Doctors strike

[rimfire4969]

We need a 24/7 365 day a year NHS.

You shouldn't get a worse service because it's the weekend

Well said, when I have a heart attack, stroke or whatever I will try and time it for about 11:00 o'clock Thursday morning.

[CharlieT]

Well said, when I have a heart attack, stroke or whatever I will try and time it for about 11:00 o'clock Thursday morning.

 

Indeed. To the best of my knowledge there are only 8 hospitals in the entire country operating a 24/7 angioplasty service.

[DrBob]

Vince

Sorry matey, you're way out of order with dentists.

The stress and hassle of coping with patients, volume of disease, regulation, interference etc is absolutely phenomenal.

I'm an NHS dentist, senior partner, multiple postgraduate qualifications; just the sort who should be ticking away to retirement with a nice list of private patients..

The reality is an overwhelming volume of work, people with complex medical issues, the sad, the bad and the disturbed, the pressures of business and the absolutely stunning-I really mean unbelievable-crass incompetence of NHS management, the most regulated workforce in the world, and every chav and his dog trying it on for compensation via crooked back-street lawyers.

In thirty odd years, I've personally resuscitated two patients, one died, one made it, have personally diagnosed around twenty cancers ( not including several dozen skin cancers, including a couple of melanomas), repaired several dozen lacerated faces, lips and tongues, in addition to routine pain relief, routine dentistry etc. I regularly see emergencies at weekends and evenings, my number is freely available.

It costs me around twenty to twenty five thousand a month just to go to work, the CQC, LAT, GDC, PCT etc all drop tons of rules, regs and protocols on me on a daily basis. We have an entire room full of protocols, forms and compliance certificates, any one of which could get me closed down, and the endless pressure to deliver artificial Government targets. Every day, there is another compliance order, invariably involving someone needing to issue a certificate at five hundred quid a time.

Just as an aside, next time we read about someone unable to access NHS dentistry, it ain't the dentist who is refusing it. The Government decides how many patients need to be seen and we cannot see any more. They will take disciplinary action against anyone who does.

Three years ago, I was fast-tracked with suspected kidney cancer, I ended up having surgery for a stone in my kidney. Missed some targets, so they fined me sixteen thousand quid. I could have made up the shortfall, we had patients waiting by the hundred, but no chance, I was fined. Most people are quite shocked to hear this, other dentists just shrug as they know the reality. The fact is, politicians are deceitful, lying scumbags who will repeat whatever they are told to say, and it is far easier to play up to stereotypes.

For the record, we keep the NHS going in my part of the world. The reason is simple, people need it. However, the pressure, the stress, the endless, constant hassle, is why the suicide rate among colleagues is such an issue.

A new dental graduate leaves with debts of up to sixty grand, insurance is up to five grand annually, there are educational requirements, further exams, etc.

It is not possible to walk into fantastic careers, with no responsibility etc. I wish it was..............

Edited March 9, 2016 by DrBob

[oowee]

My daughter is on post grad medicine and looks at the contract, the pay rates and the expectations and has ambitions to work abroad.

[Mungler]

Isn't it the case that trainee / junior level in most professions is poor and the Bucks kick in with age, experience and clients?

 

All the doctors I know (who were all junior over worked and skint at one point) are now raking it in.

 

Just for balance some TV company should get the names of the 50 most in your face striking doctors just so they can catch up with them in 15 years and see how it's all panned out for them.

[rovercoupe]

Whats it about? Currently there are not enough doctors to cover the shifts, hunt wants this 24 hour service so you will be booked in for your general op at 3am on a saturday as thats what will happen if his plan comes to life but it wont because the doctors cannot work more than they allready do so the goverment are going to magic up 100s of more doctors overnight even though they have limited training at university level for years. The pencil pushers have lost the plot, they dont have enough doctors the cover the emergency shifts so have to offer it out to locum cover at crazy rates but the locums are few and far between so the normal doctors end up covering the shifts but the pencil pushers see it as profiteering by the doctors so they in some hospitals have banned there own doctors who know the hospital and procedures from taking those shifts. I can go on for hours about the problems as my other half is a surgical trainee just below consultant level and some of the things she does frighten me just to keep things running and just so there is cover which includes working for free if no cover is available because of the above. Not many people become doctors for the money but thats what the goverment think its about and thats why it will fail if the goverment don't quit messing with this 24 hour ****.

