[Lund]

Despite a feeling that I'll be going against the wind here, and apologies if I missed the answer, but I'm really struggling to understand what this is all about.  Pete JH keeps trying to wield Occam's razor, and not really getting anywhere, but I guess it's worth a go...  humour me, perhaps I'm stupid.

I want facts only - and as little politics as possible...

* The Tories want a 7-day NHS.  That is, they want non-emergency cover to be available on saturday and sunday too.

* They are starting with junior doctors.  They'll need to do it for the rest (technicians etc.) too, but have started with junior doctors.

* They want the new junior doctors contract to be cost neutral.  Justification for this is that the overall number of patients seen will not increase - people can take a sunday appt instead of taking time off on a friday, for example.

QUESTION 1: IS THIS WRONG?  IF IT IS WRONG, WHY?  WHY WILL THE OVERALL WORKLOAD INCREASE?

There are three linked variables: cost, quality, and flexibility (“choice” is the government's buzz-word for the latter). Cost: the NHS is cheap by affluent western standards. Quality: health outcomes are middling-good. Consequently NHS cost-effectiveness is probably the best amongst affluent western countries. High cost-effectiveness is achieved through a relatively inflexible system: waiting times, no 24/7 access to non-emergency care. Making things a little awkward for people has a filtering effect and reduces demand.

The NHS also has good staff buy-in to the idea of a fair system for all, even if it isn't. Extra voluntary hours helps efficiency.

If you increase the flexibility of a service demand will go up so it either has to cost more or quality goes down for the same cost. This is irrespective of political hue: French healthcare has more flexibility, slightly better quality but costs more and is less cost-effective. US private healthcare is slightly more flexible still and slightly higher quality at double the cost and is much less cost-effective. Hunt says he wants to increase flexibly with no increase in cost or deterioration in quality. This simply can't be done.

If you piss-off your staff, efficiency deteriorates.

Oooh.  This is another good reply.  So can you explain why flexibility and demand are linked in a non-emergency healthcare setting?  Or rather: why flexibility and supply are linked - as that is the Q PeteJH and I are asking I think...

This isn't elective really btw.  It's non-emergency.  Cancer care is hardly elective.  But we can keep using elective as the word if that is best.

[slackline]

I want facts only - and as little politics as possible...

They can't be separated in this issue because as has been clearly stated in the news the other day "No trade union has the right to veto a manifesto promise voted for by the British people,”.

It is about dismantling the NHS and privatising it, why else would someone who's previous experience is public relations and conveniently having co-authored a book published in 2005 on dismantling the NHS would have been appointed to the position of Health Secretary.

Its a tried and tested method....




There are tons of statistics I'm too busy to look up and quote for you right now on the efficacy of public v's private healthcare, but you're outlooks (all-cause mortality) are worse and more expensive under the later.

[Lund]

For fuck's sake Slackline, if you can't discuss it without banging on about left wing right wing tory labour privatisation etc. etc. etc. despite being asked please just shut up for ten (non-literal) minutes.  Jesus Titty Fucking Christ on a bike I'm trying to from an actual cunting opinion here without all the partisan bullshit.

I know it's more complicated, I know Labour started it when they were in their Tory period, I know a doctor should get more than a tube driver and starts with higher debts, I know a consultant makes more than me, I know skipping appointments is bad, I know we should just skip getting eye treatment and just look through pinholes made by our fingers when we need to see in focus, in I know Jeremy Corbyn cures AIDS with his bare hands, I JUST WANT TO LEAVE IT OUT FOR THE MINUTE PLEASE

[galpinos]

* There were arguments about not working too many hours, and lots of other things.  During the talks over the winter, the BMA and the government agreed on all of these things.

* The one remaining piece of disagreement between the BMA and the government was saturday pay.  The BMA want it to go up; the government don't.

QUESTION 2: ARE THE PREVIOUS TWO BULLETS CORRECT?  IF NOT, WHAT IS IT ACTUALLY ABOUT?  WHAT SPECIFIC POINTS ARE STILL REMAINING IN CONTENTION?

