The Doctors are SEETHING

[Bartholomert]

Isn't Mert Turkish? Why is he suddenly American?

I was born in Virginia and have lived the greater majority of my life in the States. Phonics probably isn't terribly off, but it's more along the lines of readily re-embracing my 'native' culture more than anything.

[7om]

Yeah you won't need a bank loan in the US either so long as you choose to buy healthcare. And at least then you can count on dedicated service from world class doctors operating the most advanced medical equipment science has yet conceived, rather than hand me downs from the US bought on sale after we upgraded.

After experiencing both services first hand I know I'd take our system any day of the week. I have very good insurance and it's still expensive to get anything done here. Don't be disingenuous by missing out the massive deductibles that you still have to pay with insurance.

It's a fucking shambles and I'd be terrified to get anything serious at a young age here. You'd be completely fucked and to suggest otherwise is incorrect.

[Bartholomert]

Yeah, if I got a serious life threatening illness I know where I would want to be that's for sure.

[7om]

Me too. I'd get on the next flight home.

[Magic]

Me too. I'd get on the next flight home.

Hopefully Mert would too. :eyemouth:

[randomlegend]

That makes sense. Do you have a link to the report?

I've found the paper but the Uni identities are hidden (they are just numbered). They had a labelled version of the graph up in a lecture given by the course director but I don't think I can get it.

[Bartholomert]

Me too. I'd get on the next flight home.

Eh? You'd go to a country 10 years behind the US in terms of medical advancements and cutting edge experimental treatments? Darwinism at work I guess.

[simon]

Yeah, but it's free.

[Davgooner]

The perception of the NHS amongst the right-wing in America is superb. We come out at worst level with the US in terms of outcomes, yet pay about a third of what those cunts do.

[Davgooner]

In fact, using your logic, you'd better evaluate the provisions of our private healthcare providers and throw them into the mix.

[Lewis]

We're well behind the Americans (and everybody else) on things like cancer survival rates and heart attack non-death. How many free bandages are worth that lingering death sentence?

[randomlegend]

http://www.theguardian.com/society/2016/feb/15/weekend-effect-on-hospital-deaths-not-proven-say-hunts-own-officials

:harold:

[phonics]

5k GPs and 11,000 other staff by 2020.

lol.

[randomlegend]

The other day I came across that story of him Tweeting a photo with confidential medical information in the background from a few months ago. He MUST have something on Cameron.

[Magic]

http://www.dailymail.co.uk/news/article-3449031/Hopes-fade-missing-junior-doctor-walked-hospital.html

Bit Mawkish but all in the name of #thecause

[Byron]

Of course it's not proven, but you'd think even Hunt couldn't shrug off the idea of a doctor being tipped over the edge and killing themselves.

[Lewis]

'Is that really the type of person you would want on a busy ward?'
*next Prime Minister*

[randomlegend]

http://www.independent.co.uk/news/uk/politics/nhs-hospitals-reject-financial-targets-and-set-up-clash-with-regulators-a6877476.html

Lee any insight on this?

[Lee]

I don't blame Trusts for pushing back. There's nowhere near enough money in the system to cope with the continually rising demand, and the money there is is wasted on bloated institutions (between the DH and providers) who spend millions on inspecting places only to conclude that they're shit because they have no staff and thus rely on locums.

Since 2010 the NHS has outstripped the private sector in productivity gains and, taking hospitals only, has management costs of 1.5% compared to 5% in the private sector. Hospitals are really lean and are starved of the cash there is in the system. There is barely anything left to cut without jeopardising quality of care.

The big costs are people. People we have to pay at ridiculous locum rates because no government takes the long term view that, just maybe, training some more doctors and nurses might be a half sensible idea. And lol at the idea of suspending boards as though it would make any difference but inflate costs further as a result of replacing them with expensive career interim execs. Being a CEO of a hospital is an unattractive enough prospect for talented leaders already.

Get rid of these arms length bodies and commissioning organisations. Roll the lot into local government and combine health spend and planning with public health, social care and education. Budget, plan and train on the basis of current and projected population need. We have the data. Think about fixing the system rather than your chances of winning the next election, you gang of absolute cunts.

[Boydy]

The big costs are people. People we have to pay at ridiculous locum rates because no government takes the long term view that, just maybe, training some more doctors and nurses might be a half sensible idea.

Why won't they do this? Surely being able to say 'we've increased the numbers of doctors and nurses being trained by x' would be pretty good coming up to an election?

[Lee]

Why won't they do this? Surely being able to say 'we've increased the numbers of doctors and nurses being trained by x' would be pretty good coming up to an election?

It takes years and people vote based on what they see or experience now. It does a government no good at during an election campaign to say "but in five years time......"

All that said, this government has been very clever in removing the bursary for nursing degrees. It means universities, in partnership with hospitals, can set up their own degrees outside of the national bursary allocation. The ones being set up so far are all oversubscribed. Lots of people want to enter nursing enough that paying back £50 a month once they've qualified won't put them off.

[Boydy]

If you did it at the start of a parliament though, you'd have results showing at the end of it, right at election time, no?

[Bartholomert]

http://www.independent.co.uk/news/uk/politics/nhs-hospitals-reject-financial-targets-and-set-up-clash-with-regulators-a6877476.html

Lee any insight on this?

That feel when the government forces hospitals to ration health care and provide lower quality care because of budget concerns. Does this look like empathy to you?

[randomlegend]

All-out strikes are coming, lads.

[Lewis]

I'm alright. I don't get ill.

[GS]

This is an interesting one in terms of how public support will shift. You'd think if the government are prepared to ride it out, the doctors will lose public support and it would become politically untenable to continue repeated strike action.

Then again, they could be like the RMT and literally not give a fuck.

[randomlegend]

Yeah, I think generally the public has very much been on-side so far but I'm not sure that'll survive an all-out strike, as you've said.

If 'we' lose public support I think we'll be fucked so I dunno how wise a move it is, but what else can you do? Maybe just give up and let them privatise it.

[Magic]

There are plenty of foreign doctors that would work twice the hours for half the pay. Fuck 'em.

[randomlegend]

Yeah, the current recruitment crisis is made up.

[GS]

My two mates are both junior doctors and hate it. I think it's mostly the shift work and irregular hours, which seems to me an unavoidable consequence of being a doctor.

What's your take on the whole situation?

[randomlegend]

My take is that we need more doctors to even cover what we are currently meant to be covering, and instead the plan is to cover more without increasing the number of doctors. Because that makes sense.

My own experience is that that's not what people hate about it - they went in expecting that. It's the absolutely constant unpaid and unappreciated hours (and hours and hours) of overtime and enormous workload due to the understaffing. They don't have a life outside medicine.

I'm very much on the fence at the moment as to whether I'll go into medicine once I qualify. I recently did paeds and absolutely loved it though, so I'm more inclined to stick with it than I was a few months ago.

[GS]

With respect to the fact that if doctors fuck up someone gets hurt, whereas if I fuck up then it leads to an awkward conversation with someone more important, I would say that a load of professions expect people to work unpaid 'where needed'.

I'm not saying this makes it okay, but it seems completely unavoidable if you're in any sort of professional environment.

[randomlegend]

I understand that, but (and obviously I can only pass on what I hear, since I'm not doing the job yet) you hear of people in some of the jobs - like the tough surgical jobs - finishing 2 or more hours late every day.

I might be wrong, but I don't think most people would put up with that.

[GS]

Again, there are plenty of people in my office who would consider two hours a day overtime to be a 'normal' day. You can say people "wouldn't put up with it", but plenty do across any number of professions. Maybe they shouldn't put up with it, but they do. Doctors are very well paid so I can't say I have much sympathy with that particular contention.

[randomlegend]

They aren't that well paid at all, actually. Nothing like the public perception anyway.


Again, there are plenty of people in my office who would consider two hours a day overtime to be a 'normal' day.

I suppose it depends what hours you are doing in the first place as well. But as I said, I have no experience of working life outside medicine so maybe they are all just total pussies.

[Magic]

I jest. Give them what they deserve. You can't clock off if someone's just shat their guts all over you.

[Lee]

The juniors ought to be a bit careful here. During the last strike we got our contingency plans bang on and the hospital worked much better without them. We were getting calls from diagnostics teams wondering why they weren't being asked for tests, for example. Our first thought was that it was because there were fewer people about to request them. Some work we've done with our consultants since shows that, actually, junior doctors had been requesting unnecessary diagnostics which meant patients were staying in hospital for longer than necessary.

That's a feature of the way the system is designed rather than juniors being shit. They're all trainees so they make their mistakes on the job. And the mistakes usually come from being overcautious as they're frightened to make more serious errors; not the worst criticism to level at a group of people who have fucking hard jobs. We'll be going with the same plans for cover in during future strike action and if we get the same results we'll be thinking very seriously about whether the current medical workforce model suits us. There are alternatives and, given the shortage of doctors throughout the system, we're already looking. I know other hospitals are doing the same. The BMA might well be hastening the shift to an era of fewer junior doctors.

The juniors also need to be careful with the language they're using to justify their actions. On the wider point about working conditions they are absolutely correct. I haven't come across a single person from any NHS profession who doesn't back them on the principle. But the more I hear them on the telly saying "urgent care is still happening so it's okay!", the more I get pissed off with them. The NHS is cancelling loads of elective surgery. None of it is deemed to be 'emergency' surgery in the strictest sense but all of it is an emergency to the poor bugger waiting for it, particularly if they are waiting in pain, or fear, or unable to work until they are operated on. The newspapers will turn eventually, When that first person dies waiting for an op....just watch the shitstorm begin and public support disappear.

[Magic]

Yes but if there's no trainees there's ultimately no doctors.

[randomlegend]

That's a feature of the way the system is designed rather than juniors being shit. They're all trainees so they make their mistakes on the job. And the mistakes usually come from being overcautious as they're frightened to make more serious errors; not the worst criticism to level at a group of people who have fucking hard jobs. We'll be going with the same plans for cover in during future strike action and if we get the same results we'll be thinking very seriously about whether the current medical workforce model suits us. There are alternatives and, given the shortage of doctors throughout the system, we're already looking. I know other hospitals are doing the same. The BMA might well be hastening the shift to an era of fewer junior doctors..

How's that going to work, when there aren't enough people to fill the posts as it is? Yes consultants were prepared to cover the juniors during the strikes (and weren't fulfilling normal commitments in doing so as I understand?), but I can't see how that's feasible long-term.

I genuinely don't understand.

[Lee]

The workforce doesn't necessarily need to be so doctor heavy. Not at the junior level anyway. Once Physicians' Assistants get prescribing rights (it's coming) we can rely more heavily on them; there isn't much an FY1/2 can do that a PA can't and you get the added benefit that they don't rotate and so you don't lose out on continuity of care. Specialist Nurses, ENPs and ANPs are able to take on a lot of the work traditionally completed by junior doctors too (the former have been doing so very successfully for years and are now much more skilled than most junior doctors in dealing with specific conditions), and to a high standard. Higher even, in the longer term and you're not replacing them every four months with people who need to be taught the basics all over again. It would make no difference to care planning because all of your decisions are in the hands of consultants anyway. We'll end up training fewer doctors but to a higher standard, so you keep your consultant base and change the way things work beneath that.

[randomlegend]

I guess we'll see.

Sounds like that sort of system would end up being much better for the juniors (although I suspect you'd de-skill them a lot during FY1/2 if they aren't doing anything) in the long run anyway. I can't see any reason I wouldn't prefer it.

[GS]

Lee, what's your view on how the system works for recruiting and training junior doctors? We've mentioned rotations, numbers etc. What would your optimum system be as someone in the operational arm whilst protecting (or indeed improving) patient care?

[Lee]

Lee, what's your view on how the system works for recruiting and training junior doctors? We've mentioned rotations, numbers etc. What would your optimum system be as someone in the operational arm whilst protecting (or indeed improving) patient care?

Firstly, the operational arm is all about the delivery of patient care. The whole point is that we make the hospital work in such a way that the direct delivery of good care is a) as easy as possible for clinicians and b) as safe, efficient and as pleasant as possible for the patient. Obviously that's done within the limits of the available financial resource but, like in any business, if you get the quality of delivery/product and customer service right the value falls out anyway.

