[Closed] doctors on strike

ut people are leaving it, there is a real workforce recruitment and retention crisis, which increasing the number of medical students hugely over the years has not addressed.

You sure about that?

[b]Registered doctors each year from 2006 - 2015[/b]
[img] [/img]

[b]Doctors added to the LRMP each year from 2006 - 2015[/b]
[img] [/img]

Yeah, but "cost of training" in that context actually means the cost of paying the doctor their salary. And I don't think that anyone can argue that doctors aren't working in that time.

In addition, that £500k on the BMA site that you quote also includes tuition and accommodation costs that are borne by the doctor, not the taxpayer.

Finally, a point on recruitment and retention of junior doctors. I spoke to a more junior doctor on one of my wards the other day, who informed me that only 46% of medical SHO posts in our Deanery had been filled this year. That's more than half of medical jobs that will be empty in August. That's a disaster.

Oh, and we didn't appoint any registrars in my specialty in 2014 and 2015 in my region because there weren't any appointable candidates...

[b]dragon[/b] Yep. That is registered Drs and includes those not working, retired but still on the register, the increasing number who have chosen to work part-time so provide less overall time...

And BTW the government's own equality assessment team says the new contact for JDs discriminates against women!

Now if you want to use your mad point-of-view-justifying skillz to look for vacancies and recruitment issues... feel free.

A friend in an excellent local practice told me last year when they were trying to recruit a new GP (and still are) that they had got to the stage where they would accept anyone who owned a stethoscope...

[url= http://www.hee.nhs.uk/our-work/attracting-recruiting/medical-recruitment/specialty-recruitment-round-1-acceptance-fill-rate ]Fill rates for specialty training decline dramatically in 2016[/url]

Core medical training decreased from 87% job fill rate in 2015 to 78% in 2016
Paediatrics 96% to 84%
Obs and gynae 100% to 91%
A+E 99% to 96%
Psychiatry regularly fills less than two thirds of its posts

[b]legolam[/b] thanks...

Good moment for Mr Hunt to pick a fight and demoralise JDs even more, isn't it?!

Good moment for Mr Hunt to pick a fight and demoralise JDs even more, isn't it?!

almost as if he's doing as much damage as he can, so that the good ol' private sector can step in and save the day.

That £8 bn that the Tories promised is going to be spent on private hospitals built with public money and some very, very expensive elective surgery.

Dramatically is over stating the case overall it has gone from 82% to 79%, but with only one comparison it is fairly meaningless, you'd need a good few more years to see a proper trend.

retired but still on the register

Well 6% are aged over 65, so say they are all retired, I can't see how that % would have fluctuated wildly over the years, so the general trend of increasing numbers of registered doctors is till valid.

Working part time well, that's almost certainly primarily due to an increase in women coming into the profession, so you want to ban part time working? It is a interesting point though that no one addresses about the NHS, as part-time working becomes more prevalent, then the tax payer needs to pay for more to be trained, as a country how do we address this?

Salaries for more experienced pilots could range from £36,000 to £48,000 in a first officer role. The starting salary for a captain with a medium-sized airline may range from £57,000 to £78,000, while those with the major operators could earn from £97,000 to more than £140,000.

The FOs will be on substantially less than the 36-48k for their first few years whilst repaying the >£100k cost of training, either to the airline or to their lender.

Yes, the starting salary for a captain is correct, but you'd need to be a pilot for probably 10 years to get the LHS.

For the majors, Virgin require you to be [u]in the company[/u] for about 10 years and BA [u]20[/u] for long haul (I accept that command times are reducing for short haul at BA - not sure what the pay is there, though)!!

Good pay eventually, but you'll have many hours under the belt to get that money. Factor in a couple of divorces too and the fact that you'll be totally burnt out well before 65 so early retirement is a must.

As above, numbers registered are not a useful guide.

We are going to 1 of 11 slots filled on one of our rota slots from August. That's in a major city hospital.

No hope of getting locums either as now the rates are capped they refuse to work in busy units.

The system is creaking more and more. Ironically staffing levels are relatively higher today than many days due to cancellation of elective work.

Miker sounds very similar to doctors then.

Well 6% are aged over 65, so say they are all retired,

Nope. Some are still working even if they are not they can remain on the register.

Good pay eventually, but you'll have many hours under the belt to get that money. Factor in a couple of divorces too and the fact that you'll be totally burnt out well before 65 so early retirement is a must.

What about pilots?

Good moment for Mr Hunt to pick a fight and demoralise JDs even more, isn't it?!

