Thread: New Junior Doctors' Contract Board: Hell / Ship of Fools.


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Posted by alienfromzog (# 5327) on :
 

From next August the government has decided that it is going to force a new contract on junior doctors. In addition they are being completely dishonest about it.

None of this surprises me but it does make me angry.

Admittedly, this is partly about me (I am a junior doctor) but it's also about my colleagues and moreover it is very much about patients. This is really bad for patients. I think anyone who knows me on the Ship (and elsewhere for that matter) will know that I speak up for others so please forgive me for speaking up for me. It needs to be done though, it is about fairness. But if not that, then it is about the rest of you - all of us are patients at some point.

I put this in Hell in order to rant the following is a Purg-esque explanation. Feel free to skip to the ranting, it is quite long but I wanted to provide the details for anyone not familiar with the complexities.

Oh and there are a few official petitions out there if you’re interested – I won’t link to them because I’m not allowed but if you want to find them…

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Firstly, the government has said that they have to enforce the contract because the BMA (representing doctors) have refused to negotiate. This is an interesting statement. The Department of Health invited the BMA to talks but stipulated that the BMA had to agree to all the major provisions prior to negotiations. This is an interesting definition of ‘negotiations’ where you stipulate that you will not actually negotiate anything.

Secondly, it is a quite complex contract and no-one quite knows what’s going to happen. Overall, most of us will get a 10%-30% pay cut. But beyond that we do not know. Even if you think the pay cut justified (and I will explain in a moment why this is a hard sell) the uncertainty about it is incongruous.

So let’s start with current junior doctors’ contracts. They all fall under what is known as the ‘New Deal’ This stipulates a basic pay (based on a theoretical 9-5 Monday to Friday) which increases with experience year-on-year and then a banding based on the out-of-hours workload. This was really important as it put an end to the 90-120 hour average weeks seen in the early 90s because it became very expensive for the hospitals to not employ enough doctors. This new contract reverses that as it removes the necessity to pay 'overtime.'

The banding for most of us is around 50%. In most jobs I’ve worked we theoretically average only 48 hours in a week but will often work a 90 hour week (i.e. with weekends or nights) followed by some rest days. A standard rota will mean when working the weekend we would work 12 days straight.

So what is in the new contract? Well firstly the basic is going up. But as I’ve said, the basic is only 2/3 of the salary. Anti-social hours are being redefined so that anything from 7am to 10pm is ‘normal hours’ and also Saturday is a ‘normal working day.’ This has two effects, firstly it will mean overall most of us (i.e. not the small minority who work normal hours only) seeing a pay cut and also an increase in weekend working. Quite apart from the money, the work-life balance effects are what really worry me. In my 10 years of service to the NHS I have worked literally thousands of hours more than I’m paid for and done so gladly, I have worked many weekends, missed birthdays, Christmases, weddings and christenings. I could tell you about how often I stay late – but it would be must quicker to talk about how often I leave on time. I have done so gladly – I do truly love my job and the vast majority of us get that we have a wonderful vocation and want what is best for our patients. So this is what we do. It is a massive slap in the face to be forced to take this new contract.

So, let us talk about money. Doctors in the UK are not hard up. We are well paid, but – and this is important – it is not dramatically high when you look at it properly and it’s probably not as much as you might think.

Just to be clear a ‘junior doctor’ in this context is anyone who has not yet become a consultant or GP. So someone like me who’s a ‘middle grade’ or registrar in paediatric surgery is still a ‘junior’ in this sense. And I will be until I complete my specialist training and apply for consultant jobs.

So a first year doctor will be paid a basic of £22,636 and then a banding of 40-50% on top. In general the banding is a compensation for how rubbish the rota is. After 5 years of study and taking on huge responsibility, this is what apparently we are worth. If you can show me an equivalent professional job that pays less, I’ll be surprised.

Pay goes up every year and my current basic is a lot more than that but to put it in context my basic now is around £19/hour based on a normal working week. I did a laparoscopic appendicectomy on an 11 year old the other day in half an hour. So the cost of that is £9.50. Obviously that’s a little ridiculous as I’m paid the same even if I’m not operating – if I’m seeing patients, doing a ward round or nothing as sometimes it’s quiet. (It is sometimes!). In addition, I’ve spent thousands on courses and exams to progress my career – and will spend thousands more. It costs me around £1500/year in professional registration, Royal College membership, medical indemnity etc. That’s £1500/year before I can even do my job. As juniors, we also have short-term contracts and have to move (sometimes long distances) on average once a year.

In my job I have been threatened, vomited on, bled on – in fact most bodily fluids have come my way at some point. I have been scared of how I might get something wrong and harm a patient. I have dealt with rude relatives and frightened patients. This is life as a doctor. It is really tough. It is also wonderful and I would never do anything else.

We have a crisis in medicine at the moment, we are struggling to recruit people to key jobs – General practice, Emergency medicine to name just a couple – paying people less to train in these places seems like a strange response to this crisis. There are massive gaps in the rotas where posts are unfilled. This is where is really begins to affect patients – I cannot tell you how many extra hours I’ve had to work in the past 2 years to cover gaps because I’ve no idea – I really don’t want to work it out. I can tell you that in a 12 day period in May this year, I worked 180 hours because of this problem.

It will get worse. For one very simple reason. My colleagues (as a whole) are bright, motivated and hard-working. They are also sought after in other countries (Australia, New Zealand, Canada) where they will be treated better and paid better. The more who leave, the worse it will get. And I cannot blame them, burnout is a real risk.

