Where do you stand on the Junior Doctors' strikes ?

guitarfishbay

Right now my understanding is GPs aren't routinely doing bloods - unless it literally can't be fit in with a phlebotomist but needs doing. As I said the smart money is to train a receptionist up, and get the nurse doing more complex work.

Higher practice list can mean more money but it is a double edged sword as your targets are based on percentages - if you take on a lot of high workload patients with chronic diseases you still have to see them.

Edit - also new patients come from one of two streams.  Either new to the area, or from another practice.  People don't tend to move unless there's a breakdown in patient/practice relations.  I fully understand the needs of working people but even small practices tend to do extended opening hours on certain days, and if they're running it effectively will be using these appointments for working people.  Small countryside areas are a different ball game to cities, the demographics are also different.  If there isn't as much going on economically then there will be a lower flow of new people to the area.  

PolarityMan

Bottom line there's a lot of a GP's day that doesnt provide significant value-add on google. It's not fucking rocket science to workout that you could probably save some of their 100k salary and use that to pay more, less skilled staff.

If that annoys over some "practice owners", well they're businesses right? they'll have to provide a way to compete, otherwise as other have said they'll be out-competed by people who will provide an efficient service.

UnclePsychosis

ToneControl said:

My opinion is that doctors, nurses, army, police, etc. should never strike. Work to rule perhaps, but not strike, I don't think it's ethical

Doctors working to rule would be far worse than them going on strike. With strikes, cover was found. If Doctors fucked off home as soon as their contracted hours were up hospitals would collapse and a lot of people would die. The Government doesn't have enough Doctors to cope with work-to-rule. 

guitarfishbay

PolarityMan said:

Bottom line there's a lot of a GP's day that doesnt provide significant value-add on google. It's not fucking rocket science to workout that you could probably save some of their 100k salary and use that to pay more, less skilled staff.

If that annoys over some "practice owners", well they're businesses right? they'll have to provide a way to compete, otherwise as other have said they'll be out-competed by people who will provide an efficient service.

And what if they aren't? If they continue to run a business as they see fit then that's that - otherwise changes come from legislation/changes to payments. As noted - in some countryside areas practices are very different. Small, less staff and clinicians. There isn't the same competition as in cities. Even in cities - if there's enough locum work why be a partner? My mate is earning about as much as the partners at his practice via salary + locum work. This is central London. The only real reason to be a partner in that scenario is if you can buy into a building.

strtdv

I'm very late to this thread.

Full disclosure: I'm a medical registrar, although I work in Northern Ireland and am in a training programme so am relatively protected from any pay change aspects (contractually they can't give me a pay cut while I remain in the same training programme).

The NHS is approaching a crisis point. There aren't enough GP's, there aren't enough hospital doctors in a range of specialities, and the UK is haemorrhaging junior doctors to Australia, New Zealand, the USA and Canada. 

A lot of Foundation doctors finishing up their F2 year, and Core Trainee doctors finishing their CT2 year aren't applying for training posts at the moment as they're waiting to see how things pan out. If the new contract is forced on them in its current form, then it just isn't worth their while going into a new training programme. It makes much more sense for them to work as a locum doctor, as they'll be paid at least double what they would on the new imposed contract (and that's just trust locum rates, never mind agency locum rates), and they can pick and choose what shifts they want.

The government solution is to try to prevent hospitals from hiring locums, but it's actually the junior doctors who are holding all the cards. Ultimately, rotas need filled, and trusts will in the end pay whatever it takes to get there.

Ironically the shift towards 7 day full cover actually makes this problem worse, and arguably makes the position of locum doctors even stronger.

In Northern Ireland we're in limbo at the moment as our health minister won't say whether the new contract would be imposed here. I sincerely hope it isn't, as medical staffing levels are close to crisis point as it stands. Currently close to 2/3 of core medical posts advertised this year are unfilled, and most SHO rotas in Northern Ireland will likely be around 50% staffed by locums.

