doctors on strike

My money is that it’s just a statistical quirk and that the death rates in hospital are pretty much the same on each day of the week. The danger is that statistics can all be manipulated to “show” whatever you want them to show.

+1 on the huge numbers of vacancies in junior doctor rotas.

My rota has 7 doctors working a rota for 12, and the next nearest hospital has 9 doctors on a 12 person rota for my specialty. The gaps are plugged by the current junior doctors being forced to do the extra shifts, and research fellows (currently studying for PhDs/MDs) doing extra shifts at locum pay – which the government would like to reduce by more than 50%.

The reduction in locun pay will cause huge problems – the suggested values are likely to be far less than people value their free time at…

legolam – Member

The gaps are plugged by the current junior doctors being forced to do the extra shifts, and research fellows (currently studying for PhDs/MDs) doing extra shifts at locum pay – which the government would like to reduce by more than 50%.

What is the solution considering all other industrial sectors consider themselves important as well?

I’d suggest, if an industry is struggling to recruit enough employees, reducing their remuneration and making their working conditions worse is hardly likely to improve the situation.

I’d suggest, if an industry is struggling to recruit enough employees, reducing their remuneration and making their working conditions worse is hardly likely to improve the situation.

Funny how the Tories don’t like the free market when it doesn’t suit them!!

Given that Joe Public should neither trust the government nor the BMA, who has the best assessment of the state of play that is well informed and as least biased as possible?

That’s easy. Just ask any Dr.
The most trusted professionals

Doctors? Many of which (myself included) don’t trust the BMA or government either. I’m not a member of the BMA (after they rolled over following the implementation of MMC/MTAS), and I certainly didn’t vote for a Conservative government.

DrJ – Member

legolam – Member
I’d suggest, if an industry is struggling to recruit enough employees, reducing their remuneration and making their working conditions worse is hardly likely to improve the situation.

Funny how the Tories don’t like the free market when it doesn’t suit them!! [/quote]

The question is why are they struggling to recruit?
Have we stopped producing qualified medical personal?

Free market? I think what you are witnessing is precisely the work of free market by moving resources around. Please bear in mind other industrial sectors also want a piece of the resources. As for priority I am afraid everyone will say they are the first priority.

Question is how do you ensure all industry sectors is happy? Coz all of them want to get the first priority.

There are no “neutral ” [in the sense you mean it] sources of data as anyone with facts will be connected to the NHS.

I Have no idea why you dont just say
IMHO we should use x as a source because the others are biased rather than ask us to guess at your thinking

I would assume almost everyone will trust individual doctors, if not the BMA, over the govt minister/dept.

https://www.ipsos-mori.com/researchpublications/researcharchive/3504/Politicians-trusted-less-than-estate-agents-bankers-and-journalists.aspx
Legolam, just supplying some facts as per the request.

Why are you more likely to die on a Wednesday? No idea. Maybe it’s a statistical quirk? Maybe it’s because more complex procedures are done in the middle of the week?

It’s certainly not because there are fewer doctors on a Wednesday, although the new contract will necessitate reduced medical cover during the week to give better cover on the weekend.

Maybe its because we are comparing eggs with oranges.

There are 2 sets of figures circulating and being selectively quoted to fit ones preferred spin. The figures Hunt is quoting relate to a higher risk of mortality namely what proportion of patients admitted on a particular day of the week are likely to decease rather than leave hospital. Likely reasons for this being higher at the weekend are as quoted below.

There is a higher death rate at the weekends but this is in part or in whole because less patients are admitted for routine operations at the weekend and in some areas end of life care is less available in the community at the weekends so such patients get admitted to hospital instead.

The Wednesday high relates to the absolute number of deaths and not the rate/percentage, and probably reflects the increased numbers of major operations being done towards the early part of the week and the working week being associated with increased numbers of RTAs/work related accidents etc.

Of course now we have in addition to that the Hunt effect as documented above, where the good Jeremy and the less informed members of the press, have persuaded the seriously unwell that it is safer to deteriorate at home than seek medical attention at the weekend which may be having the effect of increasing both the absolute number of deaths and the mortality rate but has at least made sure that a higher percentage of those deaths happen on a normal working day.

Re pension, I am another old fogey needing to look at whether I continue to contribute.This year the NHS pension will pay a net contribution of over 2 billion ukp to the treasury. In each financial year the contributions from current members pay the pensioners pension payments and any surplus at the end of the year goes straight to the treasury. The pension was already in yearly surplus before the contributions doubled so the increase was in effect a tax on all members of the scheme regardless of salary. I think I now pay 12-13% of my salary as a pension contribution whereas I am told the judiciary gets the same pension arrangements and pays but 3%.

Even though there is no pot, I will in due course be taxed as if there was. Current advice is that those of us making the biggest contributions may be better off ceasing to contribute and investing the money, after tax, in other ways. Where that leaves the pension fund, the pensioners and the taxpayer God only knows.

