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Source: (consider it) Thread: New Junior Doctors' Contract
alienfromzog

Ship's Alien
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[Mad] [Mad]
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. [Mad]

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.

[Mad] I put this in Hell in order to rant [Mad] 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. [Biased]

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… [Biased]

=================
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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Erroneous Monk
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The government's refusal to negotiate with the BMA is outrageous. The junior doctors have my full support.

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Jack o' the Green
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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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claret10

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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 [Mad] [Mad] [Mad] [Mad] [Mad]

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

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Leorning Cniht
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quote:
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.

Don't work in academia [Smile]

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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Arethosemyfeet
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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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Schroedinger's cat

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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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no prophet's flag is set so...

Proceed to see sea
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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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Patdys
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That is truly a shit situation.
I hope the consultants care enough to walk.

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Adeodatus
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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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Alan Cresswell

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# 31

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quote:
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…

I Googled "Junior doctor contract petition", if anyone is interested.

A reasonable comparison to make in terms of salary is with MPs. Currently £74,000 per year plus expenses. More for any MPs who chair committees, and even more for cabinet ministers. And, that follows a pay rise in excess of 10% this year. What kind of sick country pays more (and then gives a big pay rise) to government ministers who seem to go out of their way to enact policies that kill people than we pay to our doctors who try their hardest to save lives?

If the government wants to enforce wage austerity on the rest of us their position would be a lot stronger if they started with their own pay, allowances and pensions.

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Anglican't
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quote:
Originally posted by Adeodatus:
The Government is currently in phase two of the standard privatisation tactic: de-fund - demoralise - privatise.

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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Schroedinger's cat

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I do think this government is not incompetent most of the time. They are deliberately manipulative and pursuing their policy by deceit and sleight of hand.

Their policies are, of course, obnoxious and vile, and if they admitted what they were doing, they would be hounded out (not least because they would be breaking every one of their election promises).

Scum.

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Blog
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Anglican't
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quote:
Originally posted by Alan Cresswell:
A reasonable comparison to make in terms of salary is with MPs.

I don't see why, personally. In fact, being an MP is such an usual job I struggle to compare it to anything.

Reading this part of the opening post:

quote:
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 thought this could apply to lots of professionals. Certainly to junior lawyers.
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Anglican't
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Ahem.

In fact, being an MP is such an unusual job, &c.

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Alan Cresswell

Mad Scientist 先生
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Probably more of a contrast rather than comparison.

MPs get a generous salary, and expenses, and a big pay rise this year.

Doctors (and quite a few other professionals such as teachers, or the civil servants who do most of the work keeping the country running) get paid much less, have to fund expenses such as travel to work out of that salary without an expenses top up, and because of the idiocy of austerity face real-term pay cuts, increased unpaid overtime, and considerable job insecurity.

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All I want for Christmas is EU

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Anglican't
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quote:
Originally posted by Alan Cresswell:
have to fund expenses such as travel to work out of that salary without an expenses top up

They're funded because they have to work in two different places. In much the same way that an employer who sends its employee to a different city for a week might pay for his hotel bill. I don't see the relevance of this to public (or indeed private) sector workers with one place of work.
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Alan Cresswell

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Yeah, but I only get my expenses on production of receipts. It wouldn't include first class rail fares. It wouldn't include paying a member of my family as a researcher. Since I'm currently working away from home, my "second home" is a small one bed apartment paid out of my salary - last year it was a bedsit that made most student accommodation seem like luxury. I certainly don't get paid to maintain a castle as a second home.

If these things are considered essential to be an MP, and therefore covered by an expense account on top of the salary, then why not membership of professional societies (essential in medicine and other professions where you can only work if you have such membership) and insurance for doctors?

It's basically a whole shit load of double standards which continue to screw the people who serve us faithfully for not much more than peanuts, often at considerable expense to their personal and social life. While our MPs accept very generous salary increases and expense allowances.

