Doctors' strike

[Earl Aelfheah]

LondonMix Wrote:

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> No one is asking junior doctors to work more

> rahrahrah!

>

> Doctors are being asked to work the same or fewer

> hours. However, more of the shifts on the rota

> would be weekends and evenings, when cover right

> now is comparably low.

>

> Because the NHS pay more for weekend and evening

> work under the old contract, the reduce the

> financial impact of this change, the NHS want to

> reduce pay for unsociable working times. They

> have redefined basically what's considered

> unsociable so they don't have to pay for early

> evening shifts and shifts on Saturdays.

But with no more doctors?

[Earl Aelfheah]

This is what I do not understand (genuinely, if someone can explain it, fair play). How can you ensure that there are more doctors at weekends, the same amount during the week, but with no increase in staff numbers and with them all working the same or less hours?

[LondonMix]

The government want to recruit more doctors! There are actually new restrictions on overtime some of which is governed by EU law.

However, its all meaningless though as A&E and maternity are already understaffed. Working overtime and holidays (despite technically not being required / allowed) are endemic to deal with the pre-existing staff shortages.

That's my issue with this policy. Working A&E etc is already awful because the T&C are worse than they legally should be because of major staff shortages.

The government want to reduce pay for weekends and evenings, which will further exacerbate the recruiting crisis.

I get what they are trying to do but it simply won't work.

[Jeremy]

rrr - I think the general feeling seems to be that it will ultimately either lead to longer hours, or thinner coverage (more patients per doctor).

[LondonMix]

http://www.bbc.co.uk/news/health-35667939

There is a 9% vacancy rate for nurses and a 7% vacancy rate for doctors.

The government would much prefer to hire more staff and pay less overtime-- its much cheaper to do so. However, they simply cannot recruit enough people in the understaffed areas of the NHS (primarily A&E and maternity).

If you can't fill existing positions, dropping pay in the areas where there are shortages is totally idiotic.

[Earl Aelfheah]

@Londonmix - The government's current approach doesn't scream 'recruitment drive' to me. They may want to reconsider their 'attraction and engagement' strategy.

[Earl Aelfheah]

Jeremy Wrote:

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> rrr - I think the general feeling seems to be that

> it will ultimately either lead to longer hours, or

> thinner coverage (more patients per doctor).

Yeah, this was kind of my assumption. This seems pretty undesirable and potentially dangerous to me.

[LondonMix]

Agreed.

The government have put aside funding for an additional d 11,000 doctors as part of the overall NHS proposal.

However, the current pay package and the governments approach means they won't be able to get anywhere near those numbers. They already are heavily recruiting from abroad to make up some of the existing shortage.

[Otta]

LondonMix Wrote:

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> Otta Wrote:

> --------------------------------------------------

> -----

> > Personally I think it's quite shocking how low

> the

> > pay is for people that have studied for years

> to

> > qualify as a doctor. But what I think they

> should

> > do is raise their basic salary, and reduce

> > opportunities to supplement with overtime

> rates.

>

>

>

> Otta, that's kind of what the government is doing.

Not in the way that I am thinking.

[LondonMix]

The policy overall is bad but they are raising base pay for all junior doctors and trying to reduce overtime. The only difference is they are lowering the supplementary pay doctors get for Saturday and evening work.

What did you have in mind?

[Mick Mac]

Jah Lush Wrote:

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> I fully support the strike. Save our NHS. Fecking

> Tories want to put a price on everything.

Every government has to put a price on all public sector expenditure. I know everyone knows that already but if it keeps going up, who pays?

like public sector pensions it needs reform. Its not good to have your employment terms changed but its got to be addressed at some point.

[Blah Blah]

LondonMix is correct on this one. The recruitment crisis is real. I know many qualified professionals who have moved abroad, from nurses and midwives to doctors. Australia seems to be a favourite destination.

At the same time, the latest recruitment drive is targetting countries like the Phillipines and there is something to be said about taking qualifed staff from countries that need them as much as we do.

Personally I think that Hunt is playing chess on this one. He's hoping for public support to drop off etc rather thsn make any real effort to resolve the dispute.

And whomever posted the scenario of cancelling docotors contracts and making them reapply is right. That is the only way this new contract can be imposed, but I think that would enrage the BMA if he went down that route (although I wouldn't put anything beyond this government).

