the money he is paid and doesn't deserve to be forced to do the same job for less?
How happy would you be to have a pay cut in real terms forced upon you whilst everyone was told you were getting a raise? How much would you enjoy that? As much as you did making such an asinine comment?
Arsehole syndrome much?
It doesn't seem to have even crossed your mind that you're overpaid - entitlement syndrome?
Why are they currently overpaid? They could get a job in Wales or Scotland earning more money, and abroad even more.
Are you suggesting they are over paid compared to you ? If you are get your head in a book for the next 15yrs, make bigs sacrifices to your family life, work until your too exhausted to be working, then you too could be an over paid doctor. Get a grip FFS
My wife earns more than x 2 what I earn, and I earn slightly more than the national avg. I am not clever enough to be a doc, and quite frankly I couldn't work the number of hours she works day or night.
Oh and that £4K over payment would just about pay for the exam that Mrs FD has just had to pay for to enable her to continue her training
Lots evidently
Has it crossed your mind that he earns the money he is paid and doesn't deserve to be forced to do the same job for less?
I've been in a job and had a 10% pay cut - didn't like it but it was the circumstances the time.
Arrogant know all syndrome?
Nurses are much less inclined to do hands on care than their non-degree qualified peers of 20 or 30 years ago.
I had to return to this, because it made me so friggin' angry. I've just finished a 12.5 hour shift in an emergency surgical admissions unit, and [b]every[/b] member of the nursing staff - student nurses, health care assistants, diploma-trained nurses, degree-trained nurses, senior staff nurses (several of whom started as ENs) - all worked flat-out in the face of immense pressure, and every one of 'em was "inclined to do hands-on care". Nobody ignored buzzers, nobody acted as if tasks were "beneath them" - the unit would fall apart if that was the case.
How telling that you omit to mention how nurses' clinical responsibilities (and acuity levels on general wards) have vastly increased in recent decades. I've spent the best of twenty years in the NHS, and if there's one thing I know for sure, it's that raw ability & clinical acumen [b]always[/b] shine through, regardless of educational background. There are concerns about the academic content of nursing degree courses (e.g. reflective practice gubbins at the expense of fluid management) and the dubious (i.e. cheaper to employ) overlap with medical roles... but it's utter tripe to suggest that there is a contradiction between academic study and simple (and I use that word in the best possible sense) compassion. What gets described as 'basic care' is not basic at all - it's one of the best opportunities for proper patient assessment... I'd dearly like to see you walk into ITU and complain that the degree-educated nurses therein were "too posh to wash"... and whilst you were there, you could ask about the relationship between patient mortality and nurse:patient ratios. I'm not disputing that neglect happens, and that some people shirk their duty, but FAR more goes wrong because there simply ain't enough boots on the ground... and in the mendacious slimeball Hunt, you have a creature who champions "patient safety" whilst also quashing the NICE work on safe staffing - and now he's pretending that improved weekend services (and, for the record, EVERYBODY would welcome improved weekend cover - but it will be impossible with increased numbers of nursing, OT, PT, clerical & ancillary staff...) can be delivered by stretching existing resources ever more thinly. It's a maths fail - and if you believe him, more fool you.
There are already yawning gaps in acute speciality rotas - an imposed contract will do nothing to fill 'em. Indeed, how ironic that many of the doctors working the "longest hours" (and at weekends) are the ones holding the line in ED, ITU etc. There is a massive disconnect between frontline reality and Hunt's ongoing spin. He is not fit for purpose.
Teef-It's a shame that's happened to you, but why delight in it happening to someone else? I'd have thought it may actually give you a sense of empathy. Wouldn't you have liked to attempt to change that? That's what they are doing. It's a terrible thing to revel in others misfortune because it mirrors your own.
I may be arrogant, in fact my wife would probably agree with you, although I certainly don't claim to know it all. I do get annoyed by people making nasty comments like your last one.
Don't blame teef; the game is divide and conquer.
Good post noteeth.
With one daughter training to be a nurse and another a doctor I listen to them discussing their training, jobs, the NHS and the government. They are far more serious, dedicated, conscientious and motivated than I or any of my peers were at their ages. They are certainly not doing it for the money and aren't afraid of hard work. I despair at some of the comments above. I have lived and worked abroad for years and wouldn't wish for the health care systems of any other country I have experienced. Carp at the care professionals if you want, but then ask yourself if you are really mean it and would wish for them to be badly treated, over worked and demotivated.