The two previous bullets are not correct.

Shifts - The BMA were not happy with the DoH's classification of shifts. DoH "day shift ends at 2am, so a 9am to 2am shift is a day shift, you then start at 9am the next day. BMA wants between 10pm - 6am to be classed as a night shift to prevent a succession of long shifts.

Overworking Protection - Currently, there is a robust system of hours monitoring (that is a system signed up to by trusts and doctors) that CAN be used to stop the Trust from implementing shift patterns/hours that are outside the contract for that post. (Doctor's contracts differ depending on what "band" they are in, higher ban, more hours, moe antisocial shift, more money). If the trust is breaking it's agreement, the trust is obliged to modify the shift or pay more money. This isn't often used (most doctors, when monitored, lie to say they work less) but when trusts start to take the piss, the doctors have somewhere to turn. This is effective when required. The DoH want to get rid of this and have an appeal system to a "Guardian" who is a trust employee. No independent monitoring, no independent body, no appeal system, just consideration by the trust.

Pay - Doctors currently have pay bands as described above. DoH want's no extra pay for Saturday, a standard day to move from 9-7 to 7-9 and the extra 10% for working over 1 in 4 weeks* to go. BMA conceded to move the standard working day to 8 - 8 as that is the standard day for a doctor but would move on the Saturday pay and weekend supplement.

*This is to incentivise doctors into the emergency care as the shifts are pretty horrible so as a pay-of for spending your life in a hospital, you get a bit more money

(Run out of time to say more, maybe later.....)

[Footwork]

I guess the summary is: in the sample rotas, compared to the rotas now, are there more hours worked, or the same?

I'll try and dig one out as I've seen a few. They look like they've been written by an algorithm rather than a person.

There are cases of 4 nights worked 9pm - 9am. Say this finishes Monday 9am. Monday has been coloured in green and counted as a 'day off' before being back at work on days Tuesday. Any idiot can see that this doesn't count as a day off but is a non day spent sorting out sleeping pattern.

Next is the average hours worked a week. Their average has got two wild extremes. From 35 hour weeks to 100 hour weeks. Again, the body does not cope well with these inconsistent work patterns.

The contract removes financial penalties on trusts for overworking their Dr's. Why the fuck would you do this other than being able to abuse your staff and it not being wrong.

EDIT: Didn't see post above by galpinos. If the "guardian" is as good as some rota co-ordinators (and yes there are some good ones!) then having the matter sorted will be as much use as an honesty box outside Westminster

[galpinos]

This isn't elective really btw.  It's non-emergency.  Cancer care is hardly elective.  But we can keep using elective as the word if that is best.

Cancer treatment is mostly elective*. There is sometimes an "emergency" element to it at the start but then treatment can be scheduled. There is also sometimes an emergency element at the end but the bulk of it is classed as elective.

*elective in the medical sense has a definition of non-urgent.

[duncan]

Oooh.  This is another good reply.  So can you explain why flexibility and demand are linked in a non-emergency healthcare setting?  Or rather: why flexibility and supply are linked - as that is the Q PeteJH and I are asking I think...

I edited my last post as you replied - in part anticipating this.

There are several reasons why increasing flexibility increases demand, a similar process occurs when you build a new road. People get better, or no longer see the need for healthcare, as they wait on waiting lists. Make it harder to seek non-urgent care and borderline-necessary consultations will drop. There are a lot of these, ask any GP or A+E department. I probably avulsed my middle finger collateral ligament last December. I considered going to my GP but it was Christmas and there was a three week wait for appointments so I managed it myself. Had I been able to get an appointment the same day I would have done.

In any service industry I'm aware of, it costs to increase flexibility: if Apple wanted to reduce the waiting time to see a Genius they would employ more Geniuses per number of Mac users. Why should healthcare be different?

[Lund]

Oooh.  This is another good reply.  So can you explain why flexibility and demand are linked in a non-emergency healthcare setting?  Or rather: why flexibility and supply are linked - as that is the Q PeteJH and I are asking I think...

I edited my last post as you replied - in part anticipating this.