Well 6% are aged over 65, so say they are all retired, I can't see how that % would have fluctuated wildly over the years, so the general trend of increasing numbers of registered doctors is till valid.

Working part time well, that's almost certainly primarily due to an increase in women coming into the profession, so you want to ban part time working? It is a interesting point though that no one addresses about the NHS, as part-time working becomes more prevalent, then the tax payer needs to pay for more to be trained, as a country how do we address this?

[quote=Jon Taylor said]
That £8 bn that the Tories promised is going to be spent on private hospitals built with public money and some very, very expensive elective surgery.

Fact or supposition ?

I don't want to go back over what I have written before but the main thing I want to say today is that it is the specific jobs that are going to lose out way worse than others that makes the new contract so unfair. Hospital-based jobs are already awful rotas to work. This contract goes out of it's way to target those same specialties that rely so heavily on out of hours work. These guys should be the ones recompensed the most and given the biggest incentives to be away from their family, life, happiness for essentially their whole career. We were all struggling on until this new contract came along. It now makes it untenable for the manner of work we are asked to do.

10% drop in medical registrar applications means hospitals across the country losing decision-making people through the evenings, nights and weekends. Same goes for surgical registrars, O&G, all specialties that have unpredictable and persistent patient flow. Out hospital are getting into trouble for trying to bully GP trainees into working the medical registrar rota despite them repeatedly saying they do not feel safe doing it and they are not adequately trained. Hospitals are desperate to cover these shifts already. I should say this is in Scotland and not actually affected by the strikes. Think what further discincentive will do to this.

Those arguing against us in this argument cannot understand what it will mean for their own care should they need to go to hospital during these times. You must understand this is personal to each and every one of us, doctor or not. I'm not sure we have got this message across enough..

[quote=speedstar said]I'm not sure we have got this message across enough..

That seems to be the case. We've heard it's not about money, then it is about money. About weekend working but then we're told doctors already work weekends.

Is it down to doctors currently getting a substantial salary premium when working "unsocial hours" and the new contract reclassifying the "unsocial hours" definition such that the salary premium will go ?

Is it down to doctors currently getting a substantial salary premium when working "unsocial hours" and the new contract reclassifying the "unsocial hours" definition such that the salary premium will go ?

No.

Oh, and we didn't appoint any registrars in my specialty in 2014 and 2015 in my region because there weren't any appointable candidates...

This crudely assumes that people are motivated to become a doctor for money. From the large portion of my friends that work in healthcare, teaching and other public sector and care related jobs, I can safely say this is not the case.

[quote=Drac said]Is it down to doctors currently getting a substantial salary premium when working "unsocial hours" and the new contract reclassifying the "unsocial hours" definition such that the salary premium will go ?

No.

Well it certainly seems to be a part of it.

From Auntie http://www.bbc.co.uk/news/health-34775980

How is the contract changing?
Basic pay is to be increased by 13.5% on average.
But that comes at a price: other elements of the pay package are to be curbed, including what constitutes unsociable hours.
Day hours on a Saturday will be paid at a normal rate, while extra premiums that are being offered for night and the rest of the weekend are lower than what is currently paid.
Guaranteed pay increases linked to time in the job are also to be scrapped and replaced with a system linked to progression through set training stages.

Well it certainly seems to be a part of it.

From Auntie http://www.bbc.co.uk/news/health-34775980

Yeah they're wrong.

Ah I see. The BBC are incorrect.

Riiiight.

Fact or supposition ?

Let's just call it foresight.

Jamablaya:
As I posted on the other thread the Tories won the election with a higher nhs spending pledge than Labour (+£8bn pa vs £2bn)

and

Tory Health Minister Jeremy Hunt
"Our ambition should be to break down the barriers between private and public provision, in effect denationalising the provision of health care in Britain"

Doesn't take a genius to understand where the Tory ideology will take them.

On page 31, I posted this:

The dispute is categorically NOT about pay for weekend working. It's barely about pay at all.