The current system doesn't work. The main reason for this is that the existing set up is predicated on the notion that only doctors can do really complex stuff. That just isn't the case any longer. There are lots of roles and disciplines who can do stuff as well as, or in some cases better, than junior doctors. That's not a criticism of junior doctors. They are there to learn and only spend short periods of time in given specialties. But because of those constraints our reliance on them leaves us exposed. They aren't expert in the specialties, which means they lack the knowledge and confidence to make decisions about patient care. And when they finally start learning some of the specifics of their specialty they rotate out and we start all over again.

I've seen demented patients in their 90s sent for scans by junior doctors because they're too frightened to make the correct (but difficult) decision and discharge them back to their nursing home/wherever. I understand the rationale but ultimately you're putting somebody who is vulnerable and who will never get any better through a traumatic experience for no good reason other than to reassure yourself. And scans cost money so it's bad from a value point of view too. What we ought to be doing is staffing clinical areas with specialists from other clinical professions (nursing, physicians' assistants, therapists etc) so the junior doctors are supported to make the right decisions by people who know their specialties. Juniors would be left less exposed and more likely to make good decisions for patients, and you're also safeguarding against the problems caused by rotation (there's plenty of evidence to suggest that it's dangerous for patients) by having a stable non-doctor specialist team present in a given clinical area at all times.

So, in essence, increase the number of permanent specialists of whatever stripe in clinical areas, thus improving continuity of care and clinical decision making whilst creating a more supportive environment for rotating juniors and limiting the damaging impacts of rotation. You might need to reduce the number of junior doctors in the system to afford it but then we wouldn't need as many anyway.

[Lewis]

'I'd sack all these pen-pushers and train more doctors and nurses.'

[Lee]

Don't let them run it, for fuck's sake. I dread to think what they'd spend. The amount of shit I have to stop. One tried to slip through an order for three executive office chairs a few months back.

"What for?"

"My current one is uncomfortable."

"Good, you shouldn't be sat in the fucker anyway."

Christ knows why he wanted three.

[niko_cee]

Lewis is right though. There is no hope.

[Lewis]

I also think that those same doctors and nurses should be paid more than footballers.

[Jimmy Floyd]

But presumably less than the Prime Minister.

[Lee]

Really footballers should be forced to donate at least half their wages to our hard working doctors and nurses. And another quarter to our hard working hard working families.

[Lewis]

Oh yeah. I'd forgotten that he has to sit at the top of the state payroll. Right. Footballers on 'average wages'; doctors and nurses on more than that; and the Prime Minister on more than that (provided he is eligible in the first place having come straight from a 'proper job').

[Pepe]

Where will university professors fit in?

[mikem]

Are junior doctors the equivalent of the US residency system?

[Lewis]

My old supervisor reckoned that the entire university system needed burning down, but that it escapes serious criticism and reform because voters are satisfied so long as their kids can pass through it relatively unscathed in return for a degree that increases their chances of landing a Good Job (I bet he works himself up into a right state on his farm). Once that stops being the case, most of them will be down the Proper Job Centre with Fox.

[GS]

The problem with the current university structure is that too many people go to university when there's no need for it. It doesn't enhance their job prospects and instead it's just three or four years of subsidised binge drinking. I think it's safe to blame Tony Blair for this one too.

[Boydy]

My old supervisor reckoned that the entire university system needed burning down, but that it escapes serious criticism and reform because voters are satisfied so long as their kids can pass through it relatively unscathed in return for a degree that increases their chances of landing a Good Job (I bet he works himself up into a right state on his farm). Once that stops being the case, most of them will be down the Proper Job Centre with Fox.
Why did he think it needed burning down?

[GS]

Firstly, the operational arm is all about the delivery of patient care. The whole point is that we make the hospital work in such a way that the direct delivery of good care is a) as easy as possible for clinicians and b) as safe, efficient and as pleasant as possible for the patient. Obviously that's done within the limits of the available financial resource but, like in any business, if you get the quality of delivery/product and customer service right the value falls out anyway.

The current system doesn't work. The main reason for this is that the existing set up is predicated on the notion that only doctors can do really complex stuff. That just isn't the case any longer. There are lots of roles and disciplines who can do stuff as well as, or in some cases better, than junior doctors. That's not a criticism of junior doctors. They are there to learn and only spend short periods of time in given specialties. But because of those constraints our reliance on them leaves us exposed. They aren't expert in the specialties, which means they lack the knowledge and confidence to make decisions about patient care. And when they finally start learning some of the specifics of their specialty they rotate out and we start all over again.

I've seen demented patients in their 90s sent for scans by junior doctors because they're too frightened to make the correct (but difficult) decision and discharge them back to their nursing home/wherever. I understand the rationale but ultimately you're putting somebody who is vulnerable and who will never get any better through a traumatic experience for no good reason other than to reassure yourself. And scans cost money so it's bad from a value point of view too. What we ought to be doing is staffing clinical areas with specialists from other clinical professions (nursing, physicians' assistants, therapists etc) so the junior doctors are supported to make the right decisions by people who know their specialties. Juniors would be left less exposed and more likely to make good decisions for patients, and you're also safeguarding against the problems caused by rotation (there's plenty of evidence to suggest that it's dangerous for patients) by having a stable non-doctor specialist team present in a given clinical area at all times.

So, in essence, increase the number of permanent specialists of whatever stripe in clinical areas, thus improving continuity of care and clinical decision making whilst creating a more supportive environment for rotating juniors and limiting the damaging impacts of rotation. You might need to reduce the number of junior doctors in the system to afford it but then we wouldn't need as many anyway.

That's a seriously interesting take on things. The rotation system always struck me as a 'necessary evil' so that junior doctors could be exposed to a range of specialities, but perhaps that's not the case.

Do you think there would be any political will whatsoever to change the system or would the idea that our HARD WORKING DOCTORS AND NURSES aren't actually great make it a political non-starter? As a tremendously provocative question, do you think a private system would allow these issues to be addressed?

[Lewis]

Why did he think it needed burning down?

Marxism (obviously). He wasn't in the union because it was 'run by communists', and he likes behavioural psychology, which he thinks is unfairly shut out of History because embracing it would mean people having to 'let go of Marx'. He used to be a counter-terrorism officer, so he thought that if he got on all of the committees he could run the department by stealth and manage it 'properly', so he ended up doing things like taking responsibility for devising the new employability strategy (lol) for the department before deciding it was pointless when they wouldn't let him ground it all in evolutionary biology.

[Lee]

That's a seriously interesting take on things. The rotation system always struck me as a 'necessary evil' so that junior doctors could be exposed to a range of specialities, but perhaps that's not the case.

Do you think there would be any political will whatsoever to change the system or would the idea that our HARD WORKING DOCTORS AND NURSES aren't actually great make it a political non-starter? As a tremendously provocative question, do you think a private system would allow these issues to be addressed?

I think it is a necessary evil, we just don't support it properly. We leave the juniors too exposed which means we leave our patients too exposed.

Doctors and nurses are pretty good, speaking generally. They're just not as good as public perception would have you believe. Even if that weren't the case there is no political will to make dramatic changes to the existing, outdated, system.

I'm not sure how moving to a private system would improve things in that regard (not saying it couldn't, I'm genuinely just not sure of the benefit). What I'd do is change the training structure. Allow hospitals to work with universities to set up their own medical schools based on local demand/workforce models. There's no reason to have a single national workforce model as long as the qualifications and training are up to standard.

There has been a lot of criticism of the government's decision to get rid of the bursary for nursing degrees but actually, rather than seeing people put off applying because of cost, we are seeing more people applying as its a career people want to pursue. Removing the bursary has also removed the requirement to have a set number of funded places. Now they're all unfunded universities can run courses for as many as they like and we'll end up with more nurses than we have now once universities and hospitals cotton on.

No reason we can't do the same for doctors. In fact Milton Keynes hospital is going to be doing its own medical school so it's starting anyway.

[Boydy]

Marxism (obviously). He wasn't in the union because it was 'run by communists', and he likes behavioural psychology, which he thinks is unfairly shut out of History because embracing it would mean people having to 'let go of Marx'. He used to be a counter-terrorism officer, so he thought that if he got on all of the committees he could run the department by stealth and manage it 'properly', so he ended up doing things like taking responsibility for devising the new employability strategy (lol) for the department before deciding it was pointless when they wouldn't let him ground it all in evolutionary biology.

That doesn't really explain why he thought it was run badly other than he was a bit mental and thought everyone was a communist.

How would he have changed it?

[Lewis]

I don't think he had got that far. He was still sussing the communists out.

[Pepe]

One thing at a time, sounds like a smart fella.

[randomlegend]

https://scontent-lhr3-1.xx.fbcdn.net/hphotos-xlp1/v/t1.0-9/12717882_10153980107187159_5468847885856348725_n.j pg?oh=748966b49306694d3c9fda4f3adeebba&oe=578A8DF6

This is apparently the actual wording from the contract.

Lmao.

[Lewis]

Don't birds take up all the university places and then cry off into [semi-]retirement earlier than men? Fuck 'em.

[Spikey M]

As someone who has a wife on 9 months maternity leave whilst I had 2 weeks paternity leave I would like to join in on the loling.

Have a kid and see where the 'sexism' falls. Whingey cunts.

[Chrissy]

As someone who has a wife on 9 months maternity leave whilst I had 2 weeks paternity leave I would like to join in on the loling.

Have a kid and see where the 'sexism' falls. Whingey cunts.

Actually agree with this.

[GS]

I don't see why it merits a 'lmao'. They've acknowledged that there may be an adverse impact, but that the wider benefits merit pushing the changes through.

[GS]

http://www.bbc.co.uk/news/health-36084356

This is quite interesting, as it's their regulator suggesting it may have some fairly significant consequences and advising them (subtly) not to go ahead with it. You'd assume that once public 'support' (or indifference) turns, and they're losing the PR war, it's going to be very difficult to justify continued action. The government can just ride it out.

[Lewis]

I was approaching this with the view that unions are ineffective because they are completely BOTTLE-less and unwilling to cause any major disruption, since I was going off Team Lofty being successful precisely because they were willing to piss everybody off. The idea that they work on the assumption that people simply haven't got time for that sort of shit these days is something I haven't really considered, but the SEETHING that accompanies every Tube strike should have given some indication that all of the doctors' apparent goodwill and Twitter support would evaporate in about ten seconds once it starts to inconvenience people.

[Magic]

I like the Facebook photos of people dressed in doctor uniform giving some spiel about how they can't remember the last time they had a wank because they've been too busy mopping up refugee gonnorhea or that they've worked STRAIGHT for 48 hours. Boring cunts.

[GS]

This is it. No-one cares when it doesn't impact them. People will be SEETHING when it does.

I have limited sympathy. They earn a ridiculous amount when they locum, which they inevitably put through a company to save tax. Plus they use said company for 'working' expenses to reduce the tax bill further. They're earning a packet. Fuck them.

[randomlegend]

The locum wages have been capped.

The average junior doctor really doesn't earn a "packet"

[GS]

They needed to be capped, as some of the hourly charges they are able to extract from hospitals which are desperate for resourcing are unacceptable.

I'd also make the point that medicine is a profession. One can question whether accountancy or law are comparable on a 'line item' basis, but they remain professions. It's expected that junior staff will start on shit money and do stupid hours, but you get 'proper' training, a proper qualification and your salary prospects significantly increase in the years ahead. It's about putting the hard yards in to get there. Medicine is no different. It's okay pretending that this is all for 'patient safety', but it is the same as every strike ever - they want more money for less work. It was ever thus.

[randomlegend]

they want more money for less work.

Except they don't :D

They want the same money for the same work they were doing before, they never asked for a payrise. They just asked not to get less money for more work.

You're obviously completely ignorant of the actual issues and are just spouting what you think it's probably about.

[randomlegend]

You also say it's just like accountancy or law, but they are both significantly better paid for the equivalent stage of training than medicine despite being shorter university courses.

So, you're wrong.

[Magic]

What if THE MARKET drives them all abroad for a much better deal and we're left with a bunch of ancient old school farts and useless immigrants?

[Jimmy Floyd]

I like the idea of all doctors being ancient old school farts.

'I don't believe in all this newfangled stuff. When I was in the field at Anzio, we'd just tie a dead man's shirt around it, stiff upper lip, and back for another crack at Jerry.'

[Kikó]

Considering doctors have that task of keeping you alive against say advising where you can be most tax efficient, I'd argue there's a pretty strong argument to pay them more.