[GingerCat]

Lucky they can strike. I didn't see many supporting us when we marched. Not that it did any good as I now have to work longer for less and pay more in for a pension that's not a patch on what I signed on for.

The fire brigade had the same so why should Dr's carry on as they like.

[Bangbangman]

That is certainly the message that is being put forward from the BMA.

 

The counter argument is that the doctors who ***choose to work up to 90 hours weeks*** will have their maximum amount of hours cut to 70 hours per week so they will lose out, also the government sought to change the rate of pay for much of a Saturday to make it the same as Mon - Fri.

 

There are of course some junior doctors who will have to work additional hours and they now have rota hours to cover the weekend as normal instead of the weekend being*** elective overtime.***

 

In real terms the majority of junior doctors actually have a pay rise even when pro-rated against the additional hours, albeit some of those additional hours are over the weekend. The only doctors that are losing out financially are those who chose to work their elective overtime hours over a weekend/night time when the rate was significantly higher and those who were working more than 70hrs per week.

 

You have a fundamental misunderstanding of how Jnr Drs work and are paid. They do not get to ***choose*** to work 90 hr weeks and nor is there ***elective overtime***. They are already rota'd to cover weekends and out-of-hours periods: they cannot opt in and out of this. They receive a higher rate of pay for these anti-social hours. Hunt wants to expand the periods which are classed as sociable.

 

His motives for doing this have nothing to do with improving the spurious weekend effect (you are most likely to die in hospital on a Wednesday and the stats and definitions used in the NHS England commissioned paper that Hunt repeatedly misquotes are dodgy in the extreme) nor is he interested in improving patient safety.

 

His goal is to bring about the demise of the NHS (in its current form) from within. He wants the Drs to strike, leave, form private agencies that sell their services back to the privatised "NHS".

 

This is already happening. No government can abolish the NHS, it would be political suicide. Getting it to fail via a mass-exodus of workforce is another matter.

 

Hunt knows many Jr Drs will not want to emigrate, though plenty will. But he also knows that they may resign on mass, after their pre-registration or foundation years and form their own private enterprises and sell back labour on their own terms.

 

Hunt, like many politicians, has connections with private healthcare provision and may have a tasty board position lined-up for his "retirement."

 

This isn't about pay, patient care, weekend mortality, nor hours worked. It's about dismantling the free-at-point-of-use NHS.

[GingerCat]

Seems familiar with other public sectors.

[Medic1281]

You have a fundamental misunderstanding of how Jnr Drs work and are paid. They do not get to ***choose*** to work 90 hr weeks and nor is there ***elective overtime***. They are already rota'd to cover weekends and out-of-hours periods: they cannot opt in and out of this. They receive a higher rate of pay for these anti-social hours. Hunt wants to expand the periods which are classed as sociable.

 

His motives for doing this have nothing to do with improving the spurious weekend effect (you are most likely to die in hospital on a Wednesday and the stats and definitions used in the NHS England commissioned paper that Hunt repeatedly misquotes are dodgy in the extreme) nor is he interested in improving patient safety.

 

His goal is to bring about the demise of the NHS (in its current form) from within. He wants the Drs to strike, leave, form private agencies that sell their services back to the privatised "NHS".

 

This is already happening. No government can abolish the NHS, it would be political suicide. Getting it to fail via a mass-exodus of workforce is another matter.

 

Hunt knows many Jr Drs will not want to emigrate, though plenty will. But he also knows that they may resign on mass, after their pre-registration or foundation years and form their own private enterprises and sell back labour on their own terms.

 

Hunt, like many politicians, has connections with private healthcare provision and may have a tasty board position lined-up for his "retirement."

 

This isn't about pay, patient care, weekend mortality, nor hours worked. It's about dismantling the free-at-point-of-use NHS.

 

AND THERE IS THE TRUTH!!! I'm glad others can see it too!

[Bangbangman]

Isn't it the case that trainee / junior level in most professions is poor and the Bucks kick in with age, experience and clients?

All the doctors I know (who were all junior over worked and skint at one point) are now raking it in.

Just for balance some TV company should get the names of the 50 most in your face striking doctors just so they can catch up with them in 15 years and see how it's all panned out for them.

I am a 42 year old Consultant surgeon. I choose not to do private practice. I live in a rented 70's bungalow, drive a Ford Mondeo (56 plate) and haven't had a holiday abroad in ten years. I'm not complaining but I think there has to be balance, too. My salary is by no means poor but I earn the least out of my peers from school/uni who didn't do medicine. I was a lot brighter than most of them but I couldn't do what they do for their substantial £100K plus pay packets; I'd go mad.