Even registrar posts, which historically are pretty competitive over here, are going unfilled. 

Off the top of my head I can think of about 10 empty registrar posts in Northern Ireland, which is very significant and is likely only to get worse.

In case anyone thinks that junior doctors are only interested in making money, bear in mind that since I started working 6 years ago, there has been a pay freeze on doctors salaries, effectively amounting to about a 20% pay cut in real terms for any doctor who doesn't progress through a training programme. As well as this, frankly, if you want the brightest and the best, and you want them to be motivated in their job, then you're going to have to pay them reasonably fairly compared to other sectors. A good friend of mine is exactly a day younger than me, similar exam results, and is now an actuary earning roughly double what I do.

If you want to earn lots of money then don't work as a doctor, and certainly don't work in hospital medicine. There are much easier ways to make much more money.

If you want a minimum wage doctor looking after you, that's fine, but I certainly wouldn't.

My personal view is that the endgame here is the privatisation of the NHS. The government is fed up with the political hot potato of healthcare (people want world class healthcare but don't want taxes raised to pay for it), so privatisation is the obvious solution, and the way to do that is to provoke a major crisis in the existing system.

Personally I can see advantages to a semi-private system like New Zealand, and it would certainly improve funding, but it seems dishonest for the government to avoid being up-front about it. Incidentally, if things go the way I reckon Jeremy Hunt would like them to it will work out very well for doctors. I'd earn a lot more in a private setting than in an NHS setting. It's the public that would suffer, they just don't seem to realise this.

Regarding the points about GP pay, actually for the service they provide they aren't spectacularly well paid. They're also paying huge amounts of money on professional indemnity (over a months wages), as well as paying back the money they had to contribute to become partners (which is one of the reasons GP practices are struggling to get partners and a lot of GPs are going down the salaried GP route). I'm not a GP (frankly I don't know how they stick it), but I hear enough to know they're working very hard for ever diminishing gratitude from the public, and the majority would be better off in the southern hemisphere.

Sambostar

Young GP at our local surgery was attracted with £90k package, obviously less fee and insurances.  So what about £60k?

After 6 months he quit being a GP and did something completely different that wasn't even in the healthcare profession as it paid more.  The only GP they could get after that was a renowned incompetent who was nearly struck off and that no other practice would have.  They literally cannot get them to work there for love nor money.  What is the reason?  I mean it's not like the money isn't enough (Thanks Bliar) or maybe it isn't and perhaps doctors are like many others of their station and the bottom line is income?

They then do a two days week and retire at 50.  Yeah, their hearts are in it alright. 

Drew_TNBD

Tabbycat == Lixarto

PolarityMan

strtdv;1063864" said:

I'm very late to this thread.

Full disclosure: I'm a medical registrar, although I work in Northern Ireland and am in a training programme so am relatively protected from any pay change aspects (contractually they can't give me a pay cut while I remain in the same training programme).

The NHS is approaching a crisis point. There aren't enough GP's, there aren't enough hospital doctors in a range of specialities, and the UK is haemorrhaging junior doctors to Australia, New Zealand, the USA and Canada. 

A lot of Foundation doctors finishing up their F2 year, and Core Trainee doctors finishing their CT2 year aren't applying for training posts at the moment as they're waiting to see how things pan out. If the new contract is forced on them in its current form, then it just isn't worth their while going into a new training programme. It makes much more sense for them to work as a locum doctor, as they'll be paid at least double what they would on the new imposed contract (and that's just trust locum rates, never mind agency locum rates), and they can pick and choose what shifts they want.

The government solution is to try to prevent hospitals from hiring locums, but it's actually the junior doctors who are holding all the cards. Ultimately, rotas need filled, and trusts will in the end pay whatever it takes to get there.Ironically the shift towards 7 day full cover actually makes this problem worse, and arguably makes the position of locum doctors even stronger.