Sorry, I thought this was all about doctors being forced to work extended hours that would put their patients in danger?
Strangely all the talk about that seems to have gone quiet, and all that's left appears to be the money...
God no ninfan - it's about the government dismantling the NHS
and all that's left appears to be the money.
Smooth talk from DoH will not paper over the (widening) cracks in cover... personally, medics working weekends in acute care are the [i]last[/i] people I would target for pay-management. Aiming for a cheaper workforce will backfire, IMO.
Thanks gowerboy. One of my younger sisters is a paediatric registrar - and her academic ability and sheer graft far (far) outshines mine. The weasel Hunt, by comparison, makes me want to vomit.
it's about the government dismantling the NHS
Like Scargill and the NCB? 😉
in terms of end result ?Like Scargill and the NCB?
jury's out, and it depends what you think the NHS is for
Be interested to see how this pans out. Wales and Scotland are keeping the contract as per current one, so there will be disparity in pay against England.
There may well be a significant shift in people taking up posts there.
Boom there it is teef's response, mind blown! A typical small minded answer, lets all suffer then at least it's fair, fighting for parity of misery! 😥
No wonder the working classes only get crumbs off the table when the majority fall for shafting each other, generation after generation, enjoy the race to the bottom chaps.
Strangely all the talk about that seems to have gone quiet, and all that's left appears to be the money...
And even if that is the case, so what? Paying the people who are tasked with saving our lives a fair wage for the ridiculous amount of work they have to do only seems fair to me.
there are people who look after THE PEOPLE YOU CARE ABOUT MOST in this world, when they are at their MOST VULNERABLE. they run into burning buildings, make decisions on medicine, scrape you up off the road, stop a drunk **** caving your head in, hold your hand when you're scared-for-your-life, or that of your wife/husband/mother/father/brother/sister/!child! they wipe your ass when you have shit yourself, talk to you when there is no-one else, they look after your nan when she doesn't remember who you are anymore. they wipe your sick off your skin and tell you its ok on a daily basis for christ's sake
......... and we pay them less per hr than a ****ing checkout worker in aldi.
what in god's name has led us to this point?
how can anyone possibly be arguing they are not worth their wages let alone a massive raise?
all of them, not just the doctors but the firemen, nurses, carers, front line police, paramedics all of these front line staff who do so much for less than i pay my bloody labourer!
what is wrong with you people?
Sorry, I thought this was all about doctors being forced to work extended hours that would put their patients in danger?Strangely all the talk about that seems to have gone quiet, and all that's left appears to be the money...
Only by those that think it's fair or don't understand it despite it being explained man? times over.
Been some deleting of teefs posts?
Edit: "...it will impossible [b]without[/b] increased...".
Was typing in anger!
****ing hell. I cannot believe people like teef are looking to put the boot into junior doctors just because they got shafted at their jobs. A race to the bottom benefits noone.
If it's so easy to be a doctor, then why not do it yourself?
All you have to do is:
- Go to university for 5 years, have little to no social life if you want to pass your exams with a decent chance and take on loads of debt.
- Work ridiculous hours for a pittance of an hourly wage.
- Continuously study. Again at the expense of your social life and your family.
- Deal with a fair amount of idiots if you work in A&E, and see things daily that would break your heart. Terminally ill patients, people with no family slowly dying, people losing their dignity, you know, that sort of cheerful thing.
But hey, that doesn't matter. You're being paid £33k a year for doing all this. You should be glad for that and work weekends on top for an even lower hourly rate right.
****. Someone in a very mid level 9-5 IT job could easily be paid that and more. You're begrudging these people who literally save lives daily a fair working contract? The mind ****ing boggles.
Interesting point made above. Are any of the other parties commiting to going back to the previous contracts?
...... and we pay them less per hr than a **** checkout worker in aldi.
what in god's name has led us to this point?
What has lead us to the point where people think working on a checkout is shameful?
People working on checkouts are frequently paying tax/NI which helps to pay for the NHS.
They should be commended.
Any truth in this I wonder?