 

I could do private work (in my field I'd be paying about £45-50k per year indemnity and a big heap of tax, of course) and lose my weekends and evenings (unless I give up NHS work.) I'd be raking it in but I doubt I'd be happier, so I don't.

 

It is an oft quoted cliché, but I really didn't go into this career for money. However I know what I'm worth, Imhave self-respect and I'm not going to get **** on. I left England in order to stay on the old consultant contract and if that is changed or if they mess with my pension any more, I'll leave the NHS and set up an LLP with the many, like-minded consultants I work with. Since the Jr Doctor contract dispute started, we have had a 5x increase in applications by English Drs to our Jnr posts; we had a post unfilled for 2.5yrs until now! The recruitment and retainment crisis will really bite in a few years, at which point NHS England will be screwed.

 

The government will blame those greedy Doctors and the readers of the right-wing press will lap it up!

[Bangbangman]

1. Junior doctors already work weekends, and nights, and bank holidays.

 

2. The new contract has always been within the same "pay envelope". There has never been any potential for additional pay. No version of this contract could give junior doctors a pay rise. This is not why they are striking.

 

3. Any "pay rise" you may have read about would apply to basic pay only, and is offset by cuts in pay for compulsory out of hours work. THIS IS NOT OVERTIME! For those that do the most out of hours, including Emergency Medicine and there will be a drop in overall pay. See point 2. These are the same specialities that already have the greatest recruitment and retainment problem.

 

4. Jeremy Hunt has never been clear about what he means by a seven day NHS. We already have one that provides for emergencies 24 hours a day, 7 days a week. This is done well, and there is data to demonstrate it.

 

5. If he wants more planned clinics and operations at the weekend we either need more doctors, each doctor to work more hours, or to work less hours Monday to Friday, thus making any "weekend effect" an "all week effect". This is just simple maths. This is the patient safety issue junior doctors are striking over.

 

6. We are in the middle of a recruitment and retention crisis. Applications to medical school are down, and around 50% of this year's new doctors will leave the NHS after two years to go elsewhere. Rotas are unfillable and loss of good will and locum pay caps make it impossible to find someone to do the extra work. There aren't enough doctors to staff the NHS for five days a week, never mind seven. See point 5.

 

7. The NHS is in trouble, and you will miss it when it is gone.

[chris1961]

Doctors 1% mp10% plus an extra £1000 it stinks mp's are nothing but money grabbing parasites everyone else has to suffer cuts apart from our mp's how can they sit there and preach when they give themselves such hugely inflated rises they are parasites on the back of the working man rant over

Edited March 9, 2016 by chris1961

[grrclark]

You have a fundamental misunderstanding of how Jnr Drs work and are paid. They do not get to ***choose*** to work 90 hr weeks and nor is there ***elective overtime***. They are already rota'd to cover weekends and out-of-hours periods: they cannot opt in and out of this. They receive a higher rate of pay for these anti-social hours. Hunt wants to expand the periods which are classed as sociable.

 

His motives for doing this have nothing to do with improving the spurious weekend effect (you are most likely to die in hospital on a Wednesday and the stats and definitions used in the NHS England commissioned paper that Hunt repeatedly misquotes are dodgy in the extreme) nor is he interested in improving patient safety.

 

His goal is to bring about the demise of the NHS (in its current form) from within. He wants the Drs to strike, leave, form private agencies that sell their services back to the privatised "NHS".

 

This is already happening. No government can abolish the NHS, it would be political suicide. Getting it to fail via a mass-exodus of workforce is another matter.

 

Hunt knows many Jr Drs will not want to emigrate, though plenty will. But he also knows that they may resign on mass, after their pre-registration or foundation years and form their own private enterprises and sell back labour on their own terms.

 

Hunt, like many politicians, has connections with private healthcare provision and may have a tasty board position lined-up for his "retirement."

 

This isn't about pay, patient care, weekend mortality, nor hours worked. It's about dismantling the free-at-point-of-use NHS.

Junior doctors working full time are employed on a basic 40 hours per week which are based around core working hours. Anything worked beyond that is overtime and it is paid on a sliding scale dependent on a number of factors.

 

Overtime is elective, there are limitations on what can be requested beyond the contractual obligation, however for various reasons the junior doctors nearly all want to work extra hours for both pay and for development.

 

They may of course have a rota for overtime hours, but they are not contractual core hours.