There are several reasons why increasing flexibility increases demand, a similar process occurs when you build a new road. People get better, or no longer see the need for healthcare, as they wait on waiting lists. Make it harder to seek non-urgent care and borderline-necessary consultations will drop. There are a lot of these, ask any GP or A+E department. I probably avulsed my middle finger collateral ligament last December. I considered going to my GP but it was Christmas and there was a three week wait for appointments so I managed it myself. Had I been able to get an appointment the same day I would have done.

In any service industry I'm aware of, it costs to increase flexibility: if Apple wanted to reduce the waiting time to see a Genius they would employ more Geniuses per number of Mac users. Why should healthcare be different?

I think you've answered my counter here inline.  Increasing flexibility at front line services DOES increase demand: so A&E and GPs.  I think we can split those off from this discussion they are governed differently.  The ability to get an antenatal appointment on a saturday as opposed to having to take a wednesday morning off is the kind of thing we're talking about really: you need it, it's not an emergency, it's not "elective" in sense of "optional" - and as such I argue that the increased flexibility will not increase demand by much if anything.  Until we wade into things like missed appointments.

[slackline]

Jesus Titty Fucking Christ on a bike I'm trying to from an actual cunting opinion here without all the partisan bullshit.

You normally come across as someone who is well informed on issues, so go and do your own fucking research on which to base your cunting opinion.

[Lund]

Pay - Doctors currently have pay bands as described above. DoH want's no extra pay for Saturday, a standard day to move from 9-7 to 7-9 and the extra 10% for working over 1 in 4 weeks* to go. BMA conceded to move the standard working day to 8 - 8 as that is the standard day for a doctor but would move on the Saturday pay and weekend supplement.

*This is to incentivise doctors into the emergency care as the shifts are pretty horrible so as a pay-of for spending your life in a hospital, you get a bit more money

(Run out of time to say more, maybe later.....)

Great post, thanks.  (And the same to Footwork.)

In the bit I've split out - is that a typo?  What do you get 10% extra for - working more than four shifts in one week?  And do you mean the BMA would not move?

[36chambers]

My girlfriend is half way through doing a PhD looking into the relationship between GP wellbeing, burnout and patient safety. This is not directly related to the current junior doctor affair.

Having recently submitted a lit review for publication, studies have shown that doctors are already worked too hard and have a higher than average rate of burnout, and that patient safety is compromised due to stress related medical errors. The (crude) conclusion being that doctors need much greater support and more breaks. (A rough example, trucks drivers are expected to have a break every 3 hours but a doctors is expected to have one every 6)

There is great concern that the new contracts will put even more strain on doctors and thus cause even more medical errors.

[galpinos]

Pay - Doctors currently have pay bands as described above. DoH want's no extra pay for Saturday, a standard day to move from 9-7 to 7-9 and the extra 10% for working over 1 in 4 weeks* to go. BMA conceded to move the standard working day to 8 - 8 as that is the standard day for a doctor but would move on the Saturday pay and weekend supplement.

*This is to incentivise doctors into the emergency care as the shifts are pretty horrible so as a pay-of for spending your life in a hospital, you get a bit more money

(Run out of time to say more, maybe later.....)

Great post, thanks.  (And the same to Footwork.)

In the bit I've split out - is that a typo?  What do you get 10% extra for - working more than four shifts in one week?  And do you mean the BMA would not move?

The extra 10% is for juniors who work more than 1 weekend in 4. (a weekend is classed as a Saturday and Sunday shift, day or night). This is pretty much only relevant for those in emergency disciplines.

And yes, I did mean they would NOT move on the 10% for weekends and the classing of Saturday as a standard working day.

[galpinos]

There were other bits they didn't agree on but those were the ones relative to the points you made.

My wife is a doctor (cancer) so I have a vested interest/bias.

[monkoffunk]

This is the key bit really.  You can't have some of this as part of your argument directly as it doesn't make the razor: yes, it's relevant, but it's not ONLY relevant.  Increasing pressures on the NHS as a result of increasing demands on the increasing population will happen with or without a seven-day NHS - unless the seven day thing makes it worse... because all the doctors fuck off to Oz... don't get me started on that, Oz is not all that as many will discover... but that's a different topic too.