'Jeremy Hunt - MP for South-West Surrey. Received donations of £32,920 from U.S-based hedge fund CEO Andrew Law. Mr Law is the CEO of Caxton Associates who as of November 2011, owned a market value of $217.659 million in healthcare. He is also funder and board member of Social Finance Ltd, a company which invents new ways to bring finance into public services, and is pioneering the first Social impact Bond for the NHS. Andrew Law has given £1,229,677 to the Conservative party.'
There is nothing wring with working on checkouts but I bet even the most diligent checkout worker would be surprised to learn Hunt thinks his hourly rate and a DR's should be in the same ball park.
There is nothing wring with working on checkouts
I was responding to "**** checkout worker".
Lifted from somewhere else
Not to denigrate those who work in retail obviously but it's a striking comparison. Surely no one can argue that shelf stacking and being a dr are similar jobs in terms of emotional stress and responsibility
[url= http://www.theguardian.com/politics/2014/oct/03/healthcare-companies-links-tories-nhs-contracts ]bit more here[/url]
Are any of the other parties commiting to going back to the previous contracts?
THey are all keeping out the way as the Tories shoot themselves in the foot and show themselves to be the "nasty party" again.
No need to get involved for them as this is not a great scenario for the tories Public sympathy against them and the public doubt they love/respect the NHS. Best thing to do is let them slug it out and take all the hits.
As for the tiries being linked to private healthcare
Its not really surprising. Some of them [ and to be fair some of the labour MP's - would do anything for a little bit more money
Personally I want to and we deserve to have MPs who are free from the external influences of private companies with vested interest.
IMHO the only jobs they should be allowed to take are in the public sector /charity. Its not a badly paid job and if you are in it for the money then you are not fit to serve the public
Surely no one can argue that shelf stacking and being a dr are similar jobs in terms of emotional stress and responsibility
Indeed, same could be said of airline pilots who frequently pay the carrier for their initial first officer job! Seemingly some jobs are so good that people will do them without a large financial incentive.
THey are all keeping out the way as the Tories shoot themselves in the foot and show themselves to be the "nasty party" again.
That's 'none' then.
I explained what they are doing and why you can guess what this means, in relation to their view on the contract, if you like and assume it means they actually agree with the Tories.
Its seems unlikely this is true but hey its your choice 😕
It doesn't mean they agree. It certainly means the change isn't so disastrous that it must be reversed.
What has lead us to the point where people think working on a checkout is shameful?
Only you came up with that, suggesting only you think that.
Can somebody explain why the focus of the Junior Drs debate has become weekend working? Surely the important factor in all of this is that Drs shouldn't be forced into doing dangerous levels of overtime, regardless of the day?
Its not about weekends working per se its about the pay for weekend working
As for dangerous levels of overwork. you can only alter this by having more staff. no organisation can go from 5 day a week to 7 day a week *, with the same staff numbers, and not be making folk more overworked.
Junior Docs have expressed safety concerns over the lack of punishment for ignoring maximum week worked and a number of other safety concerns but it gets little coverage
* I know its 7 days lets just use his BS for this point.
Surely the important factor in all of this is that Drs shouldn't be forced into doing dangerous levels of overtime, regardless of the day?
Which is what they're arguing about but also that when they do work a Saturday Hunt has decided that's no longer unsociable, meaning they work longer and for less. The longer hours is the crux as tiredness can lead to mistakes which effects patients.
Ignore the 7 day bull that Hunt is on about he's no idea.
The Saturday on standard pay is the bit that would stick in my throat. The difference between 7&8 would bother me less.
Junior doctors don't do themselves any favours with those Aldi comparisons. What's the pay progression, career progression, job security and pensions comparison after 5,10,20 years in those jobs? Chalk and cheese.
Just stick to the facts, which unfortunately neither side seem to be willing to do.
Just stick to the facts, which unfortunately neither side seem to be willing to do.
Obese chance....
...meanwhile the patients look on aghast.
Is the strike still on?
What else do they want?
Crikey ... 😯
Hang on, I work weekends and get no extra pay, that's what I knew I was getting into when I chose my career.
I don't think Drs should be paid more for working weekends, they should be paid a fair wage for the job they do, regardless of the day.