So, even if you don’t care about doctors, just out of self-interest you should speak up. Do not let the government lie to you and about this dangerous and unfair policy. It’s bad for doctors and it’s bad for you.

AFZ
 

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Posted by Erroneous Monk (# 10858) on :
 
The government's refusal to negotiate with the BMA is outrageous. The junior doctors have my full support.
 

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Posted by Jack o' the Green (# 11091) on :
 
And mine. As a Registered Mental Health Nurse, who has worked on both wards and in the community, I'm very aware of how much work is done for free by health professionals outside their agreed hours of working simply out of good will and patient care. Without that good will, the NHS simply wouldn’t be able to function.
 

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Posted by claret10 (# 16341) on :
 
I think the only thing this stupid government is good at is demonising deserving groups and turning the public opinion against them: implying they get far too much money and are not actually deserving of what they get.

They started with the sick and vulnerable by finding ways to reword and change benefits so people lost money they needed and then now attacking the health system on which they rely.

Well if the sick and vulnerable can no longer obtain the support they need to survive as the NHS looses good and caring doctors...

Keeps the benefits bill down!!!

Just

Why destroy a health system that is the envy of most of the world
 

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Posted by Leorning Cniht (# 17564) on :
 

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Originally posted by alienfromzog:

So a first year doctor will be paid a basic of £22,636 and then a banding of 40-50% on top. In general the banding is a compensation for how rubbish the rota is. After 5 years of study and taking on huge responsibility, this is what apparently we are worth. If you can show me an equivalent professional job that pays less, I’ll be surprised.

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Don't work in academia

If I include your banding, your first year doctor starts on something like £31,000-£34,000. That's a few thousand more than a typical starting salary for a new UK postdoc, who is at a similar stage of his career and education.
 

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Posted by Arethosemyfeet (# 17047) on :
 
Depends, of course, on what you mean by equivalent professional jobs but most Physics teachers I know have 5 years study under their belt and start on less than a junior doctor. They do, of course, have more flexibility about when they do their unpaid overtime.

I do agree, however, that junior doctors are getting shafted and were not overpaid as it stood.
 

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Posted by Schroedinger's cat (# 64) on :
 
I think academic jobs and teachers are also poorly paid. It shows how much the government values education - at least for those who cannot pay.

But treating junior doctors like crap is probably worse - just because they have lives literally in their hands. When people are making life-and-death decisions on a daily basis, you should treat them well, and acknowledge the pressure and significance of what they do.

I think we need a new 8th day board, much deeper than the depths of hell, just for the incompetent decisions and choices of this government.
 

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Posted by no prophet's flag is set so... (# 15560) on :
 
I just checked the provincial contrast for medical residents, which would be the equivalent of junior doctors. The range (in UK £ from Cdn $) is £23,000 to 41,000 per year. Because of the differential cost of living in the UK - spending power is greater here. I'd probably suggest you are about 20% underpaid in your 'new improved' contract. I am gauging this based on my understanding of what my child in London earns for comparable work as well.
 

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Posted by Patdys (# 9397) on :
 
That is truly a shit situation.
I hope the consultants care enough to walk.
 

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Posted by Adeodatus (# 4992) on :
 
The Government is currently in phase two of the standard privatisation tactic: de-fund - demoralise - privatise.

They're demoralising various sectors of the NHS - junior doctors are just this month's fashion - to create poor public opinion, which will lower public resistance to privatisation.

Their attitude to the NHS is beyond scandalous, and is based on spinning blatant, full-on lies to the Press, who tend to just print whatever lands on their desk.

Junior doctors deserve a much better deal than the Government is offering them. They have my full sympathy and support, up to and including strike action.
 

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Posted by Alan Cresswell (# 31) on :
 

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Originally posted by alienfromzog:
Oh and there are a few official petitions out there if you’re interested – I won’t link to them because I’m not allowed but if you want to find them…

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Originally posted by Adeodatus:
The Government is currently in phase two of the standard privatisation tactic: de-fund - demoralise - privatise.

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Originally posted by Alan Cresswell:
A reasonable comparison to make in terms of salary is with MPs.

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I have worked literally thousands of hours more than I’m paid for and done so gladly, I have worked many weekends, missed birthdays, Christmases, weddings and christenings. I could tell you about how often I stay late – but it would be must quicker to talk about how often I leave on time.

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Originally posted by Alan Cresswell:
have to fund expenses such as travel to work out of that salary without an expenses top up

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Originally posted by Anglican't:

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Originally posted by Adeodatus:
The Government is currently in phase two of the standard privatisation tactic: de-fund - demoralise - privatise.

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The left have been saying that the Tories will privatise the NHS since the early 1980s, at least. Either they're not or this is the most incompetently enacted Tory policy ever.

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Originally posted by Anglican't:

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Originally posted by Adeodatus:
The Government is currently in phase two of the standard privatisation tactic: de-fund - demoralise - privatise.

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The left have been saying that the Tories will privatise the NHS since the early 1980s, at least. Either they're not or this is the most incompetently enacted Tory policy ever.

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Originally posted by ExclamationMark:
Two thoughts here both a bit tangental

It's a way of getting back at the Doctors who even the Tories think are getting too uppity for their own boots - it doesn't help their case that Consultants have to be forced to work weekends.

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Originally posted by ExclamationMark:
Two thoughts here both a bit tangental

First, since this is hell, welcome to the real world. It's been happening to everyone else around you for a while and you weren't exactly rapid in coming forward for them were you? Where were you, Doctors, in the fight for the living wage for the people who make sure you have a clean theatre to operate in?...