[Otta]

LondonMix Wrote:

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> The policy overall is bad but they are raising

> base pay for all junior doctors and trying to

> reduce overtime. The only difference is they are

> lowering the supplementary pay doctors get for

> Saturday and evening work.

>

> What did you have in mind?

A higher offer.

I basically think the idea of higher salary, less overtime, and unsocial hours rate is good. And I suspect the doctors would have stayed at the table had there been continued negotiations over the fine details and numbers.

[uncleglen]

Has anyone mentioned that they each cost ?360,000 to train and then they sod off...and they would be nowhere without nurses and other support staff....

Under Blair my relatives were frequently sent for NHS appointments to Harley Street...to see docs that work in the NHS. They should suck it up imho since their clients are flat on their backs compliant most of the time...unlike the cops who have to deal with crims and are not allowed to strike...and the hostile general public.

[heartblock]

I was asked to formulate a plan to provide a 7 day NHS service with the same amount of staff and at the same cost by the senior management in a large south London trust due to pressure from the DOH. Of course this ask was completely ridiculous in that if staff work a 37.5 hr week - they will either have to work overtime that needs to be paid or not work on one of the week days - which would mean closing a diagnostic room down on a weekday and cancelling a list of patients on a weekday. Also patients prefer to be seen electively on a weekday - I've asked patients and the vast majority want urgent care over the weekend, but really do not want to come in for routine care at the weekend. Intellectually I cannot understand J. Hunt's reasoning. If he wants elective cover across 7 days then he needs to fund more doctors, nurses, porters, laboratory staff, radiographers, clinical scientists, physios etc. Doctors do not work in isolation they are just one part of the team - a 7 day elective non-emergency service would be very expensive and I'm not sure it's necessary. The weekend death rates the J H is using for his argument is flawed - patients who attend and are admitted to a hospital at the weekend do so due to an urgent medical need - obviously suffering from an issue that is life threatening or serious in nature - therefore the patient is at a higher risk of death due to the nature of their illness.

[Blah Blah]

I think you are spot on heartblock. Sadly this is yet another ideologically driven pursuit.

[LondonMix]

I think more than that is necessary. To deal with the existing recruitment crisis in A&E and maternity, they needed to increase both base pay and the rate for unsociable hours,but only in those services where they are struggling to recruit.

Once they can recruit staff in adequate numbers, the overtime issue will automatically resolve itself.

The real crisis as concerns doctors is the recruitment crisis. Everything else can't be addressed without tackling that first.

Otta Wrote:

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> LondonMix Wrote:

> --------------------------------------------------

> -----

> > The policy overall is bad but they are raising

> > base pay for all junior doctors and trying to

> > reduce overtime. The only difference is they

> are

> > lowering the supplementary pay doctors get for

> > Saturday and evening work.

> >

> > What did you have in mind?

>

>

> A higher offer.

>

> I basically think the idea of higher salary, less

> overtime, and unsocial hours rate is good. And I

> suspect the doctors would have stayed at the table

> had there been continued negotiations over the

> fine details and numbers.

[LondonMix]

The government don't actually want 7 day elective service though. They want 7 day emergency service with senior consultants carrying out diagnostic testing.

I think the plan they have won't work but its important to be clear what they are actually hoping to achieve.

heartblock Wrote:

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> I was asked to formulate a plan to provide a 7 day

> NHS service with the same amount of staff and at

> the same cost by the senior management in a large

> south London trust due to pressure from the DOH.

> Of course this ask was completely ridiculous in

> that if staff work a 37.5 hr week - they will

> either have to work overtime that needs to be paid

> or not work on one of the week days - which would

> mean closing a diagnostic room down on a weekday

> and cancelling a list of patients on a weekday.

> Also patients prefer to be seen electively on a

> weekday - I've asked patients and the vast

> majority want urgent care over the weekend, but

> really do not want to come in for routine care at

> the weekend. Intellectually I cannot understand J.

> Hunt's reasoning. If he wants elective cover

> across 7 days then he needs to fund more doctors,

> nurses, porters, laboratory staff, radiographers,

> clinical scientists, physios etc. Doctors do not

> work in isolation they are just one part of the

> team - a 7 day elective non-emergency service

> would be very expensive and I'm not sure it's

> necessary. The weekend death rates the J H is

> using for his argument is flawed - patients who

> attend and are admitted to a hospital at the

> weekend do so due to an urgent medical need -

> obviously suffering from an issue that is life

> threatening or serious in nature - therefore the

> patient is at a higher risk of death due to the

> nature of their illness.

