The Doctors are SEETHING

[randomlegend]

It's looking increasingly likely that it might all actually KICK OFF.

For anyone who doesn't know, the BMA withdrew from negotiations over new contracts for junior doctors a few weeks ago. The Department of Health subsequently announced that they would be imposing new contracts from next August.

The major issues being highlighted with the new contracts are:

• Big pay cuts (figures around 20-45%, depending on the particular training post, are being put forward)
• Changes to what constitutes 'sociable' working hours to include everything between 7am and 10pm Monday to Saturday
• Removal of penalties for Hospitals who routinely work doctors beyond agreed limits
• Other changed which will make having kids or doing other study (research etc) more punishing to progression

At the same time as all this is going on, a new position of "Physicians Assistant" has been created. They undergo less training, have less responsibility and yet are to be paid significantly more - there are posts being advertised at £50,000 a year - than junior doctors. There is of course not the same scope for progression, but it will be a good few years after qualifying before a doctor earns a similar amount under the (apparent) proposed changes.

Having said all that, the DoH are denying some of the claims but haven't given any further explanation as far as I've seen.

Needless to say, it's all getting MENTAL on my facebook feed. There's a petition for the BMA to support strike action which currently has nearly 60,000 signatures. People are applying for Certificates of Good Standing (required to work abroad) in unprecedented numbers - to show they are willing to take their skills elsewhere - as a form of protest. There's of course plenty of just general raging as well.

From a personal point of view, if everything I've read about the contracts is true and they go through, I'll seriously consider either leaving the country or pursuing a career outside of medicine when I qualify. As much as I want to be a doctor (in the NHS), I'm not prepared to have no quality of life in order to do it.

[Magic]

Don't worry, we'll be able to employ those 20,000 Syrian doctors and nurses that have just been shipped in to the country at a much lesser wage than you would command.

[Pepe]

While British doctors can just move to another country were they will be paid much more (thanks Lewis).

[SvN]

I've got about 6 doctors on my Facebook and they're all posting huge rants about it daily. It does seem absolutely absurd on the face of it.

[Magic]

http://www.dailymail.co.uk/health/ar...-000-year.html

Fuck your doctors.

[Lewis]

They should just make people sign ten year NHS contracts in return for their training.

[randomlegend]

It takes at least 7 years after medical school (so 12 in total) to be a newly qualified GP.

It's pretty irrelevant to conditions of junior doctors.

EDIT: @Magic

[Magic]

It takes at least 7 years after medical school (so 12 in total) to be a newly qualified GP.

It's pretty irrelevant to conditions of junior doctors.

EDIT: @Magic

Boohoo. So what, you train for 7 years then get paid a thousand pounds just for a weekend shift? Sounds alright to me.

[Lee]

They should just make people sign ten year NHS contracts in return for their training.

Yes to this.

The government does seem to be going for doctors, presumably because it's easy to make it look as though they're forcing well off people to put back in, because that's what most people think doctors are.

Consultants and GPs are loaded and depending on their speciality can make a shitload in private work too so I don't listen when they moan about money. Nor was I especially enamoured with the weekend bollocks over the summer. Well done for doing your jobs, guys.

But this is stupid. Juniors work stupid hours for shit pay and there aren't enough of them as it is because we don't fund anything like enough training places. That will only get worse now so we'll pay out even more for locum cover. You ought to see what I spend a year on it; it's obscene.

Not that that they're all poor little souls. I know plenty who bleed us dry with locum work and they have us over a barrel. They aren't the root cause but some of the fuckers love to take advantage. I've had to blink first on numerous occasions because I need to deliver safe services.

We are the biggest user of Physicians Assistants outside of London and have played a big part in pioneering their use. We pay ours around £30k which is more than most junior doctors but there are benefits to it. They don't rotate so you get better continuity of care, for example. When they're able to prescribe they will be a major asset. And their training is getting a lot better. I'd much rather have a PA than some of the HOs/SHOs I've seen. Our consultants love having them. Doctors (especially older ones in my experience) need to move away from the idea that only doctors can do most stuff. It kills us.

[Lee]

Boohoo. So what, you train for 7 years then get paid a thousand pounds just for a weekend shift? Sounds alright to me.

The big point is that this will make prospective doctors fuck off abroad which means we don't have enough doctors to deliver services so end up spending loads of your money on locums.

Not to mention that locums work all over the place and do long hours to rake in cash. So they're knackered and they aren't familiar with host hospital processes, which os dangerous. This shouldn't be about sympathy for doctors; in the end it's a very lucrative career.

But if you put people off with policies like this we end up with less able doctors delivering poorer services for more money. And in the longer term we'll be fucked for quality medical leadership as there will be no fucker coming through the ranks.

[Shindig]

Lee will have them all back in with no problems, man.

[Multi]

I make £2300 a month with no experience as a junior doctor. That will bump up to 3000 within a month when I get my license.

