doctors on strike

I hope they vote for industrial action. It’s just going to be one of many over the next few years I think. It’s a devolved matter so it doesn’t affect my friends or the service up here directly, even so, the NHS is something worth fighting for.

I suppose, it’s a no-win situation though. The government is out to cause problems in the NHS, I don’t think they’re too bothered exactly what problems result- whether it’s understaffing and bad morale, or striking and resistance to change, both suit their agenda. I just feel sorry for the poor buggers caught in the way of the train.

I’ve asked the question a few times but nobody seems to be planning for it… How does a member of the public really show support? Petitions, blah blah… Industrial action is good but is there a wider campaign?

Can I just check – the proposal that would lead to a pay cut is that you would only receive unsocial hours pay supplements for the unsocial hours actually worked, yes?

No, it’s changing the hours that are classes as unsocial. Apparently working until 10pm at night isn’t unsociable.

If it was being paid for the hours you work, Mrs FD. Would be way better off than she is now

What this boils down to is “give us more money or we kill you and your family”

Good luck getting support for that.

deev – Member

What this boils down to is “give us more money or we kill you and your family”

Yeah, that’s 100% exactly what it doesn’t boil down to

Thanks FD – is there a rise in the basic pay as part of that?

Doctor do make a decent salary and I don’t grudge it one little bit. People can die under their watch if they choose to clock off at 5pm. I respect them more than leeches that choose to make a few extra grand for a share holder.

I have no problem with how much doctors get paid, especially when compared to many who’s jobs don’t have such a direct benefit to society.
How can it be safe that someone with such responsibility, directly effecting life or death everyday can be expected to work such long shifts and weekly hours?
If cuts need to be made then why not look at cutting hours so therefore cutting overtime banding. Trouble is that needs long term thinking to increase the uptake of the profession, instead the Tories go for a short term gain that will instead decrease uptake and ultimately lead to huge problems financially, medically, and ethically in the future.

Yes there is going to be a rise in basic pay as part of the deal.

I find it hard to feel that sorry for doctors working silly hours when they’d have known that was the deal before they signed up.

And I know lots of people work hard. And I don’t feel entitled to a fortune. We are well paid, but I don’t think it’s excessive for what we do. I work with a lot of really good people. The kind of people you’d want caring for you if you were ill. When my turn comes to be sick I don’t want them all in Oz!

My sentiments exactly

This is the bit I don’t get. I don’t see how weekend working can lead to a net benefit, it must just slightly redistribute the ‘poorer’ care. Unless they’re increasing staff by roughly 40pc to add two days full cover.

On the face of it, it’s mental.

They are not planning on increasing the staffing or resources by 40%, indeed the government is very keen not to answer any specific questions on this matter e.g. what they mean by 7 day services, how much it will cost etc. Instead we are seeing an awful lot of half baked excuses about why it won’t happen (it’s them doctors who don’t want to work). Despite the protestations of ring fenced funding, from a financial perspective we are seeing year on year cuts of around 4% per year in the name of increased efficiency. On the face of it taking 20billion out of the service over 5 years and then trying to get elected on a promise to put 8 of it back (just) before the end of the next parliament shouldn’t be a winner but clearly I am not going to progress in politics as it seems to have served them well.

In my hospital, the consultants are already working extra weekend shifts and we are not necessarily against a more shift based system with some additional weekends traded for time off during the week. Where it all falls down is that there is no one else to do the weekday work that we will be missing, so as things stand we would finish up doing it for free in our spare time – not a great incentive to change.

We’re having similar things in the Ambo service re. unsocial hours….the understanding has always been that anything after 7pm was unsocial as this encroaches on your evening….the gov want it changed to 9pm or 10pm I forget which….it’s nonsense, who works at 10pm and considers it social hours, most people are in bed by then!