In no particular order, here are some of the things that I disagree with on the imposed contract:

1) No financial penalties for Trusts that allow their doctors to work unsafe hours
2) More weekend working with the same number of doctors means less cover during the week, when most of the day to day work is done (due to everyone else doing elective work M-F)
3) Thin end of the wedge with regards to other doctors and allied health professionals having their pay cut
4) "Creative" rotas that have doctors working random shifts with absolute minimum length of breaks, meaning tired and disorientated doctors looking after patients that have no continuity of care
5) Widening of the gender pay gap due to:
a) no pay progression whilst on maternity leave,
b) no provision for how less than full time training (LTFT) will work in the new contract
c) a pay structure that could mean that 2 female junior doctors on 60% contracts (ie doing a total of 120% of a full time job) could together earn less than the equivalent male doing 100% of a full time job
d) no pay progression for the final 5 years (full time) of training, which could mean that female doctors in their 30s could work for 10 years (gaining experience and skills) without any hope of a pay rise
6) Disincentives for doctors to do academic research, further diminishing our status in the worldwide scientific community
7) No pay progression in the final 5 years of training, which is where the biggest gains are made in terms of experience and skills.

Junior doctor rotas are already at breaking point. My own place of work has 7.6 people working a rota meant for 12. Next weekend, we don't have any doctors covering the day shifts on Saturday and Sunday. Imposition of this ridiculous contract will mean that the exodus of doctors from the NHS will accelerate and I suspect we are in for a very hard decade or so in the NHS (if the NHS survives at all).

It's still true.

In fact, we don't have any doctors to do the weekend day shifts AGAIN this weekend. It's like groundhog day.

@JT - yup that's the French system, a proper mix between private and public - we have a right dogs breakfast and it's not working - our expectations of it are nowhere near what we fund though state. The French have much higher taxes, vat on food etc and they still have greater use of private health service provision via personal insurance. We need a serious rational discussion.

Put simply - if it was purely about money then Junior Doctors would welcome privatisation due to the vastly inflated pay cheques that it would bring.

They don't. It's not.

No financial penalties for Trusts that allow their doctors to work unsafe hours

On 4 January Daniel Mortimer, chief executive of NHS Employers, wrote that a system of financial penalties for trusts who abuse doctors’ working hours had been proposed.

He said trusts who breached working time protections would have to pay fines to a “Guardian” who would spend the money on “supporting the working conditions or education of doctors in training in the institution”. He added: “The BMA seemed unwilling or unable to discuss this major development with us.”

Creative" rotas that have doctors working random shifts with absolute minimum length of breaks, meaning tired and disorientated doctors looking after patients that have no continuity of care

Without being a fly on the wall in the negotiations, it’s hard to know what the real sticking points are. The BMA has made no secret today that it sees status of Saturdays as the main obstacle.

At the same time, the doctors’ union is not conceding that all the other areas of disagreement in these complicated negotiations have now been completely settled.

If it is the case – as the government claims – that earlier fears over unsafe working hours have now been allayed, this message has not trickled down to striking doctors on picket lines.

They are still telling the public, perhaps wrongly, that this industrial action is still at least partly about unsafe hours.

[url= http://blogs.channel4.com/factcheck/factcheck-doctors-strike-patient-safety/22458 ]Source[/url]

Remember, BBC reporting is very heavily skewed towards the London 'Establishment', especially now that Cameron has one of his pals as editor in chief of news...

The BBC has just done their lunchtime report, they've concentrated on 'pay rises' 'unsocial hours' but never mentions the unsafe practice. 🙄

@Drac - I agree.

I think it's got very muddy and emotional that some of the orginal concerns are struglling to get through. They interviewed a doctor on the picket line and her reason for striking didn't come across well either...although you do have to be media savy to sum up your concerns in a minutes soundbite on the radio..

Maybe that's why they used her footage.

allthepies - Member

Ah I see. The BBC are incorrect.

Riiiight.

The BBC are reporting what they say are doctors' reasons for the strike. It's not a big reach to say that if this reporting doesn't tally with doctors' reasons for the strike, it's probably not the doctors that are wrong.

Or maybe the doctors should tune into the BBC to find out what they think, and then act accordingly.

we need no discussion tories and there apologists need to learn that the people want the NHS to be in the public sector rather than engineer shit like this so they can then argue its "not fit for purpose" then make it more expensive so their chums can make more money.
There is no public support for a privatised NHS except amongst Hunt and a few other loons.

My apologies - the details regarding financial penalties for breaches of the contract appeared after my initial posting on page 31. In the previous version of the contract, there were no financial penalties for Trusts.

