+1 to everyone above, get it checked out. Difficult to tell from that graph, but it doesn’t look like a one off spike in HR caused by interference at the HR monitor.

If it happens again, it helps if you are able to take your own pulse (feeling at the neck is probably easiest) and note the heart rate (count beats for 15 seconds and multiply by 4) but, more importantly, whether it feels regular or irregular/erratic. If you are near a place that can do an ECG whilst it is happening, that’s helpful too.

Noting down when it happens, how long it lasts and what seems to trigger it is useful for the doc – it’s amazing how quickly people forget the details of these kind of intermittent episodes and, without being able to see what’s happening on a monitor at the time, the description is all we’ve got to go on.

Hope you get it sorted soon,
Hannah (cardiology registrar)

“Super-steep” is all relative… I really am a bit of a mincer!

Yep, you can pretty much go down anything that looks promising. Occasionally tracks peter out, but most are fairly well worn. If you hit the river, just turn around and come back uphill. The golf course is the boundary of the wood at the top of the hill.

I was there on Saturday, but am much more of an XC mincer. This is my regular loop anyway: https://www.strava.com/activities/583436176 . It takes in lots of the usual segments, but not the super-steep stuff. The new Powerline stuff is still a bit loose as it’s literally only a week old.

It was bone dry at the weekend so hopefully it shouldn’t be its usual knee-deep mud bogfest even with the recent rain. I’m hoping to head up there for a quick blast tomorrow at some point so give me a wave if you see a girl on a small FS Canyon.

All the singletrack bits are pretty short – you won’t go wrong with just picking a track heading into the forest. They all pop you out on a fireroad soon enough, then just cycle uphill and pick another trail to explore.

going to have a knock on effect for the rest of the NHS.

Consultants next, then AfC staff, I’m sure.

The ACAS statement is a bit light on detail, but my initial thoughts are:

Good points:
Enshrining whistleblowing protection in the contract
Protected time off after 3 (or is it 4) night shifts
Some attempt to redress the gender/less than full time imbalance

Bad points:
Guardian still isn’t independent of the Trusts it will be supposedly investigating
Lack of pay progression for at least half of the time that someone is a junior doctor will still unfairly disadvantage women/less than full time trainees
Lack of safeguards for “non resident on call” trainees regarding working after a night shift
Out of hours payments will still hit the specialties that already have trouble recruiting the worst, exacerbating rota gaps

I will await the publication of the full contract with interest (and, despite what JH says, will again read every page of it before making up my mind about it).

One thing to note – this contract will be staying no matter what the vote of BMA members says. Results of the JD ballot will be due on 6 July; even if they/we reject it, there won’t be enough time to amend it before the start of August. So this is it, like it or lump it.

Moorland above Edmundbyers/Blanchland (Meadows Edge/B6278)? Might be a bit far, but has lovely smooth tarmac, twisty road, and great views.

“Asymmetric mess perception” – the husband has this too. Doubly annoying when he “tidies” (ie hides) my stuff because the house is a mess, but leaves all his own stuff out. I once gathered it all up and put it in a gigantic pile near the stairs for him. He stepped over it…

Now I’m wondering if my husband is everyone’s wife?!

Oh, thought of another one: spending over an hour sitting on the toilet when I’d like to get in to shower after commuting home (or when we’re just about to go out, or when I’ve asked him to tidy stuff…). WHAT ON EARTH DO MEN DO IN THERE?! Surely it’s not that comfortable?

What is it with men and stacking dishwashers? Every man is convinved that their way is the best and only way to do it.

My husband and my father were locked in a passive-aggressive dish-stacking war the last time my dad stayed with us. I kept catching one of them re-stacking the dishwasher after the other one “done it wrong”. Eventually, my mum and I just threw everything in and turned it on. Dishes were cleaned.