It’s a canny way to reduce unsocial hours payments without getting DR’s, nurses and paramedics to actually stop working unsocial hours.
I gave up trying to make sense of it years ago and just milk the private sector for all its worth now, the NHS pays me my basic 37.5 hours per week salary and I earn up to £60 per hour for the same job but wearing a uniform without an NHS logo on it.

The problem isn’t pay, or unsocial enhancements, or private contractors….although none of this helps….the elephant in the room nobody wants to talk about is how long people are now living.
The life expectancy when the NHS was set up was decades less than now….and it was affordable….children born today are expected to hit 90 years old….that’s what is unsustainable.

Most these days are in education until their early 20s and not paying tax….then you might get a 40 year tax paying career from them….only for them to live another 20-30 years costing the country literally billions in care, meds etc….

We also need to get rid of the myth that “i’ve paid my taxes, I’ve paid for my retirement”….no you haven’t, you’ve paid for those who are already retired, your retirement is based on the generation behind you working hard and paying their taxes….and this is where things get ‘uncomfortable’….there is no younger generation coming through, we’re a top heavy society, the over 60s now outnumber those under 16….it’s truly bloody terrifying.

None of the political parties really want to tackle the problem because telling the massive grey vote that they’re living too long is political suicide….as much as I love the NHS if the electorate doesn’t want to pay more tax then I can only see insurance as the viable solution….and then you get cries of a two tier system based on who can pay…..yep, that’s the price you pay for living too long!

Anyway, it’s late and I’m at FoD uplift tomorrow, none of the above applies to me as the men in my family drop dead of heart attacks at about 70….good citizens that we are.

So I thought I would write about what I, a junior doctor 3 years out of medical school does for a job. I do it simply to enhance understanding and I am not blowing any trumpets about what we do, simply trying to show people who may not understand our role fully some insights into my daily work activities.

Humorously, I am actually locuming currently but before any naysayers out there have a go, I did have a training post in what’s termed core medical training ie. the training you do to become a consultant in, say, cardiology or neurology (or even dermatology, although why they’re in the same training rota is intriguing) although I turned it down as I am not absolutely certain this is what I wish to pursue and have taken a year out of the normal training process to make a decision. Many people take 2 or even 3 years out at this point to work in different specialties although this has been looked down by some although not all a little more in recent years due to training post shortages. Anyway I digress.

So last week I was working in a geriatric orthopaedics role. I am being used in 2 or 3 different medical roles depending on the week but this is what I did last week.

8:30 I attend the handover which is essentially a multi-disciplinary meeting where the information on each patient is discussed, new patient’s are discussed in detail and a general plan is made for each patient so each relevant person including nursing staff, Ot’s, PT’s and discharge officers can all understand where each patient is heading relevant to their role. I tend to take a prominent role in this as I both know the medical information pertaining to each patient in the most depth and possibly (not always!) understand it in the most detailed manner. I therefore am responsible for helping make key decisions pertaining to each patient including the likely outcome of patient’s conditions and when they may look to go home or have investigations completed or need social work input etc.

This is usually over by 9am and everyone goes about their separate tasks and we do our best to action the plan and obviously deal with new information as it arises. Everyday I start doing a ward round by myself as the orthopaedic and geriatric consultants often are busy elsewhere and it is important all the patient’s get seen individually each day. Often this results in my forming a plan for each patient independently, taking into account anything that has happened to them over the preceeding couple of days and any new symptoms they might have developed. I examine some although not all depending on need. I discuss people’s family issues, work issues on top of the routine medical questioning and information exchange that is a part of each interaction. Often this ward round is interrupted by a whole littany of things including phonecalls, other staff wishing to discuss matters with me, people bleeping me, consultants arriving and wanting to do their ward round so they can go to theatre or continue the geriatric ward round that now encompasses the whole hospital. Frequently my ward round can run into the afternoon as some things end up taking significant amounts of time to deal with and I am personally responsible for around 18 patient’s in total. Some days feel as if no progress is being made at all whilst other days things go more smoothly and the team feels adequately functional.