In Northern Ireland we're in limbo at the moment as our health minister won't say whether the new contract would be imposed here. I sincerely hope it isn't, as medical staffing levels are close to crisis point as it stands. Currently close to 2/3 of core medical posts advertised this year are unfilled, and most SHO rotas in Northern Ireland will likely be around 50% staffed by locums.Even registrar posts, which historically are pretty competitive over here, are going unfilled. Off the top of my head I can think of about 10 empty registrar posts in Northern Ireland, which is very significant and is likely only to get worse.



In case anyone thinks that junior doctors are only interested in making money, bear in mind that since I started working 6 years ago, there has been a pay freeze on doctors salaries, effectively amounting to about a 20% pay cut in real terms for any doctor who doesn't progress through a training programme. As well as this, frankly, if you want the brightest and the best, and you want them to be motivated in their job, then you're going to have to pay them reasonably fairly compared to other sectors. A good friend of mine is exactly a day younger than me, similar exam results, and is now an actuary earning roughly double what I do.If you want to earn lots of money then don't work as a doctor, and certainly don't work in hospital medicine. There are much easier ways to make much more money.

If you want a minimum wage doctor looking after you, that's fine, but I certainly wouldn't.



My personal view is that the endgame here is the privatisation of the NHS. The government is fed up with the political hot potato of healthcare (people want world class healthcare but don't want taxes raised to pay for it), so privatisation is the obvious solution, and the way to do that is to provoke a major crisis in the existing system.

Personally I can see advantages to a semi-private system like New Zealand, and it would certainly improve funding, but it seems dishonest for the government to avoid being up-front about it. Incidentally, if things go the way I reckon Jeremy Hunt would like them to it will work out very well for doctors. I'd earn a lot more in a private setting than in an NHS setting. It's the public that would suffer, they just don't seem to realise this.





Regarding the points about GP pay, actually for the service they provide they aren't spectacularly well paid. They're also paying huge amounts of money on professional indemnity (over a months wages), as well as paying back the money they had to contribute to become partners (which is one of the reasons GP practices are struggling to get partners and a lot of GPs are going down the salaried GP route). I'm not a GP (frankly I don't know how they stick it), but I hear enough to know they're working very hard for ever diminishing gratitude from the public, and the majority would be better off in the southern hemisphere.

Thing is I think there is no problem rewarding people at the top of their profession significantly,

 I think there is a large proportion, especially in GP's who aren't providing value add in line with their expertise however and that solving this problem would still allow those at the top of the professions to earn a lot but also provide more money to hire people more appropriately (read less) qualified to do the things that don't require expertise.

Combined with investment in technology I think this would provide a significant improvement on the current model.

 It's criminal that the average salary for a cardiologist is less than the average salary for a GP.  

guitarfishbay

It is performance pay to a large degree - if they don't provide the value (hit the targets) they don't get paid the big money. All the GPs making the quoted £100k are being efficient, hitting a high proportion of targets, and or doing significant additional private work, and have a handle on staff spending. I know full time partners barely making over salary pay in the North. It isn't a salary that is defined, it is drawings from a business. But again public perception of GPs is low and quite frankly their PR is poor because they are individual businesses rather than a workforce in a bigger hospital (so aren't well unionised). If they aren't providing value for money it is hitting their own pockets.

strtdv

The GP pay issue was actually the government misjudging things again. They established the Quality and Outcomes Framework as the method by which GPs get paid, and GPs being a rather clever bunch overall got very good at playing the system to maximise their income.

I know a GP who once told me (in jest) that it was a shame none of his patients were on Lithium as it meant he couldn't get paid to monitor their levels and renal function.

The government is very poor at establishing what amounts to "good healthcare". They set lots of targets that are largely not evidence based and don't really reflect good healthcare, and rather than encouraging doctors (and managers) to provide good care, it actually hinders them.

The new consultant contract will be equally dismal. It won't be long before a store manager in Tesco is earning more than a consultant who makes daily life and death judgement calls and does life saving (and equally life threatening if they go wrong) procedures.