How's that compared to the UK RL?

[Magic]

Fucking hell. I'm retraining.

[randomlegend]

I make £2300 a month with no experience as a junior doctor. That will bump up to 3000 within a month when I get my license.

How's that compared to the UK RL?

Lee will correct me if I'm wrong, but I think that's about comparable to what UK juniors currently earn.

[Lewis]

How hard is it to hoover up foreign doctors, Fox? I would have thought it must be reasonably easy to just stick job postings up in Crappolaland, but does that have drawbacks that aren't obvious (like medical leadership)?

[Lee]

It's (£2,300) more than a House Officer earns and at the low end of the SHO scale. £3,000 is just about mid-range for a Registrar.

[Yevrah]

Not sure about doctors, and my name's not Lee (I'm Yevrah), but a nurse friend of mine said the NHS get loads of applications from nurses in crappoland who're then subsequently put off when they find out how much it costs to live in certain parts of England.

[Lee]

How hard is it to hoover up foreign doctors, Fox? I would have thought it must be reasonably easy to just stick job postings up in Crappolaland, but does that have drawbacks that aren't obvious (like medical leadership)?

We do that but they tend to be reluctant to take on internal contracts and so rip you off on the private locum market. At junior level anyway. They're more receptive to internal contracts when they're senior Registrars or Consultants because the money and development is easier. Plus, once you're a Consultant you pretty much have a job for life.

[Lee]

Not sure about doctors, and my name's not Lee (I'm Yevrah), but a nurse friend of mine said the NHS get loads of applications from nurses in crappoland who're then subsequently put off when they find out how much it costs to live in certain parts of England.

Depends where they come from. It can he difficult to recruit from outside the EU because the Home Office has a set annual quota of VISAs they'll shell out for foreign health workers. But if you get in early there are certain countries which are a goldmine. India is one (Central Manchester is about to employ 200 Indian nurses) amd Nigeria another - although more for doctors than nurses for some reason. Portugal and Spain are good EU bets and Greece is getting that way.

I'm not sure about the cost of living thing but there does tend to be a high attrition rate with nurses simply because you tend to go out for tens or even hundreds (for bigger Trusta) in one go. The drop out rate is quite high recruiting from within the UK too but that's because we're chronically short of nurses (that lack of funded training places again) so there's lots of competition.

[GS]

I haven't done the necessary analysis, but I've a couple of mates who are doctors and the system would appear to be somewhat broken. An overhaul would appear reasonable, but I couldn't tell you if this is the way forward or not.

On the face of it, it seems quite unreasonable.

[Lee]

The entire health system is shit. Successive governments have meddled to make it far more complex than it needs to be. Fuck knows hpw we get the results we do. It could be so much better though.

[Lewis]

Write a manifesto and take hostages.

[Reg]

This is shit.

@Lee, from what you've experienced how has this government been compared to the last?

[Lee]

The first thing I'd do is end this fucking stupid regime of inspection by spastics. Addenbrookes is in 'Special Measures' pretty much because they have no staff. How is that their fault? Train some more people you fucking idiots. I know it costs money and all, but fuck me. How the fuck is it right to plaster a massive sign over a hospital saying it's shit. Absolutely mental to destroy local confidence in a place where most will have no choice but to go at some point.

Inspection doesn't work. Full stop. They've been finding shit care homes since they started inspecting the system and yet they're still shit? Somebody get a fucking brain. Share good practice rather than calling good providers shit because of problems you and your mates have created, morons.

[Reg]

I have a relative who's a teacher and she shares similar feelings re school inspections.

[Lee]

This is shit.

@Lee, from what you've experienced how has this government been compared to the last?

I wasn't involved under Labour and this lot have only had a few months so it's hard to compare.

They're shit though. They pretend they're not cutting the NHS by putting in money and then demanding we don't spend it. There aren't enough training places for doctors or nurses; a problem created by successive governments. The health system is too complex - this lot have increases the bureacracy to the point that improving any service in even a minor way takes months. And they've raped the fuck out of stuff like social services which has a massive impact on how the health system functions.

The whole thing would be greatly improved just by simplifying the system. Abolish organisations, pool budgets, let experts decide how best to improve services and let people like me put their ideas in place. It shouldn't be as difficult as it is. Oh, and roll everything into one. Forget the NHS; it makes no sense for it to be separate from education or any other local authority run service. They're all interdependent and they all affect one another. Make everything local population based.

[randomlegend]

It always seems mad to me that hospitals/schools/etc. which are 'failing' lose out financially, and are then expected to improve - and catch up to the 'good' places with all the funding - with less resources than they had before.

[Lee]

They tend to be a symptom of a failing system, rather than failing in their own right. Even Mid Staffs was a result of a culture of primarily focusing on financial performance promoted by central government. I have a big problem anyway with the idea that you fix anything by shouting about how shit it is.