[Magic]

But THE MARKET.

[phonics]

Look Magic, CEOs that lose an absolute shit ton of money can't be held responsible for it and should get a 20% raise for existing. Jr. Doctors on the other hand, need to be cunted out the door at the first opportunity.

[Lee]

The locum wages have been capped.

The average junior doctor really doesn't earn a "packet"

The capped rates are still very high, and Trusts are having to go way above them anyway because doctors are refusing to work for the new rates. Junior doctors absolutely can earn 'a packet'. Most of them don't even make decisions about care and piss and moan if they're asked to. HOs and SHOs are monkeys following consultant instructions. They're getting paid reasonably to train in a pubic service. It's a fucking privilege. Not to mention the social currency a person has just by being able to call themselves 'doctor'. How useful the caps are all depends on how firm a given Trust wants to stand. One in Lancashire has closed emergency services overnight because doctors won't work for the new rates, for example. Which means an essential service is not available because of the greed of a staff group. That's unacceptable.

The doctors are right that their working conditions will be made much more difficult by the government's proposals and I don't blame them, in principle, for taking action. The answer isn't to piss about with rates or stretch current resources over seven days (we need more than just doctors over seven days anyway), but to train more professionals to meet service need. GS is absolutely correct that it's difficult to have too much sympathy when many of the same faces I see on the picket line are quite happy to rip the public off when we're desperate to fill a shift to keep the hospital safe though. It's appalling behavior and the (large number of doctors) engaging in such practice should be fucking ashamed of themselves. They're not though, because they're entitled wankers.

Something which may happen is that Trusts may start arranging their own contracts with doctors. They have the legal right to do so independently of the Department of Health but none has ever exercised the right. If ever there was something which was going to push them in that direction....And given the state of hospital finances I wouldn't expect any of these deals to be favourable. Be careful what you wish for. You aint all going to the Antipodes.

Public opinion will turn soon. It only takes one person to die waiting for surgery - whether they'd have died anyway or not - and the tabloids will be all over it. I'm sick of hearing how "emergency work is still being covered, only routine surgery is being cancelled". Fuck off. It's not true and the doctors know it. Just because surgery has been arranged in advance doesn't mean it isn't important. It would hardly have been arranged if it wasn't. Surgery for cancer is labelled as 'routine'. Other urgent surgeries are labelled as 'routine'. 'Emergency' surgery only means those who are rushed in through ED or who go off on a ward. As for the emergency strike, doctors are just buggering up any long term increase in numbers. Hospitals will cope just fine. Nurse specialists with prescribing skills will do the clerking and we have plenty of people with the skills needed to populate a crash team. And we're only a district general hospital.

The government and BMA need their heads smashing together. But remember, only one of those entities has a nationwide public mandate. Governments almost always come off best from these disputes - even if they do have to compromise a little. All they have to do is to wait for something to go wrong as a result of the action. And something will go wrong. The BMA, already seen as a bit of a laughing stock outside of its own walls (many doctors get to consultant level and fuck off their membership) ad they're going to be fatally weakened by all of this.

[Jimmy Floyd]

I'm really conflicted on this issue. I support the doctors on the issue and think the government have been clueless pricks on the subject. However, as ever the doctors are so ear-bleedingly patronising and sanctimonious in the way they go about things that it's hard to feel much sympathy for them.

[Lewis]

Look Magic, CEOs that lose an absolute shit ton of money can't be held responsible for it and should get a 20% raise for existing. Jr. Doctors on the other hand, need to be cunted out the door at the first opportunity.

In this alternative world of arbitrary non-market pay, graphic designers would owe the public money. Wind it in.

[John Arne]

You also say it's just like accountancy or law, but they are both significantly better paid for the equivalent stage of training than medicine despite being shorter university courses.

So, you're wrong.

Source?

http://www.bma.org.uk/support-at-work/pay-fees-allowances/pay-scales/juniors-pay-england
Foundation Level Jnr Doctor - 22,862

http://www.payscale.com/research/UK/Job=Accountant/Salary/1da3ddf6/Entry-Level-Manchester
Entry Level Accountant (excl. London) - 21,991

Lawyers appear to be paid a lot more.

I have a few accountants in the family, and they are generally paid pretty shitty, unless they are with a big four. They also have to do a lot training and courses after University (CIMA etc.)

[randomlegend]

Apologies, appears I was wrong on accountancy. I'd seen a comparison where doctorising was shown to be lower paid than a load of other graduate jobs and I thought one was accountancy, but I've obviously misremembered and was too lazy to check.

Explains why GS is so butthurt though :eyemouth:

[John Arne]

Apology accepted. xxx

[Magic]

The capped rates are still very high, and Trusts are having to go way above them anyway because doctors are refusing to work for the new rates. Junior doctors absolutely can earn 'a packet'. Most of them don't even make decisions about care and piss and moan if they're asked to. HOs and SHOs are monkeys following consultant instructions. They're getting paid reasonably to train in a pubic service. It's a fucking privilege. Not to mention the social currency a person has just by being able to call themselves 'doctor'. How useful the caps are all depends on how firm a given Trust wants to stand. One in Lancashire has closed emergency services overnight because doctors won't work for the new rates, for example. Which means an essential service is not available because of the greed of a staff group. That's unacceptable.

The doctors are right that their working conditions will be made much more difficult by the government's proposals and I don't blame them, in principle, for taking action. The answer isn't to piss about with rates or stretch current resources over seven days (we need more than just doctors over seven days anyway), but to train more professionals to meet service need. GS is absolutely correct that it's difficult to have too much sympathy when many of the same faces I see on the picket line are quite happy to rip the public off when we're desperate to fill a shift to keep the hospital safe though. It's appalling behavior and the (large number of doctors) engaging in such practice should be fucking ashamed of themselves. They're not though, because they're entitled wankers.

Something which may happen is that Trusts may start arranging their own contracts with doctors. They have the legal right to do so independently of the Department of Health but none has ever exercised the right. If ever there was something which was going to push them in that direction....And given the state of hospital finances I wouldn't expect any of these deals to be favourable. Be careful what you wish for. You aint all going to the Antipodes.

Public opinion will turn soon. It only takes one person to die waiting for surgery - whether they'd have died anyway or not - and the tabloids will be all over it. I'm sick of hearing how "emergency work is still being covered, only routine surgery is being cancelled". Fuck off. It's not true and the doctors know it. Just because surgery has been arranged in advance doesn't mean it isn't important. It would hardly have been arranged if it wasn't. Surgery for cancer is labelled as 'routine'. Other urgent surgeries are labelled as 'routine'. 'Emergency' surgery only means those who are rushed in through ED or who go off on a ward. As for the emergency strike, doctors are just buggering up any long term increase in numbers. Hospitals will cope just fine. Nurse specialists with prescribing skills will do the clerking and we have plenty of people with the skills needed to populate a crash team. And we're only a district general hospital.

The government and BMA need their heads smashing together. But remember, only one of those entities has a nationwide public mandate. Governments almost always come off best from these disputes - even if they do have to compromise a little. All they have to do is to wait for something to go wrong as a result of the action. And something will go wrong. The BMA, already seen as a bit of a laughing stock outside of its own walls (many doctors get to consultant level and fuck off their membership) ad they're going to be fatally weakened by all of this.

Tl;dr

Middle managers should be paid more than doctors.

[Sam]

Source?

http://www.bma.org.uk/support-at-work/pay-fees-allowances/pay-scales/juniors-pay-england
Foundation Level Jnr Doctor - 22,862

http://www.payscale.com/research/UK/Job=Accountant/Salary/1da3ddf6/Entry-Level-Manchester
Entry Level Accountant (excl. London) - 21,991

Lawyers appear to be paid a lot more.

I have a few accountants in the family, and they are generally paid pretty shitty, unless they are with a big four. They also have to do a lot training and courses after University (CIMA etc.)

As an accountant that's a pretty high starter wage tbh. I was stuck on £16k for a good 2 years.

[John Arne]

Indeed. I took the average entry-level figure for post-Uni students.

[Kikó]

Why are nurses not paid the same as Jamie Vardy?

[Magic]

I was only paid 15k to start with as a technician.

[Lee]

Tl;dr

Middle managers should be paid more than doctors.

People who make decisions and have responsibilities which will have an impact on people should certainly be paid more than those who do not, yes.

Regardless of discipline. Your tabloid view of what managers do (bully and box tick, as far as I can tell) is about as far from the truth as it's possible to imagine. There are great managers and shit ones, great doctors and shit ones, great nurses and shit ones. Conferring respect on the basis of a job title is as daft as it gets.

[Magic]

Respect my engineer status, bitch.

[randomlegend]

People who make decisions and have responsibilities which will have an impact on people should certainly be paid more than those who do not, yes.


??

Because doctors don't do that.

[Lewis]

There aren't any shit nurses.

[Lee]

??

Because doctors don't do that.

FY1s and FY2s very rarely do anything without being instructed to. Which is fine; they're learning. But they're not making decisions about care, they're following plans made by seniors. I wouldn't do it. I think it's a shit job at that level. But then I wouldn't be a bin man either.

[randomlegend]

You say that a lot but it doesn't tally with what I see or experiences FYs I know. Perhaps that's how it SHOULD be but I'm not sure it plays out like that in reality.

EDIT: Also as you well know "Junior Doctors" aren't just FYs.

[Lee]

You say that a lot but it doesn't tally with what I see or experiences FYs I know. Perhaps that's how it SHOULD be but I'm not sure it plays out like that in reality.

EDIT: Also as you well know "Junior Doctors" aren't just FYs.

Anybody below registrar level should just be following instructions. Most juniors (by a long way, too) are not registrars.

If there are juniors taking responsibility for stuff they shouldn't be - and I'm sure there are - that's an issue of consultant leadership and should be dealt with as such. It shouldn't be a consideration in this contract dispute.

[John Arne]

This sounds like typical business... Lee is saying that senior people make the important decisions, and therefore, take on the responsibility, whilst RL suggests that the workers actually do the work (perhaps falling into the trap of thinking that the juniors/workers are also making the decisions). So, of course, the people making the decisions should be earning more than the junior people actually doing the work - I don't see the problem with that.

[randomlegend]

I'm not sure whether how you think it should be is realistic.

[randomlegend]

This sounds like typical business... Lee is saying that senior people make the important decisions, and therefore, take on the responsibility, whilst RL suggests that the workers actually do the work (perhaps falling into the trap of thinking that the juniors/workers are also making the decisions). So, of course, the people making the decisions should be earning more than the junior people actually doing the work - I don't see the problem with that.

Give me a bit of credit, I'm not entirely stupid.

[Lee]

I'm not sure whether how you think it should be is realistic.

I am. I see it every day. I spend a lot of time with doctors and spend a lot of time being pissed off at how basic stuff isn't happening quickly enough for patients because seniors aren't getting their fingers out and giving junior doctors the guidance they need.

The strike days so far have been interesting in that regard too. No juniors = stuff happening quickly. It isn't the fault of the juniors, but that's the reality.

[John Arne]

Give me a bit of credit, I'm not entirely stupid.

Of course, apologies if it sounded like that. I was simply making a comparison with real business - also, I believe you are quite young (and probably went into doctoring from college) - so it's not entirely unlikely that you haven't got years of "real world" (ugh) experience.

[randomlegend]

I'm nearly 25, I'm practically middle aged :(

But yes, there's no doubt I'm extremely sheltered from what it's like to work a job at all (I dunno if it's clear I'm still a student), especially one not in the bizarre world of the NHS.

[John Arne]

25? You're still a young whippersnapper. Either way, the NHS seems pretty fucked up - so good luck!

[randomlegend]

Maybe they'll privatise it and we'll get paid loads. :)

[Pepe]

More like you'll get all fired.

[randomlegend]

And replaced with Mexicans, I presume.

[Pepe]

One for every ten of you, yes.

[GS]

The capped rates are still very high, and Trusts are having to go way above them anyway because doctors are refusing to work for the new rates. Junior doctors absolutely can earn 'a packet'. Most of them don't even make decisions about care and piss and moan if they're asked to. HOs and SHOs are monkeys following consultant instructions. They're getting paid reasonably to train in a pubic service. It's a fucking privilege. Not to mention the social currency a person has just by being able to call themselves 'doctor'. How useful the caps are all depends on how firm a given Trust wants to stand. One in Lancashire has closed emergency services overnight because doctors won't work for the new rates, for example. Which means an essential service is not available because of the greed of a staff group. That's unacceptable.