 

Not every junior doctor has the opportunity to work overtime so there is a top up payment given to the JD's who don't have the same opportunity, i.e, those training to be a GP may not have the same opportunity as say someone specialising in being a hospital doctor in trauma.

 

There is a maximum under the working time directive that limits the amount they can work to 48 hours per week averaged over a 26 week period, if over 18 they can elect to opt out of the WTD and work up to 56 hours per week on average.

 

The junior doctor cannot be compelled to opt out of the WTD, but mostly all will as it gives them greater exposure to development opportuity and speed up their progression.

 

The hospital cannot compel a junior doctor to work hours beyond that permitted by the WTD or the other safeguards restricting hours in any one week.

 

Of course that does not mean they wont ask.

 

The current contract around junior doctors can allow them to work up to 91 hours in any particular week.

 

The new contract this limits the maximum to 72 hours in any one week, but the average must still fall within the WTD.

 

Absolutely there is an objection to extending the core hours to include the weekend.

 

The government and BMA agreed on 15 of the 16 disputed points, the single point on which they did not agree on was the rate of pay per hour on the Saturday.

 

In essence the junior doctor strike is now entirely based on the rate of pay on a Saturday, any other argument put forward is spurious as full agreement was reached on every other contested point.

Edited March 9, 2016 by grrclark

[Psyxologos]

You have a fundamental misunderstanding of how Jnr Drs work and are paid. They do not get to ***choose*** to work 90 hr weeks and nor is there ***elective overtime***. They are already rota'd to cover weekends and out-of-hours periods: they cannot opt in and out of this. They receive a higher rate of pay for these anti-social hours. Hunt wants to expand the periods which are classed as sociable.

 

His motives for doing this have nothing to do with improving the spurious weekend effect (you are most likely to die in hospital on a Wednesday and the stats and definitions used in the NHS England commissioned paper that Hunt repeatedly misquotes are dodgy in the extreme) nor is he interested in improving patient safety.

 

His goal is to bring about the demise of the NHS (in its current form) from within. He wants the Drs to strike, leave, form private agencies that sell their services back to the privatised "NHS".

 

This is already happening. No government can abolish the NHS, it would be political suicide. Getting it to fail via a mass-exodus of workforce is another matter.

 

Hunt knows many Jr Drs will not want to emigrate, though plenty will. But he also knows that they may resign on mass, after their pre-registration or foundation years and form their own private enterprises and sell back labour on their own terms.

 

Hunt, like many politicians, has connections with private healthcare provision and may have a tasty board position lined-up for his "retirement."

 

This isn't about pay, patient care, weekend mortality, nor hours worked. It's about dismantling the free-at-point-of-use NHS.

 

This is exactly why he is doing it. Well put.

 

The NHS is already a 24/7 business, despite what cockwomble wants the population to believe. The wards are staffed all the time, day or night, Monday or Sunday. Elective procedures, meaning operations, outpatients' clinics for non urgent conditions etc are Monday to Friday.

 

When hunt says he wants a 24/7 NHS he really means he wants to sell these elective, generally easy procedures/clinics that have a profit generation potential to private firms and leave the NHS with the difficult, non profit operations/cases/clinics.

 

Junior doctors work an awful lot of hours, in a profession that does not and should not allow for complacency. I am sure nobody would like to be seen by a doctor that has been working for 12 hours continuously, with maybe two breaks for some lunch and a drink or a toilet break. Lorry drivers, if I am not mistaken, have very strict working hours and it is illegal for them to drive for longer than certain amount of time (I cannot remember what that is).

 

Think the irony of this for a minute...

[Houseplant]

I was a junior doctor in the NHS. I'm moved (permanently) to New Zealand. Most of the close friends that are trained with are in Australia and one is in Canada. Take from that what you will.

 

A few points that get missed by the media:

 

1) The term junior doctor applies to almost every qualified doctor who isn't a consultant or GP. It does not apply to medical students. It is a broad term that covers a range of experience/competence. It is quite likely that a "junior doctor" will resuscitate you in the emergency department, perform your operation, administer your anaesthetic, treat your desperately unwell child etc.

2) The extra money earned for working out of hours is called banding. This is where the government wants to reduce costs. Banding may be 0 - 50% of basic pay (sometimes more), but basic pay is low by anybody's standards. Regardless, particular jobs are banded and individual doctors have no say in how much out of hours work they do, or indeed how much they earn. It is not the same as over time.

