[petejh]

7 days a week written into staff contracts would be a better model for maximising profit in a privatised industry, just ask John Lewis, Tesco, Debenhams etc. I imagine private contractors would rather that battle be won before they take up the reins.

Well the bottom line to that is that I'd rather an efficiently run and good value John Lewis/Tesco etc. than an inefficient/expensive/not open on weekends State-run supermarket.
(To the rest of your Q's, I don't know)

Very briefly, The government say it's about quality. They say having more juniors at the weekend will achieve this (although they have also said it's senior cover that makes a difference). There is no evidence for this.

They say it is cost neutral. There will be no more doctors.

So, for the same money and number of staff they will increase working at weekend.

Logic dictates that either weekday covers falls, or people work longer hours for less.

Is there evidence against?

Logic also dictates that, while there may be 'no more Doctors', there are also 'no more patients'. Therefore weekday cover should fall - in line with a 7 day spread of patients. It's simple isn't it - you spread the 'customers' and mirror that by spreading the Staff. How is that not correct?

(I can see how politics might preclude the gov saying weekday cover will fall. Cue knee-jerk dumb reaction by some public, media and the BMA. But it should.)

[GCW]

No, the plan is for seven day elective work so patients will increase.

Bottom line is its unfundable.

[Footwork]

Just give me the figures. Then I'll be able to make my own mind up about whether I should believe the apparently hysterical BMA line, or the apparently heartless Goverment line.

Regarding pay deal

I don't think this is an easy thing to show. Dr's are all in different training programmes, specialities and bandings (pay scale). Some work more on the weekends, at nights etc. There are a LOT of variables. The contract affects everyone in a different way so it's very difficult to just say 'here are the figures'.

I haven't read the contract but coming from the Dr's themselves and not the BMA, it sounds like a lot of them are getting shafted. Pay protection is being offered but at the cost of selling out future DR's down the line.

[petejh]

No, the plan is for seven day elective work so patients will increase.

Bottom line is its unfundable.

I don't understand, how will patients increase? Logically, there are only so many sick/injured people at any one time. This number doesn't change depending on which days Doctors work.

[GCW]

These are already covered by current working patterns. The government want to do routine work on Sat and Sun too, which currently doesn't happen.

[petejh]

Just give me the figures. Then I'll be able to make my own mind up about whether I should believe the apparently hysterical BMA line, or the apparently heartless Goverment line.

Regarding pay deal

I don't think this is an easy thing to show. Dr's are all in different training programmes, specialities and bandings (pay scale). Some work more on the weekends, at nights etc. There are a LOT of variables. The contract affects everyone in a different way so it's very difficult to just say 'here are the figures'.

I haven't read the contract but coming from the Dr's themselves and not the BMA, it sounds like a lot of them are getting shafted. Pay protection is being offered but at the cost of selling out future DR's down the line.

I accept it's complicated but it isn't THAT unfathomable to provide an overview and some details for the person in the street to chew over. People all over society work in pay bands, specialities etc. (cue 'it might be brain surgery but it's hardly rocket science'). What I'm getting at is the BMA/Jnr Doctors are asking the public believe them without giving any details to believe other than their word - 'look just trust that we're right we're Doctors'. That era has passed.

Also - I think a lot of Doctors are taking their stance from what the BMA is telling them rather than a clear understanding of the real terms and conditions. My GP friend doesn't disagree with that view.

[petejh]

These are already covered by current working patterns. The government want to do routine work on Sat and Sun too, which currently doesn't happen.

And that to me, and most of the public, seems quite correct - you're a service industry, not a 9-5 office job. What are the arguments against routine working on Sat and Sun?

You're saying patient patterns are 'already covered by current working patterns'. Is it not likely to be the case that Doctor's current working patterns dictate patient patterns?

I don't try to visit the post office on a Sunday and expect to find it open.

[GCW]

Do it. But you'll need to increase staff and funding by 2/7.

[webbo]

Pete
You say nurses are becoming more powerful, where not in the NHS I work in. The only ones who are becoming more powerful are the managers, who appear to be driven to reduce costs no matter how if it might effect the day to day delivery of care.
They seem to be driven to do this by constantly changing government targets.
My own area of work has some new standards and apparently £250,000 was supposed to be given in order to meet these standards, however what was offered was do you really want the 250K up front or would you rather have 300K off your efficiency savings.
So you end up trying to deliver improved care with no extra money.
The outcome of all this is that Australia and New Zeland will have the best health services on the planet

[petejh]

The outcome of all this is that Australia and New Zeland will have the best health services on the planet

Don't they already? Or at least very decent.