The doctors are right that their working conditions will be made much more difficult by the government's proposals and I don't blame them, in principle, for taking action. The answer isn't to piss about with rates or stretch current resources over seven days (we need more than just doctors over seven days anyway), but to train more professionals to meet service need. GS is absolutely correct that it's difficult to have too much sympathy when many of the same faces I see on the picket line are quite happy to rip the public off when we're desperate to fill a shift to keep the hospital safe though. It's appalling behavior and the (large number of doctors) engaging in such practice should be fucking ashamed of themselves. They're not though, because they're entitled wankers.

Something which may happen is that Trusts may start arranging their own contracts with doctors. They have the legal right to do so independently of the Department of Health but none has ever exercised the right. If ever there was something which was going to push them in that direction....And given the state of hospital finances I wouldn't expect any of these deals to be favourable. Be careful what you wish for. You aint all going to the Antipodes.

Public opinion will turn soon. It only takes one person to die waiting for surgery - whether they'd have died anyway or not - and the tabloids will be all over it. I'm sick of hearing how "emergency work is still being covered, only routine surgery is being cancelled". Fuck off. It's not true and the doctors know it. Just because surgery has been arranged in advance doesn't mean it isn't important. It would hardly have been arranged if it wasn't. Surgery for cancer is labelled as 'routine'. Other urgent surgeries are labelled as 'routine'. 'Emergency' surgery only means those who are rushed in through ED or who go off on a ward. As for the emergency strike, doctors are just buggering up any long term increase in numbers. Hospitals will cope just fine. Nurse specialists with prescribing skills will do the clerking and we have plenty of people with the skills needed to populate a crash team. And we're only a district general hospital.

The government and BMA need their heads smashing together. But remember, only one of those entities has a nationwide public mandate. Governments almost always come off best from these disputes - even if they do have to compromise a little. All they have to do is to wait for something to go wrong as a result of the action. And something will go wrong. The BMA, already seen as a bit of a laughing stock outside of its own walls (many doctors get to consultant level and fuck off their membership) ad they're going to be fatally weakened by all of this.

I would agree with the view that there should be 'seven day' coverage. Now, whether they're (the government) going about fixing it the right way or not is a different question. As you say, the solution may be to train more people, not necessarily doctors, and be 'smarter' about the way to provide care. One of the consequences of these strikes could be demonstrating to hospital administrators that having too many junior doctors who just rotate off after four months into another speciality isn't the way to go about things. Could you see a decrease in the number of junior doctors accepted at your hospital on the back of the findings from these strikes? That'd be an irony.

Regardless, the locuming culture is absolutely rotten. You simply cannot have doctors standing on the picket line one day and the next they're holding the hospital to ransom when they're desperate for resource. The hypocrisy is astounding.


I'm really conflicted on this issue. I support the doctors on the issue and think the government have been clueless pricks on the subject. However, as ever the doctors are so ear-bleedingly patronising and sanctimonious in the way they go about things that it's hard to feel much sympathy for them.

I think much of it boils down to an outdated view that being 'a doctor' is a high social status profession and therefore we, the ordinary folk, should respect them simply for being doctors.


Apologies, appears I was wrong on accountancy. I'd seen a comparison where doctorising was shown to be lower paid than a load of other graduate jobs and I thought one was accountancy, but I've obviously misremembered and was too lazy to check.

Explains why GS is so butthurt though :eyemouth:

The worst that happens if I fuck something up is that the client waits an extra period of time for us to fix it. I don't expect to be paid the same as doctors, but that's irrelevant to the point at hand - which is, it's a profession and whilst you start on shit money and do the hard yards for a few years, when you 'climb the ranks', as it were, you do very well and you can start to suit yourself a lot more. But you have to do the hard yards - you're not entitled to anything right off the bat.

With complaints such as weekend working, night shifts or staying late after your shift is over - you knew all that was either part of the deal or highly likely, particularly at junior grades, when you took medicine on at degree level. You can't really complain after the event.

[randomlegend]

With complaints such as weekend working, night shifts or staying late after your shift is over - you knew all that was either part of the deal or highly likely, particularly at junior grades, when you took medicine on at degree level. You can't really complain after the event.

Yes, we did know that. What we didn't expect was for it to get considerably worse and to get less money for it.

[Lee]

I would agree with the view that there should be 'seven day' coverage. Now, whether they're (the government) going about fixing it the right way or not is a different question. As you say, the solution may be to train more people, not necessarily doctors, and be 'smarter' about the way to provide care. One of the consequences of these strikes could be demonstrating to hospital administrators that having too many junior doctors who just rotate off after four months into another speciality isn't the way to go about things. Could you see a decrease in the number of junior doctors accepted at your hospital on the back of the findings from these strikes? That'd be an irony.

On numbers of qualified people required to a) keep the place safe and b) have a consistently high quality of care we'd defer to the consultant body. We'll make sure they know what we can pay for and help design the processes required for care to be delivered as efficiently/quickly as possible (the 'production/business process' and 'customer service' bits, basically) whilst the experts tell us what's necessary for the quality to be high. It's telling that the consultants are initiating conversations with us about how we might change move away from the traditional junior doctor heavy model in light of what has been learnt from the industrial action. I know similar conversations are taking place in other hospitals too.

There's a very real possibility that junior doctors, guided by the BMA it should be said, are taking action which will be the catalyst for a reduced junior doctor workforce in years to come. Which may well be great for patients, so good. But it will be bad for the BMA. They'll become increasingly marginalised ad they'll have done it all by themselves. It will take years to get there but I think that's the way things will go. It's already happening, albeit very slowly. The clinical workforce is diversifying as stuff that used to be really complex and thus the preserve of doctors only becomes less so due to a greater availability of educational resource to non-doctors and advances in medical science. But the current bollocks could really accelerate the process. By the middle of the next decade (to take into account the long training period) I think the BMA will look at this action as the moment they lost the plot and killed their influence.

[GS]

Yes, we did know that. What we didn't expect was for it to get considerably worse and to get less money for it.

When I accepted my graduate job, it came with TOIL. I got a leaflet two months before starting telling me that this was being sacked off, and I was instead going into firm-wide 'bonus pool'. This meant I lost several days TOIL a year in exchange for fuck all (my first bonus was a paltry £200 after the tax man had its way with it). Shit happens, basically. It's a profession - the rewards further down the line, and the qualifications, meant it was a worthwhile exchange regardless.

To reiterate the point I made to Lee, I don't disagree with the need for 'proper' coverage across the full week. Whether the government are going about it the right way is a different matter, but I simply cannot accept the hypocrisy of doctors ripping the shit out of the system when it suits them and then pleading a lack of fairness on the other.

[Lee]

GS is completely right here.

[phonics]

To steal a phrase, I'm no expert, I'm phonics but isn't the whole issue with the NHS that we have to hire a bunch of mercenaries and/or foreigners because there's not a wide enough pool of trained talent (whether that be nurses, doctors, radiologists etc.) and therefore going about a negotiation where the junior level have better paying, instant opportunities from abroad due to commonwealth visas and the like just fuck you even more and you eventually get to spending money like the U.S. does?

[randomlegend]

So however shitty your 'boss' tries to make your working conditions, however much they lie and belittle you in the press, however much you feel the proposals are unsafe (I know you lot love to make the discussion all about pay, but that's not what the vast majority of the junior doctors' complaints have been about) you should just accept it because 'shit happens'?

Nah, fuck that.

[Pepe]

So however shitty your 'boss' tries to make your working conditions, however much they lie and belittle you in the press, however much you feel the proposals are unsafe (I know you lot love to make the discussion all about pay, but that's not what the vast majority of the junior doctors' complaints have been about) you should just accept it because 'shit happens'?

Nah, fuck that.

First time you read GS?

[randomlegend]

I think so? He's new isn't he?

[GS]

So however shitty your 'boss' tries to make your working conditions, however much they lie and belittle you in the press, however much you feel the proposals are unsafe (I know you lot love to make the discussion all about pay, but that's not what the vast majority of the junior doctors' complaints have been about) you should just accept it because 'shit happens'?

Nah, fuck that.

I find it difficult to accept the idea that this is about 'patient safety' when they're happy to go on strike (what's this, the fourth time?) and routinely hold hospitals to ransom when they're seeking better locum pay. Medicine isn't a 'calling' - it's a career choice for the vast majority of people, and they want the best circumstances for themselves. This is perfectly fine - but the sanctimonious bollocks about how this is about the patients and not the doctors themselves simply doesn't cut it.

Now, again, I'm not saying that the way the government is going about 'reforming' the system is the right way to do it. However, there were certain practices which clearly needed to be addressed. Doctors cannot exercise this level of hypocrisy and expect everybody else to congratulate them on their principled stand. That doesn't mean Jeremy Hunt isn't a complete wanker, but we really need to move on from this idea that junior doctors are entitled to something simply because they're junior doctors.

[randomlegend]

I find it difficult to accept the idea that this is about 'patient safety' when they're happy to go on strike (what's this, the fourth time?)

Strikes which haven't compromised patient safety...

What else are they actually meant to do in protest when the government declares they will unilaterally impose something they fundamentally disagree with? Just suck it up is your position, I guess. I think that's bollocks.


and routinely hold hospitals to ransom when they're seeking better locum pay.

You talk about this like every doctor is lining their pockets with high paid locum shifts every chance they get, which just isn't true.


Medicine isn't a 'calling' - it's a career choice for the vast majority of people, and they want the best circumstances for themselves. This is perfectly fine - but the sanctimonious bollocks about how this is about the patients and not the doctors themselves simply doesn't cut it.

If I didn't feel some sort of 'calling' (if that's what you want to call it) towards medicine there is no way in fucking hell I'd have gone into it and I would be very confident that's true for the vast majority of people I know. There are a million other things I could have done with my ability which would have been higher paid, less stressful, more prestigious and a better 'career'.

And it is about safety. It's about not treating someone after being on shift way too long and having worked way too many hours that week and making a prescription error because you're exhausted and harming someone.

Yes, they want to be paid fairly for what they do (i.e. they don't want a wage cut for more work), but amongst everyone I know the primary concerns are preserving the NHS (despite the fact they suspect they'd stand to benefit financially from it being privatised) and being a safe doctor.


Now, again, I'm not saying that the way the government is going about 'reforming' the system is the right way to do it. However, there were certain practices which clearly needed to be addressed. Doctors cannot exercise this level of hypocrisy and expect everybody else to congratulate them on their principled stand.

Again, this is on the presumption every Dr is rolling in it from all the locum work they are doing. They aren't. You can't shit on a whole profession for 'hypocrisy' when - and I don't have figures but my experience is that - most people aren't doing what you are accusing them of.



That doesn't mean Jeremy Hunt isn't a complete wanker, but we really need to move on from this idea that junior doctors are entitled to something simply because they're junior doctors.

They are entitled to something. They are entitled to work in decent conditions for decent pay and to be part of a system which allows them to practice safely. If they don't get that, you can't expect anything other than for them to fuck off.

[Magic]

But SAVING LIVES.

[GS]

Strikes which haven't compromised patient safety...

What else are they actually meant to do in protest when the government declares they will unilaterally impose something they fundamentally disagree with? Just suck it up is your position, I guess. I think that's bollocks.

You talk about this like every doctor is lining their pockets with high paid locum shifts every chance they get, which just isn't true.

If I didn't feel some sort of 'calling' (if that's what you want to call it) towards medicine there is no way in fucking hell I'd have gone into it and I would be very confident that's true for the vast majority of people I know. There are a million other things I could have done with my ability which would have been higher paid, less stressful, more prestigious and a better 'career'.

And it is about safety. It's about not treating someone after being on shift way too long and having worked way too many hours that week and making a prescription error because you're exhausted and harming someone.

Yes, they want to be paid fairly for what they do (i.e. they don't want a wage cut for more work), but amongst everyone I know the primary concerns are preserving the NHS (despite the fact they suspect they'd stand to benefit financially from it being privatised) and being a safe doctor.

Again, this is on the presumption every Dr is rolling in it from all the locum work they are doing. They aren't. You can't shit on a whole profession for 'hypocrisy' when - and I don't have figures but my experience is that - most people aren't doing what you are accusing them of.