Now you could have an argument that said at present, patients cannot get an appointment.  At the moment they would go on a waiting list, and one that is eternally growing longer and longer as there are not enough appointments - i.e. supply is lower than demand and remains so overall.  I don't think waiting lists are getting longer and longer?  (Yes there are peaks and troughs?)  Or is this not the case?  But in any event: this too doesn't make the razor...

... the "same cost" thing works if and only if there are the same number of appointments overall.  Keeping the same number of hours worked per doctor the same (another thing I hear is agreed) = the same number of appointments overall?  This is why I don't understand the argument that changing to a model that has doctors available on a saturday and a sunday as well as M-F *increases costs* (unless you pay more for doctors to work saturday and sunday which is quite the point).

The fundamental thing I'm not getting though is really about the appointments and the hours and whether or not the move to seven days is in fact asking doctors to see more patients, or just to the same number of patients all week?

Seven day NHS might not make pressures worse, but it is truly impossible to provide identical levels of care on a Saturday and Sunday in a cost neutral fashion. As has been said already junior doctors are the tip of the iceberg in terms of infrastructure and other staff required. Regardless of length of hours work, there is a massive difference when you spread people too thin, before accounting for people leaving. Spread the same number of doctors out over more time and you will increase pressure on those doctors. This is separate to more global issues of increasing patient numbers, increasing burden of chronic illness, which is going on anyway, and will mean no shortage of patients to fill expansion of service.

There will not be the same number of appointments over all. The point is they want full services 7 days a week. Not reduced weekday services. They want to increase service provision without (official) increased doctor hours. That is unsafe.

I get the rest.  There is loads of interesting stuff there.  The penalising women thing - at first glance I don't agree with that, sorry, because it's OK for Dad's to get fucked but not Mum's?  What about Mum being able to work weekends when Dad is about instead because she can choose saturday shifts?  But we should leave that for the time being and I may well be missing something.

I don't believe its ok for Dads to get fucked and not Mums, but my point is that if the government themselves are saying anyone is getting fucked then doesn't that make the point that this isn't just junior doctors throwing their toys out of the pram?

Just like we should also leave the fact that A&E is surely stuffed at the moment because nobody chooses a specialty where you have to work regular, 12 hour, unsociable shifts... it's much easier to be a single body part doctor M-F....

Yes its increasingly screwed as it is. I worked 3 in 4 weekend rota. It was horrible and I'd never go back.

I'm still not quite sure whether you think its fair to view Saturday working as the same as Wednesday? Do you value your weekends at all?

[monkoffunk]

As a side point on how much of a pipe dream this whole thing is:

There is a growing movement towards more NHS services being available seven days a week.

This is being driven by three primary factors:

A desire to improve quality of care
Services redesign and reconfiguration
Improving access and convenience.

In practical terms, achieving the same care quality throughout the week will mean more NHS staff, especially senior doctors, on site at hospitals at weekends and evenings. There are also implications for access to general practice.

It also requires other services being available to enable clinicians to provide high quality care as usual. This includes diagnostic and clinical support, social care, transfer services and administrative support.

Some individual hospitals have developed the availability of some services over seven days. But as yet there has been no robust modelling of what the impact of seven-day services would be more generally on staff numbers or working patterns, the financial implications, or clinical outcomes for individual specialties.

The BMA believes patients should receive the same high quality of care every day.

The royal colleges have developed quality standards for the care of acutely ill patients that set out a clear aspiration of what should be achieved in all NHS hospitals. However, there are significant resource and ways-of-working implications that require close examination.

The BMA believes that urgent and emergency services should be the priority for investment to bring the standard up to the very best, every day. Only when we have improved the quality of care for acutely ill patients can the debate start as to whether a weekday service can also be afforded at nights, weekends and bank holidays.

In the current and foreseeable economic climate, with huge financial pressure on the NHS, we do not believe resources could be freed up to deliver routine and elective services seven days a week.