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Originally posted by Soror Magna:

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Originally posted by ExclamationMark:
Two thoughts here both a bit tangental

First, since this is hell, welcome to the real world. It's been happening to everyone else around you for a while and you weren't exactly rapid in coming forward for them were you? Where were you, Doctors, in the fight for the living wage for the people who make sure you have a clean theatre to operate in?...

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This. Same thing happened here - thousands of people were fired, the courts came back years later to say it was illegal, but the MDs did nothing except ask for more money, cross picket lines, and continue to vote for the governing party. Doctors may not be the greediest of the professions, but their greed is the most hypocritical because it stands in such sharp contrast to the essays they all wrote to get into med school. You know, back when what they really wanted to do was help people get better and make the world a better place. And every demand for more money is justified as being necessary for "better patient care". Who else can get away with saying, "pay me more and I'll do better work"?

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Originally posted by Sioni Sais:
i) We aren't talking about medics as a whole but junior doctors

ii) Governments have used a "Divide and conquer" tactic to push austerity measures through and your attitude only strengthens this. Most other groups have had damn all support from others and restrictive trade union legislation mostly pushed through by governments in the 1980's has played huge part in restricted secondary action. Still, if you want to support the pro-austerity policies that's your call.

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Originally posted by Soror Magna:
Who else can get away with saying, "pay me more and I'll do better work"?

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Originally posted by alienfromzog:
P.s. My better half said to me last night (she's non-medical) that doctors must stand up because if we don't everyone else will be next. Firemen, teachers, nurses (no anti-social hours payments has already been hinted at) etc. will all be next.

I know all of the public sector has been afflicted and us as well. This is a step change in what they are doing.

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Its aim is privatizing the worldwide trade of services such as banking, healthcare and transport. Services comprise 75% of American economic output; in EU states, almost 75% of its employment and gross domestic product.

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A recently leaked proposal tabled by Turkey in the TISA negotiations argues for a system that promotes insurance reimbursement (for those who have health insurance) for treatment at lower cost in another country.

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Originally posted by alienfromzog:
Just wanted to add this link from The Economist.

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One junior doctor says going on strike was previously “unthinkable”. No longer.

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Originally posted by Doublethink.:
Really, do you have no concept of duty of care ?

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Originally posted by Arethosemyfeet:

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Originally posted by Soror Magna:
Who else can get away with saying, "pay me more and I'll do better work"?

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CEOs, senior bankers, politicians...

And, frankly, all of us to some extent. If you're paying me £10/hour you're not going to get the full engagement of my intellect and skills that you will if you pay me £30/hour. A case in point is exam marking. When I mark exams each paper gets roughly the amount of attention and time that the rate I'm getting paid deserves. You want me to spend 20 minutes on each paper? Pay me £10 per script.

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Originally posted by alienfromzog:
My better half said to me last night (she's non-medical) that doctors must stand up because if we don't everyone else will be next. Firemen, teachers, nurses (no anti-social hours payments has already been hinted at) etc. will all be next.

I know all of the public sector has been afflicted and us as well. This is a step change in what they are doing.

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Originally posted by Karl: Liberal Backslider:
I'm concerned less by the pay rate than by the possibility of being scraped off the road at 9pm and treated by a doctor who's been on duty since 7am. It's the 90 hours that bothers me; insane.

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Originally posted by betjemaniac:

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Originally posted by Karl: Liberal Backslider:
I'm concerned less by the pay rate than by the possibility of being scraped off the road at 9pm and treated by a doctor who's been on duty since 7am. It's the 90 hours that bothers me; insane.

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But it's far from unusual in the public and private sectors - the military routinely do it and they have to make life and death decisions as well.

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Originally posted by Karl: Liberal Backslider:

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Originally posted by betjemaniac:

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Originally posted by Karl: Liberal Backslider:
I'm concerned less by the pay rate than by the possibility of being scraped off the road at 9pm and treated by a doctor who's been on duty since 7am. It's the 90 hours that bothers me; insane.

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But it's far from unusual in the public and private sectors - the military routinely do it and they have to make life and death decisions as well.

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That scares me as well. No-one should in this day and age be expected to do this. When do people sleep? Eat? Do anything else?

That people are shafted and their health (and the safety of those who depend on them) is jeopardised by working absolutely ridiculous hours is no reason it should be done. It's insane. I work 37.5 hours a week and I'm absolutely knackered by it - I'd be ill, probably dead after a few months - on 90 hour weeks, and I'm not exaggerating.

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Let me explain my old job....


The "working day" in theory ran 0700-1800, but of course this was complicated by the fact that I was working and living in the same place (my bed folded up in the daytime to make my desk). However, on top of the "core working day" outlined above I had to stand at least one watch in three on the bridge.

A watch is 4 hours so it goes:
0000-0400
0400-0800
0800-1200
1200-1600
1600-1800
1800-2000
2000-0000

(the observant will note that there are two watches of 2 hours in there as well - this means that which watches you have moves from day to day. However, many times we went into "standing watches" where those 2 hour ones were merged into 1 x 4 hour one and everyone did indeed do the same ones every day.)

Watchkeeping was on top of work. The absolute killer was afternoon middle, where you kept watch on the bridge 1200-1600 and 0000-0400 on top of an 0700-1800 day (and work in the the evening as required). This could go on for weeks or months at a time.

Occasionally, if we were really lucky, we went into defence watches, which is 6 hours on, 6 hours off round the clock for anything up to 8 or 9 weeks. There's just about time to eat in all that - complete with quality experiences like having breakfast then going to bed, or getting up and eating dinner before starting the day.

The short answer is that there's time to work, eat and get (some) sleep - probably 4-5 hours at any one time and sometimes in one 24 hour period.