They are entitled to something. They are entitled to work in decent conditions for decent pay and to be part of a system which allows them to practice safely. If they don't get that, you can't expect anything other than for them to fuck off.

They've led to repeated cancellations of 'routine' surgery (if it wasn't needed, it wouldn't have been scheduled, would it), which causes a serious amount of inconvenience to the patient. Perhaps it does not directly lead to immediate safety issues for the patient, but one suspects that there are many vulnerable patients who have had surgeries reorganised or postponed indefinitely on the back of this action. And you don't know what impact on quality of life, however short or medium term that may have, that has.

You can fall back on the 'safety' argument if you wish, but let's not pretend there have been no consequences to patients arising from these actions. You're also about to go on full walk-out, including emergency care. This is definitely jeopardising patient safety, in spite of the contingency plans hospitals will put in place. This is also the view of the GMC.

On the subject of why you went into medicine, that may be why you went into it. However, training to be a doctor still has the perception as a high 'social status' profession and it is very well paid. This isn't the professional equivalent of digging wells in the depths of Africa for eight years to help poor communities. I have no problem with that, because you want the brightest people putting themselves forward for the job. It is living in a fantasy land to pretend that the 'vast majority' are only training in the profession because they perceive it as some great social enterprise to work in and defend the NHS.

With respect to the locum issue, you certainly can highlight the hypocrisy involved. If you've taken even one locum shift at an extortionate hourly wage, you've ripped the shit out of the system. Full stop. It's widespread practice, and I don't blame doctors for doing it - but if you have, you simply cannot turn around and pretend you're doing anything other than suiting yourself.

[randomlegend]

How much do you think doctors get paid, out of interest?

[Lewis]

It would be good to see them just WALK OUT indefinitely until one side BOTTLES IT (most likely them). Randrew could be excused, like. They don't need him flagging on the picket line and using up all the strike fund on Lucozade.

[GS]

How much do you think doctors get paid, out of interest?

I believe they start on somewhere around mid-twenties, with increases once you move outside your first two year training rotations. It's also dependent on whatever band you're in, but I don't know how that works. I'm also aware of locum hourly rates of £93 an hour for a 12 hour shift, which appears to be standard.

Again, starting salary isn't important in and of itself. It's about pay progression, which is very good because you should be earning very well after eight, ten, twelve years after starting.

[Lee]

'Routine' surgery means anything that isn't rushed in on an ambulance or burst inside of somebody already in hospital. Cancers and other urgent surgeries count as 'routine'. Somebody is going to die waiting and the doctors will look like cunts for saying they're not jeopardising patient safety. Stop saying it, for fuck's sake.

[Lee]

I believe they start on somewhere around mid-twenties, with increases once you move outside your first two year training rotations. It's also dependent on whatever band you're in, but I don't know how that works. I'm also aware of locum hourly rates of £93 an hour for a 12 hour shift, which appears to be standard.

Again, starting salary isn't important in and of itself. It's about pay progression, which is very good because you should be earning very well after eight, ten, twelve years after starting.

I haven't come across a junior taking away more than £65 per hour since the caps were introduced and that's an extreme example. Juniors haven't been too bad with the capped rates, but that's not saying much given that the rates are very generous.

Consultants are taking the piss though. It will be interesting to see what happens when the consultant contract is negotiated. I suspect they'll bend over, leaving the juniors isolated. Not a chance consultants will risk their cushy positions. Far too clever for that.

[GS]

Are there increased rates for bank holidays / weekends / nights etc. for locum rates or how would it usually work? All I hear are the 'headline' figures whenever my mates (and, by extension, their 'work' mates) are talking about potential earnings.

[Lee]

Are there increased rates for bank holidays / weekends / nights etc. for locum rates or how would it usually work? All I hear are the 'headline' figures whenever my mates (and, by extension, their 'work' mates) are talking about potential earnings.

There are. What we're finding is that juniors were more willing to work for the February rates but not the April ones (they've been capped in stages). So for a lot of weekday shifts we're paying out (April) weekend/bank holiday rates so we can keep services going. It isn't great and it's more than a bit annoying when the same doctors are being all pious about the necessity for industrial action.

The juniors are nowhere near as bad as the consultants though. One cunt refused to work for the internal rate and tried selling himself to me as an external locum for £120p/h. I paid more (in totality - it was less when you take into account NI etc) for another external to prove the point. I've also had consultants threaten not to deliver a service because of rate caps. You just have to hold your nerve and give it the old "go on then, lads" in the hope that they bottle it. They did, fortunately. I find the money side of things really pisses me off. I find it genuinely disgusting that people can be asking for so much money to deliver a public service.

The 'routine' surgery thing is a sore point as well. Before three of the four strikes we've had so far (I was abroad for one) I've personally made phone calls to patients awaiting surgery to tell them they can't have it. These people have spent weeks getting worked up, taking time of work, arranging for relatives to take time off work to care for them while they recover. It's fucking cruel. The BMA and the juniors can talk about how they're not risking patient safety but they're only right in the strictest sense. They ought to try being cried at down the phone by a woman with cancer who just wants the fucker cut out.

[randomlegend]

Yeah, I'm sure they're complete strangers to dealing with that kind of distress and emotion.

I think you just see the worst side of the situation I.e. the extortionate locum rates and forget that most doctors genuinely care and do a lot beyond their remit out of good will. People don't stayate to look after people because they think it will progress their career, they do it because they know the patients need looking after.

Or maybe your doctors don't, maybe you work with a bunch of cunts, but it's certainly not my experience.

[Lee]

Yeah, I'm sure they're complete strangers to dealing with that kind of distress and emotion.

I think you just see the worst side of the situation I.e. the extortionate locum rates and forget that most doctors genuinely care and do a lot beyond their remit out of good will. People don't stayate to look after people because they think it will progress their career, they do it because they know the patients need looking after.

Or maybe your doctors don't, maybe you work with a bunch of cunts, but it's certainly not my experience.

Obviously they're not strangers to it. Even more reason that they should know better and stop lying with their patient safety message. I don't forget anything. I see doctors both good and bad. I'm just not conned into believing they're all virtuous souls because, unlike you, they're not what I aspire to be.

Of course doctors genuinely care. They're human. But equally some are in it for the locum money and others are in it for the cushy lifestyle they'll get if they make it to consultant level. Being a doctor doesn't make them more caring towards other humans than the IT bloke or the cleaning lady though. The self righteousness is annoying.

And yes, many stay late to complete jobs they've started. That happens in factories too. Although most are gone at 5pm. As they should be; they've done their bit and there are people to take over. The 'your doctors might be cunts' argument is piss weak. They rotate. We get new ones all the time. There's no reason why what I see shouldn't be representative. And in any case I speak to people from other hospitals regularly.

I don't hate doctors. I get on really well with most and my job means I've formed friendships with loads of them. Like any group in society they're mostly good. But also like any group there is greed and dishonesty in there.

You clearly find it very hard to see that doctors aren't all wonderful and that there's no way they can't be 100% correct on this matter. You go on as though they're poorly paid. They're not. When anybody mentions ridiculously high locum rates your response is that it's not the majority. I can tell you that I've never met a single junior doctor who hasn't been willing to work for mental rates. You're at pains to tell us that they care about patients. Good. That's the fucking minimum expectation, that they don't want people to die. And you parrot the 'routine surgery' line. It's bollocks.

On the principle of the matter the junior doctors are correct. But that doesn't mean they should be above criticism. Especially when some of those protesting are happy to rip the service off on other days and they're happy to let seriously ill patients down to make their point.

[randomlegend]

I also don't think it is a fantasy that most people who go into medicine don't do it for the career aspect.

The few I know who did are already deciding to finish med school and do something else.

Yeah, obviously we didn't all go and decide to spend our lives volunteering in Romanian orphanages, but I still find most peoples main motivations were fairly altruistic. Perhaps that's because I go to the fluffiest med school in the whole world and we are all the freaks.

[randomlegend]

This is too long to be doing on my phone. I'll respond later.

[Lee]

I don't doubt that most go into it for the right reasons. Just not any more so than any other person who gives a shit about other people. People generally want to do good, they just have different abilities and skills to enable them to do so. Doctors are privileged in that regard. And they aren't doing it for free. If they stay the career path they can become a consultant, end up basically rich and be among the most respected groups in society. Good luck to them too. But let's not pretend they're hard done to as a profession.

[phonics]

I don't doubt that most go into it for the right reasons. Just not any more so than any other person who gives a shit about other people. People generally want to do good, they just have different abilities and skills to enable them to do so. Doctors are privileged in that regard. And they aren't doing it for free. If they stay the career path they can become a consultant, end up basically rich and be among the most respected groups in society. Good luck to them too. But let's not pretend they're hard done to as a profession.

But isn't that the issue? Not the junior doctors. It seems very much stomp on the little man because we can save a few quid here but don't actually go after the people raking it in. Then by stomping over these people you're going to have less people in the talent pool to become consultants meaning they can charge even more money.

Very much like going after people's benefits and benefit fraud when tax fraud dwarfs it.

[randomlegend]

The consultants' turn is coming, I would imagine.

[Lee]

But isn't that the issue? Not the junior doctors. It seems very much stomp on the little man because we can save a few quid here but don't actually go after the people raking it in. Then by stomping over these people you're going to have less people in the talent pool to become consultants meaning they can charge even more money.

Very much like going after people's benefits and benefit fraud when tax fraud dwarfs it.

Having a smaller talent pool might be the way it goes, deliberately. If consultants cost us more in tbf long run than so be it. I've no issue with people being paid very well for being experts in their field.

Again, on the principle the junior doctors are right. But by making the argument public some of their hypocrisies are fair game too.

[randomlegend]

Also I obviously don't think all doctors are 100% wonderful and can't possibly be wrong.

I just think some of the opinions (like GS' that we are a primarily career-driven) put forwards are unfair.

[Lee]

The consultants' turn is coming, I would imagine.

It is. Negotiations are due any time. I doubt things will go the same way though. Neither side will be able to afford another argument like this.

[randomlegend]

It's all going to get privatised and this will be irrelevant anyway ;)

[Lewis]

There are blogs out there that would love this Fox stuff. Imagine if the anonymous 'Ginger Rodent' became a hate figure. :drool:

[phonics]

'Leicester may be top of the table but this Director of Operations is anything but *multi quotes every bus perv post he's ever made*'

[GS]

Also I obviously don't think all doctors are 100% wonderful and can't possibly be wrong.

I just think some of the opinions (like GS' that we are a primarily career-driven) put forwards are unfair.

I'm sure if you told doctors they would have no career progression and cut their wages in half, not very many would be prepared to stick it out because they're providing a valuable 'altruistic' public service. People like money. People are ambitious and want career progression. This isn't a criticism - but it really does need recognised that people go into these professions because they offer very generous pay packages, good career opportunities and a profession which carries social status.

As everyone's acknowledged the principle behind the protests is probably sound - but this could well prove a Pyrrhic victory for the BMA, if they even 'achieve' a victory at all.

[randomlegend]

That's all well and good, but if they were people's primary motivations they'd still have chosen something else.

[Lewis]

'We just want to save lives. :('

[GS]

That's all well and good, but if they were people's primary motivations they'd still have chosen something else.

Hardly. The pay is very good (here (https://www.healthcareers.nhs.uk/about/careers-medicine/pay-doctors)). It comes with options, potential for an excellent pension and the opportunity to absolutely scam the system as a locum when you fancy earning a few extra quid. It is naive in the extreme to imagine that people are there exclusively because they want to help the masses, or that they're undertaking the training because they support 'our NHS'.

If they were / did, they wouldn't act as they do. Judge not what doctors say, but what they do. Everything else is just sanctimonious noise to justify their actions, past and present and future.

[Lee]

That's a point actually. The juniors seem at pains to point out that they compare badly to other professional training routes (they don't) but those in other professional fields aren't getting paid for overtime. The salary is the salary and the expectation is that you put in the hard yards early in you career.

[GS]

This is true. As you say, my salary is my salary and that's it. Any overtime anybody does is without additional remuneration. We also can't undertake additional work when it suits us at inflated rates. Doctors have plenty of options open to them. There's also nothing about getting extra remuneration for working into the night or at weekends. I don't do this, but there are plenty of people who do and - again - it's just expected they will. It's the same with lawyers too.

Which reinforces the point that it's a very good career choice, irrespective of motive.