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All I want for Christmas is EU

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alienfromzog

Ship's Alien
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quote:
Originally posted by Anglican't:
quote:
Originally posted by Adeodatus:
The Government is currently in phase two of the standard privatisation tactic: de-fund - demoralise - privatise.

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.
Maybe.

But if you look at it in three time frames:
1990-2000: horrendous working conditions for doctors, appalling pay for nurses and many others, crumbling hospitals and massive waiting lists.
2000-2010. New hospitals, waiting lists disappearing, very high patient satisfaction, big pay rises for professions-allied-to-medicine, outcomes caught up to the best in the world.
2010- (see above)

You see the point?

AFZ

[ 26. September 2015, 11:59: Message edited by: alienfromzog ]

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Adeodatus
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quote:
Originally posted by Anglican't:
quote:
Originally posted by Adeodatus:
The Government is currently in phase two of the standard privatisation tactic: de-fund - demoralise - privatise.

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.
It takes a long time because public opinion is so resolutely against it. The foundations were set down with the introduction of the internal market and PFI. The Blairite "Red Tories" kept that version of the NHS ticking over by introducing Foundation Trusts - which were intended to compete, not cooperate, with one another - and by pushing PFI as far as it would go.

The real clincher, however, was Andrew Lansley's Health and Social Care Act. Some people said it paved the way for future privatisation, but they were wrong: it enacted privatisation. But privatisation could only happen either when contracts were due for renewal, or when the Department of Health had an excuse to introduce private healthcare into "failing" hospitals. Hence de-funding to accelerate the process, followed by a constant stream of Government-sourced bad news stories about the NHS designed to lower public resistance.

A couple of results are that -

(1) In 2013/14 about 70% of contracts that came up for renewal were awarded to the private sector
(2) Private healthcare companies are now for the first time running front-line (rather than support) services.

Every study that's been done shows that this is detrimental to care and more expensive than the public sector. This is partly because the private sector has no ultimate duty of care in the way that the NHS has - hence, for instance, Circle pulling out of running Hitchingbrooke hospital when the going got tough for them (i.e. they weren't making enough profit), leaving the NHS to pick up the pieces.

But some will ask, why are the Tories doing it, if it's so demonstrably a bad idea? Simple answer: money. If you're one of those people who make money from money, then private healthcare is just about the most lucrative business to be in - and a majority of the Cabinet have significant interests in it.

As David Cameron's adviser Mark Britnell said back in about 2011, "The NHS wil be shown no mercy."

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"What is broken, repair with gold."

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Sioni Sais
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Leading up to and into the 1990's was the "internal market" which created hundreds, possibly thousands of managerial posts in general practice (I know because my b-i-l had one). It was intended, as most management posts are, to do things more efficiently but this simply put another link in the chain, although it was a good little earner for those in the posts.

[ 26. September 2015, 12:09: Message edited by: Sioni Sais ]

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Arethosemyfeet
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The tories certainly want to privatise the NHS, but they have to convince the public that the NHS is crap first - otherwise they'll be out of power for a generation - and the public who actually experience it stubbornly refuse to be convinced.
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no prophet's flag is set so...

Proceed to see sea
# 15560

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With publicly funded medical and hospital care, those who do the budgets are keen to reduce costs. What we've seen in Canada is use of other practitioners to do things physicians used to do.

Are you seeing a rise in the use of nurse-practitioners? Here they get an additional qualification, usually a Master's degree, and additional supervised practice. They are specifically on salary for hours worked, unlike physicians who are paid per visit and per procedure. The difference in amount earned per year is vast. The nurse practitioners cost the budgets about 50% of the general practice physicians. About 30% of medical specialists (consultants).

We see this in other areas as well. Physical therapy (phyisiotherapy) assistants and ETs (exercise therapists) may be employed to do the work of a physio under supervision at a ratio of 5 or 7:1. We see nurse-therapists, OTs (occupational therapist) and social workers employed as "mental health therapists" under supervision of a psychologist or psychiatrist. Pharamicsts are giving injections and re-prescribing medication with assistance of a phone service consultation. Nurses are nearly always the point of first contact in rural hospitals, with physicians only called in if required, or the patient transported.