Things I may eventually kill my husband for (other than an unhealthy obsession with the dishwasher):
Being loud when he gets up before me in the morning
Leaving things on stairs to be taken up
Used teabags on the kitchen worksurface
Moaning about my muddy MTB kit in the utility room (that’s what it’s for!!)
Losing something, asking me where it is, then saying it’s not there so that I have to come and find it – WHERE I SAID IT WOULD BE
Asking me a question, then not listening to the answer so that he has to ask it again
Eating with his mouth open
Leaving the lights/TV on when he goes out

Every day I love you less and less – Kaiser Chiefs
Good Riddance – Green Day (we actually used this as the processional music at our wedding ceremony – friends got the joke, family thought it was a nice acoustic guitar tune, hopefully)

You actually got my hopes up there for a second

:lol:

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).

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.

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.

Fill rates for specialty training decline dramatically in 2016

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

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…

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.

The point of the all-out, “emergency care” strike is NOT to hit patients. The problem with previous strikes is that it hasn’t caused the hospital management or government to sit up and take notice because all the consultants and non-junior doctors have been coerced into keeping the lucrative elective operations, procedures and appointments going (as the junior docs doing “emergency care” are enough to keep a service running for 2 days – we do it like that every weekend FGS).

Withdrawing emergency care forces the consultants to be on the “shop floor” – admitting and discharging patients, requesting bloods, making day-to-day decisions etc – rather than doing the elective services that the hospital actually gets paid for (and the government publishes statistics, and is therefore judged, on). Patients in hospitals for the 2×8 hours during the strikes will almost certainly get better care than usual due to the high numbers of senior doctors looking after them for those hours (until 5pm when it’ll be the juniors in charge again). Safety WILL NOT be compromised during this strike.

However, just letting the consultants do this forever clearly wouldn’t work, as then no elective work would be done and everything would eventually grind to a halt.

Totally agree. On the road I mentioned above, my MTB handlebars (720mm!) are pretty much the width of the cycle lane and I’ve had my hands gently brushed by wing mirrors several times. I cycle on the main bit of the road now and don’t really GAS who I piss off.

Gateshead Council have done something similar near us. Except that they haven’t removed the middle white line, just painted a cycle lane taking up about a third of each carriageway (that was only just wide enough for a car on each side anyway).

The upshot is that cars assume that the half lane that they’ve been left with is plenty and just ignore anything/anyone that happens to be in the cycle lane. Bloody terrifying.

Saint Felicien is my current favourite. But you have to keep it for at least a fortnight after its best before date in this country, until it’s runny enough to pour straight from the fridge.

He seems to ride with a club called Alton CC – worth contacting them? Or post on one of his contacts’ rides if one of them uses a smartphone to log rides?

Iranian pistachios. They don’t just salt them, but also put a slightly lemon-y flavouring on that is just heaven. They might as well be sprinkled with crack cocaine at the rate that I can get through them. My father in law brings them back from Iran by the kilo, and they’re invariably gone within a couple of hours.

The best bit is that my husband is allergic to them, so they’re all mine!

And for those who are saying “you knew what you were getting into” – I’m right in the middle of the 54,000 junior doctors caught up in this mess, and I decided to go to medical school in 1999, when I was 16. I had no idea that this is what it would be like, but thankfully our medical students now are much better informed.

50% of the most junior doctors stepped away from training last year to do something else, up from 30% 4 years ago. And those figures are from before the dispute really got going. They should have been consultants in around 2020-2022.

I said it wasn’t about pay for weekend working, which was what Ben Gummer (Jeremy wanted a lie in this morning) was claiming in parliament this morning.

Maybe a better way of wording it is to say that the dispute is not about how much we are paid, rather the way that pay is structured and the obvious lack of independent safeguards in the system for patients.

Pay and safety are linked though – if all the doctors leave, it’s not very safe. And you can’t just make the remaining ones work harder to cover – that’s not safe either.

Agreed. You could pay me a million pounds and I’d still have massive issues with the contract as above.

Just wanted to make the point that pay progression isn’t automatic. Every junior doctor in training has an annual review at which you have to prove that you’ve hit all the competencies and skills targets that were set that year via an eportfolio. If you fail the review – no progression. The only times this doesn’t happen is during maternity/paternity leave and during breaks for research, to reduce the disincentives to having women/parents and academics in the profession (rightly so, I believe, although I should disclose that I’m a female academic junior doctor…)

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).