Each day I:
1) order all the blood tests and investigations either I or one of my senior colleagues has felt necessary
2) liaise with up to 6 or 7 consultants during the day depending on who is doing what that day, often doing a ward round with 4 or 5 with their individual patient’s
3) communicate with radiologists, radiographers, microbiologists, psychiatrists or psychiatry liaison nurses plus a continuous and usually comedic communication process with nursing staff
4) Discuss patient’s condition with them and their relatives, being often the sole source for them to ask questions regarding the patient’s condition, outlook, social care issues etc
5) and overall generally often function as the source of much of the information pertaining to individual patient’s for all interested parties.

There are other things I do although I won’t bore you with dealing with all the IT issues, paper filling and many other inane tasks that seem to seek to make my workflow grind to a halt.

At some point between the hours of 12-3pm I will manage to fit my mandatory 30 minute break in. I often feel guilty going as I know there is always more needing done but often there is a point in the day where things are all in motion and there is nothing left practically to do at that point so you opportunistically grab lunch. Frequently this is interrupted by a bleep that you respond to, leaving your lunch whilst you write down whatever you require to deal with the issue at hand.

2-3 days a week I will go at 5pm to work either in the Medical Assessment Unit where we assess acutely unwell patients either in the unit of in A&E, making decisions on whether to admit, when to start treatment etc. We experience the 4-hour targets acutely as A&E relies on us to make decisions within this window, although frequently patient’s just get “punted” straight to wards if they’re too busy, where a junior doctor will fully complete all their basic assessment. This is after an already busy day on a ward doing all of the above. Often you are already quite tired but I find a good source of caffeine goes a long way in the mid-afternoon.

Then eventually I hand over to the night team (whom I will be a key member of tomorrow) so that all the acute patient’s are discussed and the team is informed of outstanding tasks and any more seriously unwell patient’s. I normally get home at 10pm on these nights due to a short commute. Then I go home and fall into bed, then i’m up and ready to go for 8:30 again.

Thankfully under the current rules I am only allowed to work stretches of 12 days straight very infrequently, although I worked a 12-day stint every 4 weeks on my first job in general medicine in my first year of work. To give an example of my rotas I work 4 nights this week then I am off for 2 days then back into a weekend long day working in the medical receiving unit on Sunday then a 9-5 day on MAU again on Monday then off for 2 more days then back in for 3 more nights. We tend to work our nights in the hospital I am based at in quick succession which has it’s advantages and disadvantages but I know I am going to be zombie like for much of the next 2 weeks and will probably get out on my bike only once or twice in those two weeks, which is naturally by far the most negative aspect of this particular pattern of rota.

I am not going to say anything about ethics and the application of learning we implement as there are many other jobs that require a high degree of intellectual input. I more mean to inform those who might wish to feel that somehow as a junior doctor we do not work hard or are not good value for the money invested in us. My personal belief is that we are.

If cuts need to be made then why not look at cutting hours so therefore cutting overtime banding.

As I understand it, the whole point of those bandings was to discourage the Trusts from making doctors work stupidly long hours and no more than a certain level of anti-social hours per month.

I believe the idea was to make it financially viable to hire more doctors.

The new proposals are basically “hey we can reduce the number of anti-social hours that our doctors work by simply changing what the contracts define anti-social hours as. After all, getting home from work at 11pm isn’t really “anti-social”. I’m sure there are loads of social things they could do before getting up at 6am for their next shift”

dragon – Member

I find it hard to feel that sorry for doctors working silly hours when they’d have known that was the deal before they signed up.

So, it sounds like you’re in favour of people sticking to the deal that both parties have signed up to? Welcome to the team!