[LondonMix]

For anyone who is interested in the actual details of the proposals:

https://www.gov.uk/government/speeches/nhs-7-day-services-and-the-junior-doctors-strike

Secondly, there is concern that the government may want to see all NHS services operating 7 days. Let me be clear: our plans are not about elective care but about improving the consistency of urgent and emergency care at evenings and weekends. To do this, the Academy of Medical Royal Colleges has prioritised 4 key clinical standards that need to be met. These include making sure patients are seen by a senior decision maker no more than 14 hours after arrival at hospital; 7 day availability of diagnostic tests with a 1 hour turnaround for the most critically ill patients; 24 hour access to consultant directed interventions, such as interventional radiology or endoscopy; and twice daily reviews of patients in high dependency areas such as intensive care units.

Thirdly, there is the concern that proper 7 day services need support services for doctors in the weekends and evenings as much as doctors themselves. Less than half of hospitals are currently meeting the standard on weekend diagnostic services, meaning patients needing urgent or emergency tests on a Saturday or Sunday, such as urgent ultrasounds for gallstones or diagnostics for acute heart failure, face extra hours in hospital at weekends or even days of anxiety waiting for weekday tests. Our new standards will change this, with senior clinician-directed diagnostic tests available 7 days a week for all hospitals by 2020.

[heartblock]

I've worked in the NHS for over 30 years. I've worked in 5 different Trusts and spent some years in the private sector, much of my time in the last 2 years has been on the question of 7 day working and I was part of a DOH 7 day working group advising in how to deliver weekend diagnostics. I'm am acutely aware of the actuality and to have 7 day diagnostics will be very, very expensive.

Senior consultants/ doctors do not carry out or perform elective diagnostic tests in the NHS or the private sector, despite what everyone sees on 'House'. Respiratory physiologists, cardiac physiologists,neurophysiologists, vascular scientists, audiology physiologists, MLSOs, sonographers etc carry out diagnostic tests using specialist equipment and report on them. The report is then uploaded to the patients medical records for the doctor view. For example the team I used to manage recently were cardiac physiologists and echocardiographers - The ultrasound for heart failure is an echocardiogram - carried out by a BSE registered sonographer/echocardigrapher- not by a junior doctor.

Just having more doctors at the weekend will not mean an increase in diagnostic services, to have diagnostics more healthcare scientists would have to work 7 days and this has so far not been funded by the DOH.

[uncleglen]

A friend was having an all day pre- heart op assessment along with about 15 other people and got to the echo-cardiogram bit. There were 6 cubicles and 1 technician because 2 were on courses, 1 was on holiday, 1 was off sick and 1 was at lunch

what a shambles and such bad organisation.

[heartblock]

The key phrase is 'senior-clinician directed diagnostic'. That means a doctor requests a test - but the doctor doesn't do the test. If you don't have more 'diagnostic staff' it doesn't matter how many doctors are in at the weekend. Ok I won't add anymore to this. I resigned from my senior clinical manager post recently after 30 odd years to take on a less stressful role. The demoralised staff and constant pressure to do more with less was sad to see. When it's gone you are all going to miss it! Unless you have shares or interests in private health providers as do many in the Conservative party....although if you have a heart attack in the middle of the night it will be my NHS acute coronary team that come in to rescue your blocked artery and your life, not BUPA.

[heartblock]

Yes I've been in that situation. Three people off sick with norovirus, one person on AL in Lisbon, one person booked on an Advanced Life Support course for three days so that they could go on call for cardiac emergencies the following week. Lots of patients having an extra hour waiting time that day and the majority were very understanding. Still I've left now so one less shambolic manager eh?

[LondonMix]

Hearblock-- I agree the governments policy is bad.

All I was clarifying is that they do not want full elective non-emergency service 7 days a week as you indicated in your original post.

They wanted emergency care andspecific diagnostic support that complements emergency care 7 days a week.

The only problem I have with the policy is that the government won't be able to recruit the staff they need to make this plan work for the reasons I've already stated.

[EastBoundDown]

This is a nightmare.