And this ^ line belies the BMA bullshit of 'it's about patient safety', because underlying it is the (completely understandable) attitude of 'well I'm going where they pay us eqully well/more, for working less than I would in the UK (and the weather and quality of life are better)'.
 
From what I can tell it's mostly about money and power, and a bit about patient safety.

[Fultonius]

From where I'm sitting it's mostly about minimising pay and maximising working hours,  so that *when* it all gets privatised the companies can be more profitable.

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[GCW]

I wouldn't worry too much, it's about collapse anyway.

[webbo]

The outcome of all this is that Australia and New Zeland will have the best health services on the planet

Don't they already? Or at least very decent.

And this ^ line belies the BMA bullshit of 'it's about patient safety', because underlying it is the (completely understandable) attitude of 'well I'm going where they pay us eqully well/more, for working less than I would in the UK (and the weather and quality of life are better)'.
 
From what I can tell it's mostly about money and power, and a bit about patient safety.

With your line of reasoning clearly there is a career in NHS management just waiting for you.

[Oldmanmatt]

The outcome of all this is that Australia and New Zeland will have the best health services on the planet

Don't they already? Or at least very decent.

And this ^ line belies the BMA bullshit of 'it's about patient safety', because underlying it is the (completely understandable) attitude of 'well I'm going where they pay us eqully well/more, for working less than I would in the UK (and the weather and quality of life are better)'.
 
From what I can tell it's mostly about money and power, and a bit about patient safety.

Is it?

Or is it sheer hell being a Jnr Dr and about to get much worse.

One of our regulars at the Bunker is a Jnr Dr called Rose Polge, along with her friends and boyfriend. I'll ask them what it's like, when they come in again; they've been searching for her body for the last week or so.


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[a dense loner]

Just what is that supposed to mean in this discussion?

[Oldmanmatt]

I know what was written in her note. The rest you can work out for yourself surely?

If you fall for the Gov. ploy of greedy Doctors, then you are, in my opinion, a moron.


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[a dense loner]

I'm sorry Matt the way you present things is bizarre. Whenever you make a long post I think where are we going to end up with this? As always by the time I've finished reading I don't know what you're talking about or have tried to talk about. The passions there but that's it. Plus the way you finish your posts is quite definitive as if that's the last word on the subject, it might be if people understood what you were trying to say.

[petejh]

That's extremely sad Matt but is it relevant, or appropriate? People commit suicide every day for a multitude of reasons, work pressure being one. Other than suggesting that 'being a Doctor can be extremely tough' which I think everyone over the age of 18 probably already realises - including anyone considering entering the profession, I don't see what your point adds. Probably best left there.

I'm not suggesting falling for a 'government ploy' (as you put it) of 'greedy doctors' - but I do happen to believe the NHS should provide a genuine 7-day service to the public, which currently it doesn't. It is after all a public health 'service'.

But neither am I taken in by the BMA 'ploy', if you want to use that word, of this being about 'patient safety'. I'm suggesting the BMA argument doesn't come across to me as convincing because it seems overly reliant on the use of emotive rhetoric about wanting to do 'what's best for the public'.

Btw, I don't buy GCW's (or the BMA's) 'staffing spread reflects patient spread': if that were so why - over a ten year period of seeing doctors, physios, having scans, seeing consultants, having operations - was I never once offered a Saturday or Sunday appointment to any of the NHS services? Hint: it wasn't because I chose to be treated only on a weekday.

[Oldmanmatt]

Because I'm sick of everything being about the numbers. I was an Engineer Dense, I understand numbers; they are laid out all over Social media and any news outlet you care to choose. So are the comparisons to what you might earn working similar hours at Lidls. How is reproducing that of any benefit?
Damn it, you're the one who likes to remind us how useless it is.

This is about the death of the NHS and the fundamental change to life in this country that that means. The root of all of this is people, not numbers, the numbers are a blind for an ideological putsch.
The consequences will fall upon first those employed by the machine and very shortly after the rest of us.
And this has been brought home to me by a young girls (apparent) suicide. Because I got to hear from her friends just how hard it is. One of my staff was a close friend of hers. I'm old, I've seen too much shit and life should never be about the numbers. If the "2% of the wealthiest own 90% of the wealth" theory is even half right, then this whole debate is an obscenity. A world where epidemics of obesity and famine exist either side of an imaginary line on a map? What a load of Cunt-bollocks-twatfetishness we put up with.