The question is why are they struggling to recruit?
Have we stopped producing qualified medical personal?

We haven’t stopped producing qualified medical personnel. It’s just that things are so bad working for the NHS, that doctors are voting with their feet and going elsewhere to ply their trade. Market forces in action. I’ve lost count of the number of friends and colleagues who’ve gone to Australia, NZ, Canada, even Malawi!

Regards the most deaths on Wednesdays – I think it’s something to do with more more serious cases happening at the weekend and those folk only surviving a couple of days.

legolam – Member

The question is why are they struggling to recruit?
Have we stopped producing qualified medical personal?

We haven’t stopped producing qualified medical personnel. It’s just that things are so bad working for the NHS, that doctors are voting with their feet and going elsewhere to ply their trade. Market forces in action. I’ve lost count of the number of friends and colleagues who’ve gone to Australia, NZ, Canada, even Malawi! [/quote]

Out of interest.

Do they uproot by moving their entire family members there?

Or are they young free and single?

Both. It’s more difficult with partners and families, but I know plenty who have still done it.

legolam – Member
Both. It’s more difficult with partners and families, but I know plenty who have still done it.

In a free market the valuable ones (good ones) are normally head hunted while the rest are just filling up vacancies.

Where I came (Borneo where I used to be) from I was told there are now over supply of (junior) doctors with low experience. The good ones are going on to greener pasture overseas …

In my part of the world becoming a doctor is to earn good money or once they gained good experience they go private. Apparently, it is the profession that can earn the first million apart from being corrupted politicians.

Chewy producing as many as ever. Many juniors, even with the existing contract just find the hours/rota patterns/increasing assessment and training requirements not worth it and are choosing to locum for a few months/years or go overseas.

Some specialties – eg A/E frequently fail to fill their training posts every year.

Morale is low, stress levels are perhaps highest ever – contract changes have come at the worst possible time in many ways.

And seven day services needs way, way more than a few more doctors. Will need massive numbers of all staff groups.

I would still maintain being a doctor is the best job in the world, but if staff feel undervalued enough then they will walk.

jet26 – Member
Chewy producing as many as ever.

Calm down dear please don’t get too excited over my comments.

I am not here to argue negatively but rather trying to understand the situation a bit more.

Many juniors, even with the existing contract just find the hours/rota patterns/increasing assessment and training requirements not worth it and are choosing to locum for a few months/years or go overseas.

As can be seen from the number of certificates (required for overseas working) that are currently being issued:

In 2015 the GMC has issued 7,588 certificates compared with 4,925 last year. In 2013, doctors were issued with 5,142 certificates.

— http://www.buzzfeed.com/laurasilver/doctors-poised-to-leave-the-uk-as-applications-to-work-abroa

Sorry if gave hat impression, thought fair question.

This was posted by Dr Rant on Facebook. Yes it’s long, but it summarises the current situation nicely. It’ll be interesting to see how many of his predictions come true:

Dear Readers,

it is the final few days of polling for junior doctors to decide on whether they will take industrial action or not. Polls suggest that they will. And over the next few days, I expect to see them demonised by the government and by the media. I am going to write a summary of some of the lies I expect to be used in the forthcoming days. I write this as a GP who used to be a junior doctor, who is not part of the BMA committee, and who has no involvement in any of the planning of this action.

1) “They’re only doing it for the money”. “The offer of an 11% pay rise is generous, and they are being greedy”.
Junior doctors are straight ‘A’ students who have been through a vigorous selection process, five years of arduous training with no pay, and amassing tens of thousands of pounds worth of debt. Most of them could succeed in better paying fields than medicine. Most of them couldn’t care about the pay, other than expecting that society should take care of them. The 11% pay rise is on basic pay only, which only makes up around half of the hours worked. There will be a big cut in the rest of the pay, the ‘on call’ hours. And overall, in terms of pay per hours worked, there will be a relative paycut for most of them.

2) “They are being led by a bunch of militants”.
The chair of the junior wing of the BMA is a trainee gynaecologist, who does the BMA bit as a side-line. All those organising the action are working junior doctors. There is no ‘hard core’ element, just a few junior doctors who have been elected by other junior doctors to speak for them. The media will be hunting for smear stories. So far, they have found out that the chair has photography as a hobby, and sometimes does wedding photos. I expect they’ll find more stories somewhere.

3) “There is a secret forum of militant doctors”.
Three Daily Mail journalists uncovered this story by using the Facebook search function, and found a large group called ‘Junior doctors contract’. The only screening tool was a moderator asking if they were doctors. Over 2/3rds of junior doctors in the UK are registered with this group. It is not secret – it is a social media debating area. This is hardly Al Quaida. The group have even created the twitter hashtag ?#?meetthedrs? so that the public can engage.