They knew what they were getting when they signed up too. That happened to include unsocial hours payments. It's their removal that is one of the issues. It's like you suddenly getting told you'll be paid less for working the same hours. They aren't after more money, just the same money they got when they took the job.
. It's like you suddenly getting told you'll be paid less for working the same hours.
More hours but yes that.
Sorry not sure if this has been posted yet or not ?
Vote of no confidence in Mr Hunt 😆
https://petition.parliament.uk/petitions/121152
227,000 signatures
Signed in a heartbeat; not that it'll make a shred a difference I don't suppose. It's now up to more than 234,000, and growing rapidly. Petition terms of reference not damning enough in my opinion.
Petitions are all very well but there was an election last year - if people didn't want tory policies they should have voted labour. Too late now. There's no cooling off period with these things.
I wanted to reply to some of the more recent comments regarding the impression that this is about pay. What the government are cunningly doing is reducing the amount that out of hours will be paid in a way that will discourage people from entering certain specialties. This is probably not going to make a lot of sense to some people who don't have previous experience of working in hopsital's but I will try to make it as clear as I can.
1) It is possible that for many wages will even actually rise. Yes rise! Yet there is a 98% vote in favour of strikes. How could this be? Surely if many people will gain then there is nothing to complain about?
2) The basic rate of pay is to rise. The government has offered 11%. This sounds fantastic! Most people would be delighted with that sort of rise! And if we all worked 9-5 every day (or 7-10pm as David Cameron would have us work) then we would all indeed be 11% better off under the new pay deal.
3) Currently working Saturday and Sunday and nights are regarded as shifts that count towards a "banding" in a job and for many rotas that work 1:3 or 1:4 weekends this banding is 40-50% on top of the basic salary. One of the key things to remember in this is the rotas for jobs are not negotiable and are worked to the absolute limit of 48 hours averaged over 13 weeks with many working rotas of 11-12 days in a row starting on Mondays and finishing the following Friday. Naturally these 11-12 days are all high stress, emotional and by the end make you want to be anywhere but caring for patient's, although this does not appear to factor into rota planning, probably because it is not done by doctors or even nurses but managers.
So we have a situation currently where doctors will often rotate through long stints followed by weeks with more normal hours although these will often still include the following weekend but you may only say work 40 hours the following week. Again the rota is averaged out to meet the criteria set out in the contracts
4) for overnight registrars, there are 2 types of jobs either 1) basing oneself on site physically or 2) available on the phone at home. Currently there are complicated rules regarding how people are paid for this although currently there is a set amount that is connected to the banding the doctor receives. The government is proposing drastically reducing the amount paid for non-resident on-calls. What's important to know is that often although these doctors are at home they will be phoned often several times a night for advice, sometimes be required to go in to see seriously unwell patients and will get very little sleep. Then they are expected to work the preceeding and following day as normal. This is a bigger problem than it looks from the outset as these types of jobs are often the ones where highly complex decisions must be made. Reducing the incentive to do these types of jobs will mean complex care will suffer as less people will want to do them! Difficult point to explain but for very tired more senior junior doctors, it's important!
5) Currently pay progression is automatic year on year. This is because unlike other jobs, every year of clinical experience gained literally means you become entrusted with more seniority and also more independent decision-making. For example, I am currently in my 3rd post-graduate year. I would still go to another junior doctor who may be in say their 6th or 8th postgraduate year as they are both most definitely my senior and will also likely know the answer to my question. Doctors do not become consultants until they literally can be trusted to know the answer to almost any question posed to them and if they don't will know exactly who to ask to receive a very swift response. So year on year pay progression is particularly important to doctors as it is in line with responsibility and decision-making.increasing. Yet this government wants to remove this. It wants to set specific definitions of what more seniority means and reduce the number of times pay progression occurs. This means in real terms that people will take on greater responsibility, training and all out stress without any real rise in income. What other job does this? Do people stay in these jobs for long?
There are also other interesting aspects including those taking time to do academic training that would lose out in the new contract as this time would now not be considered as part of pay progression despite many working par-time in their old jobs out of necessity plus there research increasing their seniority within a specific specialty. Plus those who take maternity leave in particular are really going to lose out as none of these years will be counted for progression. This has been a matter of hot debate but what's important to realise is that this may in particular disincentivise potential mothers from entering specialties where they currently make up large numbers of the workforce eg. medical specialties or emergency medicine. Needless to say these are the specialties that are in crisis already over recruitment as they tend to offer the worst rotas out of necessity.
