I’ve just received the letter setting out the terms of the contract and have been doing some number crunching based on my best guess on how the new contract works (it’s a lot more complex than my current one!).

I believe that I will personally be losing £1500 PA in the first year after imposition, and losing £4000 PA in the second (after which I hope I will be able to escape!). Interestingly, the old offer made in November was actually better financially for me – I would have lost £1200 in the first year but gained £4000 in the second.

It would seem that those in less than full time jobs (mainly women) will stand to lose a significant amount as they won’t go up the pay scales as quickly as before.

Doctors taking time out to do academic degrees will also lose, as they will not go up any pay scales whilst doing research (even though most still work in clinical medicine during their research) and will only gain the bonus for academics once they have actually submitted and passed their degree, rather than when they return to work.

Yup, I do this all the time. I met P20 and Ahsat on a remote moor in Northumberland and stopped for a chat – they’re now very good friends and regular riding buddies. Plus I spent half of the Kielder 101 being towed around by Thenorthwind and shared a beer at the finish line with him. Ir_bandito once greeted me at the end of the North Pennines MTB Marathon with “hey, you’re that girl off strava/STW!” – which my non-STW friend found a bit odd!

My husband regularly thinks I’m going to be abducted by some strange man I’ve met on the internet, and my IRL friends think I’m weird for using the internet to make friends (although they just use it for finding people to have relationships with, which I think is way worse!)

“Normal” hours for those on the Agenda for Change contract (which I believe includes nurses and other allied health professionals) are 6am-8pm on weekdays. Saturdays and evenings/nights attract a 30-50% premium. Sundays and bank holidays attract a 60-100% premium.

Link

Edited for rogue apostrophe

Apart from the bit that they want services 7 days a week but on the same budget. I guess spreading services over 7 days and not 5 is possible as the demand is the same but you treat patients over more days, however I am sure its si not as simple as that. In addition the doctors are only one tiny part of the NHS and actually you need all the nurses, X ray staff, lab tech, etc to be working 7 days and the costs associated with that.

This is exactly what the dispute is about. Why are we pushing for a “7 day NHS” when no-one can tell us what that means? We already have emergency and urgent care 7/7, and there isn’t a need for 7 day elective care currently. Even if there was, we don’t have the numbers of doctors to provide this. And even if we did, we’d need all the other healthcare professionals to buy into it as well to make it work.

What I don’t really get is the the BMA side. They say its is all about patient safety but if that is the case why is not every other person in the NHS striking as well. Would it not also effect the consultants the nurses, etc, etc. If it really is all about safety then wouldn’t it be the duty of any and every professional person in the NHS to strike as well.

The BMA only represents doctors, not nurses or other allied healthcare professionals. Therefore the latter group cannot strike unless their union (Unison, for the most part) ballot them on industrial action. I’m not sure, but I think consultants have various no-striking clauses written into their current contract.

To me on the outside it really does just look like doctors not wanting or liking to be told what to do and wrapping it up in the patient safety argument. If not why are all the other NHS staff not supporting them as well and as equally alarmed about patient safety.

Nurses, midwives, porters, consultants etc etc are all supportive of this action. They are all aware that they are in the firing line of Mr Hunt next. The exodus of junior doctors following this contract imposition will be nothing compared to the exodus of other healthcare professionals if they are treated in the same way.

I’m not sure if I pointed this out earlier, but I actually did the figures to compare my current salary to my potential new one under the new contract and I actually stand to personally gain from this debacle (as I’m a senior trainee at pretty much the top tier of the salary scale, I worked out that I’ll be around £4k per annum better off).

However, I still think that the new contract is an utter pile of horseshit and am against it in its entirety. It’s bad for my junior colleagues, it’s bad for future recruitment, it’s bad for women, it’s bad for academics, and it’s really bad for our fellow healthcare professionals, who are just about to get royally screwed over as well.

I’ve just seen the best idea for a counter-measure against (K)Hunt on Facebook:

Coordinated. Mass. Pregnancy.
It’s the only way.
It’s like a strike, but with pay.
43% of staff will still have to work though, just like yesterday.

I’ve just accidentally applied for my Certificate of Good Standing from the GMC to be allowed to apply to work overseas. I picked Vancouver from the drop down menu they helpfully provide – I’ve heard it’s nice over there…

Bruneep – that’s exactly what the (old) junior doctors’ contract looked like. And look what’s just happened to us…

Scotland announce extra £23m to boost medical school applications

They’re not stupid up there…

This is the worst game of “shag, marry, kill” I’ve ever played…

Well, there aren’t many female cardiology trainees round here, so next time you’re in the vicinity feel free to pop in and say hi!