[GS]

It would be good to see them just WALK OUT indefinitely until one side BOTTLES IT (most likely them). Randrew could be excused, like. They don't need him flagging on the picket line and using up all the strike fund on Lucozade.

As if by magic, leaked emails indicate the BMA are considering that as an option: http://www.theguardian.com/society/2016/apr/21/uk-junior-doctors-may-follow-april-strikes-indefinite-walkout

[randomlegend]

Anybody below registrar level should just be following instructions. Most juniors (by a long way, too) are not registrars.

If there are juniors taking responsibility for stuff they shouldn't be - and I'm sure there are - that's an issue of consultant leadership and should be dealt with as such. It shouldn't be a consideration in this contract dispute.

I've had enough of going over most of the stuff in this thread again and again, but I honestly can't get over the fact this is what you believe.

I'd be laughed out of the room if I said in a lecture that a junior should be going to their registrar with every single decision. Obviously they aren't deciding on what type of surgery someone will have for their cancer and there should always be someone on hand to ask things above their competence or they aren't sure about, but I just don't believe it's true that juniors aren't expected to make any decisions or manage anything for themselves.

[Lee]

I've had enough of going over most of the stuff in this thread again and again, but I honestly can't get over the fact this is what you believe.

I'd be laughed out of the room if I said in a lecture that a junior should be going to their registrar with every single decision. Obviously they aren't deciding on what type of surgery someone will have for their cancer and there should always be someone on hand to ask things above their competence or they aren't sure about, but I just don't believe it's true that juniors aren't expected to make any decisions or manage anything for themselves.

They shouldn't need to go to a registrar every five minutes. They should be following an agreed plan. A clear plan is put in place for each patient upon admission to hospital. Any changes to this are put in place by the consultant leading the ward round each day. Jobs are distributed to juniors every morning by the consultant leading the ward round. The job of the junior is to learn by doing as they're told. They can challenge, of course (it's all part of their learning), but any decisions are made by consultants. Experienced registrars can do so if the consultant in charge deems it to be appropriate. A board/ward round isn't considered to have taken place if not led by a consultant or by a registrar with explicit delegated authority from a consultant.

It isn't safe for a person at that stage of their training to be making decisions about care. It's also against all (clinically developed) national guidance. If senior doctors are leaving juniors doctors to make decisions about the care of a patient that's real safety concern and is a disciplinary matter for the consultant in question. It's neglectful and can result in consultants being in the shit with the GMC, so they take it seriously.

What you're taught in lectures is clearly very different to what happens in a hospital. What I'm writing isn't "what I believe". It's what I see every day. It's part of my job to make sure it's happening. I have worked in two very different acute hospitals full time and have visited countless others all across England through my career so far, often with the sole purpose of observing clinical process to ensure we are doing the safest things possible. The expectations are the same everywhere. If a relative of mine died in hospital and I found that decisions outside of a consultant-agreed plan were being taken by junior doctors I'd be suing the fuck out of that hospital.

I'm not inventing this to make a point. It's my job to understand how hospitals work.

[GS]

Lee donning matters on the basis of actual experience.

[Yevrah]

You also say it's just like accountancy or law, but they are both significantly better paid for the equivalent stage of training than medicine despite being shorter university courses.

So, you're wrong.

This may have been already been covered, but there's no university course for accountancy that counts for anything whatsoever, so I can only assume you're making that up.

[randomlegend]

It was, and I said I was wrong :)

[randomlegend]

http://www.brightknowledge.org/knowledge-bank/medicine-and-healthcare/careers-and-courses/a-day-in-the-life-of-a-junior-doctor


Ward round: twice weekly consultant led rounds where it was my job to tell the consultant about each patient, to ensure unwell patients were seen first and no one missed. Hopefully the round would be finished by midday to give time for lunch. On days with no consultant the F2 and I conducted our own ward round ensuring that all patients - especially new patients – were seen. This gave us the opportunity to develop clinical assessment and decision-making skills.

http://www.yorkshirepost.co.uk/news/analysis/seven-days-in-the-life-of-a-junior-doctor-1-7611437


In A&E junior doctors will make decisions about what investigations to do, what tests to order and what treatment to give. If you come into A&E, or are admitted to hospital, it is quite likely that the first person you meet, the one who will be responsible for your care while you’re in, and the last person to wave you off when you leave, will be a junior doctor.

Other than posting shitty links and saying "that's not my experience from talking to friends and spending time with junior doctors" I'm not sure what else I'm meant to say to make my point. I simply don't believe every patient who enters a hospital sees a consultant before any decisions are made about their care. I don't even think it would be possible.

If you're called in the middle of the night to see someone who's vomiting as a junior, you'll be expected to prescribe something and you won't be running to your reg with it.

[GS]

I don't really see why you're continuing to argue the point with him given its actually his job. To be honest, your arguments do come across as somewhat naive and the sort of student idealism that is soon beaten out of you when you actually go to work for any length of time.

[randomlegend]

Idealism? What Lee is saying sounds much more ideal to me.

Being a junior doctor is actually the job of the people I talk to about what it's like being a junior doctor.

[GS]

Idealism with respect to your views on doctors and the medical profession in general.

Lee appears to have outlined the existing, and sensible, procedure which is in place to protect the hospital and limit its exposure - it would also appear to be safer for the patient.

[Lee]

http://www.brightknowledge.org/knowledge-bank/medicine-and-healthcare/careers-and-courses/a-day-in-the-life-of-a-junior-doctor



http://www.yorkshirepost.co.uk/news/analysis/seven-days-in-the-life-of-a-junior-doctor-1-7611437



Other than posting shitty links and saying "that's not my experience from talking to friends and spending time with junior doctors" I'm not sure what else I'm meant to say to make my point. I simply don't believe every patient who enters a hospital sees a consultant before any decisions are made about their care. I don't even think it would be possible.

If you're called in the middle of the night to see someone who's vomiting as a junior, you'll be expected to prescribe something and you won't be running to your reg with it.

An F1 and F2 led 'ward round' is not a proper ward round. The vast majority of patient on a ward have got there via ED. In ED a patient likely to be admitted (around 25% of all who attend) is seen by a consultant or registrar in Emergency Medicine who will agree and initiate a short term plan. The other 75% likely will be seen by a junior. They will refer for investigations. That is not a decision about care. That's ordering a test so a more senior doctor can make a decision about care. They will also recommend and provide medication - normally pain relief and normally nothing stronger than what I can decide to buy for myself over the counter.

If a patient needs admission they'll be referred to the relevant specialty (medicine in about 70% of cases) where they will be seen by a junior doctors but with a plan (again short term, as these will not necessarily be doctors from the relevant specialty) agreed by the first on call registrar, who is based in ED for the duration of their shift for this very reason. Any decision to admit the patient must be made by a doctor not more junior than a registrar.

Once a patient arrives on a ward they will be cared for by the nurses and junior doctors on the ward. These people will follow the plan initiated in ED. At some point within 12 hours of admission (assuming the presence of a medical assessment unit or equivalent, which is now standard in most acute hospitals) - usually much more quickly than that - MAUs tend to have twice daily consultant-led rounds - they will be seen by a consultant who will formally review their condition and begin planning for treatment and, ultimately, discharge from hospital. Once they move on to a speciality ward the MAU plan will be followed until such time as the speciality consultant reviews the patient and makes any changes, usually following the morning ward round.

If a junior is called to a vomiting patient in the middle of the night they may prescribe something to stop the vomiting, depending on the genesis of the vomiting. That's really basic and it's stretching it to call that a decision about care of a patient. It's barely more than a mother would do for their kid at home. If the vomiting is cause for concern and suggests a deterioration in the patient's condition the junior will be calling the reg on call who is then likely (depending on their experience) to discuss with the on call consultant to discuss how best to stabilise the patient. A junior doctor is not qualified to be making choices about a patients care plan and it would be unfair to expect them to do so.

The first link is the experience of a junior doctor in 2010. This is before the Francis Report (Mid-Staffs disgrace) recommendations could be implemented and before the Keogh Report of 2013. Both made very clear that staffing levels across all clinical disciplines needed increasing. This has happened. Twice weekly consultant led ward rounds were a thing then. Indeed that was the recommended level. It was a poor recommendation and is now no longer in place. That was a period during which hospitals were deliberately keeping clinical staffing levels as low as they could get away with without being called cunts in order to meet the stupid financial targets necessary to become more autonomous Foundation Trusts. The NHS wasn't using all of the doctors at its disposal because Trusts were desperate to report surpluses. The Yorkshire Post link doesn't contradict anything I've said.

[randomlegend]

I think it's clear we disagree what constitutes a 'decision' and that's where this argument is really coming from.

I don't think junior doctors see people in A and E on their own, do the investigations, decide what's wrong with them, send them for surgery and admit them to a ward. I'm not an idiot.

But seeing someone in A and E and deciding whether it's safe to pursue investigations before seeking guidance and what those investigations should be is making a decision and it's a fairly daunting one for someone straight out of medical school. There are things which need urgent senior attention which can be and are missed. That's a scary prospect.

Giving someone an anti-emetic in the middle of the night as a junior isn't the same as a mum giving her kid paracetamol at home. People in hospital are there for a reason and you have to decide whether prescribing something to stop their vomiting is the safe thing to do or if there is a more serious reason for their vomiting and you should seek help. As someone with little/no experience, that's not a straightforward decision. You might feel 99% sure they are fine, but should you call someone every time just because there will always be that 1% doubt when you start out? No, of course not. So how much uncertainty do you need to have before you draw the line?

I understand these decisions seem banal to you and certainly to a consultant, but I don't think they are to new doctors.

And on the changes of policy etc, fair enough.

[Lee]

I think it's clear we disagree what constitutes a 'decision' and is that's where this argument is really coming from.

I don't think junior doctors see people in A and E on their own, decide what's wrong with them and decide their ongoing treatment plan and/or admit them to a ward.

But seeing someone in A and E and deciding whether it's safe to pursue investigations before seeking guidance and what those investigations should be is making a decision and it's a fairly daunting one for someone straight out of medical school.

Giving someone an anti-emetic in the middle of the night as a junior isn't the same as a mum giving her kid paracetamol at home. People in hospital are there for a reason and you have to decide whether prescribing something to stop their vomiting is the safe thing to do or if there is a more serious reason for their vomiting and you should seek help. As someone with little/no experience, that's not a straightforward decision. You might feel 99% sure they are fine, but should you call someone every time just because there will always be that 1% doubt when you start out? No, of course not. So how much uncertainty do you need to have before you draw the line?

I understand these decisions seem banal to you and certainly to a consultant, but I don't think they are to new doctors.

An investigation is often pursued precisely so a care decision can be delayed. Caution borne of inexperience. We know this because, during all of the recent strikes, we've seen a dramatic reduction in the number of investigations of all types ordered. And yet clinical decisions have still been made. The same decisions. They've just been happening more quickly, without the need for a scan here or bloods there. There's a strong argument building that the traditional role of the junior doctor in ED is actually slowing down decision making about care and the strikes are allowing that evidence base to be built.

You're having a laugh if you think ordering a CT, for example, is a decision about care. For certain presentations a given set of scans/tests is compulsory, so the decision is already made. In other cases it's fear of not being able to say they've done everything possible. I understand why, I get that it's daunting. But I care about what's in the interests of patients, not junior doctors. If we're doing the same things to a patient more slowly, because a junior doctor has ordered every test under the sun, then that's really shit.

In terms of the vomiting example, a good clinical plan will already have that covered. "If 'x' happens to Mr Smith then do/prescribe/order/ask 'y'. Doctors used to try arguing that such plans weren't possible because "PEOPLE ARE DIFFERENT IT ISN'T A FACTORY". But actually all the research shows us that sick people are remarkably predictable. Clinicians are on board with this these days and we'll get to a point where most things are checklisted. They already are in surgery.

Anyway; yeah, I was flippant with the 'mummy and paracetamol' example I gave but I wasn't too far off the mark. A 'decision' in an acute clinical context is something that's going to get somebody better and out of the hospital so other, newly sick, people can have their turn. That's the whole point of a hospital. Fixing sick people, getting them home to make room for other sick people, getting them home. And on.

