[Closed] doctors on strike

He discussed conceding the weekend pay issue if the government increased the total medical pay bill for Junior Doctors by £500m-£700m.

So, they discussed conceding what was effectively a pay cut (cutting weekend pay) in return for more money, presumably elsewhere in their pay packet. This could only be spun as JDs striking for more money if it could be proven that the JDs would all end up better off, i.e. if the cut in weekend pay was less than each JD's share of the £700m. I doubt you'll find the figures for that one.

The Government wants to improve the service and have offered more money to do so. The Doctors don't think they've been offered enough of a payrise to work more weekends and nights.

Semantics. The government offered a basic pay rise, which was shown to only just (at best) make up for the cut to the weekend pay, and at worst to leave JDs out of pocket. So whilst the JDs may have been aggrieved at the size of payrise, it was only because their GROSS pay was still effectively being cut.

For all those additional doctor hours to be cost neutral something has to give...

...and for full cover at weekends, you'll need to pay for pharmacists, physio's, radiographers, theatre staff, pathology staff, ward clerks, porters and so on. The only way to make that cost neutral will be to not pay anything extra for all those groups to give up their weekends, which is a whole new set of industrial discomfiture.

Jeremy Hunt either knows this and doesn't know how to fix it, or doesn't know it yet and still doesn't know how to fix it.

I hate to say #jambafact but that isn't true.

remember it as it will be a long time before it is seen again, if ever

No, what the DH has tried to do is to move from all of the weekend work being effectively worked on "overtime" rates for working a Saturday morning or afternoon, to making Saturday daytime hours "normal rate" and thus releasing additional funding for evenings. As an aside a lot of locum work is currently done by doctors leaving the door of their own Trust and going a few miles to the next one and immediately starting a Locum shift there (which completely blows a hole in the "safety" argument).

This alignment of weekend pay rates simply puts doctors in the same position with pay as many other comparable roles in the NHS or other essential roles like Police / Fire etc - who generally don't get paid 50% more for doing a shift rostered in the day on a Saturday.

If overall pay were to go up £500-£700m that's more pay all round - around 15% based on the current pay bill.

The BMA is / was still demanding that anyone working a Saturday morning should be paid 50% more for doing so.

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Source for image: http://www.bbc.co.uk/news/health-34775980

As an aside a lot of locum work is currently done by doctors leaving the door of their own Trust and going a few miles to the next one and immediately starting a Locum shift there

Really?

You'd have to be pretty keen for money to finish a 13+ hour shift and then voluntarily drive to another one (and then presumably drive back and go straight into your third consecutive shift the following day?).

I've never heard of anyone doing that. I'm sure it happens sometime/somewhere but "a lot"??

I've never heard of anyone doing that. I'm sure it happens sometime/somewhere but "a lot"??

Well enough for the BMA to refuse to budge on a DH request in the negotiations that Junior Doctors should notify the employing Trust if they are going to do Locum work elsewhere.

This would mean their employer has a complete view of the hours they are working, potentially avoiding unsafe working hours. So why exactly are the BMA not willing to commit to this given all the endless statements to the effect of the main concern being long hours / unsafe doctors / risks to patients?

i dont know[ though i would also ask for proof this claim is even true from a neutral and reliable source with appropriate quotes etc as you have a jambian grasp of truth and facts]

However i do know that "fact" in no way proves your original assertion.

So why exactly are the BMA not willing to commit to this given all the endless statements to the effect of the main concern being long hours / unsafe doctors / risks to patients?

Because private practice, which is a Consultant thing, not a JD thing. Important to remember that Consultants and JDs are different things, and the battle to get consultants to work more weekends will be an interesting one.

...and the NHS has no effective way of monitoring how many hours anyone works; nurses can work agency shifts on top of their usual hours and there is little will to check this. EWTD comes into play after 17 weeks of averaged hours, supposedly...

My understanding is that the locum clause in the new contract requires that Junior Doctors must offer any extra hours they are prepared to work to their own Trust first (at much lower rates) before being allowed to locum anywhere else.

The [url= https://www.bma.org.uk/collective-voice/influence/key-negotiations/terms-and-conditions/junior-doctor-contract-negotiations/new-contract-faqs ]FAQ on the BMA website[/url] says:

Will I still be able to undertake locum work?

Yes, you will still be able to undertake paid locum work in addition to the hours set out in your work schedule. However, initially, you will have to offer these additional hours exclusively to the service of the NHS via an NHS staff bank - but only at the grade you are currently working at. Under the proposed March offer, you would have had to give your primary employer first refusal on these hours. You will be paid a 22% premium for any such locum work, above the prevailing hourly rate.