There is vanishingly little free time, although you might get an hour or two every couple of days if the cards fall your way (not at all in defence watches).

I lasted 5 years.

One of the surprising things is how easily the human body adapts to such things. It might take years off your life at the back end, but at the time people that couldn't hack it were a very small number. You also get very good at getting on with people - as you're locked on a box with them for long periods of time with limited sleep!

[ 28. September 2015, 11:06: Message edited by: betjemaniac ]
 

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Posted by Karl: Liberal Backslider (# 76) on :
 
How did you stay awake? I'd be having to poke myself with a fork every 10 minutes.
 

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Posted by betjemaniac (# 17618) on :
 

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Originally posted by Karl: Liberal Backslider:
How did you stay awake? I'd be having to poke myself with a fork every 10 minutes.

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Originally posted by Karl: Liberal Backslider:
Back to the point though - I'd sooner have doctors who are firing on all cylinders than doctors who have trained themselves to not actually fall asleep when examining me. The risks from being treated from someone who's been on the job for 12 hours and had only three hours sleep in the last 24 must be significant - I'd not let them drive a car, for example.

I base this on the fact that one of the ways I know I need to go to bed is that my thinking becomes disordered and even dreamlike. That usually happens by 11pm if I was up at 7. I'd not like to try to change a plug in that condition, never mind stabilise a trauma patient, any more than I'd want to do it after six pints, which is a very similar feeling.

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Originally posted by Alan Cresswell:
You start by seeking to slow the loss of doctors out of the system, which means not shafting them so that they decide that working in the US, Canada or NZ looks - or quiting medicine altogehter - very attractive

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Originally posted by betjemaniac:


Essentially, "we've got a problem with not enough pay and too many hours which we'll solve with this contract. On the other hand, that's going to need investment and expansion of the training pipeline." They just didn't do anything after "on the other hand" and we've had 17 years of governments of both stripes looking away sheepishly.

17 years.

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Originally posted by mr cheesy:
But if we're really saying that highly paid staff should retain their perks (and remember that junior doctors already have higher than average pay before they've fully finished their training), then I say no, sorry.

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Originally posted by alienfromzog:
I just want to say, that pay and conditions for the military really does need addressing.

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Originally posted by mr cheesy:
[qb] But if we're really saying that highly paid staff should retain their perks (and remember that junior doctors already have higher than average pay before they've fully finished their training), then I say no, sorry.

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Higher than average pay?

Really?

Average earnings in 2014 were reported as £26,500. Now, I know that doctors are not the only group who do antisocial hours, that would be ridiculous. But Our income for a 37 hour week is £22k in the first year rising based on experience to £40k for me now 10 years down the line. Yes we are all still in training but it's junior doctors who do most of the (medical) work in the NHS.

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Yes we do earn above that but the point is, we earn it. It's pay for hours above and beyond a normal working week and at antisocial times. The following is based on my job up until April of this year. I have moved trusts and where I work at the moment is a complete disaster in terms of the rota - and so it is not representative.

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I worked 8-5 Monday to Friday, with a rota'd day off after on-calls. So our on-call would be from 5pm to 8am. Or we would do 24 hours (8am to 8am) on a Friday or Saturday or Sunday. Monday-Thursday 8-5 on-call would be covered by the 'on-service registrar' for that week. And during this week we wouldn't do any overnight on-calls. This was on a 1 in 7 rota.

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This kind of rota is not unusual in paediatric surgery and most of us like it. It provides good continuity of care and is usually not too onerous. An average on-call evening would start from 5 when we take hand over from the colleague on during the day. (We would have done a normal day so often clinic or theatre that day). We would see emergency admission, operate and do a ward-round in the evening. Most week days evenings would require some operating - sometimes operating on my own, sometimes assisting the consultant. It was fairly standard to finish operating around 11-midnight and then do a round and see any new admissions / unwell patients. Then we would try to sleep from One-ish. It would be unusual not to get 2-3 calls before 8am but on about half of the nights I would not need to get out of bed before 7 as it would be just specialist advice that was needed. Conversely I have had nights where I've operated all through the night.

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This kind of work pattern is fine - as long as you don't have a fixed commitment the next day.

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We would do a Friday/Sunday in the same weekend or just the 24hours Saturday. Hence with 7 of us, I would work part of 1 in three-and-a-half weekends.

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If you work out the hours, my basic pay of £40k was for 4x9 hours (with the rest day after on-calls). So 36 hours a week with paid holiday. That's £21.37 /hour. (My pay slip actually said slightly less than this but I won't bother you with the technicalities).

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Originally posted by betjemaniac:


Essentially, "we've got a problem with not enough pay and too many hours which we'll solve with this contract. On the other hand, that's going to need investment and expansion of the training pipeline." They just didn't do anything after "on the other hand" and we've had 17 years of governments of both stripes looking away sheepishly.

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Originally posted by mr cheesy:
<snipped a whole heap of jealousy>

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Originally posted by Sioni Sais:
Er, no. We have a problem with governments of many decades (I take it back to the oil crisis of 1973/74) baring their arses to corporate business interests to do whatever they want.

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Originally posted by alienfromzog:
Mr Cheesy,

That's completely inconsistent. You think I work too many hours that's fine - but the reason the contract is constructed this way is to control that. Are you saying we shouldn't be paid for working when we're tired. You should REALLY be against this new contract.

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As to your other point, I have been very vocal in support of others (My DWP thread is a good example) but even if not, as others have noted divide and rule is the strategy. Moreover, as Alan observed trade union law makes collective action across disciplines difficult.