This job is very simple when you take the politics away. Everything, even the finances, is about patient pathways. Get your pathways right by focusing on what gets the patient the best care in the quickest way and the care will be good and the costs low. The problem is that everything needs to be commissioned or signed off by somebody and often these people have no idea what they're talking about or have political agendas.

[phonics]

So now Medical Schools around the country are sending very similar worded emails on the same day about all this

View Tweet

View Tweet

View Tweet

at least bristol, georges, peninsula, modified version to warwick, and leicester according to the group so far

[randomlegend]

Wonder if UEA have sent them, I'll ask a fifth year.

[Lewis]

What's wrong with that exactly?

[Luca]

What's wrong with that exactly?

My thoughts precisely. Holding a contrarian view on social media isn't going to prevent you from getting a placement, but if you're mouthing off like a twat (regardless of how "in the right" you are), people can and will look and judge.

They just seem to remind (young and presumably angry) people that, seeing as they're going on to become highly respected professionals, they should act the part. It's not some Orwellian suppression; you can express your views strongly without being unprofessional about it.

[mikem]

Isn't that also just a firm but friendly warning to people young enough to forget that their social media footprint can affect their job chances and prospects?

[randomlegend]

http://www.telegraph.co.uk/news/nhs/...-go-ahead.html

As if it will be even close to those percentages of people who actually follow through

Having said that - and in response to Jimmy's "where will they go?" on the old board - a third of A and E doctors buggering off to (mainly) Australia or New Zealand in the last five years is pretty stark.

[randomlegend]

This is disgraceful.

[Jimmy Floyd]

The Act

What you do when you handle the Act, as I once did many jobs ago, is you look for any possible way out of providing the information and if there isn't one, you use the time/cost exemption. Rightly so, as the Act is an absolutely shambolic piece of legislation that shouldn't be there, as Tony Blair himself now freely admits.

[randomlegend]

Yeah, the DoH outright lying to people and then trying to hide it is cool as fuck.

[Jimmy Floyd]

Do you know what that actually means? It means that somebody very junior in the Department for Health, who also has 15 other responsibilities, would have to spend hours and hours looking for some shitty emails that in all likelihood don't even exist anymore, if they ever did, instead of doing their actual job, and to what end?

The only way FoI would be usable and useful would be if every department and every public organisation spent £150,000 a year employing a four man team to actually handle the volume of knobrot that gets sent in and reply in a full and professional manner, and that would clearly be a gigantic waste of money. As it is, this is what we have, so people have to live with it and they can thank the 1997-2001 Labour administration for falsely raising their hopes.

[randomlegend]

The fact they didn't actually complete the request isn't the main issue, obviously. It's the fact they were (are?) telling people something which is just completely untrue in order to justify what they are doing with the contracts..

[Jimmy Floyd]

What is untrue about their response?

[Davgooner]

Some of the FOI requests we get are maddening.

[Toby]

He's not talking about the response, he's talking about the non-existent opt-out, which has apparently been mentioned at least 354 times in outgoing correspondence.

[phonics]

"I'm sorry, I can't face being a doctor any more"

I’m nearly 40 years old and I have a six-year medical degree, a BSc, an MD and membership of the Royal College of Surgeons. I also have two children, debts which make me sick with worry each month, a marriage which is likely over and a good going stomach ulcer. I work part-time but that involves a 100-mile round trip, three-hour commute and being away from my children for 48 hours every week because I can’t afford to live close enough to the hospital. I work 60 hours a week in order to make my part-time arrangement work.

I can’t afford to attend the conferences and courses I need to in order to make consultant. I can’t afford the last exam I need to do. I can’t afford my General Medical Council fees, my medical defence insurance or my membership of the Royal College of Surgeons that I worked so hard to earn. I can’t afford the petrol to drive to work each day.


This year I have been screamed at, spat at and kicked. I have physically removed excrement from someone who needed that help. I have cut off people’s legs. I have told people that the most important person in the world to them is dying. I have told people that they are dying. I have told a woman her child may not survive. I have not eaten or drunk anything over a 13-hour period more times than I can remember. This year, once a week, I have woken up on the floor cold, jittery, anxious, hungry and traumatised by the things I have seen and the things I have had to do.

http://www.theguardian.com/healthcar...amily-children

No idea how relevant it is. RL/Lee?

[Boydy]

How is a surgeon struggling financially?

[phonics]

How a part time job involves a 60 hour work week confuses me, I must be honest.

[Boydy]

Yeah, I don't get that either. Unless they're doing a lot of unpaid overtime.

[Lewis]

He sounds like a wanker.

[Boydy]

It's a woman.

[randomlegend]

Pretty relevant.

[randomlegend]

How is a surgeon struggling financially?

Because she won't be earning anywhere near what most people think of as a surgeon's wage.