You are entitled to carry out additional activity over and above the standard commitment set out in your work schedule - up to a maximum average of 48 hours per week (or up to 56 hours per week if you have opted out of the 48 hour limit in the Working Time Regulations).

So it's another pay decrease for those who currently work locum shifts.

Also means you get situations where a doctor could be available to put in some locum hours at a hospital near their home, but can't because it is in a different trust.

Also a very effective restraint of trade situation, which isn't really going to help smooth things out is it?

The locum Dr agencies need to start donating money to the Conservatives...

I guess it would be naive of me to expect a sensible reply from Jamba to my last post? Suspect he's left the building... 😉

What this latest debacle shows is that health is far too important to be left to politicians, doctors and their union (BMA). They should be COLLECTIVELY hanging their heads in shame - a bloody shambles where all three obscure the truth for tortured ends leaving the poor patients to suffer.

Forget - the NHS is the best in the world; the Tories are privatising the NHS; this is not about pay etc - that BS is just unhelpful noise and will someone get a bloody grip. Its pathetic.

What this latest debacle shows is that health is far too important to be left to politicians, doctors and their union (BMA). They should be COLLECTIVELY hanging their heads in shame - a bloody shambles where all three obscure the truth for tortured ends leaving the poor patients to suffer

Yes, but the blame for the latest icing on the cake of shambles can and should be laid firmly at the feet of Jeremy Hunt and the Conservative Party.

No, your response is part of/symptomatic of the problem (excuse the bluntness).

[b]All parties are to blame here[/b] - in the wider definition of the word - [b]and they have collective responsibility for the on-going shambles.[/b]

The whole Tories are killing the NHS BS is part of the reason why the debate never moves on. Health provision in the UK needs fundamental reform, but despite endless change initiatives and money invested, the core issues remain, no they don't, they get worse. And part of the reason it the crap noise the prevents rational debate.

And by the looks of things, they will get a lot worse too. Pathetic.

All parties are to blame here

But the Tories have been (mostly) in government for the past 6+ years, so I think it's pretty safe to blame them. If this were 2011, then maybe you'd have a point, but it isn't, so you don't.

The Tories are in power. They have the means to fix it. Instead they seem to be doing their level best to make the best clinical staff leave, and disincentivise prospective staff/students from training for a career that frankly looks horrific.

[b]THM[/b] I and pretty well all my colleagues feel the NHS was at its very best about 4-5 years ago. But rather than build on that - a new layer of Market Rhetoric and a failure to act on evidence rather than ideology has led to an utter clusterf***

The Conservatives declared the NHS broken, and proceded to break it... And all the performance data and satisfaction surveys tends to bear this out. 🙁

Odd that its only the tories on here who seem to get upset about the widely held view that the Tories are trying to privatise the NHS..possibly by destroying it first. personally I think many would support this if they knew it was not electoral suicide hence they do this instead. you can call it BS if you like but then one has to remember your own political leanings.

I wonder why the defensive tories call it noise and try to deflect the debate?

part of the reason it the crap noise the prevents rational debate.

The real issue here is we all know Hunt lied/misused in his use of the statistics [which has led to deaths as folk dont attend hospitals at the weekend when they are ill] and his methods/approach have angered an already annoyed workforce who are not exactly renowned for being on the coal [ see what i did there] face of industrial disputes and challenging the govt of the day. IMHO a decent manager would realise he is part of the problem and move him on- I have no idea why May has backed him so much as they have now drawn a line in the sand and they dont want to back down as they will look weak - compromise has been made less likely by both groups actions but the new PM had a chance to kick start a new debate she ignored it as emphatically as possible.

As for the real debate you saying that - does anyone speak more in tongues/obtusely on here than you? [ chewk?] Oh the irony

here you go state clearly what the "fundamental reform" is that is required as it's rather vague/nebulous concept

go on what do we need to do then- you do practice what you preach dont you?

...and it doesn't need 'fundamental reform' FFS.

It needs funding properly now and a commitment to funding it properly in the future.

The NHS is the only healthcare that 90 odd % of the people in the UK will ever have, it's been paid for by the previous generations and should be as good as we can make it, not as cheap as we can get away with.

...and let's be sensible and rational; if you choose to move away from a centrally funded model it will cost more.

Odd that its only the tories on here who seem to get upset about the widely held view that the Tories are trying to privatise the NHS

Hmm, about as odd as it being only the hand wringing Lefties who seem to get upset about the widely held view that Corbyn is unelectable

...not as cheap as we can get away with

So what would you think would be the best way to cheapen it?