[Lund]

I don't believe its ok for Dads to get fucked and not Mums, but my point is that if the government themselves are saying anyone is getting fucked then doesn't that make the point that this isn't just junior doctors throwing their toys out of the pram?

....

I'm still not quite sure whether you think its fair to view Saturday working as the same as Wednesday? Do you value your weekends at all?

Thanks for your reply.  Two to answer.  In reverse order. :-)

1. I haven't said what my opinion is - because I don't really have one yet.  Do I think doctors should strike?  No.  You're not fucking tube drivers or French farmers.  For some reason I hold all doctors up like I hold MSF: paragons of heroism and virtue, choosing to be a doctor for reasons other than money and personal worth.  That is exactly why I stepped right not left at 18 and chose Physics over medicine.  But that's an emotive feeling, not a considered one.  My father is a doctor.  He's been through all this before, and chose to not leave to Australia (to the endless chagrin of my mother) - because the NHS and free healthcare was to important for him to abandon.  He detests the BMA too though.  But on the flipside - what are you to do?  So I'm forming my opinion on this bit - and I need information.

Saturday working?  On the one hand, you've got to work it.  No use bleating about it, this is the 21st Century, and I despise the Scots and the religious types for making it so that I can't go to the supermarket early on a Sunday with my toddler before the hordes awake.  But then... I have worked Saturday.  I still work weekends sometimes.  I don't get paid for it at all now.  When I did, I got time and a half.  So I think you should work it - but get paid a bit more for it.

2. My biggest problem here is with the communication paths.  I don't know who to believe.  The fact that everyone keeps banging on and on and on and on and on and on about privatising the NHS and being childish about the Health Secretary's name just makes me irritated and question everything I hear as bullshit.

The women thing is an example of poor comms: it's a smokescreen from the real issue, and has no value in the communication of the core arguments.  We can spend too long discussing whether it's OK to break eggs to make an omelette.

Negative publicity brings everyone down the same level.  A low one.  Which makes me not give a fuck: everyone = Drumpf.

Finally I decided to step away from my irritation and find out some facts, and then think about it.  Which I'm now doing.

I hope that makes sense.  And thanks for your input.

[Lund]

As a side point on how much of a pipe dream this whole thing is:

There is a growing movement towards more NHS services being available seven days a week.

This is being driven by three primary factors:

A desire to improve quality of care
Services redesign and reconfiguration
Improving access and convenience.

In practical terms, achieving the same care quality throughout the week will mean more NHS staff, especially senior doctors, on site at hospitals at weekends and evenings. There are also implications for access to general practice.

It also requires other services being available to enable clinicians to provide high quality care as usual. This includes diagnostic and clinical support, social care, transfer services and administrative support.

Some individual hospitals have developed the availability of some services over seven days. But as yet there has been no robust modelling of what the impact of seven-day services would be more generally on staff numbers or working patterns, the financial implications, or clinical outcomes for individual specialties.

The BMA believes patients should receive the same high quality of care every day.

The royal colleges have developed quality standards for the care of acutely ill patients that set out a clear aspiration of what should be achieved in all NHS hospitals. However, there are significant resource and ways-of-working implications that require close examination.

The BMA believes that urgent and emergency services should be the priority for investment to bring the standard up to the very best, every day. Only when we have improved the quality of care for acutely ill patients can the debate start as to whether a weekday service can also be afforded at nights, weekends and bank holidays.

In the current and foreseeable economic climate, with huge financial pressure on the NHS, we do not believe resources could be freed up to deliver routine and elective services seven days a week.

I get that.  And it makes a lot of sense.  But... the government said in their manifesto that they would provide 7-day services.

So they have to do it right?  Or at least try?

Whatever you believe, the democracy we are stuck with means that has to happen.  And the BMA - which isn't representative of everyone in the country - they can't fight against that... it's not right.

On the flip side, they can represent their member's interests and fight for the right pay and working conditions...

[GCW]

The sad thing is, I've had enough of all of this stuff and no longer really care. I half want it all to fall apart so people may appreciate what they used to have and abuse.