Patient expectation is the problem. I used to work in a day hospital for people who needed help with physio, nursing, OT and medical needs. Once their issues were sorted out they would be discharged. The thing about that is that all these old people loved the social part of it and were gutted when they couldn’t come any more. What they did to combat this was go back to their GP and tell them a pack of lies that they were back at the point where they were before they were referred to the day hospital. They would often get their mates to do the same. The service was bogged down with people who had no need for it. This had a knock on effect of keeping people in hospital who could have been discharged if they had access to day hospital services.

I also used to work in an orthopaedic unit. I used to get dogs abuse because I would say that people were fit for discharge, but their families wanted 4 times/day package of care to help their relative go for a piss when they were perfectly capable of walking there themselves. These people would often kick up so much fuss that they stayed in hospital for months when there was no need for them to be there.

Dont blame the employees within the NHS – blame the people who are ripping the arse out of it.

As for Drs working long hours – how can that possibly be safe? Would you want someone making life and death decisions when they can hardly keep their eyes open. I have a mate who is a GP, the stories she tells me about her old classmates who have died on their way home from a shift due to falling asleep at the wheel are horrendous.

I find it hard to feel that sorry for doctors working silly hours when they’d have known that was the deal before they signed up.

This isn’t the deal they signed up to!

If your boss turned around to you tomorrow morning and said “Right we’re changing your contract. You no longer get overtime so your take home pay will drop by about 30% for the same hours. Although we’re also planning to work more weekends now and they won’t be overtime either” then would your response be “Fair enough, I knew the deal when I joined”?

Yes there is going to be a rise in basic pay as part of the deal.

Can you tell the class what it’s going to be ?

I find it hard to feel that sorry for doctors working silly hours when they’d have known that was the deal before they signed up.

it isn’t about the hours, it’s the change in contract, i.e. exactly NOT what they signed up to.
… and in terms of overall hours, the working time directive is 12 years old now so vast majority of junior doctors will have signed up while it was in force anyway.

There’s some powerful arguments being out forward by Jeremy Hunt supporters on here :

What this boils down to is “give us more money or we kill you and your family”

I find it hard to feel that sorry for doctors working silly hours when they’d have known that was the deal before they signed up.

I’ve learnt not to expect too much in the way of intelligent and coherent arguments from Tory supporters on here, but ffs.

Any new system being piloted?

A system that is completely new?

No, I don’t mean re-engineering or re-structuring or unicorn fencing or innovation generation or creativity discovery or new mission statement etc …

😯

Yes there is going to be a rise in basic pay as part of the deal.
Can you tell the class what it’s going to be ?

Erm..no because they won’t say. Which means it can’t be going to be very much.

I have only skimmed through comments here. But can clearly see most comments are very ill informed!

My son is in his 5th year of medical degree. That’s 5 years s of racking up debt. When he starts as junior doctor next year … he starts on £22k a year, then something like £25 the following. And he apse has to pay around £2k a year out of that for professional membership and exams.

To get to the £56k a year I read quoted here will take a very long time.

Junior doctors are on the frontline day I n day out. To compare them to firemen is ridiculous.

Some crazy comments above,some well informed, some well meaning…
Pretty much sums up the mix of society.

I often chat with my patients and we mull over where the NHS (if it remains called that) is going.

Primary care (general practice) is in a big recruitment crisis (I guess ten squillion pounds a year clearly isn’t enough money for us…) and I really think will ‘shut up shop’ in the next 5-10 years, if nothing changes or improves.
It will start slow – your surgery cutting clinics and appointments initially, then simply closing down.
3 surgeries in the local area have already shut here.
Don’t forget, GP (partners) aren’t ‘paid’ by anyone – they take the remaining share of the business profits. As that figure goes down and down (less income, higher fees etc) there’s a turning point where partners will say ‘forget this, I’m out’…

Now it seems hospitals will go the same way.
The painful this is that people will just drop out of training and move country, or locum. Locums cost a fortune. Staff costs will actually climb, which creates it’s own issues.