Although I’m only doing locum shifts at the moment while I write up my PhD to prop up our rota (7.5 people on a 12 person rota…)

My career path:

Left school in 2000
6 years medical school (did an intercalated physiology degree as well as my medical degree)
BECAME A DOCTOR
2 years foundation training (general medical and surgical training)
2 years core medical training
3 years core cardiology training
Currently in my 3rd year of a PhD
Still have 2 years of specialist cardiology training to do – current finish date is August 2018

For 12 of those years, I’ve been working full time as a “junior” doctor. “Trainee” is such a crappy term.

PS Drac – almost certainly! I believe we work in the same region

Um, a medical student isn’t the same as a junior doctor.

And I’m pretty sure that teachers would say that they’re in it for the kids…

On the plus side, not being able to afford to pay for parking at work means that I have a lovely 12 mile cycle commute every morning :D

My heart bleeds for you. I’m sure you can leave the profession if you so wish.

Back to the original point – I do it for the patients.

The difference is that we don’t offer to do a 91 hour week of nights, or work 15 hours in a row. We are rota’d to do that. And it is legal for us (well, not the 15 hours in a row – hospital management don’t recognise that we do this, so as not to be fined).

Well, I’ve never been a lorry driver or a security guard, so my opinion here may be misinformed. However, I think junior doctors (and most other frontline NHS staff) DO work harder than them.

A typical long day for me would see me starting at 8am and finishing around 9-10pm (I’m paid from 8am till 7:30pm for long days). I can often not eat, drink or pee during that entire time. For the majority, I’m in the cardiac cath lab, which is a never-ending conveyor belt of patients who need stents for blockages in their coronary arteries. When the nurses are wheeling the patients in and out of the room, I’ll be furiously typing up their notes into the database, and duplicating that in their written notes. I’ll also be returning calls from other doctors both within my hospital (who want me to see critically unwell patients) and from hospitals anywhere from Inverness to Manchester (as we’re the regional centre for heart transplants in the north of the UK). I’m personally responsible for the cardiac patients in my own hospital too – 30 in the elective ward, 30 in the main ward, and 8 on CCU.

Did I mention that I do this without eating, drinking, or going to the toilet?

He’s trolling just ignore him.

Nah, I can’t be bothered writing up my PhD today. This is much more fun.

So many doctors interviewed on radio seem to say that they are in it for the patients, and thats their sole reason for being a doctor. If thats the case, maybe they should donate some of their extremely generous salaries to the less well off or allow it to be ploughed back in to the NHS.

Er, which “extremely generous” salary? I’ve been qualified for 10 years and, after paying for my mortgage, bills and food, I break even every month. I only managed to buy my first property (with my doctor husband) 3 years ago (I’m now 33). I have £2,047 in my bank account at this moment. I give a small amount to charity by direct debit every month, but I don’t think I could afford much more.

I’m not asking for a pay rise either. Just not a pay cut.

I’ve been doing a bit of digging and, not only are competition ratios falling, but the quality of applicants is also dropping. The mean score for core medical trainee applications in 2013 was 26, in 2014 it was 24, and in 2015 it was 23. Link – under “2013-2015 total score data”

Junior doctors were abandoning medicine even before this new contract was mooted due to pay and conditions. The new contract will only accelerate this.

We’re getting fewer doctors and the ones that do stay aren’t as good.

Doctors training as specialists at all time low

This is one of the main issues facing the health service due to the threat of this new contract.

My own (broad) specialty – core medical training – has seen competition numbers fallen by more than a half since I applied (down from just under 4 applicants per job in 2008 to 1.6 applicants/job this year). This means far fewer cardiologists, respiratory physicians, gastroenterologists, endocrinologists etc. We are already struggling to find any appointable candidates for cardiology jobs in my region. GP and Emergency Medicine training are in even worse shape.

The two medical students working with me at the moment aren’t even planning to work in the UK at all after graduation – they’ve already had enough, and they haven’t even started yet. Unless Mr Hunt does something to improve pay, conditions and morale in the NHS quickly, we’re going to be faced with a huge workforce crisis within the next decade.

We used to do the drive from Fife to La Plagne every Easter when I was a kid. Initially, we would leave Fife at 9am and get the Hull-Zeebrugge ferry, arriving in the Alps at around 7pm the following day. Very civilized (plus we always stopped at the same places – Metrocentre for lunch, York for a quick break, Luxembourg for petrol, Aire de Jugy for a late picnic).

When my brother and I were older, we started going via the Dover-Calais ferry – left at 3am, got an early afternoon ferry, then stopped at family in Arras in the north of France for the night. The second leg took us 10 hours the next day.