[Oldmanmatt]

The sad thing is, I've had enough of all of this stuff and no longer really care. I half want it all to fall apart so people may appreciate what they used to have and abuse.

Amen.


Sadly...

[monkoffunk]

Thanks for your reply.  Two to answer.  In reverse order. :-)

1. I haven't said what my opinion is - because I don't really have one yet.  Do I think doctors should strike?  No.  You're not fucking tube drivers or French farmers.  For some reason I hold all doctors up like I hold MSF: paragons of heroism and virtue, choosing to be a doctor for reasons other than money and personal worth.  That is exactly why I stepped right not left at 18 and chose Physics over medicine.  But that's an emotive feeling, not a considered one.  My father is a doctor.  He's been through all this before, and chose to not leave to Australia (to the endless chagrin of my mother) - because the NHS and free healthcare was to important for him to abandon.  He detests the BMA too though.  But on the flipside - what are you to do?  So I'm forming my opinion on this bit - and I need information.

I'm on the flip side. I truly believe that if this contract goes through it will be far worse for patients than the impact of the strike. I can't ethically stand by and let it happen. I can't seen any other option. Striking causes inconvenience and is unsustainable in the long run, but it doesn't cause patient harm. Go to A+E on Monday or Tuesday and you'd have been seen by a consultant.

We aren't striking for the money. We never asked for a pay rise. We aren't asking for one now. We have taken real term pay cuts for years, we haven't complained (whilst MPs pay goes up, irrelevant I know).

Saturday working?  On the one hand, you've got to work it.  No use bleating about it, this is the 21st Century, and I despise the Scots and the religious types for making it so that I can't go to the supermarket early on a Sunday with my toddler before the hordes awake.  But then... I have worked Saturday.  I still work weekends sometimes.  I don't get paid for it at all now.  When I did, I got time and a half.  So I think you should work it - but get paid a bit more for it.

Again I already work Saturdays. I'm not complaining about it. I weekends, I work nights. In four months of A+E I worked 11/18 weekends of which some were nights. 1/4 structure accounting for annual leave. Hated it, but did it. I don't know how many I'll be expected to work in future, but the government does not want to pay extra for extra shift. And I don't want that anyway. I want more doctors to provide more care. I have also work probably hundreds of hours for free due to the impossibility of leaving on time in certain jobs, but again, irrelevant.

2. My biggest problem here is with the communication paths.  I don't know who to believe.  The fact that everyone keeps banging on and on and on and on and on and on about privatising the NHS and being childish about the Health Secretary's name just makes me irritated and question everything I hear as bullshit.

Fair enough. Jeremy Hunt's name has been listed as an author on documentation calling for the NHS to be dismantled, although he denies that it reflects his views. I'll admit to being partisan. I do personally believe he would like to see the end of the NHS and I do personally believe that an attempt to cut junior doctor pay reflects wider Tory economic policy, reflected in the treatment of all public sector workers. All of this is separate from the issue of patient safety. Motives aren't relevant, outcomes are.

The women thing is an example of poor comms: it's a smokescreen from the real issue, and has no value in the communication of the core arguments.  We can spend too long discussing whether it's OK to break eggs to make an omelette.

Negative publicity brings everyone down the same level.  A low one.  Which makes me not give a fuck: everyone = Drumpf.

Finally I decided to step away from my irritation and find out some facts, and then think about it.  Which I'm now doing.

I hope that makes sense.  And thanks for your input.

Thanks for yours.

[monkoffunk]

the government said in their manifesto that they would provide 7-day services.

So they have to do it right?  Or at least try?

Introducing a truely 7 day elective NHS requires a spending commitment they aren't willing to make. It was a stupid thing to put in their manifesto if they didn't intend to implement it in a sensible way. This way is unworkable. And no, they don't have to. Governments often break manifesto promises (LibDems and tuition fees spring to mind); they only act like it's some unbreakable pact when it suits their purposes.