AFZ

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Originally posted by Sioni Sais:

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Originally posted by mr cheesy:
<snipped a whole heap of jealousy>

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Howabout just agreeing that we're all getting shat on instead of helping the government and their chums in their attempt to divide and rule?

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Originally posted by mr cheesy:
nobody should be working this number of hours, be they a lorry driver or a doctor. It is insane.

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Originally posted by mr cheesy:
Fuck off and die, prick-face.

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Originally posted by mr cheesy:


Or is there something unique about doctors that means the rest of us have to support you in your privilege?

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Originally posted by Doc Tor:

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Originally posted by mr cheesy:
Fuck off and die, prick-face.

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Oh dear. I'm sure you can do better than that.

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Originally posted by ExclamationMark:
I calculate that I'm pretty close to being minimum waged based on my stipend and hours worked each month. You'd get no more out of me if you paid me £30 per hour -- I've chosen to do this work, I've gone into it eyes wide, open knowing the pay deal and conditions.

I can't actually come to terms with those who equate higher productivity and/to quality for higher pay. Perhaps its some kind of warped protestant work ethic but I give whatever I can to whatever I can. The pay etc doesn't come into it - and that's boasting or being some kind of martyr, it's just the way I am. And yes, I have worked and been paid in very different terms, the equivalent of hundreds of pounds a day: I gave no less nor no more then.

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Originally posted by mr cheesy:
Grow a fucking backbone: nobody should be working this number of hours, be they a lorry driver or a doctor. It is insane.

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Originally posted by Arethosemyfeet:
If it were making jewellery or cakes then you wouldn't expect the same quality from a £5 piece as a £20 or £200 piece, because by paying more you are hiring a longer period of labour.

When I'm being paid by the script, I have to treat it as a commercial relationship, otherwise I get exploited.

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Originally posted by ExclamationMark:

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Originally posted by Arethosemyfeet:
If it were making jewellery or cakes then you wouldn't expect the same quality from a £5 piece as a £20 or £200 piece, because by paying more you are hiring a longer period of labour.

When I'm being paid by the script, I have to treat it as a commercial relationship, otherwise I get exploited.

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I agree. But I do my best whether it's a £5 piece or a £200 commission. I don't see it as £5 and an excuse to skimp on anything. The post implied something quite different.

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Originally posted by ExclamationMark:

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Originally posted by Arethosemyfeet:
If it were making jewellery or cakes then you wouldn't expect the same quality from a £5 piece as a £20 or £200 piece, because by paying more you are hiring a longer period of labour..

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I agree. But I do my best whether it's a £5 piece or a £200 commission. I don't see it as £5 and an excuse to skimp on anything.

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Originally posted by Leorning Cniht:
Would you be more diligent for an extra 50% in your pay packet?

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Originally posted by ExclamationMark:

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Originally posted by Leorning Cniht:
Would you be more diligent for an extra 50% in your pay packet?

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No.

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Originally posted by Leorning Cniht:
(I agree with EM here - I would be being the best security guard I can, whatever I got paid.

If I wasn't getting paid much, however, then I wouldn't stay as the best security guard I can for long - I'd go and get another job.)

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Originally posted by alienfromzog:
[QB/] The money thing - what I was driving at above, and I'm not sure how well I communicated it is that doctors are not badly paid but have lots of other pressures and adding to that a financial pressure is both unfair and unwise. It is not that doctors don't (and won't) do their best for patients, it that the more the outside stresses are, the harder it is to remain so committed.

Junior doctors are indeed cash-rich but significantly time-poor. The most challenging of lives, the most stressful are those who are both cash-poor and time-poor. I would argue - in fact I have argued - that this government has been ruthless in targeting these people.

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Originally posted by Sioni Sais:

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Originally posted by ExclamationMark:

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Originally posted by Leorning Cniht:
Would you be more diligent for an extra 50% in your pay packet?

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No.

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OK, but why impose you own high standards on others who are facing a real cut in pay?

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Originally posted by ExclamationMark:
What I do find hard to stomach is that Doctors seem to think they are a special case. You aren't alone in this: in fact, you're well down the list in terms of people who are cash poor and time poor. Lots of people - in far greater numbers - have been going through this for years.

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Originally posted by Palimpsest:
In the US where things are more privatized and random there has long been a tradition of having junior medical staff work insanely long hours. It was considered part of the initiation.

It's changing a bit. People who have been mistreated by Doctors who haven't slept in a couple days have started to sue hospitals and win large malpractice awards from the hospital. That has a way of encouraging the Hospitals to figure out how to deal with the problem, but it's a slow process.

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Originally posted by alienfromzog:
Some more whining

AFZ

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Originally posted by no prophet's flag is set so...:
That's special pleading. Many people who are not physicians work long hours and are taken from their children and families to do so, are paid much less than even the contract you're complaining about, and have very little recourse.

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Originally posted by alienfromzog:
Conversely, working as a junior doctor means I understand what it's like. It's not like other jobs; it is incredibly intense sometimes.

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Originally posted by alienfromzog:

The thing is though, your argument about low pay and retention rates I don't think works because it relies on the assumption that people are only motivated by money. Which isn't true of - well - anyone.

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Because they are dedicated to what they do for reasons other than financial remuneration, it's really easy to underpay them.

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Originally posted by Curiosity killed ...:
The reasons given are workload and the continual monitoring .... a 10% wastage rate in teachers across the profession.

The government managed to downgrade teachers a few years back as education has always been a lower hanging fruit than the health service.

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Originally posted by Leorning Cniht:
My argument works just fine. If good people who are motivated to do the work, and love the work, are nevertheless leaving to do something else, the pay is clearly too low. (I'd expect to see the effect on recruitment first, because potential new recruits have less invested in the career.)