We only once got the tunnel, but my parents hated it because it meant that we couldn’t get out the car to stretch our legs properly. As soon as I got my driving license, I helped out with the driving (mostly on the autoroute in France as it’s much quieter). I can’t imagine doing that drive in one go with only 2 drivers.

I got mine up to just over 70 before the Kielder 101 in September, which was after a winter of training and a summer of short course XC racing. I never get my “freshness” much above single figures though – daily commuting doesn’t seem to allow for much recovery in the algorithm, even if it is at a ridiculously slow pace.

Lansoprazole (or any other PPI). Bloody wonderful stuff. Get thee to a GP to make sure there’s nothing else going on, and get a prescription (+/- H pylori eradication).

Something like this?

Or this?

You need to either get on to NCN 14 earlier (on my map it looks like there is a bridleway/path from Market Lane to the North of Whickham which goes under the A1 then to the back of the Metrocentre to join the cycle path at Mandela Way), or go slightly West to drop down to the Derwent Walk, and cross the river over Scotswood bridge and use the excellent Scotswood Road/Quayside cycle paths (NCN 72)

How do you know if the necessary history has been relayed to the paramedics (or is on the form)? What one person deems important information may not necessarily be the same as the next person, so it’s often useful to speak directly to the carer/family to answer specific questions.

In an ideal world, the medical team looking after the patient would be able to talk directly to both the carer who knows the patient well, and the family (either in person or by phone).

I have no idea regarding the actual legalities of this, but can answer from a healthcare professional point of view.

It’s very difficult to assess and accurately treat a care home patient with dementia who hasn’t come with a carer (whether that’s a nurse from the care home or a family member). I’ve admitted patients like this when the carer has dropped the patient off at the front door and left – it’s often impossible to get any information from the patient in this situation e.g. how the fall happened, what has been injured, past medical history, medications, allergies, usual functional status etc.

In my experience, some nursing homes do send their patients to hospital without anybody accompanying them, but it’s a PITA and dangerous for the patient IMO. Even more nursing homes send them with the most junior member of staff, who didn’t see the fall, has never met the patient, and doesn’t know the first thing about their medical history.

EDIT: the ideal scenario would be that the carer stays until the patient is assessed by the medics and can give all the relevant information. I would hope that the patient would be triaged to be seen as a priority, not least because treating the pain will help to alleviate the patient’s anxiety/aggression and lead to an all-round better outcome.

EDIT 2: I’ve only ever refused to treat aggressive patients when they were fully compus mentis and are kicking off because of alcohol etc (even then, I’ve only ever seen one patient chucked out of A+E because of violent behaviour, and that was because he gave a nurse a black eye and threw a pair of crutches at the policeman who was attempting to reason with him). I don’t think any A+E department would refuse to treat a patient with dementia even if they were being aggressive.

bencooper – Member
How can mustard go out of date? What on earth is going to grow in it?

To be fair, it’s luminous yellow, so I doubt it will ever go out of date. It tastes the same as the decade we bought it and I’m not throwing it in the bin after it has survived two house moves!

We have almost managed to work our way through the 9L (yes, that’s NINE LITRES) of bright yellow American mustard that my other half managed to buy a few (8) years ago. We occasionally use it on BBQ food in the summer.

It was the result of two closely-spaced trips to Costco where, on the second trip, he thought that we’d run out so bought a second multi-pack of 2x2L bottles. I yelled at him because I thought there was no way that we’d ever get through that much mustard, plus it was a colossal waste of money.

The yelling must have made a big impression on him because, the following week, he did a quick trip to the local supermarket and picked up another litre of the stuff. His excuse was that he knew there was something important to remember about American mustard, but he couldn’t recall what, so he thought we must have run out and wanted to make sure there was some in the cupboard.

We’re down to the last litre now – it’s 4 years out of date. He’s threatening to go back to Costco…

I’m a size 38 and use the carboncycles flat pedals with no problems (http://www.carboncycles.cc/?s=0&c=84&p=940&tb=001). Have also used the DMR V8 with no issues.

8,600km
443 hours (!)
100,969m elevation (got into outer space!)
428 rides (a lot of commutes, but a lot of fun MTB and CX rides with friends too)

Aim for next year is to do a bit more “fun” riding and a bit less commuting/Strava climbing challenges (I got suckered into doing all 12 this year, which was a nice challenge but led to a few unexciting rides to reach the monthly targets).

An ECG is a fairly blunt diagnostic tool to look for structural abnormalities in the heart. It can point towards issues, but can equally give “false positives” i.e. show an abnormality where none exists.