Hold tight chaps and chappeses….those ‘greedy doctors’ some of you talk about won’t be here forever….

They’re paving paradise and putting up a parking lot….

DrP

I wouldn’t be prepared to work the hours/conditions that junior doctors already do so I fully support them striking to oppose things getting worse. There’s so much waste and inefficiency in the NHS but it’s rarely on the front line, it’s just the front line is where the biggest costs are so it’s easier to find an excuse to cut that for a quick ‘win’ than spend years reforming the back-end side of things.

To compare them to firemen is ridiculous.

As a potentially useful comparison, here is a (reasonably rigorous) list of what City law firms pay trainee and junior solicitors up to 3 years post-qualification (6 years post-university). Most trainee salaries in the City are GBP35-45,000, climbing rapidly on qualification. For that, you do unsocial hours, but it’s basically word-processing, paper-management and gratuitously staying up late to show how tough you are. It’s hard work, but it’s not life-and-death.

Trainee admission will need a 2:1 degree from a top-20 university, plus some chat and nice hair. Almost anyone capable of getting into med school will ace that admission process. (I mention law only because I know the market a bit. Finance, management consultancy, management training programmes will all be fairly similar).

I’d be far less worried about existing doctors fleeing to New Zealand than a chunk of next year’s university intake deciding to skip med school because it’s just not worth the hassle any more.

I have only skimmed through comments here. But can clearly see most comments are very ill informed!
My son is in his 5th year of medical degree. That’s 5 years s of racking up debt. When he starts as junior doctor next year … he starts on £22k a year, then something like £25 the following. And he apse has to pay around £2k a year out of that for professional membership and exams.
To get to the £56k a year I read quoted here will take a very long time.

But this is only half of the facts isn’t it?

Junior doctors earn allowances of between 1/3 and 1/2 of their “salary”. Professional membership is fully tax deductible, and on top of this they will be effectively earning around 25% of their salary via the defined benefits pension that everyone else would have to it for as an employee contribution.

So the £22k is actually around £35-40K of effective remuneration and the £56k is close to a £100k – both of which put a very different light on the “we strike you die” threat.

Just5minutes – you are trolling right?

Yes my wife puts professional fees on her tax return. So far this year she has paid out over £6k on indemnity and course fees. Have you done the same just to do your job?

Oh and what is also worrying is that if doctors sociable hours become 6 days a week, 8am to 10pm, it’s a slow erosion for everyone in private industry so working to 10 pm will be normal

I’m not a doc tor but when they docs strike, I’ll be taking a day off work to join them.

Professional membership is fully tax deductible

That doesn’t mean you get the money back, it just means you can offset it against tax, in the early years you’ll only earn enough to offset against 20% tax, so you still pay 80% of it.

Most of them could walk into a management consultancy role and double their salary. Something wrong with our world where Doctors are half as valued as management consultants.

I hope they don’t strike because I’m not sure that will either garner support or turn public opinion. The rhetoric on both sides of recent strikes has painted nobody in a positive light (tube drivers, firemen etc)

Just 5 minutes. If you want to post to the conversation at least have the decency to read the previous posts. I wish 22k really was 40k but I’m afraid it isn’t its about 28k as I have said. It’s basic maths really – that would be a roughly 100% uplift. As you said yourself it between 30-50, but not all jobs are banded either. We get that banding because we work long hours and nights – many other people would earn that sort of money if they worked the hours we do.

Interesting to read opinions. There is no doubt morale in the medical profession is falling off a cliff.

The new contract is probably a.push toward seven day working which is a huge issue – as mentioned elsewhere 7 day working is just a redistribution of staff from 5 days to 7 = lower staffing levels.

“Right we’re changing your contract. You no longer get overtime so your take home pay will drop by about 30% for the same hours. Although we’re also planning to work more weekends now and they won’t be overtime either”

And you missed the bit where they will be a basic pay uplift.