4) “Jeremy Hunt says his doors are open for negotiation”.
No they are not. The reason that the BMA walked away from the contract talks is because preconditions were set by Hunt and his team. Of the 23 points of the DDRB recommendations, the BMA were told that 22 needed to be accepted before any negotiations took place, and only the section on ‘relocation expenses’ was open for discussion. Do you blame them for not engaging? Since then, Jeremy Hunt has used soundbites in the media, rather than serious negotiations.

5) “They just don’t want to work weekends”.
Rubbish. Since before I started training as a junior doctor in the 1990s, there has always been a 24 hour NHS, and all juniors go into the job knowing that they will spend vast numbers of weekends, evenings, and nights working. The DDRB proposals simply recommend reclassifying many night or weekend hours as ‘normal pay’, meaning junior doctors will get paid less for antisocial hours.

6) “They are only a few inexperienced trainees”.
Let’s give an example. When you come into hospital at midnight with a burst appendix, the first doctor you see, an A+E SHO doctor, sorts out your pain relief and gets all your medical details, and is likely to have had around seven years of training. The surgical SHO doctor, who prepares you for your operation, will have had eight years of training. The anaesthetic registrar, who keeps you alive during surgery will have had 12 years of training. So will the surgical registrar, who operates upon you. All of these are ‘junior’ doctors. These are the doctors who deliver your care. They may need to ‘consult’ a senior doctor, called a ‘consultant’. But they are the medical workforce of the NHS.

7) “The public will suffer”.
Actually, no. The opposite will happen. Worldwide, for every junior doctor strike in history, mortality has gone DOWN. Yes, you are in fact LESS likely to die during a strike. This is probably due to the fact that many medical procedures have risk, and for short strikes, disease and illness is usually slow enough not to be affected. The BMA are proposing only short spells of industrial action.

8 ) “These strikes should be banned”.
Erm, why? Why would anyone work in a field where pay is less, hours are longer, conditions are becoming worse, with no legal redress? Training a doctor takes a lot of time and a lot of money, and only a select few can do it. And those select few have top A-grades, degrees from well recognised institutions, and transferable skills. For training in the UK, there is a monopoly employer – the NHS. Why shouldn’t medics have the right to strike?

9) “We need a 24 hour NHS and the junior doctors are opposing this”.
There is already a 24 hour NHS. It already provides one of the best medical services in the world, 24 hours per day, while remaining impressively cost efficient. At weekends, there is comprehensive emergency cover. The Tory party seem to want an NHS were normal services also run seven days per week. They have based this on specious interpretation of some research papers, and on trials which in fact showed that the public didn’t really want to see doctors on a Sunday. Never the less, they want to steam-roller this through. A sensible person would think that this could be done by increasing NHS funding 2/7ths, or around £50 billion per year. However, the Tory party seem to think that £8 billion is enough. It would seem that none of this would be going towards the pay of junior doctors, who would be expected to provide the medical manpower.

10) “This is all to improve medical safety”.
Quite the opposite. The number of applications to medical school has dropped. There will be no increase in UK doctor numbers. The safeguards which currently exists mean that the more a hospital works junior doctors during antisocial hours, the higher the hourly pay. The new contract makes this a flat rate, regardless of how hard you work them, and promises some sort of fine or official sanction if they work beyond a certain limit. This is no safeguard to prevent doctors having inhumane shift pattern, or from being used as fodder at times when training is impractical. Lastly, if the numbers don’t increase, how will the same number of doctors who work a five day routine week plus emergency hours cover work a seven day routine week? Well, they’ll have to be spread more thinly.

11) “They are already the best paid doctors in Europe”.
Not correct. They will leave medical school with an average of £50,000 worth of debt. The starting salary is £22,000. They will be expected to rent a room in or commute into a major city for their daily job. The salary of junior doctors is about average in Europe, behind Germany, Belgium, Austria, Luxembourg, Ireland, and Denmark.

In reality, the junior doctor contract is being imposed on them by a Tory Government who wants them to work harder, for less money, in less safe conditions, and is not prepared to listen to their concerns. They are not greedy, they are not workshy, and they are certainly not militant. They are opposing Jeremy Hunt, a man who wrote a book on how to dismantle the NHS.

So, dear reader. Who do you trust? The junior doctors? Or the Tory Government?

So its decided.

99% voted in favour of action just short of full strike and 98% voted for full strike.

Just shows how far doctors have been pushed. I think previous ballots have been in the 60%’s of supporting action.

The first of 3 strike days is the 1st Dec, which I believe is retaining Emergency Cover, followed by a 2nd, and the final being full out strike ie no emergency cover. (correct me if I am wrong)

Its a very sad day that things have had to come to this, but just shows how far Government is at odds with its own employees.

