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UK Doctor Contract Row

Discussion in 'Real Life Discussion' started by TMD, Sep 26, 2015.

  1. TMD

    TMD Groundskeeper DLP Supporter

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    IMO This absolutely deserves its own thread but I don't know how many will see it so i'll post it here instead. If it generates discussion we can always make a thread for it later.

    Next week doctors and medical students will most likely be going on strike for the first time in a very very long time. This is in opposition to the new junior doctor contracts which are to be imposed upon us by the health secretary and set out to systematically abuse all doctors below the rank of consultant (equiv. of senior attending for americans).

    The contract to be enforced:

    - Core Shift: The core shift of doctors will no longer be 7am to 7pm Mon - Fri, but will be 7am - 10pm Monday - Sat. This means there will be no extra pay for evenings or Saturday working. 9pm on a Saturday night is paid the same as 9am on a Tuesday morning.

    - Working Hours: Minimum working hours per week increased from 60 to 90. The overwhelming majority of doctors will already stay on their shifts for a few hours after they are due to finish because of existing issues with the NHS for no extra pay, and purely to look after their patients. This will essentially mean breaching of the european working time directives.

    - Removal of Banding: Compare a trauma surgeon with a dermatologist. The surgeon will in any given month have a large number of night shifts, on-calls, and a generally unsociable rota. This is understandable given the emergency nature of their speciality. The dermatologist will be working mostly daytime hours with very few emergencies, and almost no night shifts. Currently, the trauma surgeon would be given an extra allowance (a higher banding) because of their speciality. Similarly, doctors who work in London where the cost of housing and living is exponentially higher than the rest of the country are allocated a higher band.

    The removal of banding means, in real terms, a average 30% pay cut for doctors. And for those of you in the USA or Australia whose doctors earn a large salary, the same isn't true here. The average medical graduate will leave 6 years of medical school with around £70,000 in debt, more if they studied and lived in London. The salary for a junior doctor is £22,000 (national average salary is £26,500.) Junior doctors are the ones who will doing a lot of their work in unsociable hours, and often don't see their families/housemates for up to 12 days at a time. Banding previously increased their salary to £30,000. Banding is now to be scrapped.

    - Removal of GP Training allowance: Similar to the the above, General Practice is facing it's worst crisis ever. Put simply, nobody wants to do it. There is already a huge strain on primary care, and with the 30% pay reduction for doctors training to be GPs, the staffing shortage will worsen massively.

    - Pay no longer linked to experience: This one is a doozy. Pay of doctors is currently linked to their experience, basically the number of years post graduation they've not been twiddling their thumbs. This means for the best and brightest medical graduates who want to apply for something like neurosurgery, they can do an academic fellowship for 3 years and complete a PhD while also doing some clinical work. Women who take maternity leave also normally take that time to complete postgraduate exams that are necessary for advancement in their speciality.

    The new contract will link doctors pay to the rank of training they are in. So a clinical lecturer in cardiology with 100 publications deciding to make more of his workload clinical will now earn the same as a fresh faced ST3 in cardiology who's only been a doctor for 4 years. Women are also penalised for taking maternity leave compared to the existing contracts.

    - Others: Removal of contractual safeguards, annual leave, etc.

    - Overall: This means, and there is no exaggeration here. Doctors below the rank of consultant, that is from graduating 6 years of medical school aged 24 (or later) till finishing their speciality training aged 36-38 (or later) will earn less than a manager at McDonalds. Doesn't matter if they are a cardiothoracic surgeon repairing a newborn babies heart in a 18 hour procedure, a neurologist managing highly untreatable degenerative brain disease, or an A&E doctor saving multiple lives daily and dealing with all kinds of cases. They will be in debt, overworked, exhausted, unable to see their families regularly, unable to afford the cost of living in London or expensive places and still making the clinical decisions and performing procedures responsible for our lives.