Given all the above information I want to now tell you why what the government is wanting to do is being roundly rejected by all doctors. And I also want to tell you why, even if many might gain from the new contracts, junior doctors and also many other more senior doctors ore now up in arms against their supposed "imposition."
The first things the government wants to do is do away with the current banding system. Instead of stating that if a doctor works evenings and weekends they will receive a set banding, the government wants to now start paying based on the actual numbers of hours worked varying on the specific hours they do. Of note is the removal of 7am-7pm on a saturday from this and the offer to pay a 30% supplement for work on a saturday night or sunday. They will pay a 50% supplement for nights. This on the face of it sounds ok. Until you come to the actual rotas. As a junior doctor working in the NHS I have become very accustomed to rotas designed by hospitals that are set to maximise the unsocial hours worked whilst minimising the pay given to juniors. The inevitable outcome of these new rotas will be to get us to be paid less overall. In fact the only reason my current cohort of colleagues will not be paid less is that the government have agreed to give those who would be paid less a promise they will receive whatever the extra would be to make up to their current wages. Naturally some will be paid more. Particularly those who work LESS unsocial hours in their jobs. What a great thing, rewarding those who work ordinary hours whilst reducing the amount paid to those who do more unsocial hours. That will clearly increase the desire to work in jobs that provide out of hours care!
Also, what about those who start working after the new contract is signed? Oh they aren't covered by any pay promise. Under the new system they will simply have a Saturday as a normal day. Plus Sunday is paid at 30% supplement whereas in real terms currently it is more like 50%. And they will be paid the same for nights. This in terms of pay is where the real issue is: for FUTURE generations this is a pay cut. And 6 days in the week are now considered "normal" working hours.
All of a sudden applying to work in a specialty where there are significant amounts of out of hours works becomes even less attractive. Specialties such as say A&E for example. Which already has a recruitment crisis. Do people feel they currently get seen in short enough time already in A&E? Sure if you feel that the time you have spent in a waiting room to see an A&E doctor, anxiously waiting with a loved one or if your child has a severely high temperature and you want them seen immediately, is time you would rather spend there in the waiting room than in the department getting seen quicker. Then sure, go ahead and support these proposals.
Because there will be less doctors there. And also probably less nurses, because we all fear that the government is coming for them next. It turns out many of them have families they like to see too. Particularly at weekends for some reason.
How about becoming a medical registrar? We currently have 4 of 8 medical registrars we are supposed to have. Maybe you didn't know this but the medical registrar at night is the most senior decision-maker actually in the hospital. Some of ours have been graduated from medical school for a mere 3 years. Yet there they are, at night, being the decision-maker for people with strokes, heart attacks, severe hypoglycaemias, you name it, they are it. Yet the new pay deal seems to want to disincentivise people from doing jobs that require out of ours work. Surely the government must see, as we do as doctors, that those who do out of hours work should be valued above all others? As the system in the NHS depends on these people working high stress jobs right through the night, surely we should be increasing these people's wages to compensate them for the incredible work they do. Alas no. Instead those who work 9-5, monday to friday will benefit significanty but those who work out of hours will see real-time decreases in their wages whilst being asked to work more weekend days for less money.
I'm hoping I am starting to make some coherent sense now as to why even on this point alone it is worth not accepting the governments offer. I think I have gone on too long to make too many more points but I want you all to know we are doing this so that when you want 24/7 care from the NHS, there are people capable to manage your illness who feel adequately supported and who feel motivated to be at work at the wrong times of the day. I also want you to know that this makes a mockery of the government's argument that they are doing this to engender more 24/7 cover by doctors. This is the very opposite of what will happen and everyone who cares about the NHS should oppose them too.
This is a letter from the BMA lead Joann Malawala. He states the case from the doctors side of course. Shows some of the political shite being loaded into the debate.
Dear All
This week has been a roller coaster of events and emotions. When I came into this job 5 months ago, I came into it because frankly I was angry at how I felt my friends, my colleagues and I were being treated. I absolutely could not stand the idea of having something being imposed upon us by a government that has no clue what it is we do.