Having advanced qualifications may mean sometimes that a health authority specifically won't hire or place on staff a practitioner who is beyond their budget.

What I foresee is that physicians will continue to be progressively sidelined for budgetary reasons; we have already seen that their training years in formal university has been shortened, and more emphasis placed on technical skills. The future may hold that nurses do much of the care and call in the physician for the specialised services only, and rarely.

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\_(ツ)_/

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ExclamationMark
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# 14715

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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?

Second, again since this is hell, don't negate the influence of history. There's been issues between Doctors and the NHS since the start: the worst decision the Labour Government made when they kicked the NHS off was to cave in to the Consultants. After all, they needed their private work too, didn't they? (Showed that Governments true colours, that's for sure).

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. The Tories want a 24/7/365 system but at present costs - something has to give.

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alienfromzog

Ship's Alien
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quote:
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.

The problem with this statement is that it's bollocks.

The clue here is that is came from Jeremy Hunt. It is absolute and total nonsense.

AFZ

P.S. Many of us have been very vocal about how the government has abused non-medics.

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Everyone is entitled to his own opinion, but not his own facts.
[Sen. D.P.Moynihan]

An Alien's View of Earth - my blog (or vanity exercise...)

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alienfromzog

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Just wanted to add this link from The Economist.

The chart is very helpful. Like all of the public sector, our pay has been falling in real terms for five years now. We haven't complained about this. But just to point out that it has been a long slog of insult upon insult from this government. It just seems to me that this could be the last straw for many of my colleagues.

AFZ

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.

[ 27. September 2015, 10:47: Message edited by: alienfromzog ]

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Soror Magna
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quote:
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?...

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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Sioni Sais
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quote:
Originally posted by Soror Magna:
quote:
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?...

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"?
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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alienfromzog

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quote:
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.

Indeed.

Now, who exactly is asking for more money?

And, as I said, what worries junior doctors far more than the money (on the back ground of falling wages anyway) is the removal of protections that stop us being forced to work more hours and more unsocial hours.

This is why the Labour government in 1997-98 introduced the current contract.

AFZ

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

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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Doublethink.
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Really, do you have no concept of duty of care ?

[ 27. September 2015, 18:14: Message edited by: Doublethink. ]

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no prophet's flag is set so...

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quote:
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.

They came for all of these others before you here. Started with not filling positions and usual casual and part time people whose hours are regulated by policies so they never get on the benefits packages or pension. They haven't been able to do the firefighters, police, physicians and others with some group solidarity. Yet. They have been doing the teachers though.

In contradistinction, they leave the CEOs alone.

I suspect it will get much, much worse. The international scene is greatly influencing it as multinationals influence gov't in their semi-secret negotiations, e.g., Trade in Services Agreement (TISA).

quote:
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.
If it means what it says, signatory nations would be paying for services out of country, cf, :

Secret proposal for trade in health services (from Public Services International)

quote:
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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Alan Cresswell

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

One telling comment, right at the bottom.

quote:
One junior doctor says going on strike was previously “unthinkable”. No longer.
I would say that for most professionals, strikes are, if not unthinkable, so far down the list of actions that may be contemplated that they may as well be. Because, there are people who depend on the provision of services only they can provide. Lawyers have clients who need a representative in court, or to handle the paperwork of buying a house. Teachers have pupils who need an education, and parents who would struggle to find child care if the school was closed by a strike. Social workers have vulnerable people needing support. Doctors and nurses have patients who would suffer without them.

The only reason the doctors I know would contemplate strike action is when what they are protesting about will harm patients more than a strike.