    Now obviously, the Tory front bench aren't stupid. They were all bright Oxford PPE graduates so they know exactly what these changes are achieving. Record numbers of doctors and medical students are requesting their CGS (certificate of good standing) from the GMC, and taking posts in the USA, Australia, New Zealand, South Africa etc. where the quality of life, pay, working conditions etc. are all infinitely better. They write in the British Medical Journals and talk about how they feel valued, not regularly attacked by the media, and able to care for their patients in a safe clinical environment while also being able to see their family more.

    The NHS was already at breaking point, and with the mass exodus of existing doctors and a large portion of each graduating class of medical students leaving the NHS is due to collapse. Already the cracks are showing, with titans like Addenbrookes hospital being placed in special measures. The thing that pisses me off the most is that the media haven't reported anything about this at all, but they're waiting for the strike to happen. At which point the government spin doctors will be out in force, calling doctors greedy and heartless and placing the blame for the collapse of the NHS at their feet. The goldfish public will obviously believe it, and so when Mr. Cameron and Mr. Hunt sell off the NHS to their friends in the private sector (whose companies they so conveniently sit on the boards of) the public won't even notice what really happened.

    I think the impending sale of the NHS by this government who I voted for is the genuinely saddest thing to happen in my lifetime. Healthcare, free at the point of delivery to whoever needed it. Sure it's always had its problems, like an old car that never quite ran perfectly no matter what repairs you did - but it always kept going, whenever you needed it. People won't realise what they've lost till its gone, and we're like the Americans with people having to pay for their healthcare. What a disgrace.

    tl;dr: https://www.youtube.com/watch?v=ScZ9EWgzmXA&feature=youtu.be
     
    Last edited: Sep 26, 2015
  2. TheWiseTomato

    TheWiseTomato Tactical Tomato DLP Supporter

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    Man, fuck that. Hope the strike tilts things in your favour.

    Edit: so when can we expect you in Australia?
     
    Last edited: Sep 26, 2015
  3. Blorcyn

    Blorcyn Professor DLP Supporter

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    Yeah, as a final year medical student, who will be one of the first to be hit by these imposed contracts from next year the feeling amongst my peers is pretty bleak.

    I've been waiting to see when DLP would bring it up, if it'd get its own thread without me doing it myself, because the coverage has been pretty hidden until a few days ago.

    To put it in perspective, the GMC gets 20-25 applications for certificates to work abroad from doctors at any rank (junior or consultant) a day. After this imposition was revealed it got 1600 over three days.

    TMD explained things really well from the junior doctor pay point of view, but the parts I'm most focused on are the two I've left in the quote above.

    Under the outgoing contract it is expensive to get doctors to work saturdays and evenings and becomes more expensive the further you drive them from 48 hours, under the incoming contracts it will be less expensive for hospitals to pay one doctor to do all this time so they won't be disincentivised to do so.

    When the current contracts came in ages ago, doctors used to work way more hours. They were tired and patients suffered for it. The contract was designed to encourage safe staffing by the hospitals and that's one of the worst things about the contract being removed. And, back then in the 90s junior doctors got hospital accomodation and other things to make their extreme hours in the hospital work. They went away to a large extent when the current contract came in.

    And, yeah, women and GP trainees - they're getting done over by this hard. The upper percentages pay cuts you may see in the headlines covering this issue, they're for GPs and Anaesthetists. GPs got a training bonus of £13-15,000 to keep their training competitive with hospital doctors (in a path that currently can't fill its places). That's gone. :facepalm

    That election pledge of 5,000 more GPs is not happening. All the parents in training, who have carefully budgeted for mortgages and childcare and work part-time from next year will either have to go full-time or no-time. Good luck there.

    At this point, it looks like an ideological decision to put the NHS under such pressure that can it be declared unfit for purpose. It's something that gets thrown around a lot by healthcare workers and I'm not sure how much credence I'd have put it in it the past. I've changed my mind on that after these last few weeks because this story is being repeated at different times with paramedics, nurses etc. etc. Also, I found out Jeremy Hunt is a co-author on a book called 'Direct Democracy' - I am told it talks about how to privatise the NHS - such a ridiculous fact if true.

    For anyone who wants a more comprehensive look at figures and videos (sorry if that's region locked) and shit.