Over the last 5 months I have felt like many of you, needing to moderate my language. I know that my job is not to simply represent my frustrations, but to stand up for all of our collective interests whether junior doctors or the patients we look after. JDC members are often the same, they represent the views of their regions with a passionate resolve to do the best for the doctors they have in their patch. I have seen the same from representatives across the board this year, whether they are college trainee groups or specialty organisations. I have seen junior doctor leaders put aside previous silo competitive traditions and work together in a way that none of us have seen before. One thing I hope beyond everything else is that as a profession this has a longer term effect on our generation of doctors. We will work together in a collaborative way for the good of our profession, patients and the whole NHS, in a way I have not seen previously. Over the last decade I have seen the bastardisation of the concept of clinical leadership by the department of health. Turning it into a method of control where professionals are trained simply to follow instructions and kept in line simply out of fear of a loss of influence or position. This week we have seen the outcome of that agenda, when clinicians stand up for themselves, their patients and what they think is right, the answer is aggression, bullying and being effectively screamed at. The will of a politician or a government will simply be imposed on those that disagree. So much for independent clinical leadership or professionalism.
On Tuesday I met with Sir David Dalton at his request. I have been clear throughout the last few months that last minute offers in general are highly inappropriate as the government has had three years to make fair offers. We have tried to talk, to negotiate in good faith. We have represented our members, but we have also been of a clear view that our members believe in a sustainable NHS. Retention of the doctors in the UK is our number 1 priority as without the talented individuals that deliver the frontline of the NHS, it is our patients that ultimately suffer. I notice in the latest HSJ article, Sir David has misrepresented that meeting and the clear view I expressed that I heard from many doctors throughout the NHS. We are always happy to negotiate, but a negotiation has to involve recognising both sides views and priorities. We had spent a huge amount of time and effort consulting with you, our membership, looking at the stated aims of the government in terms of priorities, but also using our experiences of the frontline to solve the contractual dispute to the satisfaction of all parties. We understood compromise was necessary, however we also assumed that compromise was needed from both parties.
The issue regarding out of hours has been attempted to be boiled down to simply about pay. When we constructed our structure of pay, we also took into account the implications and considerations of the needs of the NHS. If you simply move money into basic salary and undervalue the out of hours components of the salary structure, you create perverse incentives as the relative value of time out of hours diminishes. This has a knock on effect as it creates a driver that devalues specialties that have heavy out of hours commitments relative to others. This could have a further destabilising effect on the delivery of those services as already overstretched services become less popular due to their relative differences. Therefore we wanted to create a system of pay that valued time appropriately especially when we want to retain and recruit staff into those specialties. The issues regarding front loading and flattening of the pay scale were specifically trying to square a circle, a treasury red line of the removal of automatic pay progression from the public sector and our desire to ensure that we did not penalise or perpetuate the gender pay gap. We also wanted a system of pay that ultimately benefited the next generation of doctors. Ensuring that the wage inflation compared the to cost of living inflation benefitted the doctor, starting out on their career, considering the debts students now qualify with. If nothing else, this structure showed our absolute attempts at addressing competing interests that many felt were insurmountable. Our structure of pay involving appropriate rewards for unsocial hours was also staff group specific. With the majority of the staff group being at a stage in life when families and childcare was inevitable, it was important that appropriate account was taken for this to try and retain highly trained staff. It balanced competing interests of family life and professional responsibilities.
On the issues around NROC, we identified early that this was an area that was particularly of concern. We have experience of NROC on our negs team, however the full extent of the varied and diverse working structures meant we were absolutely clear we wanted to consult further on this area. We were also absolutely clear that the government position of continuously comparing the roles of junior doctors with more senior staff where the range and types of responsibilities are different does not make sense. Percentages of values that are so very different also have an impact, where the financial barrier to rostering practices that have the potential to take advantage of junior doctors cannot be sanctioned. Again there was an absolute refusal to understand the concerns we described and the “needs of the service” were always paramount - a concept we can all sign up to if those needs are not so dangerously overstretching staff that doctors and patients are forced into dangerous situations. We suggested a proper consultation and testing of positions, however this has now obviously been rejected.