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

In my day job, where I am paid a professional salary to take professional responsibilities? Sure. Exam marking is a technical task paid at a piece-work rate. The duty of care rests with the awarding body. My duty is to meet the standards required of me by that body. If they want to raise those standards they'll need to raise pay.
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ExclamationMark
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quote:
Originally posted by Arethosemyfeet:
quote:
Originally posted by Soror Magna:
Who else can get away with saying, "pay me more and I'll do better work"?

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.

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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ExclamationMark
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quote:
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.

That's been the case in Nursing for some years.

My wife and many like her with years of experience didn't get any support from Doctors then - Junior or otherwise. [Particularly galling since most a lot of Junior Doctors rely on helpful Nurses to get them through the first steps on a new ward, esp their first.]

That was a 20% reduction in income whilst in post with knock on effects for Pensions.

The Govt wants a confrontation with Doctors, I agree. I suggest that when any MP's come into hospital then treatment is minimised rather like that meted out to David Ennals in Westminster Hospital in the winter of discontent in 1978. Mind you, Doctors crossed picket lines then and a few people have long memories .....

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alienfromzog

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Something I wrote last year...

AFZ

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[Sen. D.P.Moynihan]

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Curiosity killed ...

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They've already come for the teachers too. Privatisation through academy and free schools.

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Karl: Liberal Backslider
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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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Alan Cresswell

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In addition to the hours as a simple matter of exhaustion, hours and salary (and other conditions) combine to create conditions not conducive to retaining experienced staff. Relatively young doctors, single or in the early years of a relationship, used to living in student conditions are not going to be too concerned about antisocial hours and lowish pay. Older staff, with a mortgage on a house to pay off, children (with all the sports days, plays, parents evenings etc plus family holidays etc) etc are going to find long, antisocial hours and reduced pay much less appealing. They're likely to find more fulfilling work elsewhere, leaving an increasing proportion of staff as younger and less experienced (which I'm sure the bean counters will love, less pay!). That can't be good for patients though.

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betjemaniac
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quote:
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.

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.

Knowing a lot of junior doctors I'm sympathetic to their complaints, but at the same time think the rot set in when the new contracts were signed in the first place back in 1998. Ironically, it was a cut to the idea of "it's a vocation suck it up" and made it more like a "normal" job.

Maybe the forces are old fashioned in the idea of "service" as a good in and of itself now.

One of my big eye openers as a young officer was when I found myself on a Green Goddess in a fire strike having a conversation with an able seaman (at the time on something like £12k a year).

His line was something like "these blokes earn twice as much as me, and are on strike to earn three times as much. Meanwhile we can't strike and we're doing their job for them with 25% of the numbers, 50 year old kit, and no discernible difference to the public...."

In the end, the fact that the forces were merrily doing their jobs for them with vastly less manpower and no shiny toys was one of the main reasons the FBU ended the strike and came back to the table.

Not a lot of love lost between the armed forces and the fire brigade among people of a certain age - although there was a spike in servicemen realising during the strike what a cushy number the fire brigade were on and leaving to join it...

Sorry, I digress... One of the key problems ISTM is money - no one wants to be ill/injured at evenings or weekends because medics are either knackered or understaffed, but the money tap doesn't appear to be there to grow another 25% of manning or so. Even if it were, it's going to take years to bring that pipeline on stream so, in the short to medium term, what's the answer beyond expecting people currently within the system to do more?

That's the same across the public sector, and I'm afraid it's not so much "starting with the doctors" as finishing with them. Like I say, I sympathise, but have they really not had their eyes open to what was happening to everyone else by degrees since about 2000?

The shafting of the MOD terms and conditions of service started in earnest in 2005 with the imposition of a new pension settlement; the fire brigades in 2001-2. The only difference "Austerity" is making is the low hanging fruit were already mauled in the "good" times pre 2008.

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And is it true? For if it is....

Posts: 1439 | From: behind the dreaming spires | Registered: Mar 2013  |  IP: Logged
Alan Cresswell

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That everyone else has already been mauled doesn't make the mauling of junior doctors right. In no small part because the mauling of everyone else wasn't right either.