How about shutting for bank holidays?

May has not moved him on because he is not yet toxic enough, so plenty more lies and upset before she replaces him with someone who presents as more humble and a (relatively!!) palatable alternative in time for shiny new manifesto promises. At least if it was my job to advise (and I could still sleep at night) then that's what I would recommend.

Also the Westminster heirarchy gave way to the establishment one: look who he is related to. Hunt is simply the best connected minister in the 'real' world outside the parliamentary/elected Conservative party, and it simply will not do to be just moving him on like that. My bet is that May tried to replace him, and then someone's mum rang someone's uncle who had a quiet word in a private members club with someone's aide and then suddenly May saw the error of her ways.

THM I and pretty well all my colleagues feel the NHS was at its very best about 4-5 years ago. But rather than build on that - a new layer of Market Rhetoric and a failure to act on evidence rather than ideology has led to an utter clusterf***

Well we can agree to disagree, I remember an NHS team come to my business school in the early 90s to discuss "change management" (anyone remember that fad?). I asked them why they were introducing all their pointless changes - kicking the can down the road - instead of dealing with root causes - and no that is not just money. I told them that their "changes" were a waste of time and that things would get worse if they continued to avoid the big decisions. And here we are 25 years later, with little progress.

zokes, you might want to check (1) when the Tories (spit) came to power and (2) how the left-of-centre, anti austerity SNP differ in terms of implemented policies (reality not rhetoric).

and it doesn't need 'fundamental reform' FFS.

la, la, la.... 😯

I am sure we all understand your position much better now about exactly what is required and why their is a need for reform based on your rather old anecdote

When you speak with such clarity lord only knows why they were not convinced

If hunt is taken ill or stabbed in the back by his own party, most of us wonder if any junior drs will rush up and help him, or just leave him to drown in the pit of his own making , and let someone else deal with fractures in his party.

The Nhs needs a shake up, to many grades and job demarcations, to many contractors and empire builders, along with much to many agency staff.

Talk to older nusring staff and they will tell you nurses did the cleaning /feeding and toilet duties along with other patient care activities, the matron and sister ruled with an iron rod and their word was law on a ward,now we have endless grades of staff and management along with office staff seemingly floating around and not involved in ptient care or achieving much for anyone.

Talk to older nusring staff and they will tell you nurses did the cleaning /feeding and toilet duties along with other patient care activities,

We still do.

...and the issue is not managers, it's systematic under funding. Hence the 'too many agency staff'; you only need agency staff to fill gaps.

zokes, you might want to check (1) when the Tories (spit) came to power

May 2010. Sure, you were in coalition with the lib dems, but you were the major coalition party, and most of the policy was yours

and (2) how the left-of-centre, anti austerity SNP differ in terms of implemented policies (reality not rhetoric).

When Sturgeon has been PM for a while, this point will have a purpose in the discussion.

Just break it up and put in a system similar to that in Europe. After the initial grumpiness the Doctors will be happy eventually as they'll get more pay.

Who's "you"?

Sturgeon relies on that kind of myopia? Meanwhile

If we keep pretending that this is a party political issue then we will keep suffering the inevitable results. Everyone deserves better.

Just break it up and put in a system similar to that in Europe.

[url= http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS?end=2014&locations=GB-FR-DE-SE-CH-NL-IT-ES-DK-BE-AT-PT-NO-IE&start=2014&view=bar ]You mean pay much more towards healthcare like they do? (World Bank)[/url]

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If you are prepared to pay more why don't we just stick with out comparatively efficient NHS and give it more money?

After the initial grumpiness the Doctors will be happy eventually as they'll get more pay.

Maybe some of those grumpy doctors actually believe in the NHS?
After all, if they were only interested in money then they could go private or move to a country that pays better.

Jeremy has been an excellent Health Secretary, he is an excellent Health Secretary and this deal is about a deal that is safe for patients and I think it’s crucial.

If you look at what we’re doing as a Government with the NHS – we’ve got record levels of funding into the NHS, we’ve got more doctors now in the NHS than we’ve seen in its history and this is a deal that is safe for patients.

The Government is putting patients first – the BMA should be putting patients first, not playing politics.

sage words from our 'prime minister' earlier 😯

But it's not just the PM who thinks the BMA Junior Doctors' sub ctte should be putting patients first and not going on strike - the following also concur:

- The Academy of Medical Royal Colleges
- The 14 x Consultant and GP Representatives who voted against strike action (out of the 30 people that had voting rights)
- The BMA Junior Doctors' lead negotiator who agreed the curent / revised deal with the DH and says the final deal is fair and stood down when they refused to accept it.