3) Hospital trusts routinely and possibly, universally flout the European Working Time Directive with respect to safe working hours. This may be done through administrative slight of hand or blatant lying. In addition, there are expectations on junior doctors from senior colleagues. This may mean working more hours than rostered with no extra remuneration. As a newly qualified doctor, I was doing an extra 2 - 3 hours per day unpaid and unrecognised.

4) Junior doctors already provide a 24/7 service. However, I would concede that there aren't enough junior doctors working out of hours. In the same way that there aren't enough consultants, nurses (vitally important), radiographers, physiotherapists etc. The whole system needs restructuring and more money if you want good quality healthcare. The NHS is already one of the most financially efficient healthcare systems in the world.

Everybody knows medicine is a tough career choice. It takes decades of study, debt, sacrificing family life and hard work. Yes, junior doctors are trying to protect their income and quality of life in the current dispute, but enough is enough. Jeremy Hunt should have used the carrot and not the stick in this instance.

[Bangbangman]

Watch this clip of the public accounts committee questioning a Hunt lackey and ask yourself if it inspires confidence:

 

 

Grrclark, your post is full of technical accuracies but is devoid of real-life actualities! For example, Drs can't opt out of EWTD to get more pay- if they stay beyond their shift they don't get paid, though they might exceed hours for eg. Training benefit or to finish a job. The hours monitoring is hugely flawed and most data-collection is a work of fiction (the Drs have to fudge the hours to make their hours look compliant with EWTD in order to avoid a new shift pattern being imposed that is even worse for training.)

 

The new contract claims to restrict number of hours worked in a single week yet it also removes the penalties on trusts should this occur, in other words, it does nothing to limit hours beyond paying lip service to the concept.

 

If the new contract is fair and safe, why would 98% of a high-turnout ballot (of a historically non-militant workforce) vote to strike?

 

Of course pay is, and should, be part of it. Why the hell not. Why shouldn't it be the only issue. A line has to be drawn somewhere and I'm glad they are making a stand. It may make the government pause before coming after the nurses, midwives, radiographers, porters and us fatcat consultants!

[Psyxologos]

Of course pay is, and should, be part of it. Why the hell not. Why shouldn't it be the only issue. A line has to be drawn somewhere and I'm glad they are making a stand. It may make the government pause before coming after the nurses midwives, radiographers, porters and us fatcat consultants!

 

I am sure you know, like I do, that our contract is next, right? It has not been a secret. Juniors' contract is a prelude to hunt going ahead with his 'junior consultant' idiocy and many other destructive ideas...

[figgy]

Typical government don't want to pay anymore infact cut back as much as they can and think the answer is force doctors to work work harder for less in a stressful job were people's lives are at risk.

 

Idiots they award themselves pay rises for doing nothing.

 

Doctors should never have to resort to striking.

[grrclark]

Bangbangman, i absolutely would not dispute that what the rules say and what actually happens differs, but that is absolutely true in every employment sector.

 

As I said earlier I can sympathise with both sides, I think the NHS has, all too often, appallingly bad management with massive amounts of waste, i know per capita it is seen as efficient compared to other health services, but it also benefits from huge economies of scale which skew the picture to make it appear as though it is more efficient than it is.

 

For the junior doctors there really is no other show in town and they work in an evironment that is often beset by bullying and unfair expectations being placed on them by senior colleagues who have lived through the same thing.

 

For the government they are looking at a system that has glaring shortcomings and need to try and find a one size fits all solution otherwise costs will spiral and nobody benefits.

 

However in respect to this debate the only outstanding issue is now one of pay rate on a Saturday, every other point was agreed during negotiation so any argument around patient safety, safeguard on working hours, protected floor for existing pay, etc are all now irrelevant in respect to this dispute.

 

The BMA or any other union or any spokesperson is being disingenuous to continue to cite those other reasons in respect to the strike as they have already reached agreement.

 

In answer to the OP the reason for the current strike is actually really simple and it is one thing only and that is the Saturday pay rate.

 

For what it is worth I absolutely agree that the junior doctors should have a greater level of remuneration than they currently do, along with other care staff, but I also think that the NHS and every other public service carries a burden of too many non contributors yet we cannot have any sort of conversation in how that could be bettered without getting some sort of hysterical and conspiracy laden reaction about a nefarious plot for the privitisation and destructuring of the NHS.

 

So long as the bloat is allowed to remain through fear of allegation of ulterior motive if a bright light is shone upon it those essential staff will continue to be squeezed and pushed through the sausage machine with all the rest of the gristle.