TimmyO

ToneControl said:

tabbycat said:

ToneControl said:

from my experience of watching my parents get ill, and my kids being born, and getting some serious illnesses, I can say that maternity gets more cash, and kids get fixed really fast

having read that it makes me wonder what exactly junior doctors would have to do for you and your family to get your support.

I'm not sure what you mean, I was replying to someone else's theory that the NHS as a whole is more focused on early life. What has that got to do with my support for junior doctors?

To get my support for striking (if that's what you are asking), I'd like to see clear evidence that the doctors were being shafted with the new contract, and/or that the NHS is being damaged by it.

So far I've only read slogans that imply doctors will be forced to work longer hours, and that the NHS is being dismantled or privatised.

The analyses of the new contract that I've read don't support these slogans, or give evidence for the 2 points I would like to see.

Personally, I think they are actually asking for more money, and I'd like to see them paid more money, but the BMA are not saying that the strike is about getting more pay now.

My opinion is that doctors, nurses, army, police, etc. should never strike. Work to rule perhaps, but not strike, I don't think it's ethical

@ToneControl - the Armed Forces no not strike - they are not allowed to.

In terms of 'slogans' I'm not sure how much clearer it could be re hours worked - no more doctors, but services to be extended to be equally manned out of hours. No need for any slogan. It's a thing. 

TimmyO

I do think that the BMA have been completely outmaneouvred though - in agreeing to 5 days of talking and restricting that conversation to the actual words in the contract the govt have a win-win. Nobody agreed the current draft should even exist - but the talk has to be about what tiny distance we move away format. The fundamental blow is already struck. The doctors lose, and so therefore do we :-( 

ToneControl

TimmyO said:

ToneControl said:

tabbycat said:

ToneControl said:

from my experience of watching my parents get ill, and my kids being born, and getting some serious illnesses, I can say that maternity gets more cash, and kids get fixed really fast

having read that it makes me wonder what exactly junior doctors would have to do for you and your family to get your support.

I'm not sure what you mean, I was replying to someone else's theory that the NHS as a whole is more focused on early life. What has that got to do with my support for junior doctors?

To get my support for striking (if that's what you are asking), I'd like to see clear evidence that the doctors were being shafted with the new contract, and/or that the NHS is being damaged by it.

So far I've only read slogans that imply doctors will be forced to work longer hours, and that the NHS is being dismantled or privatised.

The analyses of the new contract that I've read don't support these slogans, or give evidence for the 2 points I would like to see.

Personally, I think they are actually asking for more money, and I'd like to see them paid more money, but the BMA are not saying that the strike is about getting more pay now.

My opinion is that doctors, nurses, army, police, etc. should never strike. Work to rule perhaps, but not strike, I don't think it's ethical

@ToneControl - the Armed Forces no not strike - they are not allowed to.

In terms of 'slogans' I'm not sure how much clearer it could be re hours worked - no more doctors, but services to be extended to be equally manned out of hours. No need for any slogan. It's a thing. 

but AFAIK the new contract imposes lower max hours for doctors

I would assume that if services were spread over more days, then weekdays would need slightly fewer doctors. In any case, I'd assume that the contract won't specify a maximum number of staff to be employed, that's for NHS management to plan, and disagreements as to what people think may happen would not be a valid cause for a strike

PolarityMan

guitarfishbay;1064013" said:

It is performance pay to a large degree - if they don't provide the value (hit the targets) they don't get paid the big money. All the GPs making the quoted £100k are being efficient, hitting a high proportion of targets, and or doing significant additional private work, and have a handle on staff spending. I know full time partners barely making over salary pay in the North. It isn't a salary that is defined, it is drawings from a business. But again public perception of GPs is low and quite frankly their PR is poor because they are individual businesses rather than a workforce in a bigger hospital (so aren't well unionised). If they aren't providing value for money it is hitting their own pockets.

http://www.telegraph.co.uk/news/uknews/11856441/Average-GP-pay-dips-below-100000-for-first-time-in-a-decade.html

PolarityMan

note *average*