However, on the point of penalties for Trusts for breaching the contract:

1) Junior doctors do not have any protection under whistleblowing law (recently tested in court)

2) Breaches of the contract must first be reported to the junior doctor's educational supervisor, the person that decides whether or not a doctor progresses in their career

3) In the case of doctors working longer hours because of sick patients, they will have to get "permission" from the consultant in charge before working any time over and above rostered hours - hardly likely at 9pm on a Friday evening when you are dealing with a patient that is dying

3) The educational supervisor (another consultant) will then decide whether the breach meets criteria to be reported to the Guardian

4) The Guardian will be a senior member of that consultant's Trust, potentially the person who decides whether or not the consultant progresses in their career

5) The Guardian will take direction from the Department of Health regarding what actually constitutes a breach of contract

This system is wide open to abuse and manipulation.

The current system involves mandatory (ie breach of contract if you don't do it) reporting of hours by every junior doctor on a rota for a 2 week period every 6 months, which is collated by an independent administrative person and published publically. Trusts are fined a set amount per doctor that breaches the EWTD hours regulations.

You missed out the bit about the BMA still holding out for more of the fine to be paid to the doctor who has been "overworked" - even though it is the patients who theoretically suffer. Nothing to do with money this dispute, not at all, oh look a badger.

There is no public support for a privatised NHS except amongst Hunt and a few other loons.

There is a very big difference between a fully privatised health service and what we have now, in fact pretty much every other successful developed nation has a different system

There is a very big difference between a fully privatised health service and what we have now, in fact pretty much every other successful developed nation has a different system

You missed out the bit about the BMA still holding out for more of the fine to be paid to the doctor who has been "overworked" - even though it is the patients who theoretically suffer. Nothing to do with money this dispute, not at all, oh look a badger.

I think one of the problems with the Guardian proposal is that the fines are paid into the trusts' educational budget, and that the fines may well work out cheaper than employing a locum for the same shift. I'm not entirely sure if the current version of the contract still has these problems but perhaps someone could enlighten me.

Enforced moving of money from one part of the trust budget might be a fine but it doesn't really seem like a penalty.

You missed out the bit about the BMA still holding out for more of the fine to be paid to the doctor who has been "overworked" - even though it is the patients who theoretically suffer. Nothing to do with money this dispute, not at all, oh look a badger

To be fair, I agree with you on this point. I don't give a toss where the money goes, as long as it acts as a deterrent to Trusts taking the piss out of their staff. We certainly don't get the money now (IIRC, around £5000 per doctor that fails "monitoring") and I don't care if we get it in the future.

FWIW, although I'm a junior doctor, I'm not (and have never been) a member of the BMA due to (IMO) their total mishandling of multiple issues over the years (Modernising Medical Careers, pensions, whistleblowing case to name but a few). I would like to think that I'm capable of looking at the evidence, weighing it up, and coming to a conclusion by myself and have certainly not been "misled" by the BMA (their emails, like those from Health Education England, are deleted immediately on principle).

Enforced moving of money from one part of the trust budget might be a fine but it doesn't really seem like a penalty.

You are right, smaller fines should be paid but they should come out of operational and clinical senior staff's remuneration - sorry, got to go, flock of pigs flying outside.

Enforced moving of money from one part of the trust budget might be a fine but it doesn't really seem like a penalty.

Sorry, should have read "Enforced moving of money from one part of the trust budget [i]to another[/i] might be a fine but it doesn't really seem like a penalty."

Once again those that disagree are "loons" and its a fact no one is suggesting privatising the NHS. This is a perfect example of how a rational discussion is currently impossible

I am happy to discus show much funding is fair but not the model of delivery. As I said only right wing loons, you, Hunt, Farage, want to discuss that sort of issue.

jambalaya - Member

its a fact no one is suggesting privatising the NHS.

Well of course the Tories won't talk about "privatising the NHS", it would be political suicide for them to do so.

But they are quietly getting on with it anyway.

And if they mention it at all they refer to it as "denationalisation" rather than the dreaded [i]privatisation[/i] word.

Although it of course means exactly the same thing.

jambalaya - Member

I understand that, however it's worth noting my neighbours include a surgeon and a dentist with with very nice houses, top end Mercedes and nice yachts. Nothing against any of that of course, they deserve it.

The fact that some surgeons and dentists are rich is not the point. You suggested that doctors were in it for the money. I doubt many of them actually entered the profession with the ambition to become the Warren Buffett of healthcare.

There are people who think money is everything, and those people will tend to assume everyone else thinks the same. Even when told otherwise, they'll assume it's a lie or self-deceit or naivety. It colours everything they say and do, and you can't argue with it. Anyone who doesn't have money is jealous, anyone who gives money away is only doing it to feel good. And of course they'll believe that this strike is all about money, too. And every time anyone mentions money even as an aside or a denial, they'll go "ah hah! I knew it- they're thinking about money"