Edited March 9, 2016 by grrclark

[Bangbangman]

Bangbangman, i absolutely would not dispute that what the rules say and what actually happens differs, but that is absolutely true in every employment sector.

As I said earlier I can sympathise with both sides, I think the NHS has, all too often, appallingly bad management with massive amounts of waste, i know per capita it is seen as efficient compared to other health services, but it also benefits from huge economies of scale which skew the picture to make it appear as though it is more efficient than it is.

For the junior doctors there really is no other show in town and they work in an evironment that is often beset by bullying and unfair expectations being placed on them by senior colleagues who have lived through the same thing.

For the government they are looking at a system that has glaring shortcomings and need to try and find a one size fits all solution otherwise costs will spiral and nobody benefits.

However in respect to this debate the only outstanding issue is now one of pay rate on a Saturday, every other point was agreed during negotiation so any argument around patient safety, safeguard on working hours, protected floor for existing pay, etc are all now irrelevant in respect to this dispute.

The BMA or any other union or any spokesperson is being disingenuous to continue to cite those other reasons in respect to the strike as they have already reached agreement.

In answer to the OP the reason for the current strike is actually really simple and it is one thing only and that is the Saturday pay rate.

For what it is worth I absolutely agree that the junior doctors should have a greater level of remuneration than they currently do, along with other care staff, but I also think that the NHS and every other public service carries a burden of too many non contributors yet we cannot have any sort of conversation in how that could be bettered without getting some sort of hysterical and conspiracy laden reaction about a nefarious plot for the privitisation and destructuring of the NHS.

So long as the bloat is allowed to remain through fear of allegation of ulterior motive if a bright light is shone upon it those essential staff will continue to be squeezed and pushed through the sausage machine with all the rest of the gristle.

Who are the "non-contributors"? What would you do to fix the NHS? Obviously I'm asking tongue-in-cheek because the answer is never going to be simple, but you get some surprising answers from people (some näive, some plain bigoted, a few thought-provoking).

 

I would like to see it de-politicised, though I'm not sure how accountability to us (the taxpayers) could be achieved. A cross-party arrangement of some sort. Something to end the perpetual cycle of ill thought out changes and manifesto-promise-driven policies that destabilise the NHS and add to the inefficiencies and low morale.

 

I think there needs to be an open debate about what the NHS can/cannot afford to deliver and what we are prepared to pay for. Politicians are afraid of this because it would be very difficult to avoid taking vote-losing flak and being seen as rationing healthcare.

 

I do believe Hunt's end game is one of privatisation of the NHS except a Blue-cross style emergency service. Oncology and a few others may survive longer in the current model. I fear for a UK without the NHS- what sort of society would take the regressive step of going back to a private system (or some variation thereof).

[Vince Green]

Vince

Sorry matey, you're way out of order with dentists.

The stress and hassle of coping with patients, volume of disease, regulation, interference etc is absolutely phenomenal.

I'm an NHS dentist, senior partner, multiple postgraduate qualifications; just the sort who should be ticking away to retirement with a nice list of private patients..

The reality is an overwhelming volume of work, people with complex medical issues, the sad, the bad and the disturbed, the pressures of business and the absolutely stunning-I really mean unbelievable-crass incompetence of NHS management, the most regulated workforce in the world, and every chav and his dog trying it on for compensation via crooked back-street lawyers.

In thirty odd years, I've personally resuscitated two patients, one died, one made it, have personally diagnosed around twenty cancers ( not including several dozen skin cancers, including a couple of melanomas), repaired several dozen lacerated faces, lips and tongues, in addition to routine pain relief, routine dentistry etc. I regularly see emergencies at weekends and evenings, my number is freely available.

It costs me around twenty to twenty five thousand a month just to go to work, the CQC, LAT, GDC, PCT etc all drop tons of rules, regs and protocols on me on a daily basis. We have an entire room full of protocols, forms and compliance certificates, any one of which could get me closed down, and the endless pressure to deliver artificial Government targets. Every day, there is another compliance order, invariably involving someone needing to issue a certificate at five hundred quid a time.

Just as an aside, next time we read about someone unable to access NHS dentistry, it ain't the dentist who is refusing it. The Government decides how many patients need to be seen and we cannot see any more. They will take disciplinary action against anyone who does.

