Originally Posted by
helidoc
Ok, slightly against my better judgement, this is what I think.
I’m an NHS Consultant in Emergency Med, and have been for 22 yrs. It has been sometime since I was a junior!
Before the issue of pay / strike, it might be helpful to think about the state of the NHS, what might fix it, and where junior doctors pay and conditions have come from.
From my perspective, which is solely Emergency Dept based, the NHS has never been so pressurised, or so dysfunctional. Up to 4-5 years ago, it was a winter phenomenon, but it’s now all the time.
It isn’t a simple matter of resource. When I was appointed in 2003 (second cons job), I was number 5, which was 4.5 whole time equivalents. We now have 16 consultants and this expansion has been mirrored across all grades of doctor and nurse clinician. Our main issue is a hospital that has over 100% bed occupancy, with an explosion of demand from frail elderly that almost always need an in-patient bed, as they are sick. Our walk in stream of the less sick has also increased massively, and part of this is driven by difficulties in primary care access. There is nowhere to see patients, they queue on corridors and up to 18 have to be looked after by paramedics. Doctors and nurse clinicians can’t be effective or productive in that environment. It isn’t safe, it isn’t dignified. Ambulance response times are now hours, as the paramedics are stuck in hospitals.
I don’t deal with elective work, but pressure from emergency patients constantly pressurises this, and this includes vital cancer work.
Junior doctors pay and conditions
Obviously I’m out of this. In some ways they are much better than when I was a junior. I used to work 1:3 weekends, which meant Friday 8am to Monday 6pm without a break, the bulk of my hours being paid at 1/3 of time, I don’t mean time and a third.
Todays doctors do have a lot of antisocial hours and weekends as it’s a 168h a week service. There are enforced rest days, 4h education a week and personal development time. I think the hardest thing for my colleagues is having to consult in cubby holes and corridors. They are amazing young people, but the structural impediments to them working the way they feel they should must be hard. They are relatively protected now from high risk decisions, as much of the clinical risk is transferred to consultants. My juniors can’t discharge a feverish infant, an adult with chest pain, someone who reattends with the same issue, or admit anyone lest we ok it.
What about juniors pay?
I don’t really know these days, so I’ve had a look.
Take the example of a Specialty Trainee in year 3, ST3, so 5 years after graduation with another 3-5 years until completing training.
What do they get paid, assuming a 48h working week with a weekend frequency of 1:4 or greater?
Basic £51107
1A banding is another 50%, so £25553
Total £76600
There is also a fairly decent pension scheme which relates to final salary. At this level a 13.5% contribution from pensionable pay is £4140 net, yet that is worth 1/54 of final consultant pensionable pay CPI linked.
Is the grass greener elsewhere?
When I was responsible for Foundation training, half of our doctors used to go to Australia or New Zealand , and a chunk never returned. This ceased close to 10 years ago, as Auz / NZ had enough locally trained doctors. Since then we have seen them do a bit of travel, a couple of years of locums before returning to training in the UK. If not sure the antipodes have the capacity to soak up a lot of UK graduates.
What about the commercial sector?
I’ve never worked in industry, but to get an equivalent salary in the long term, I suspect it’s going to need long hours and productivity or you are out. The NHS doesn’t get rid of people easily. There are significant numbers of trainees needing extra support who are looked after by the NHS in a way that contrasts sharply with what I think a commercial organisation would do.
The NHS is failing, but it isn’t as simple as just funding.
I don’t have the answers, but I think it needs a total structural rethink, not pouring cash into the current structure.
Separating elective and emergency hospitals, so the most complex work could be done in an elective unit, not just the usual low-acuity activity might be a start. It needs protecting from a unscheduled emergencies
There needs to be a massive expansion in social care beds, and medical support to avoid hospital. When the elderly fall, or become unwell, a care assistant on a low wage is going to call an ambulance and then you are in hospital. You can’t blame them for that decision.
A lot more clinicians, not just doctors but also nurses, and paramedics,in ENP and ACP roles. Nurse clinicians are amazing, and I’m sure there is a role for Physicians Associates too.
We have recruited lot of doctors from Nigeria, they are amazing, and the best that the country produces. I’m conflicted, as Nigeria needs their skills.
Should doctors go on strike? I don’t know, but if they do I would be honest about the issue being pay. I would be clear about banded pay, job security, career progression, guaranteed pension. Conflating pay with other issues such as patient safety, crowding, delays to be seen, cancelled activity isn’t correct.
Dave
Sent from my iPhone using Tapatalk
Reply With Quote