[Offwidth]

I think the insults are because Hunt IS telling lies and the vast majority of the very intelligent and dedicated medical professionals are very upset about this.. Enough to include many conservatige voting doctors.. So I see no sense in debating the niceties of the highly complex detail of contractural rights and wrongs in isolation, when the real issue is the funding gap for safe 7 day working and the NHS workers next in line for major contract 'cost neutral' changes. Also that the reasons behind the need for 7 day working are wrong and best solved in other ways in the expert research based links provided up thread (for those who can be bothered to look). The manifesto commitment doesn't make sense, isn't anywhere close to be funded and would be the latest in a long line of daft ideas in manifestos from all parties consigned to the dustbin. No-one gets to vote on which specific policies they want in a manifesto so its just political rhetoric as usual...move on... no logic to see here.

I'm all for devils advocate type arguments but in this case the numbers just dont add up and the fight was one Hunt chose to pick with a group who work way more Saturdays than most professionals, and certainly enough such that the extra cost would have been chicken feed compared to extra consultant costs.

I also am saddened that people still think the equality issues raised in this dispute are not important. Women are the majority of those training to be doctors and could easily do other things in organisations who care about equality proofing to retain talent. Arguing we are doing down men is daft: equality proofing is just ensuring gender isn't an issue.

[Fultonius]

and I despise the Scots ... for making it so that I can't go to the supermarket early on a Sunday with my toddler before the hordes awake.

Wait a fucking minute here pal - how exactly do we stop you going to the supermarket?  You do realise we've had Sunday opening for....decades!

[drdeath]

As a doctor (whose wife is also a doctor) I would make the following point...

I keep hearing 'it's not about money' from the juniors in the media etc, and I agree that there is a lot here about safety/service provision etc...

But if I was still a junior it would sure as shit ALSO be about money to me...

Example - my wife is a junior (just about to be consultant) in a lab-based specialty.

When she is on the on-call rota for this specialty, she works perhaps ONE evening a fortnight at 5-9pm...in addition to her 9-5 day.

For this she receives, after tax, and additional £1000 a month.

For essentially 8hrs work.

This, anyone can see, is bonkers.

And, unsurprisingly, the Govt think it's an excellent place to save money.

But, the problem is that without this extra payment, her basic take-home pay is, while more than many
folks take home, unattractive/insufficient etc to keep someone of her talents in the specialty/profession.

For years, the basic pay element of salary has been bolstered by 30 and 40% on-call supplements/antisocial working supplement etc - adding up to what doctors have become used to seeing as 'their pay' fullstop.

No 'junior' I knew ever saw their basic pay as what they REALLY earned 9-5, with the addition as some kind of overtime - the pay was the pay and taken as a piece.

The levels of basic pay, in my opinion, are simply not enough to keep folk in the profession - which is having a recruitment and retention crisis as it is.

So, it may not be all about money, but if someone wanted to take a grand a month off my pay, while offering the mouth-watering incentive of working more weekends for nowt, it would sure as shit be about money to me.

D

 

[monkoffunk]

For years, the basic pay element of salary has been bolstered by 30 and 40% on-call supplements/antisocial working supplement etc - adding up to what doctors have become used to seeing as 'their pay' fullstop.

No 'junior' I knew ever saw their basic pay as what they REALLY earned 9-5, with the addition as some kind of overtime - the pay was the pay and taken as a piece.

Just want to add a point on this common misconception that it is 'overtime' we are complaining about. It isn't. We do not get paid any overtime, it is simply a way of discriminating between jobs with more or less out of hours commiments. This is necessary it a profession with very heterogenous work patterns.

As an example, I did a job on respiratory medicine which had a lot of on call commiment covering general medicine. This meant working lots of weekends, evening and nights. This meant my pay for the period was basic + 50%. On days when I was not on call I worked on the respiratory ward and effectively my salary was calculated for a 0900-1700 pattern. However it was never possible to leave at that time because it was so busy. 0900-1900 was the norm, sometimes later. I think 2100 is the latest I've left on a non on call day, I've heard of worse. After 1700 you were working for free. The government would never admit it, but they rely on an awful lot of goodwill for hospitals to run safely.