Three years ago, I was fast-tracked with suspected kidney cancer, I ended up having surgery for a stone in my kidney. Missed some targets, so they fined me sixteen thousand quid. I could have made up the shortfall, we had patients waiting by the hundred, but no chance, I was fined. Most people are quite shocked to hear this, other dentists just shrug as they know the reality. The fact is, politicians are deceitful, lying scumbags who will repeat whatever they are told to say, and it is far easier to play up to stereotypes.

For the record, we keep the NHS going in my part of the world. The reason is simple, people need it. However, the pressure, the stress, the endless, constant hassle, is why the suicide rate among colleagues is such an issue.

A new dental graduate leaves with debts of up to sixty grand, insurance is up to five grand annually, there are educational requirements, further exams, etc.

It is not possible to walk into fantastic careers, with no responsibility etc. I wish it was..............

Thanks for your reply I'm sorry you found my post to be inaccurate but I would contrast your story with my friend's daughter. Mel qualified at Liverpool about twelve years ago, borrowed money from her Dad and bought straight into a private practice and has never looked back. AFAIK she has never done NHS work and she can set her own hours.

.

The point I was making is that there are other options/paths for dentists. There are not for doctors, the only doctors who get private work are consultants (more or less) and the junior doctors have no choices

 

Dentists generally keep more social hours, mine is monday to friday and 9-6 more or less, I appreciate your procedures may be complex but nothing like the life threatening conditions a doctor will have to deal with routinely. You don't have your patients arriving in an air ambulance.

Edited March 10, 2016 by Vince Green

[Psyxologos]

This answers the OP's question, I think.

 

 

 

Why should we support our junior doctors?
It has struck me recently that a lot of non-medical people don’t understand exactly why the junior doctors are getting so upset about their new contract- aren’t they just whinging about getting paid enough overtime on a Saturday?
But it is a lot more serious than that, with far deeper implications if this goes through.
1. The Government want to make the NHS a 7 day a week elective service. In order to do this, they need to make Saturdays and Sundays no more expensive in pay for their staff, than any other day of the week. However in order to provide an extra 2 days planned (elective) work, they need an extra 2 days’ worth of resources- ie £1 billion in money and 11,000 more people- that they simply do not have. The NHS is struggling to provide for 5 days a week- there simply isn’t enough money, doctors or nurses for more than this.
2. If this goes through, the next targets will be consultants; then nurses and support staff- in fact anyone who currently works for the NHS will be expected to treat the weekend as no different from any other day of the week. The NHS employs a huge number of people in the UK and this policy will have far-reaching consequences; it has huge social implications, as the weekend, and family life, is eroded and destroyed. When will children spend quality time with their parents? When will couples see each other?
3. Although it is possible under the current contract for doctors to work around 90 hours, in practice, because it becomes prohibitively expensive for Trusts to ask doctors to work more than 56 hours, this simply doesn’t happen. Removing this financial penalty means that there is nothing to stop hospitals working their doctors for over 70 hours a week, with many of these hours during nights or weekends- times when training opportunities are limited. Tired doctors make mistakes. This is a dangerous contract; it isn’t safe for patients.
4. The junior doctors see this contract as a bad deal. Junior doctors tend to be young, intelligent, mobile and are already used to moving round the country with their jobs. A large number are considering moving to Australia or New Zealand, or even closer to home to Wales or Scotland. If only a small proportion of our doctors “jump ship” in August, then that will leave huge gaps in rotas all over the country, especially in less popular locations or specialities. Locum staff are hard to find, expensive and less safe for patients. Large gaps in staffing at this level could bring down the NHS.
Please support your junior doctors. Their contract affects us all.

 

[grrclark]

Bangbangman, I absolutely agree that there isn't a simple or single answer, if there was it would have been achieved a long time ago.

 

I don't believe that people working within the NHS purposely run things in an inefficient way, I think like most evolved environments that things become they way they are for good single reasons, but very often fail to consider a wider picture.

 

As a result the things that could be done to bring about improvement are effectively limitless, but of course individual change without cognisance of the wider picture is just as likely to cause as many problem as it solves. In order to bring about effective change then there has to be a commitment to change across the environment and the problem with the NHS is that it is too big to allow that to happen.

 

The breakdown into different healthcare trusts was done in an attempt to allow local agility and provide for accountability in a meaningful scale, to introduce efficiency measures in a scale that is workable and achievable, but of course that assumes an equal level of capability across all the trusts and we know that is not the case. We also know that health care needs differ depending on the social demographic so what is seen as highly efficient in one area could be as equally inefficient in another area. There is also the variables around the level of quality and availability of care in each area.