And you're right - the "market rate" for people who believe that job X is a good thing and worth doing is lower than the market rate for people who just see it as a job, and are looking for whatever career will maximize their income.

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Originally posted by alienfromzog:

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Originally posted by Leorning Cniht:
My argument works just fine. If good people who are motivated to do the work, and love the work, are nevertheless leaving to do something else, the pay is clearly too low. (I'd expect to see the effect on recruitment first, because potential new recruits have less invested in the career.)

And you're right - the "market rate" for people who believe that job X is a good thing and worth doing is lower than the market rate for people who just see it as a job, and are looking for whatever career will maximize their income.

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Yeah, okay I'll concede that point as far as it goes. But no one is asking for or expecting more money. No one.

What we're talking about is unsafe rotas coupled with a pay cut.

The money matters in the sense that it's really bad for morale in an already terrible morale situation. And because for people who are very time poor and have to pay own costs and move a lot, the pressures of that will be really felt.

Junior doctors are really committed but my argument is that we're being pushed too far. Burn out will increase.

How is that unreasonable?

AFZ

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Originally posted by alienfromzog:
Dan Poulter, former (Conservative) Health minister writing in the Observer.

Interesting...

AFZ

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Originally posted by Sioni Sais:
The more time goes by, the more one realises the extent to which the LibDems reined in the Conservatives in the coalition government. Health, education and welfare have all been cut far more enthusiastically since May this year.

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Making sure that there are proper safeguards on how long doctors work is not just about the wellbeing of doctors, it is also a vital component of patient safety and ensuring that someone is not being treated by an exhausted doctor.
Dr Chris Sheridan, chair BMA Scotland junior doctors committee

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The Government wants a fairer contract with stronger safeguards. Patient safety is our paramount concern. Average earnings will be maintained and doctors won’t be required to work longer.

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Originally posted by Arethosemyfeet:
this basic, fundamental political truth: never trust a tory.

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Originally posted by alienfromzog:
Dan Poulter, former (Conservative) Health minister writing in the Observer.

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The following statement has been issued by the Royal College of Surgeons of Edinburgh, the Royal College of Surgeons of England, and the Royal College of Physicians and Surgeons of Glasgow:

The current dispute between the UK Government and doctors in training in England and Wales has caused considerable unrest across our profession and with the general public. The Surgical Royal Colleges are concerned by the ongoing impasse.

The new contract proposed by the Government today represents a potential starting point for negotiation and we urge all those involved to take this opportunity to re-engage in discussion. However, it is crucial that both sides approach these negotiations with openness and honesty. As we have stressed before, an imposed settlement is the wrong way to bring about contractual changes.

For the first time in many years, the spectre of industrial action has arisen in healthcare. The Colleges are unanimous that such action would be damaging to all those concerned, both doctors and patients. As organisations dedicated to upholding standards for training and practice in surgery, we ask all concerned to re-enter negotiations afresh.

Doctors in training are vital to the ability of the NHS to provide 7-day care for patients. They are integral to the delivery of safe, high-quality patient care and we value them as the future providers of healthcare for all of us.”

Mr Ian K Ritchie, President Royal College of Surgeons of Edinburgh

Miss Clare Marx, President Royal College of Surgeons of England

Dr Frank Dunn, President Royal College of Physicians and Surgeons of Glasgow
(Emphasis mine)

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Originally posted by Soror Magna:
You're not special. This is what collective bargaining is like for all public sector employees.

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Originally posted by alienfromzog:
OK, let me say this one last time:

IT IS NOT ABOUT THE MONEY

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Originally posted by Soror Magna:
And when was the last time you saw an MD on a picket line?

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Originally posted by Soror Magna:
And when was the last time you saw an MD on a picket line?

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Originally posted by Soror Magna:
Anyone can join a picket line on their own free time to show support.

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Originally posted by Soror Magna:
Anyone can join a picket line on their own free time to show support.

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Originally posted by Alisdair:
The NHS is a societal sacred cow that could well do with being hosed down, cleaned up, and seen for what it really is...

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Originally posted by Doublethink.:
Current guidance is this: https://www.gov.uk/industrial-action-strikes/going-on-strike-and-picketing

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Would it have killed you to look two posts up?
 

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Posted by Doublethink. (# 1984) on :
 
We crossposted, but I couldn't be arsed to edit and add a crosspost tag.

Timetags make that seem implausible - but I am very distractible.

[ 06. November 2015, 19:42: Message edited by: Doublethink. ]
 

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Posted by Doc Tor (# 9748) on :
 

 

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Posted by alienfromzog (# 5327) on :
 

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Originally posted by Leorning Cniht:
If it's not about the money, why is it that all the headlines, facebook comments and the like that I see are going on about "Jeremy Hunt's 11% pay rise is a 25% pay cut" (usually referring to Mr. Hunt in rhyme).

If it's not about the money, why are you arguing about the money?

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Originally posted by alienfromzog:

Now, I wonder if debating the 'pay-rise' was a good tactical move by the BMA but a strategic error.

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This is good for Hunt as he probably will win if the public believe it's just about money.

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it's this financial pressure that forced the trust to comply. Now Mr Hunt wants us to believe that all rotas will magically become compliant when a) It will no longer cost the trusts not to be and b) the statutory check on rotas will be removed. Seriously? He cannot be that stupid. The thing is, he isn't that stupid.

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• 1. Are you prepared to take industrial action short of a strike?
• 2. Are you prepared to take industrial action including strike action – giving us a clear mandate to call for industrial action short of a strike and a full walkout?