The experience of all negotiators over the last three years have been of negotiating partners that continuously introduce new objectives very late in the process, - 7 days services (June 2015) First refusal on medical time (January 2016) to name two, and yet cry foul if we attempt to suggest that these involve a requirement for additional resource or that they are undeliverable due to the current overstretched staff. There is also a continuous disingenuity in that compromises made are often rowed back on and so promises can never be trusted. Add to this toxic mix of continuous political interference for objectives that have nothing to do with the service or patient care, but entirely focussed on soundbite politics and a constant need to look like there is a political victory to be had. You see why this whole sorry episode has been a lesson for the NHS and the medical profession in all that is fundamentally wrong with our current system. The department and NHSE in particular, fundamentally entered this whole negotiation with seemingly the attitude they had to teach the medical profession a lesson and put them in their place following previous negotiations.
So the contract that has been described, has several aspects that are fundamentally unfair; the distribution of resource across the whole week; the first refusal on medical time; the nature of NROC; the ultimate safety mechanisms in the contract and the confidence we can have in them, the delivery of many of the mechanisms that are reliant on collaborative working, the ultimate appeals mechanisms for dangerous activity. There have been a hell of a lot of gains as a result of our attempts to outline what junior doctors do from modifying the flawed pay structure, some of the safety limits, making a fundamentally unworkable safety mechanism have some resemblance of what could work if there was any trust left in the system. However there is so much still flawed with this system. If this was about comparing what we currently do, its easy to misrepresent the situation. But its the nature of the services and distribution of staffing projecting forward and overstitching those staff that is so flawed. There is an absolute finite staffing resource. You cannot deliver a 7 day service when the current 5 days is falling apart and is dangerous.
Several times over this process we have tried to suggest that it’s in no ones interest to have this damaging fight, however that is not simply solved by the medical profession being “taught a lesson”. In November despite an incredible mandate, we called on the government to enter Acas to find a solution, in December despite last minute interference again to try and prevent a deal being found, we were able to find the starting point for negotiations and we stood down despite significant mistrust and strength of feeling. In January despite every attempt to find a solution to the problems we all could see, giving Sir David Dalton the space to come in and pulling more industrial action to give us all the space to find solutions, we still faced this intransigence and absolute unwillingness to compromise for political reasons. We had suggested that for the last few weeks that the whole situation has got out of hand and it would be in everyones interest to step back from the abyss and try and solve the issues of morale amongst junior doctors. Build trust back in the system and try and solve some of the educational shortcomings in the current system. Unfortunately once again machismo and political interference took precedence and rather than seeing we had one opportunity to try and stop a damaging course of events, the day after junior doctors across England go out on industrial action and feelings are elevated, the Secretary of State decides now is the appropriate time to show how deeply muscular the government is. Obviously burying bad news about waiting time figures - the first time ever that the target for routine operations has been missed, or that the departments budget has been exceeded due to massive mismanagement and requires a treasury bailout, I am sure had nothing to do with making a political announcement to destroy the last vestiges of morale in the junior doctor workforce in this country.
What next is what every junior doctor and the wider profession is asking? Well the government has published a very short summary of the some aspects of the contract they intend on “imposing”. We need to truly look at this and the implications. We can already see significant shortcomings that mean this proposal is not something junior doctors have stated they would sign up to. But unlike the government, the JDC and the BMA do want to actually listen to our members. Below is a list of open meetings I will be attending:
Monday 15th Norfolk and Norwich Hospital Mess meeting 12.30pm
Monday 15th East of England RJDC, Clinical School, Addenbrookes, 7pm
Tuesday 16th Bristol for joint RJDC/Bristol Divisional meeting 7pm
Wednesday 17th East Midlands RJDC meeting TBC
Thursday 18th South Thames RJDC - BMA House 6.30pm
Friday 19th West Midlands RJDC - Birmingham Chamber of Commerce 75 Harborne Road, Edgbaston Birmingham B15 3DH 7pm
There are also open RJDC meetings:
Monday 15th Northern RJDC Royal station hotel Newcastle 6.30pm
Tuesday 16th Oxford RJDC - John Radcliffe Lecture theatre 2, 6.30pm
We will look much more into the detail of the proposals should we get detail and look at where these will need to be challenged. We will seriously now have to consider every option available to JDC and consider what is in the best interests of our generation and the next of doctors, our wider profession, the NHS and our patients. Ultimately we cannot sit by and watch the government alienate a generation of doctors and thereby destroy the NHS we work so hard every day to make better and protect. The governments aim maybe to teach the medical profession a lesson, but in doing so they have shown their willingness and almost eagerness to destroy our NHS. The government often whispers about this as their miners moment. What happened with the mining industry? Is that what this government envisages for the NHS?