 

Adding in an elected body element into the trusts to introduce a degree of public accountability also, in my view, just adds an additional layer of bureaucracy and is a key example of a non contributory element which has an exponential impact as every element has to feed back to that. Elected bodies are always limited by sentiment and emotion, decisions that need to be taken are very often not taken, not through a lack of willingness, but due to the inability to deliver a result against that decision.

 

Of course when you also have single agreements in the case of the junior doctors contract then you remove agility from each trust as they have (in theory) to impose what the government says, so this brings natural conflict. You cannot support both highly agile and self sufficient trusts within a hard and limiting central framework.

 

I believe the problem is that the NHS is no longer fit for purpose as an environment, I think that in broad terms it meets the brief to offer healthcare services to the public, but as an organisation it has suffered from largely unstructured organic evolution, but due to the protected status that it has in the eyes of the public it is also put beyond reach of a modernising hand.

 

The problem that has evolved from that hands off approach (in any meaningful sense) is that it really is no longer manageable hence we have issues like the junior doctors strike. In your previous post you highlighted that there is wide scale abuse of process in terms of manipulation of data, JD's working hours that are unrecognised, etc, but because that has been allowed to go unchecked, indeed it is accepted operating practice, that the system only really works as a result of people working outside the system, or cheating (for want of a better description). In some ways it doesn't matter what rules are established by government if they are ignored locally. That cannot be managed as it operates beyond the bounds of management process. In essence it becomes entrepreneurial endeavour as opposed to systemic and entrepreneurism relies on a collection of individual talents, it cannot be normalised.

 

Technically the JD strike today is about Saturday pay rates, but in truth we have arrived at this point due to a long term and chronic failure of so many other mechanisms within the system. The problem is that we cannot turn a blind eye to all the things that should not have been happening previously, but allowing then to happen and then try to address them all at once, i.e. this is the straw that broke the camel's back.

 

By the same token the government are doing exactly the same thing in reverse, they know that there is a requirement for wholesale change and to try and do that on the back of a junior doctor's pay deal, which is what they are doing, is nothing other than gross manipulation of an issue to suit a different agenda, even if there needs to be a different agenda.

 

Both sides are as equally culpable in that collective failure as are the public for our overtly naive outlook towards the NHS. So long as someone promises to throw money at the NHS then we can continue to put sticking plasters over the problems, but at some point we are more sticking plaster than anything else.

 

I absolutely believe that the NHS needs fundamental and whole scale change, the giant monolithic environment cannot possibly succeed or even be sustained in the longer term.

 

It is taking this thread way off topic, but I do think that the GP service should be at the forefront of any change in structure, the remit of the GP is widening way beyond what was considered normal even 10 years ago and that will only continue to widen. There is a significant level of bounce between hospital/specialist services and GP's with neither side being able to take ownership and where there is no ownership there is inefficiency and there is an inevitable failure in healthcare provision.

 

GP's are in essence privatised service providers and have been from day 1 of the NHS, they are given targets in terms of healthcare priorities, very often politicised, to meet national targets and objectives and are financially incentivised to achieve these, so much so at practice year ends they push as many eligible people through the system as they can to ensure they achieve the maximum level of income, which of course in turn just places load on the upstream services. In so many ways the approach to managing the GP service contributes to the level of upstream problems, but the GP's as with all the other bits of the health service are doing the best they can in the environment provided.

 

Of course any change will take years to achieve, especially when there is a skills shortage that has a likely lead time of 10+ years to bridge; this means that in real terms it needs to span party politics as any fundamental review will outlive any single government, even over multiple terms in office, and the public want to have an easy ball to kick at election time and the NHS is always that.

 

What that would mean is that we would have to establish a ring fenced and protected cross party leadership group that are charged with implementing fundamental reform into the NHS and that are allowed to sit outside of party manifesto pledges come election time, but that somehow also need to have public accountability.

 

In philosophical terms starting the NHS was an easy gig as once the ball was rolling it would never be allowed to stop, that could be done by one man in one government, but trying to change a system that has evolved and grown for almost 70 years is an altogether bigger challenge.

Edited March 10, 2016 by grrclark

[AVB]

Bangerman. Thanks for explaining your view (and for being a doctor). Can you explain though who makes doctors work 90 hours a week? Some people say that their contract is for 40 hours and can choose to work more others say that there is no choice. Can you shed some light?