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Originally posted by betjemaniac:


We either expect more from the people in the system, or we just close hospitals overnight and at weekends.

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Originally posted by chris stiles:

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Originally posted by betjemaniac:


We either expect more from the people in the system, or we just close hospitals overnight and at weekends.

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Or we recognise the original set of statistics on which this ludicrous decision has been made as misleading, and leave things as they are.

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Originally posted by Alan Cresswell:
That's a very big exclusive. I would be surprised if the average Sun 'reporter' had the intelligence to troll Facebook. Though, maybe the collective mental ability of four of them ...

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Originally posted by Sioni Sais:

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Originally posted by Alan Cresswell:
That's a very big exclusive. I would be surprised if the average Sun 'reporter' had the intelligence to troll Facebook. Though, maybe the collective mental ability of four of them ...

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The Daily Mirror once used "Lies, damned lies, and Sun exclusives". It could have done so, accurately, every week.

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Originally posted by alienfromzog:
Dan Poulter, former (Conservative) Health minister writing in the Observer.

Interesting...

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As it happens, he's my local MP and I have briefly met him. My politics aren't the same as his but he's a decent man.

What you may not realise is that he left his Health post last year so he could go back to part-time doctoring (GP, not hospital) while remaining an MP.

Now you may or not may think that that is a good idea, but it's at least suggestive of a disagreement with the way Government policy was going.

Or else he's planning to get out of politics altogether at the next election ... something he wouldn't have to do, as this is a very safe Tory seat.
 

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Posted by alienfromzog (# 5327) on :
 
Fuck.


 

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Posted by Doublethink. (# 1984) on :
 
Seconded, thirded, quadrupled, quintupled.
 

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Posted by Kelly Alves (# 2522) on :
 
This sucks. Standing in sympathy with the Britmates.
 

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Posted by mdijon (# 8520) on :
 
I thought this captured the lunacy of Hunt pretty well.

But not as well as this.

Only it doesn't look like the second one is satire.

The whole thing is a textbook case of how not to handle a dispute. Aside from being in the wrong to start with, even with the right reform this would be the most deliberately provocative way of dealing with it.
 

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Posted by alienfromzog (# 5327) on :
 

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Originally posted by mdijon:
I thought this captured the lunacy of Hunt pretty well.

But not as well as this.

Only it doesn't look like the second one is satire.

The whole thing is a textbook case of how not to handle a dispute. Aside from being in the wrong to start with, even with the right reform this would be the most deliberately provocative way of dealing with it.

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Originally posted by alienfromzog:
Today's Matt Cartooon in the Torygraph.

As usual, Matt is clever and funny but the thing is, here is where I park for work (100 miles from where I currently live).

Staff Parking, just one more thing from the list of perks that I don't get. I AM NOT complaining here. Not about the lack of perks, that's what I signed up for - but when the government tries to paint us as lazy wasters, I think the facts matter. So here's a list of things I don't get that might surprise you:

1. The right to decide where I work
2. My (required) professional fees paid for (£1500/yr)
3. My (required) professional exams paid for
4. Essential training courses paid for
5. Necessary conference attendances paid for
6. Annual leave for on-call work. (We have to swap our nights and weekends around any leave we take)
7. Any control over what rota I work
8. Routine overtime payments in addition to my contracted on-call work (unless it's an extra shift to cover sickness or absence)
9. Extra money for working Christmas or Bank Holidays
10. To walk away at the end of my shift and not worry about the patients I've seen.

(Ok, so 10 isn't a surprise)

I do not want to be lauded, I do not want more money, I do not want to be thanked.

All I want is to not be insulted while I do my job and for an employer to treat me as the dedicated professional I am; providing me with a work environment that is safe for me and my colleagues and most of all for my patients.

AFZ

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Originally posted by M.:
I'm in England and have never had much of a problem getting an appointment either.

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Originally posted by M.:

Booking an appointment is much less efficient from my point of view. And quite a recent innovation in the scheme of things - I can't remember ever having bookings for general 'I want to see the doctor'-type things until about 15 or 20 years ago.

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Originally posted by Leorning Cniht:

If you offered me a choice between a nearby doctor with a "turn up and wait" scheme, or one that was a little further away but offered appointments, I'd take the second one every time.

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Originally posted by L'organist:
[snip]

They do have (so I'm told) same day appointments but I've never met anyone who managed to get one.

[snip]

By way of contrast, I can call a vet for a friend and they will come out to see her horse same day.

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Originally posted by L'organist:
Our local hospice were so appalled they advised us to change surgery.

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Originally posted by mdijon:

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Originally posted by L'organist:
Our local hospice were so appalled they advised us to change surgery.

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I guess on the positive side at least that indicates they thought this was not "normal for the NHS" or there would have been no value in changing.

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Originally posted by quetzalcoatl:
Well, I used to be in a small surgery, where you could get next day appointments fine. Then some small ones were combined into a big one, in the name of efficiency, I guess, and the result (rather predictable), is that I had to wait two weeks. What seems really daft is that this will put pressure on A and E, as many people will be forced to go there, if they can't wait two weeks. I saw an old lady at reception, and they told her, you can't see a doctor today or tomorrow, go to A and E. Madness.

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Originally posted by anoesis:

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Originally posted by quetzalcoatl:
Well, I used to be in a small surgery, where you could get next day appointments fine. Then some small ones were combined into a big one, in the name of efficiency, I guess, and the result (rather predictable), is that I had to wait two weeks. What seems really daft is that this will put pressure on A and E, as many people will be forced to go there, if they can't wait two weeks. I saw an old lady at reception, and they told her, you can't see a doctor today or tomorrow, go to A and E. Madness.