Planned actions on BMA website are:

Emergency care only — over 24 hours from 8am on Tuesday 1 December to 8am on Wednesday 2 December. This would see juniors provide the same level of service that happens in their given specialty, hospital or GP practice on Christmas Day

Full walk-out — from 8am to 5pm, Tuesday 8 December

Full walk-out — from 8am to 5pm, Wednesday 16 December.

The walk out is a withdrawal of junior doctor labour. As I understand it the consultants have broadly agreed to provide emergency cover for them.

I wonder when the consultants will go on strike due to their contract negotiations going the same way.

Jeremy with the silent c is still spouting his liesstatistics and trying to spin it to make the Dr’s look bad.
Given that demand (for Dr’s) outstrips supply there’s a simple economic equation that he doesn’t seem to grasp.

No sympathy from me I’m afraid, the justifications for striking are tenuous at best, grossly irresponsible at worst. The complaints seem like typical Generation Y ‘I’m too special for this’ rubbish, perfectly exemplified by that idiotic holier than thou claptrap from ‘Dr Rant’ above.

If the junior doctors weren’t so thick, they’d realise that the real villains are the older consultants who bled the public purse dry in earlier negotiations. This is a typical baby boomer versus the rest scenario, and unfortunately neither the junior doctors nor patients are going to come out of it well.

Doctors, you have now joined ‘the list’ along with dentists and tube drivers.

No sympathy from me I’m afraid, the justifications for striking are tenuous at best, grossly irresponsible at worst.

Hi Jeremy!

No sympathy from me I’m afraid, the justifications for striking are tenuous at best, grossly irresponsible at worst.

You don’t actually know what they are, do you?

The complaints seem like typical Generation Y ‘I’m too special for this’ rubbish, perfectly exemplified by that idiotic holier than thou claptrap from ‘Dr Rant’ above.

Proof that some people can read and yet not understand.

bainbrge – Member
The complaints seem like typical Generation Y ‘I’m too special for this’ rubbish…

go on please, i only need a few more to complete my bullshit-bingo card.

The complaints seem like typical Generation Y ‘I’m too special for this’ rubbish, perfectly exemplified by that idiotic holier than thou claptrap from ‘Dr Rant’ above.

I went through university with a lot of medics. They all worked a hell of a lot harder than me, and no doubt continue to do so now they’ve qualified. Many of them are still junior doctors, and until this all kicked off and I found out how paltry their basic pay is, I always assumed they made better money than me in return for their stressful long hours of saving people’s lives.

The NHS is full of people working very hard for not a lot of money. Junior doctors exemplify this.

The complaints seem like typical Generation Y ‘I’m too special for this’ rubbish

So can we assume then that you wouldn’t complain if your boss told you he was going to forcibly change your contract to redefine your working hours (resulting in a large pay cut); and remove the safeguards that prevent you working long hours (resulting in an increased chance of you accidentally killing a customer); and disadvantage those taking parental leave or working less than full time (meaning less staff overall); and perhaps worst of all, he was telling people that he needed to do this because you don’t work weekends and nights (when you do) and that actually it was really a pay rise (which it isn’t).

You’d roll over and take that would you?

(Generation Y looks a bit older than I thought)

Graham – read the second para of my comment, of course the senior doctors support the juniors…they are the baby boomers who’ve eaten the cake already!

In answer to your first point around working conditions, I’m not convinced any of your assertions are demonstrably true. Hence my view that strike action is unjustified. I might be old fashioned but when your vocation (not ‘job’) involves saving lives, strike action is inappropriate at any time.

Maybe we will see doctors coming into work anyway if they learn that effective cover cannot be provided in their absence – do you think they will? Seems pretty clear cut in the context of the Hippocratic oath…

bainbrge – Member
…I’m not convinced any of your assertions are demonstrably true.

just out of curiousity, why do you think the Jr Doctors are pissed off?

Maybe we will see doctors coming into work anyway if they learn that effective cover cannot be provided in their absence – do you think they will?

If there was a major incident they would undoubtedly be there before the patients arrived.

Seems pretty clear cut in the context of the Hippocratic oath…

Can you tell us what the Hippocratic oath says?

I might be old fashioned but when your vocation (not ‘job’) involves saving lives, strike action is inappropriate at any time.

You make it sound like they’d strike on a whim. This is the first one for 40 years, which if nothing else, ought to be a reasonable indication that they’re extremely pissed off.

The vast majority of consultants support the juniors strike as we recognise and value the work they do. I am certainly no baby boomer, and I must have missed the cake when it was handed round. The consultants will cover the juniors work during the strike, most planned procedures will be cancelled. It didn’t have to come to this but Jeremy has royally p1ssed everyone off.

I might be old fashioned but when your vocation (not ‘job’) involves saving lives, strike action is inappropriate at any time.

Everyone should have the right to strike. They’ve given plenty of notice, so there will be adequate emergency cover from Consultants.