A huge number of things could look like that on an ECG: “athlete’s heart” (i.e. a well trained endurance athlete), hereditary conditions, ischaemic heart disease, hypertensive heart disease, alcoholic heart disease, and, of course, a normal heart.

An echocardiogram (ultrasound of the heart) would be the next test to look at whether there is any enlargement of the heart (either the muscle itself, or the chambers within, both of which may show as LVH on an ECG). I wouldn’t speculate on anything until you’ve had one of those and seen a cardiologist.

BW,
Legolam/Hannah
A baby cardiologist

But to starve someone to death.. That could take days.. It sounds pretty.. I dunno.

I just came back to say that I really don’t think that this is what “we” are doing. Patients at the end of life don’t have huge energy requirements and therefore don’t really need food/sustenance. In the vast majority of situations, the patient succumbs to whatever disease had made them poorly in the first place – in this instance, dementia.

Hand on heart, I don’t think I’ve ever looked after a patient in this situation where I thought I was starving them to death, either when I’ve been involved in withdrawing care or not instituting feeding in the first place. Personally, I don’t think starvation is a humane or dignified way to go, and I don’t think you’d find many doctors who think that it is acceptable either.

Final year PhD here.
Hopefully done and dusted by the end of 2016.
Intra-coronary imaging in elderly patients with heart attacks.

I’m going to stick my neck out here and say that I think that the LCP was a really useful pathway in the treatment of patients at the end of life and I think we’ve taken a step backwards recently with all the negative publicity.

All it did was formalise how to care for a dying patient for the nurses and junior medical staff. It made sure the nurses did regular checks and turns on the patient, even if they weren’t doing “obs”. It made sure that sedatives, anti-sickness drugs and painkillers were available for the patient so that, if they got distressed in the middle of the night, they didn’t need to wait 40 mins for the only available doctor to prescribe them. And it made sure that the necessary discussions were had with the patient and their family regarding their care and what treatments were or were not wanted.

EDIT: Thanks chaps. As I said, I’ve had this discussion many, many times with relatives (am a cardiology/medical registrar) and I genuinely believe that patients receiving palliative care should have a peaceful and dignified death. I feel a small amount of job satisfaction when we are able to do this properly (even though I’d really rather people didn’t die!) and I think it’s just as important as all the big fancy life-saving procedures that we spend years training to do.

So why give her O2?

It’s a fair question. It’s not as invasive as other treatments e.g. IV fluids, NG feeding etc so shouldn’t be causing her any distress on its own (unless it was drying her mouth out), but I wouldn’t give it unless I was using it to alleviate symptoms of breathlessness etc that was distressing the patient.

Scott,

Firstly, sincere condolences about your gran. Even when people are old and have lived a long life, it’s still difficult to see them near the end.

I’ll try to answer your questions regarding your gran’s care, but I would advise you to speak to the doctors looking after her as they will obviously be able to give you specific information as it pertains to her.

This is (unfortunately) a common way for older people with dementia to die. When someone is at the end of life, our focus moves from trying to make them live longer, to easing any pain, agitation or suffering that they may be feeling. The Liverpool Care Pathway (LCP) mentioned above is just one way of formalising that.

When the patient is unconscious and frail like this, the body actually doesn’t need much sustenance or hydration. In addition, providing these things actively for the person may actually cause more suffering than not providing them – e.g. multiple attempts at intravenous cannulae for fluids, a nasogastric tube for feeding etc.

Some hospitals give fluids through small subcutaneous needles under the skin, but there is no evidence that this actually rehydrates the patient and I personally don’t prescribe this as I think it’s just treating myself and the family rather than the patient.

The hospital are not so much witholding food/water/medications, just not actively instituting treatment that isn’t going to change your gran’s outcome and may actually cause her more suffering. They may also not be doing regular blood pressures etc, as knowing those numbers won’t change her management.

They should still be caring for her, keeping her clean, turning her to prevent pressure sores, and assessing her levels of agitation/pain on a regular basis. They will also be able to give subcutaneous injections of sedatives/painkillers if she is in pain or agitated. These are the things that I would ask about when you next speak to the team looking after her.

Best wishes,
Hannah
(a junior doctor who has had this discussion more times than I would like, but who believes in peaceful and dignified deaths in hospital)

Legalam Funny that ad there was a hen party where we stayed at the YHA ..middle of Sept wasn’t you was it

Yup, that was probably us. It was the second weekend in September, and it mainly consisted of pregnant ladies making me drink lots of alcohol. Good times

Had my hen do at the Glenridding sailing centre a couple of months ago. Sad to see the devastation there :(