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It does indeed seem like madness, especially as presumably both the surgery funding and the A & E funding come out of the NHS pot.

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Originally posted by quetzalcoatl:
if you are cynical, you will say that the Tories want to run the NHS down.

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Originally posted by TomM:

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Originally posted by quetzalcoatl:
if you are cynical, you will say that the Tories want to run the NHS down.

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Call me cynical, but it is something the Right Honorable Secretary of State has previously said.

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Originally posted by Alan Cresswell:
There are a variety of potential systems for patients to see their GP, even if they seem bizarre. I don't expect there to be one size that fits all, and therefore each surgery should assess which system best suits the needs of their doctors and patients.

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Originally posted by Alan Cresswell:
There are a variety of potential systems for patients to see their GP, even if they seem bizarre. I don't expect there to be one size that fits all, and therefore each surgery should assess which system best suits the needs of their doctors and patients.

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Originally posted by Alan Cresswell:
There are a variety of potential systems for patients to see their GP, even if they seem bizarre. I don't expect there to be one size that fits all, and therefore each surgery should assess which system best suits the needs of their doctors and patients.

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Originally posted by Alan Cresswell:
I see the government has decided to invest more money to boost the number of GPs in England.

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Originally posted by Leorning Cniht:

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Originally posted by Alan Cresswell:
There are a variety of potential systems for patients to see their GP, even if they seem bizarre. I don't expect there to be one size that fits all, and therefore each surgery should assess which system best suits the needs of their doctors and patients.

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And/or possibly patients should be able to select the surgery with the system that suits them. The rules on what surgeries you are permitted to register with have changed over time - I don't know whether they're the same nationwide, or there's local variation in that too.

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In our part of Northern Ireland it might vary with GP practice. I think you're supposed to transfer to a practice in your new location when you move. But I do know many people who still travel back to their former surgeries.

With our practice - which has about at least six doctors, and a number of regularly visiting nurses - covers a huge populous area, which also has a fair number of similar sized practices. Nevertheless, the average wait if I wanted to see my 'own' GP I'd have to wait at least three weeks. If I wanted an emergency appointment the form is to phone first thing in the morning when the switchboard opens to see if the operator will invite you into the surgery later in the morning, either as a possibility to be squeezed in, or to take up a cancellation. To be fair, you would normally be told to come in and be seen that day, but you would have to phone up first and organize it.

You just have to resign yourself to it! And I must say it works well enough, by and large. They're a good, hard-working bunch, and I often think that the workload must be oppressively overwhelming at times, and the flack they take from frustrated patients very unpleasant.
 

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Posted by Albertus (# 13356) on :
 
Twenty years ago my GPs in Tooting ran their first surgery of the day, every day, on a no-appointment, first come first served basis, and it was much appreciated.*
As the man said when the receptionist asked him if he had an appiontment, 'what do you think I am, a prophet? I didn't know I was ill until this morning...'
*The senior partner was very widely and AFAICT rightly respected as a skilful and caring GP. But I suspect that she may have had a fairly brisk way with obvious malingerers- which probably helped keep the drop-in surgery manageable.
 

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Posted by alienfromzog (# 5327) on :
 
Some excellent work by the University of Manchester has shed some light on the weekend effect.

As many of us suspected, the 'increased death rate' is nothing of the sort but a statistical result due to the fact that the patients admitted a weekends are sicker.

As most of us suspected.

I look forward to Mr Hunt's climb down...

What do mean he's reiterated his claim of excess deaths(Sky News report on this paper)? No, really? Colour-me not remotely surprised.

This is a particularly scathing analysis...

I come back to something I said a few months back:
http://tinyurl.com/jeremyhunt

AFZ
 

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Posted by ExclamationMark (# 14715) on :
 
The Government is beginning to bottle it under the premise of reflection.

Who will they give into next? Doctors, Education .... any prizes for the next one in the list?

Respect can't get any lower
 

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Posted by alienfromzog (# 5327) on :
 

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Originally posted by ExclamationMark:
The Government is beginning to bottle it under the premise of reflection.

Who will they give into next? Doctors, Education .... any prizes for the next one in the list?

Respect can't get any lower

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From the BMJ:
Editorial "The weekend effect: now you see it, now you don’t"
There is an excellent summary of how the evidence does not support a Weekend Effect and then this final paragraph.

The most interesting question, however, is how, in the face of what we now know, the Department of Health can still insist that doctors in training must accept a new contract to address any weekend effect? One possibility is that the department has an ulterior motive, viewing the failure of contract negotiations as a means to achieve local pay bargaining. Another is that ministers are simply displaying a range of cognitive biases that collectively prevent any admission of error or the learning and change of direction that should follow. Arguably, this is the next question that researchers might turn to, taking their cue from the World Bank, which has set the standard for learning organisations to aspire to.

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Originally posted by Curiosity killed ...:
<snip>
It also allows for-profit organisations to run education, even the good academy chains are commercial. Harris Academies were set up by Lord Harris, as in the carpet magnate and ARK Academies were founded by hedge financiers to provide high returns on philanthropic investment according to Wiki. This system is open to abuse. I can't verify it, but there's a story that one such for-profit chain took over a school, ran it down and then sold the land and building for redevelopment.

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Originally posted by alienfromzog:
So, watch and wait, all is not what it seems...

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Originally posted by mdijon:
This must be free-floating desire to express anger at the establishment rather than a sober assessment of the best way forward given the facts.

Hmmm. Sounds familiar.

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