Are both of you saying Hunt’s got his advice from his accountants then decides to cut cost hence the restructuring/re-engineering of NHS?

Or

Are you saying that Hunt woke up one day and suddenly decided that it’s a good day to cut NHS cost because he can?

Or

Are you saying that Hunt got bored of his political profile he suddenly decides that cutting NHS cost is his best way to improve his political profile and popularity?

All 3.

I think Jeremy Hunt has been told to cut the cost of the NHS, and the wage bill is the biggest cost that the NHS has. His plan would have been to start with the group who traditionally don’t get very politically involved (the junior doctors) as they are worried about messing up their chances of getting a consultant post and, once they had agreed to a pay cut (for more hours), it would be much easier to get the consultants, then Agenda for Change (nurses, porters, physios etc) to follow suit. Voila, a hugely decreased wage bill.

I think Jeremy Hunt has designs on the Conservative leadership and see this fight as a springboard for his personal political ambitions.

I think Cameron and Osborne have been conspicuous by their absence in all of this. I suspect that they have told Jeremy that it’s all down to him – if he wins, he gets the glory (and probably the leadership once DC steps down), if he loses then he will fall on his sword quietly and everyone will say how it was all Jeremy’s idea…

I am sure the govt is advised by someone in the medical field/NHS/related etc and would not be so stooopid to mess with NHS without their own experts advice.

I’ve been out riding with a female friend today. But I’m female. Am I having an emotional affair?

Is confused.

Indeed. I can only imagine that could be career suicide for many of us.

On the day of another strike by junior doctors, a potentially huge issue for the safeguarding of patients in the NHS has yet to be mentioned by the mainstream media.

Dr Chris Day, a junior doctor who was involved in a whistleblowing case after witnessing unsafe staffing levels in an intensive care unit, has had his appeal against the way junior doctor whistleblowers are treated turned down.

The crux of the issue is that junior doctors are not covered by whistleblowing laws to protect them and their career in the event of flagging up unsafe practices in the NHS. They are duty bound to report concerns but are not protected against harsh treatment when they do.

There is a gap in the law, through which junior doctors fall, as the courts have determined that Health Education England (our de facto employer) are a “training provider” and not an “employer” in the eyes of the law. NHS Trusts then sub-contract juniors doctors on temporary contracts from HEE, and temporary staff are also not bound by whistleblowing laws.

More info (a pre-judgement article) here

“Female cyclists do not generally need to push their limits, race against time and increase their adrenaline when riding rough downhill trails,” “They just want to enjoy the time spent in nature on the bike, and their expectations from the bike are completely different than men’s,”

The problem with saying that women “generally” conform to the quote above, is that those of us who don’t conform (and who actually do like pushing our limits, racing, and doing silly things whilst going downhill fast) are seen as a bit un-feminine by both genders.

And it raises a psychological barrier to those women who might want to ride their bike in a “masculine” way but don’t want to be seen to be “abnormal”.

I’m trying to psych myself up to do my first 8 min test since last July. But it’s sunny outside and I just want to go out and ride my mountain bike!

(I should really be writing my PhD thesis, but the thought of that is even worse than an FTP test!)

It’s actually not a “pay rise” of 13.5%. It’s actually an average of the increase in amount of basic pay “on transition” from an old pay point to a new one. Some juniors will therefore get up to a 25% pay rise. The most senior “junior doctors” are getting a 2% pay rise.

This is offset by the loss of the 40-50% banding that was received for the unsocial hours payment.

Ah well, worth a shot! Thanks for trying

I fell out of love a bit with the turbo over the last year and let my TR subscription lapse. However, I’ve definitely noticed a drop in fitness and endurance (especially my uphill speed) despite spending a reasonable amount of time on the bike over the last 12 months (although mainly commuting). So I’m going to reactivate TR and try to improve things a little. Does anyone happen to have a referral code or free month they’d be willing to email me (in profile)? Thanks!

He wouldn’t be the first politician to make the most of contacts made during his time as health secretary…

Patricia Hewitt joins BUPA board

Andrew Lansley is private advisor for drug firm