[Shindig]

I thought my experience yesterday was pretty good. I think it was helped with a student doctor being in tow because, as a patient, I got to see how they assess injuries. Doctor came in after about an hour, spoke to me about urine results and booked me in for an ultrasound which came back clear. So I was good to go with some paracetamols, codeine and a caveat of visiting my GP for another urine sample on Monday because, "That blood came from somewhere." Everything was explained clearly and, whilst I'd have liked to be in and out quicker, there's no hospital in the world that isn't busy.

[GS]

https://pbs.twimg.com/media/CgwZj4DW0AEkZ4l.jpg

[randomlegend]

Oh fuck off, I had Tuesday and Wednesday off.

[Byron]

I think Edwina Currie is actually harming the government with her performance on Good Morning Britain. Patronising cunt.

[GS]

This is quite good value: http://www.telegraph.co.uk/news/2016/04/25/the-tragic-naivety-of-immature-junior-doctors-and-their-strike/

I'd be interested in Lee 's take on it.

[Lee]

This is quite good value: http://www.telegraph.co.uk/news/2016/04/25/the-tragic-naivety-of-immature-junior-doctors-and-their-strike/

I'd be interested in Lee 's take on it.

It's very good and reflects my own views. They really don't realise just how fortunate they are.

That said, the government aren't approaching this perfectly themselves. If you want full seven day cover it needs paying for and that means training more people. Not just doctors either - they need all the appropriate support services around the, and there's no sogn of that happening. Again, it's a funding and training places thing. Hunt also needs to stop chucking around the mortality at weekends claim. It's a deliberate false representation of a paper and reduces a complex issue to a binary choice. He's a dickhead.

[GS]

https://orderorder.files.wordpress.com/2016/04/cg9anwwwiauq5px.jpg?w=1080&h=752

That's quite interesting. Not about the money indeed.

[randomlegend]

They don't want a pay cut. Nobody is denying that, but that's not all it's about.

[GS]

Yes, the strikes today certainly enhanced patient safety.

[randomlegend]

We disagree on the motives, neither of us are going to change our position. I'm not going to waste any more of my time trying to convince you.

[Lee]

One of the BMA's demands:

"First refusal for junior doctors for locum work at a nationally agreed rate."

Fuck right off. PATIENT SAFETY.

Junior doctors are clever people. Why the fuck are they allowing the BMA (whose recently elected council is decidedly left wing) take them down this route, likely towards indefinite walk out? It's dangerous, you twats.

[GS]

There are no other options left beyond an indefinite walkout, but it surely wouldn't come to that. The problem with going this route is that they've put the government in a position where they can't be seen to back down, as it would set a dangerous precedent for other public sector workers.

[Byron]

Was thinking about this the other day, and when you think about it when has a government ever lost a scrap like this? They surely know they just have to wait this out.

[GS]

Thatcher facing down the miners was the end of real union power in this country.

[Lee]

The thing is, the juniors are fundamentally right on the basic point of principle. If the government want proper seven day services they have to pay for them. That they won't is a political choice. They've set an arbitrary target of achieving a budget surplus by 2020 and the desire to achieve this stops them from being able to do stuff like this properly. It was also the coalition government which they led that cut junior doctor training places in 2010 so they're reaping what they themselves have sown.

And Hunt is lying about things like mortality which just makes him look a dickhead. Which can't be helped as he is a dickhead. David Cameron will know this and if this was any time other than now he'd have sacked Hunt and people would probably be back round the table. But Hunt is going nowhere because Cameron can't afford to sack referendum inners. He can't sack him afterwards if we stay in the EU either because the party will want his head and he'll need to reward inners to retain their loyalty.

The BMA are doing some very stupid things themselves. The patient safety argument is a nonsense in the context of countless cancelled clinic appointments and operations. They're making demands about daft stuff like length of shifts and rights to a break when they know that's all covered by the European Working Time Directive and every medical rota in the NHS is compliant, and have been since 2009. Including the demand for first refusal on locum jobs is ridiculous and undermines the oft repeated refrain that none of this is about money. They're correct on the point about which hours are deemed to be 'unsociable' and it isn't unreasonable to ask that they're paid for all hours worked. Although they'd do well to remember that their pay is good compared to other professionals at a similar career stage and that these people don't get paid overtime or locum shifts at daft rates.

If they go down the road of indefinite walk out they're fucked. We've all been asked to invoke the Civil Contingencies Act in preparation. There's a very good chance that an extended walk out will happen. Among the options being considered is reducing some Emergency Departments to 12 hours operation only. This will mean some people will need to travel further for emergency intervention (which is a clinical risk) and that those which do remain open for 24 hours will be under immense pressure. This on top of a national shortage of ED doctors. So you'll have fewer 24/7 EDs. Those remaining open 24/7 will be much busier. There is a direct link between crowded EDs and increased unexpected mortality. It's dangerous. Alternatively we can cancel all non-urgent elective work. That means no clinic appointments and no (non-emergency) surgery at hospitals. Another huge clinical risk. Either way, somebody will come to harm or die and all public sympathy will be gone.

Ultimately, it comes down to this: The Tories had seven day working in the NHS in their General Election manifesto. They were elected to government with a majority. As a public servant it is my job to work to implement government policy, whether or not I agree with it. Doctors should be no different unless direct harm is likely as a result of changes. Almost nobody believes that would be the case. Of the list of demands reiterated to Hunt by the BMA's junior doctors' lead in a letter a couple of days ago the only one which any reasonable person could agree is a big deal is the definitions around unsociable hours. On that basis, I'd be imposing the contract too if I were Hunt. The BMA aren't making a point about junior doctors' working conditions anyway. They're trying to play politics and they'll lose. The juniors are just handy fodder for the frontline in a pointless battle.

[randomlegend]

Doctors should be no different unless direct harm is likely as a result of changes. Almost nobody believes that would be the case.

Surely that's precisely what they do believe; that spreading a thinly spread workforce even thinner is dangerous in the long run?

[Lee]

I should have phrased that differently. I think the junior doctors believe it and are mostly acting in good faith. I think the BMA are using them to make a political point. Whether or not the contract changes would make things more dangerous is highly debatable. Fewer junior doctors on weekdays can probably be sustained. All of the consultants will be around, as would specialist nurses and physicians' associates. It would require a redistribution of duties but that would seem doable if it comes to it. There would be increased weekend cover alongside existing consultant on call arrangements so no harm there.

That said, the weekend increase in junior numbers is pretty pointless without all the support services being available. Word is they'll be next though. Probably would have been more intelligent to start with them.

[randomlegend]

http://www.independent.co.uk/news/uk/politics/seven-day-nhs-plan-contains-serious-flaws-and-is-completely-uncosted-a7023526.html

:********)

[Lee]

That's all correct. Unfortunately the BMA has made no attempt to make that argument at all throughout this dispute.

[randomlegend]

I've read plenty of stuff produced by the BMA which outlines those arguments.

EDIT:

e.g.

http://www.bma.org.uk/-/media/files/pdfs/working%20for%20change/negotiating%20for%20the%20profession/bma%20evidence%20to%20ddrb%20dec%202014%20executiv e%20summary.pdf


The BMA’s priorities throughout negotiations on a new contract for doctors in training were to ensure
high-quality training, safe patient care and a better professional life for doctors in training1
.
When negotiating systems of pay and work patterns, we were focused on retaining effective
safeguards to ensure working hours that protect patient safety and the welfare of doctors


Total hours worked, as well as working patterns, must be safe. This principle was agreed in the heads
of terms. During negotiations, the BMA proposed a number of new contractual safeguards against
excessive working hours. However, we could not reach agreement with NHSE because of its refusal to
incorporate those safeguards into a new contract and their insistence that they should only be issued
as guidance. Given the effects on patient safety and doctor welfare, our strong view is that guidance
is inadequate


Overall, contract negotiations stalled due to the lack of credible evidence available to underpin the
changes being proposed. In the absence of robust data, we were being asked to make decisions that
could have a huge impact on patient safety, doctors’ welfare and the sustainability of the NHS. This
would have been at best irresponsible and at worst dangerous.

No attempt whatsoever....

Yes there's a lot about pay in there as well, but I think it's fairly reasonable doctors don't want to be played less than they already are.

[Lee]

Read the specific demands outline in the letter to Jeremy Hunt sent by the BMA's junior doctor representative a few weeks back.

Nobody who knows anything thinks sticking more junior doctors on at the weekend necessarily makes hospitals safer. And everybody knows Hunt is deliberately misrepresenting the research on weekend mortality.

But the BMA have managed this whole thing appallingly. Even if junior doctors are doing this out of concerns for patient safety, their union is giving every impression of this being almost exclusively about pay.

The argument about total hours worked is a load of bollocks, by the way. It's already covered by the EWTD.

[phonics]

As someone on the outside of this thing, it's never come across once as being about pay. If anything, I've thought they would be being paid less even if they did negotiate a deal to work 7 days.

[GS]

Lee is dominating this discussion, "RL". I hope you're taking notes.

I've covered my points on the merits of the strikes above, but my view is that it's about pay and they've been desperately attempting to cover that up with reference to "patient safety" to ensure public support. You can't blame them for doing so, but one look at locum rates and the willingness to strike on emergency care would demonstrate fairly clearly that that isn't the case.

I also think a decent amount of this boils down to doctors believing they are "someone", like it's still 1920.

[John Arne]

Whilst I don't necessarily agree that this is all about pay, I do agree that the attitude of the doctors thinking that they are somehow a bit special/unique is very strange.

"We work harder than everyone else"
No, you don't
"We get paid less than everyone else"
No, you don't
"It's all about patient safety"
No emergency care during strikes

[GS]

They've agreed a deal. Changes include:

- weekends no longer being divided up between normal and unsocial hours, instead a system of supplements will be paid which depend on how many weekends a doctor works over the course of a year
- extra pay for night shifts to be reduced from 50% to 37%
- extra support being made available for doctors who take time out, such as women who go on maternity leave, to enable them to catch-up on their training and thus qualify for pay rises - after claims women were being unfairly penalised
- junior doctors getting an enhanced role in advising and liaising with the independent guardians who keep an eye on the hours doctors work

Lee - what's your view on this?

[randomlegend]

- weekends no longer being divided up between normal and unsocial hours, instead a system of supplements will be paid which depend on how many weekends a doctor works over the course of a year

Isn't that already how it works?

[Lewis]

I'm guessing you've neglected to mention the significant concessions on patient safety to make it look like they were just after more money.

[Lee]

They've agreed a deal. Changes include:

- weekends no longer being divided up between normal and unsocial hours, instead a system of supplements will be paid which depend on how many weekends a doctor works over the course of a year
- extra pay for night shifts to be reduced from 50% to 37%
- extra support being made available for doctors who take time out, such as women who go on maternity leave, to enable them to catch-up on their training and thus qualify for pay rises - after claims women were being unfairly penalised
- junior doctors getting an enhanced role in advising and liaising with the independent guardians who keep an eye on the hours doctors work

Lee - what's your view on this?

What you've written is the first I've seen of the proposed deal but my response to that is:

Definitely not about money. :harold:

[randomlegend]

They've agreed a deal. Changes include:

- weekends no longer being divided up between normal and unsocial hours, instead a system of supplements will be paid which depend on how many weekends a doctor works over the course of a year
- extra pay for night shifts to be reduced from 50% to 37%
- extra support being made available for doctors who take time out, such as women who go on maternity leave, to enable them to catch-up on their training and thus qualify for pay rises - after claims women were being unfairly penalised
- junior doctors getting an enhanced role in advising and liaising with the independent guardians who keep an eye on the hours doctors work

Lee - what's your view on this?

Lol at you copying and pasting that from the BBC website but deleting (only) the first point about reducing the basic pay rise.

[Lee]

I've had a very brief read of some stuff now and I can't see anything in this agreement (referendum pending) that is more likely to keep patients safe than what was in the previous offer.

[GS]

Lol at you copying and pasting that from the BBC website but deleting (only) the first point about reducing the basic pay rise.

I literally only copied and pasted what was in bullet point form at the time when I was looking for it, so nothing was removed on purpose.

Although in saying that, I did go and check to see where it was and it seems they've added a fifth and sixth bullet in. :moop:

[GS]

I've had a very brief read of some stuff now and I can't see anything in this agreement (referendum pending) that is more likely to keep patients safe than what was in the previous offer.

Which side 'won', to put it bluntly?

[Lee]

Which side 'won', to put it bluntly?

Neither side comes out of it well. The government come out better though. This was a case of the BMA being forced back to the table because they shot their load with the threat of indefinite emergency care strikes. There is no way they could have done that without losing public sympathy or without causing harm. They had nowhere else to go.