I suppose I hoped that was all implicit in my two liner. Any fool can google up a storm of statistics, equating those to real world consequences that include the intangibles of human emotion and suffering takes far more thought.
As I see it (and I know it might be wrong), people are going to suffer; a lot of people and they won't care that this is good for the Gov's books.

I'm not a stranger to "intensive" sleep deprived training or work conditions. Personally, I think Doctors have been the victims of the "holier than the next generation" attitude of their teachers, who seem to think each class needs less sleep and more stress than the class before. In each telling of the fairy tale the "In my day" gets a little harder until they reached; what seemed from the outside, to be a ridiculous and counterproductive meat grinder or a training regimen.
And now they want to make it harder. Why harder? Because the prospects of a career in medicine made it seem worthwhile.
Now, you've heard from many in the profession in the course of this thread and I don't recall any positivity in any of those comments.
The days of the cushy country practice (that involved more fly fishing or climbing, than Doctoring) are at least 50 years in the past and yet the public still cling to that image.

So, given that we are already desperately short of Doctors, that this will result in many more leaving the profession and stop many more from ever embarking on that route; what do you think the consequence will be?

Now, I confess at the end of all that, that I am biased. Because of Rose and because I spent last night in A&E and am currently making a shaky recovery from a darling little Sepsis. A Sepsis, which had it not been spotted by a Junior Doctor, would have taken the middle finger of my left hand, or my left hand, or me (if the Mrs hadn't insisted on taking me in, I thought I had a cold).

So, long, emotional and not a single statistic, for which I do not apologise.


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[GCW]

Btw, I don't buy GCW's (or the BMA's) 'staffing spread reflects patient spread': if that were so why - over a ten year period of seeing doctors, physios, having scans, seeing consultants, having operations - was I never once offered a Saturday or Sunday appointment to any of the NHS services? Hint: it wasn't because I chose to be treated only on a weekday.

Sorry, Pete - I don't follow - it reads like you've just contradicted your previous argument completely.  Unless I'm missing the point?

Interesting that the government now have a bill about the EWTD that specifically excludes doctors from being covered by it.

[petejh]

My point was that staffing levels likely to determine patient spread rather than patient spread determine staffing levels; because you currently can't access regular NHS services at weekends - regular appointments, diagnostics, elective procedures, physio etc. etc. So saying 'staffing levels mirror patient spread' isn't telling you much at all - it's like the owner of a  shop that has never opened on Saturdays saying 'we don't ask our staff to work on Saturdays, in fact we don't open, because people aren't queuing up outside'.

EWTD  -interesting how? Every person working on offshore installations in the UK continental shelf has signed a form to agree to be excluded from the EWTD.  If it's good enough for the people who power the country (and Dense)...

[a dense loner]

Yes, I've not understood any reply to why almost anyone in the medical profession shouldn't work at the weekend. It's 2016. The replies of its busier in the week are absolutely baffling.

[GCW]

Doctors already work weekends, Dense.

We already have a seven day NHS for urgent conditions, all evidence suggesting a continual increase in demand.

We have a five day NHS for routine work, as you say. If that's opened to seven days, all indicators suggest it won't make a significant decrease to weekday demand.

EWTD- one of the big selling points on this contract was protecting juniors from longer hours etc, which it doesn't really. Funny that a couple of weeks after forcing this through they want to remove the limits.

Listen, I'm happy for there to be a seven day NHS. But, if can't be staffed at present and the cost increase is unfundable. It leads to payment by the public.

If people think it's just about doctors being lazy and greedy, that's ok. Big we will all get the NHS we deserve.

[a dense loner]

Neither Pete or myself suggested it was doctors being lazy or greedy. We've asked about wknd work and Pete has separately asked for a few sets of figures, which no one has been able to supply. Apart from to say it's complicated there's no point doing it.
Hospitals, certainly in sheffield, are a ghost town at wknds and after 6-7pm. I can't remember what time we were there it was just after one of them, a couple of cleaners n medical staff in the whole of the hospital. Luckily I went to see the one that was working late.

I have suggested doctors are lazy and greedy many times but not in the context of a serious discussion

[GCW]

It's how it's spun though Lee, and I think many people believe if.

Figures are just that. Hunt's claims that weekend mortality can be reduced by more staffing has been denied by the person that wrote the paper Hunt quotes. Some stats suggest mortality is higher on a Friday.

We can quote figures back and forth, and we can select data to support either argument. I suppose it comes down to who you trust more.

Personally, I think this is the crossroads for the whole system. Two years, I give it.

Also- GPs get a 3.2% uplift in funding, but the move is towards Saturday opening. It doesn't add up either.