What's happening is that most of the Junior Doctors have accepted the revised contract terms but their representatives in the BMA are still hell bent on strike action and driving their own political / personal agendas.

This outcome has been entirely predictable for the last 18 months based on what the BMA's negotiators have said. There is also the issue of the BMA's accidental (or otherwise) willingness to mislead the Junior Doctors by releasing a completely flawed pay calculator that by their own admission was built off completely incorrect assumptions and guesses even though this wasn't made clear to the people using it.

The BMAs dodgy pay calculator is without question the thing that tipped the negotiations into a dispute and the BMA were very very slow to recognise this to the point that many JDs still don't even know the original numbers were guesses rather than a true reflection of the offer being made at that time.

As an aside, why does this archaic system refer to highly trained staff as Juniors in the first place? Did Fatcha introduce the term?

If you are prepared to pay more why don't we just stick with out comparatively efficient NHS and give it more money?

Yes I would be prepared to pay more, but not to the NHS because I don't believe chucking more money at the current NHS system will produce the changes required. It was built in a world 60 odd years ago to provide backstop care for the ill, it now provides services way beyond that and a free for all model just isn't suitable IMO.

After all, if they were only interested in money then they could go private or move to a country that pays better.

They keep telling us that, that is exactly what they'd do, go to Australia, USA or where ever. And as for private well a fair few double dip already.

Dragon - lots of juniors are going to NZ and Oz already, not sure numbers have gone up YET though.

Private wise - most consultants work 40-44 hours for NHS and do private work in addition to this by choosing to work in their free time. This doesn't seem unreasonable and a lot of work done in private hospitals is NHS work sent elsewhere as demand overwhelms the system.

The NHS is not perfect but the alternatives aren't perfect - 44% of all money spent on healthcare in the US goes on billing and billing admin - i.e. is not spent on treating the punters - that is not a great system...

(I accept the NHS needs continuing adaption and change. Jury out on juniors pay - is it interesting that I got paid more in 2002 as a junior doc than they do now - the cost of living is a whole lot more in 2016 than in 2002)

What's happening is that most of the Junior Doctors have accepted the revised contract terms but their representatives in the BMA are still hell bent on strike action and driving their own political / personal agendas.

Umm wasn't the contract recommended by the BMA and then rejected by the doctors when they were asked to vote?

I don't think the pay is necessarily better in those places..

My other half was a midwife in NZ for 7 years or so, and the unfortunate fact is that healthcare staff elsewhere are treated with a level of respect, humanity and dignity that makes the NHS appear a complete farce by comparison

revised deal with the DH and says the final deal is fair and stood down when they refused to accept it.

What's happening is that most of the Junior Doctors have accepted the revised contract terms but their representatives in the BMA are still hell bent on strike action

By all means speak like the PM re the dispute but FFS make sense - even tenuous would be a vast vast improvement

My other half was a midwife in NZ for 7 years or so, and the unfortunate fact is that healthcare staff elsewhere are treated with a level of respect, humanity and dignity that makes the NHS appear a complete farce by comparison

Shh (1) the NHS is the best in the world and (2) NZ replaced its public funded system with market/insurance elements and [s]privatisation[/s] a mix of public and private service provision.

You might have got away with it this time yunki, but careful!

just5minutes - Member

What's happening is that most of the Junior Doctors have accepted the revised contract terms but their representatives in the BMA are still hell bent on strike action and driving their own political / personal agendas.

I can't tell if you know this is wrong and you're just going with the traditional "big lie" approach, or if you've actually convinced yourself it's true. TBH you don't come out of it too well either way and anyone who's paying the slightest attention knows you're talking absolute pish so probably no harm done but still, have a word.

You might have got away with it this time yunki, but careful!

I get the distinct impression that it's much more to do with cultural differences rather than funding

Isn't it weird that so many people (media and individuals) are up in arms about the irresponsibility of the junior doctors strike and the safety concerns that may result...BUT..these same people don't seem to voice their concerns in the same way about the affects on the patients from the NHS cuts etc...

Why do people want to vilify the doctors regards something they haven't been so bothered about in the past.... hypocrites I say...

EVB - perhaps the same "people" can draw a distinction between the two issues

Sir John Oldham hits the spot in the Torygraph (yes, ok) today

Sir John Oldham hits the spot in the Torygraph (yes, ok) today

http://www.telegraph.co.uk/news/2016/09/05/junior-doctors-will-harm-our-patients-and-our-nhs-if-they-back-t/