But, there are severe limits on what people can do. If doctors and teachers agreed that the firemen were being handed a rum deal, and that it would only be a matter of time before it was their turn, there wasn't much they could do beyond sign some petitions and write letters to MPs. Thatcher had already destroyed the ability of unions to unite behind a common cause, so it's not as though anyone could come out in support of the firemen.

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betjemaniac
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of course it doesn't make it right, but what's the answer when every single department of state at the moment could make a credible case for needing more money? ISTM even austerity deniers aren't saying there's no problem with government finances at all?

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mr cheesy
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I have sympathy, however not very much sympathy for junior doctors. It looks pretty bad to be offered this deal when the previous deal was so much better - I understand that.

However, consultant doctors in the NHS have a pretty good deal - £70-100k plus private consultancy.

And yes, I totally accept that it takes a long time and a lot of study to become a consultant, and so on.

The fact is that those in the higher pay brackets of the public sector are able to be paid that kind of money because others get paid poverty wages. Is a council chief executive so much more valuable than the person who does the cleaning? I don't think so.

The NHS is in a ridiculous catch-22 which appears to be in a kind of downward spiral of inflated expectations and costs. And as I said, we should obviously pay well-trained staff proper wages and give them proper working conditions and hours.

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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Karl: Liberal Backslider
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quote:
Originally posted by betjemaniac:
quote:
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.

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.
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.

90 hrs - that's 13hr a day. That leaves 11 hours to sleep, eat, get backwards and forwards to work seven days a week - no weekends, no rest - is this actually physiologically possible? And why in the name of fuck are we making people do this?

[ 28. September 2015, 10:54: Message edited by: Karl: Liberal Backslider ]

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Might as well ask the bloody cat.

Posts: 17718 | From: Chesterfield | Registered: May 2001  |  IP: Logged
betjemaniac
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quote:
Originally posted by Karl: Liberal Backslider:
quote:
Originally posted by betjemaniac:
quote:
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.

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.
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.

Let me explain my old job....
[Big Grin]

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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Karl: Liberal Backslider
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# 76

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How did you stay awake? I'd be having to poke myself with a fork every 10 minutes.

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Might as well ask the bloody cat.

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

Because in all honesty you get used to it. You're also trained into it - in the first term at Dartmouth there was a week long exercise on Dartmoor where (and I'm not exaggerating) I got 3 hours sleep in 6 days. You've not experienced tiredness until you've stood on sentry duty in -6 windchill and a snowstorm and suddenly woken up about to slam into the floor at full length - I caught myself in the press-up position!

By the time we went to sea, we were a pretty resilient bunch - after all, it's a daily working pattern Nelson would have recognised certainly, and Drake too probably.

Other than that, endless quizzes through the wee small hours, the responsibility to fix the ship's position on the chart accurately every 6 minutes for the whole 4 hours, and if you're really lucky a nice busy shipping lane, ice floe, or coastal shoal to play with....

Some things tend to focus the mind pretty well. I often found the fact that I was responsible for 200 odd sleeping lives usually did it.

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Karl: Liberal Backslider
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# 76

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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.

[ 28. September 2015, 11:19: Message edited by: Karl: Liberal Backslider ]

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Might as well ask the bloody cat.

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betjemaniac
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# 17618

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quote:
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.

Indeed, which brings me back to the question I asked multiple posts ago, what's the answer?

We either expect more from the people in the system, or we just close hospitals overnight and at weekends. Secret option C is to have many more doctors to share the workload around, which a) costs money, and b) is going to take several years to filter through to the trained strength which takes us back to how we get through the 5-7 years between now and then in the meantime? And that's before we get to the problem of where the money is going to come from to achieve it.

I genuinely don't know what the answer is - but it's at least in part a problem which the last contract in the late 1990s ducked by kicking the can down the road.

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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And is it true? For if it is....

Posts: 1439 | From: behind the dreaming spires | Registered: Mar 2013  |  IP: Logged



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