It is time for us all the take stock. The staff of the NHS never asked for unfair payrises, we never destroyed the financial system, we didn’t abuse our positions for personal gain. All we want is to be treated fairly and to not have the organisation we love and dedicate our lives to be destroyed by a government that puts their personal gain above the people they are supposed to represent.
I will say one last thing, its very easy to make this about Jeremy Hunt. But fundamentally, deep down, I think we need to squarely lay the blame at David Cameron. He has stood by and ensured that ultimately the NHS he claimed to want to protect has been systematically destroyed since being elected by attacking the very staff that sweat blood and tears trying to protect it, work for it and love it.
Best wishes
Johann
ps you will hear from me in due course….
will say one last thing, its very easy to make this about Jeremy Hunt. But fundamentally, deep down, I think we need to squarely lay the blame at David Cameron. He has stood by and ensured that ultimately the NHS he claimed to want to protect has been systematically destroyed since being elected by attacking the very staff that sweat blood and tears trying to protect it, work for it and love it.
Oh yes. There is a lot of hate on social media for Jeremy Hunt, as if he is the sole architect of this nonsense. I see him more as an expendable asset to the bigger process. As soon as his reputation becomes too toxic he will be replaced just as Lansley was before him. Or Gove for that matter. In terms of putting someone in post to brazenly spin, lie and obfuscate through the drama, (which was always going to be a drama whoever was the secretary of state for health, lets not think that any of this would be all that different under any conservative minister) then in crude and cynical political terms, (rather than the interests of the taxpayers or patients I mean) Hunt is doing his job just fine.
Politically it is just great for the conservatives to be able to blame this shitstorm on Hunt rather than on the party and their financial backers as a whole.
It is lovely to blame Hunt if only for the constant gift of his name but he is just the sacrificial lighting conductor this is a Tory plan conceived in cabinet and owned by Cameron who has deliberately hidden from debate on the subject to avoid getting the blood on his hands and the stain on his reputation.
At least ninfan's its all about money point has been dealt with in the posts above.
Unfortunately ninfan and the other right-wingers will always unquestionably believe and stand up for tory values. Even if it means consistently misrepresenting the truth. Bit like Hameron and *unt really.
In 1946 the BMA mounted a highly personalised attack on the then Secretary of State for Health Aneurin Bevan.
In exactly the same way they've acted with every single health secretary since the BMA basically bullied a government minister and mounted a sustained personalised attack to stop him establishing the NHS. At the time Bevan described the BMA as follows:
[i]"a small body of politically poisoned people" who had decided "to fight the Health Act itself and to stir up as much emotion as they can in the profession."[/i] (source - wikipedia).
It'a a matter of record that at least 2 of the BMA's current lead negotiators stated their intent 18 months ago to use the renegotiations as a proxy for a left wing attack on the government -Yannis Gourtsoyannis went as far as to say " a victory for the junior doctors would signify the first real crack in the entire edifice of austerity in the UK”.
The reason the negotiations have taken 4 years is very little to do with the current Secretary of State - he has personally had very little to do with the negotiations as those have been handled by NHS Employers, comprising NHS Chief Execs and clinicians amongst others.
The real reason there's no agreement and why the BMA has effectively run a massive bullying campaign on social media is that it never intended to compromise on anything. The principles underpinning the changes to the contract they say can't work are already the basis of contracts worked by hundreds of thousands of nurses, paramedics and AHPs. Doctors have been systematically misled by their union - which has gone as far as using made up numbers in a calculator as the basis for the 40% pay cut claim. You can't blame the doctors but I think if they had first hand experience of the brazen dishonesty within the senior ranks of the BMA they may reach a different conclusion as to why the negotiations ultimately failed.