The government could have coped with sporadic stroke action forever more, confident in the knowledge that no grave harm would likely come of it and that public support for the doctors would have slowly drained away as more people became affected by ever increasing waits for elective interventions.

[phonics]

Neither side comes out of it well. The government come out better though. This was a case of the BMA being forced back to the table because they shot their load with the threat of indefinite emergency care strikes. There is no way they could have done that without losing public sympathy or without causing harm. They had nowhere else to go.

The government could have coped with sporadic stroke action forever more, confident in the knowledge that no grave harm would likely come of it and that public support for the doctors would have slowly drained away as more people became affected by ever increasing waits for elective interventions.

I initaite sporadic stroke action all the time. Hasn't hurt me.

[Lee]

You'll go blind.

[randomlegend]

It's still got to be voted on by BMA members so may still not go through.

Also Jon Snow donning Jeremy Hunt was quality.

[GS]

If it doesn't go through, what credibility do the BMA actually have to go back to the table? They've recommended the deal.

[Lewis]

http://www.hsj.co.uk/topics/workforce/exclusive-huge-leak-reveals-bma-plan-to-draw-out-junior-doctors-dispute/7005113.article?blocktitle=News&contentID=15303

:gs:

[Magic]

I love how it's all being decided via a WhatsApp group.

[GS]

It's a laugh, that.

All about safety. Right.

[randomlegend]

It's so funny how you're being about this despite all the shady shit that has come out that the government have said/done.

You made up your mind that you were anti the doctors from the start and have just been revelling in that any way you can.

[Pepe]

Who do they think they are?

[Spikey M]

It's so funny how you're being about this despite all the shady shit that has come out that the government have said/done.

You made up your mind that you were anti the doctors from the start and have just been revelling in that any way you can.

He may not be a Dr (yet?), but he's got the seething down. :drool:

[GS]

It's so funny how you're being about this despite all the shady shit that has come out that the government have said/done.

You made up your mind that you were anti the doctors from the start and have just been revelling in that any way you can.

I was hardly 'anti-doctor'. I simply took issue with the misrepresentation of the reasons behind the dispute on your side. If the BMA had openly said "we agree that there should be a seven day NHS (which is a perfectly fair aim for government) but our issue is the financial package on offer to junior doctors" then you'd say fair enough. Instead they tried to couch the argument as "patient safety" because they knew espousing their genuine views would lead to a swift erosion of public support.

I'm not glorying in anything, but this 'leak', such as it is, demonstrates quite clearly that the arguments made against the BMA's approach were wholly justified.

Do you still want to maintain your 'altruism' line in terms of supporting the strikes? Because these leaks demonstrate quite categorically that they were quite prepared to continue striking over a prolonged period and that pay represented the only genuine red line. It torpedoes your argument. Conveniently, it also simply supports what Lee has previously outlined.

[randomlegend]

My arguments were always much more around the motivations of the doctors than the BMA. That's much more important to me tbh.

[GS]

Of which "99%" apparently made clear that pay was the only real red line. Not patient safety. Pay.

[randomlegend]

Of which "99%" apparently made clear that pay was the only real red line.

Where's that from?

[GS]

Where's that from?

Dr Malawana asked his executive colleagues whether any deal including Saturdays at plain time might be accepted.

Several members replied to say that it would not.

Former JDC chair and executive member Kitty Mohan said: “It is the only real red line. It’s the thing 99 per cent of juniors told us they were upset about in August.” Arrash Arya Yassaee told Dr Malawana: “Bluntly, no.”

From Lewis' link.

[randomlegend]

I'm sure 99% were upset about pay. That it was the red line for 99% of them is not at all what that says.

[GS]

That's not an unreasonable point. However, it's logical that if 99% are upset then it's also fair to assume that a clear majority thereof must consider it the 'only real red line'.

[Boydy]

Have a day off.

[GS]

Quite right. There'd be no need for this sort of dispute in the socialist utopia you lads would organise for the rest of us.

[randomlegend]

Why? Even if it was a deal breaker for all of them (which it quite clearly wasn't) that doesn't mean the patient safety issues couldn't be a deal breaker for them all as well.

The simple fact they were annoyed about it gives literally no indication of how big an issue it was to them or whether it was their only issue.

[randomlegend]

Have a day off.

The thread hadn't had a single post for a week before yesterday :cab:

[Boydy]

The thread hadn't had a single post for a week before yesterday :cab:

I meant GS and I meant from being a tory bore. Not from this thread specifically.

[GS]

Why? Even if it was a deal breaker for all of them (which it quite clearly wasn't) that doesn't mean the patient safety issues couldn't be a deal breaker for them all as well.

The simple fact they were annoyed about it gives literally no indication of how big an issue it was to them or whether it was their only issue.

If it's the "only real red line", it clearly represents the issue of most fundamental importance i.e. all other issues can be compromised, but pay is the only one that won't. I'm happy to concede your point that it doesn't mean 99% consider it a real red line, but a clear majority must have. Otherwise they'd have been willing to discuss the point.

[GS]

I meant GS and I meant from being a tory bore. Not from this thread specifically.

Are you still a socialist? Genuine question.

[randomlegend]

If it's the "only real red line", it clearly represents the issue of most fundamental importance i.e. all other issues can be compromised, but pay is the only one that won't. I'm happy to concede your point that it doesn't mean 99% consider it a real red line, but a clear majority must have. Otherwise they'd have been willing to discuss the point.

That's just a statement from the BMA, it doesn't necessarily represent the views of the thousands of junior doctors.

[randomlegend]

I meant GS and I meant from being a tory bore. Not from this thread specifically.

My b.

[GS]

That's just a statement from the BMA, it doesn't necessarily represent the views of the thousands of junior doctors.

You should read Lewis' link, at least. The idea of stringing the disputes out for maximise impact is particularly unpleasant given the impact on patients.

I feel the need to repeat the point: I give zero shits about professionals wanting a better deal for themselves. Just don't openly lie about your reasons for acting as you are.

[randomlegend]

I read it the other day. As i understand it's messages between top members of the BMA. Just because they are saying certain things doesn't make them representative of the views of the average junior doctor (who wouldn't have had any idea about the content of private BMA communications).

It's like saying the average conservative voter must support all the dodgy positions Hunt has taken and things he's said (before they could even have known about them...)

You keep repeating this shit about them wanting a BETTER deal. They didn't. They just didn't want a big pay cut.

[Magic]

GS reminds me of Kevin the goat cunt.

[Lewis]

Have a day off.

We deserve a seven day service.

[GS]

Unless the Tories want it, at which point it should be opposed just because.

[randomlegend]

Doctors don't oppose it; they oppose it being done without the investment it clearly needs to make it happen successfully.

[phonics]

Think the Jr. Doctors are sensing a bit of weakness in the government. They've just rejected the contract.

[Lee]

That's been expected for a little while now but FOR FUCK'S SAKE.

[randomlegend]

I don't even know any more, but :drool:

[GS]

Literally nobody cares about the junior doctors right now. We don't have a government or an opposition.

It'll get forced on them and nobody will care.

[randomlegend]

You care.

[GS]

Yes, the 60 seconds it took to read three posts and draft the above is certainly evidence of that.

Suffice to say it's not a major concern for anybody right now. I believe I'm right in saying that people are rolling onto the new contract from next month anyway, so well done.

[randomlegend]

Cus that's your only post in here.

[GS]

Cus that's your only post in here.


Suffice to say it's not a major concern for anybody right now.

The political landscape has changed.

[Kikó]

I suppose the failing NHS is low down on the list of priorities when you have no teachers and oncoming financial Armageddon and no plan to solve it.

[randomlegend]

Didn't know I could have voted.

[phonics]

I thought the Junior Doctors striking was a disgrace and peoples deaths were on their head. Turns out, nah, not really.

829994637242818562

[randomlegend]

https://www.theguardian.com/uk-news/2017/sep/18/plymouth-hospital-report-reveals-unsafe-night-shift-practices?CMP=fb_gu

:)

[randomlegend]

It really is absolutely dire working in the NHS at the moment. No it's not the same in the private sector (GS) because you do an extra hour at the office some nights.

Only 49% of junior doctors are going on to do speciality training (in this country) after their foundation years. That's an absolute disaster. Yeah yeah it's because they are all greedy and want to go get rich somewhere else. It's not, it's because the working conditions are absolutely crushingly dreadful. It's taken as completely normal that people will be so completely overwhelmed and stressed that they'll just be bursting into tears before and after their shifts. I know loads of people from my previous years who've gone off to Australia already because it's so shit working here. They never planned to and didn't particularly want to leave the UK but they want to be doctors and feel unable to sustain it here.

So many people are just going to get utterly burnt out and damaged by the way things are. I think I believe the whole 'the Tories are trying to bring it down so they can privatise it' line of reasoning at this point, to be honest.

It's as bad in teaching as well. My girlfriend is ridiculously overworked. My auntie and uncle are both teachers and my uncle has just left the profession after about 40 years because the conditions are the worst he's ever known them, and my auntie is considering doing the same. I doubt my girlfriend will stay in teaching long-term either, despite loving the actual teaching.

I really don't think people get it. I'm sure I'll just get GS/Lewis/Jimmy lolling at the moaning teachers/doctors/nurses but it just genuinely is that bad at the moment.

[niko_cee]

Maybe it just isn't possible to run a 'fully funded system of nationalised healthcare' these days. Realistically, how many more tens of billions of pounds need to be thrown at it?

I know it's a sacred cow, and as someone who lives in a part privatised system I can fully appreciate the benefits of the NHS, but are systems like they have in other parts of the world (no, not fucking Murica) really the capitalist anathema they would be cast as should anyone dare speak about some form of major reform? Is it just too fucking big to effectively managed?

Is a pay rise for everyone the answer?

[Boydy]

"Everyone's being overworked to the point of burnout."

"Give them a payrise."

He doesn't even seem to be suggesting that's the answer.

[Lewis]

Australia spends pretty much the same as us on its healthcare, and they don't even have a state monopoly keeping costs down and fairness up, so if the conditions are 'absolutely crushingly dreadful' here it must be like a slaughterhouse there. Good weather though, so you can see why people would move.

[Jimmy Floyd]

It's not just the NHS though, all public services are being cut to ribbons. Police is the one I know more about but it's basically the same post to be written there as RL's but changing some of the nouns. There isn't any money to keep them up to the growing demand, there hasn't been for at least 40 years, and even putting someone like Corbyn into central government I doubt would make any difference other than a bit of polyfilla here and there.

You'd need to not just make symbolic additions to the budget to make people feel better, but pretty much double the budget of all these things to have any sort of comfortable system where everyone gets proper pay and conditions and the service is decent. I don't know where that money is coming from.

[GS]

There was a poll the other day that suggested that 77% of people view the NHS as "essential to modern life" in the UK, and that it must be protected at all costs. It's almost impossible to have a serious conversation about it with that backdrop.

Ultimately it's a question of cost. Throwing more money at it isn't going to address the fundamental, which is that it's doing too much and isn't a feasible public service any more under its current funding model. This graph illustrates the point:

https://publications.parliament.uk/pa/cm201516/cmselect/cmdfence/494/IDExport-web-resources/image/Bottom_Page_51_Health_(NHS)_Expenditure.png

There's no chance you're moving the dial on the public view sufficiently to actually tackle the issue. The Tories don't have any moral authority on it - it would have to come from, and be driven through, by Labour. That won't happen, so it's fucked.

[Pepe]

How would privatizing make it any cheaper, beyond restricting the coverage of some people? Enough of them to make up the need for profits.

[Jimmy Floyd]

No one wants to privatise it, I don't know how the word privatise even enters conversations about it.

[Pepe]

No one wants to privatise it, I don't know how the word privatise even enters conversations about it.

I was basing myself on what niko said.

So what are some suggested alternative funding models?

[Lewis]

The ones that every other developed nation uses to better effect.

[Spikey M]

No one wants to privatise it, I don't know how the word privatise even enters conversations about it.

They certainly want to (continue to) outsource services within the NHS to Private Sector companies. Old Dicky Branson seems keen to take it all on.

[Boydy]

I hope the next hurricane fucking gets him.

[Pepe]

The ones that every other developed nation uses to better effect.

Is the main difference whether employers chip in or not?