As for the 30% reduction being thrown around even the Guardian article that was broadly supportive of junior doctors didn’t think this would be applicable to anyone but a few outliers.

Something wrong with our world where Doctors are half as valued as management consultants.

Its not a remotely fair comparison as management consultants are in the private sector and wages controlled by market forces. Doctors however are in the NHS and the government control the market (which is why doctors were so anti the NHS when it was setup).

I suppose theres always the argument that junior doctors with family responsibilities, kids etc (ie. mainly women) have been screwed over fairly badly by the current system, in that they are left behind on a much lower basic wage while the carefree male doctors have been able to supplement their wages quite nicely with all the unsocial hours payments. It would be interesting to review this as a case of indirect discrimination, and compare it with what has happened in local authorities over male vs. female equal pay cases…

The other question is whether this will see an uptick in those moving into General Practice, which has been suffering a recruitment crisis itself, despite the potentially very nice money on hand?

didn’t think this would be applicable to anyone but a few outliers.

Well that’s balls. It’s anyone in a reasonably well subscribed* specialism that does a significant amount of on call work. That’ll be your anaesthetists, general medicine and so on. A massive chunk of the workforce will see there wages drop by something of that order.

Its not a remotely fair comparison as management consultants are in the private sector and wages controlled by market forces.

Except that as it turns out there is a competitive market for doctors pay – from locum work, from working abroad and from leaving the profession. Cutting pay in the face of increased competition is a bit daft.

*Depending how the mysterious stipends work out, it could apply to radically undersubscribed specialisms like A&E too.

And you missed the bit where they will be a basic pay uplift.

How much is that uplift? I take it’s at least 30%?

Ninfan not that simple. If you work part time you still do nights weekends etc just not as often.

Means many areas which have lots of antisocial hours working (eg A/E which canbe two weekends in three) struggle to recruit and then to retain.

My mum has just been in hospital for 5 weeks after suffering a brain hemorrhage. During her stay in hospital I found all the NHS staff to be amazing, particularly the ones in ICU where she spent a few days post op. Nothing was too much trouble and everything was clearly explained. The doctors I dealt with were very understanding and patient.

Compare that with MPs and the salaries they think they[/u] deserve. Was it Rifkind who said that £67K wasn’t enough to get by on?

Doctors have my full support.

A massive chunk of the workforce will see there wages drop by something of that order.

Not according to the Guardian article I read, the whole thing is supposed to be cost neutral. Although as always when things change there will be some winners and some losers.

Anyway these are all part of the negotiation process I would’t expect the terms to end up as they are proposed, as the government will water them down to an extent.

Except that as it turns out there is a competitive market for doctors pay – from locum work, from working abroad and from leaving the profession.

Do it then, although I doubt people who trained to be doctors and ‘love’ the NHS are likely to rush off to become management consultants or bankers. As for leaving the UK that’s more realistic, however, the BMJ haven’t seen a noticeable increase. And with Australia likely to tip into recession anytime soon then that option won’t look so attractive anymore.

however, the BMJ haven’t seen a noticeable increase.

Not true, applications for the license to work overseas have rocketed recently…

http://www.theguardian.com/society/2015/sep/25/nhs-doctors-contract-changes-work-abroad-applications

If I had to pick the few areas of modern society where I would prefer that we have the very best people employed, in a supportive working environment, well compensated, well resourced, well rested, respected and with the support needed to do their job it would be: (not in order)

> The people that look after us when we are sick and in need of care
> The people who come to our rescue when tragedy strikes
> The people who are entrusted with looking after and educating our children

Funny how they always seem to be the people that are squeezed time and time again, shat on, abused, and taken for granted.

I don’t know how you go about fixing or improving the situation, but I can’t help but feel that making it worse for those people is not the way forward.

Frankly, I feel a little embarrassed that I could earn as much or more than these people for just sitting at a desk all day moving 1’s and 0’s around 🙁