    I think they'll try and spin that 1,600 figure into an argument about whether junior doctors should be forced to stay due to taxpayer-funded training, to which the answer is no, and obfuscate the pay and patient safety argument.

    TMD Where did you hear about strike action, is that down London-way? Last I'd heard there was still no official response on strike action by the BMA.


    TL;DR I'm not looking forward to starting my job anymore and nor are any of my mates


    EDIT: for completeness. About two hours after I wrote this the BMA (our union) announced that it would ballot for industrial action.

    There's currently a demonstrative petition listing 50,000 signatures (there's 53,000 junior docs roughly) so, yeah . . .
     
    Last edited: Sep 26, 2015
  4. TMD

    TMD Groundskeeper DLP Supporter

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    3 years and i'm out this mofo. Get the BBQ on the beach ready mate, your drinks are on me.

    So there are demonstrations happening on Monday and some other days I think. the crock of shite that is our union is now finally considering strike action, but even if they do it'll be a mockery of a real strike. If they don't go ahead with it, the london medical schools will have their own strike. A lot of it is being organised on social media, so you might not hear about it until closer to the time. Don't know what's happening outside London.

    If you haven't done your elective yet, i'd suggest going somewhere you'd be happy to move to and get your foot in the door with the system there. Also good luck with your SJTs mate.

    I've visited several hospitals in the USA and I was always impressed with the sheer amount of money the private healthcare generates to the point where the hospitals are fantastic in terms of equipment and resources. But I knew I could never sell out and abandon the NHS for that. Given what's happening here though, the NHS is just waiting for the final bullet in the head and there's not much point sticking around while the bastards at the BBC claim doctors were the shooters.
     
  5. Blorcyn

    Blorcyn Professor DLP Supporter

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    Cheers. FPAS actually opens this Monday, scary stuff.

    And yeah, I came back from my elective at the end of summer and I'm currently procrastinating and avoiding do my report on it. Blergh.

    That's the thing really, the doctors had reasonable arguments in their last strike from what I remember but doctors on strike just sounds evil and people don't like it.

    I'm in the north but it'll be interesting to see what the London schools do, good luck with that.
     
  6. ScottPress

    ScottPress The Horny Sovereign Prestige

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    Jesus, this is honestly some kind of horror. I feel a weird connection with you guys (parents are medical professionals, sister starts med school in a few days, and I'm a failed med student myself). Problems with national healthcare aren't uncommon in Poland too, but this is medical apocalypse. Fuck. I hope the strike brings this stuff to national attention because you'll need popular support to fight this.
     
  7. Oment

    Oment The Betrayer

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    The public never, ever likes it when certain public sectors go on strike - healthcare, education, potentially the police and the military all fall under this. (Basically: anyone the public expects to 'serve' and is not maligned like civil servants). You're 1-0 behind from the start in the realm of public opinion, and like stated, the government knows that full well. Hopefully, the strike will be convincing enough to make the 'reforms'* unpalatable.

    *IMO, 'reforms' is just current political bullshit buzzwording for 'making things worse' or 'expecting 20 % better results with 15 % less means', but I'm a cynic and left-of-centre at that.
     
  8. Thyestean

    Thyestean Slug Club Member

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    What is the GMC and why would health professionals need it to acquire a certificate telling them they can work outside the country. I would think it would be the country one is trying to work in that would give a certificate that they can work there.
     
  9. Blorcyn

    Blorcyn Professor DLP Supporter

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    The certificate of good standing lets the country you're planning to work in know you're not leaving because you've committed some egregious offence in the country you're leaving. The General Medical Council is the government body that makes sure doctors are doctors and you have to be registered with them (at your own annual expense) to work in the Uk. They deal with discipline and make the rules and all that.
     
  10. Paranoid Android

    Paranoid Android Groundskeeper

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    Fuck off cunt we're full. I already have to compete with Chinese and Indians for jobs I don't want to have to deal with the English as well.

    In all seriousness though that bloody sucks mate. The NHS has always seemed to me like such a bright spot in human history. The fact that people could get together and decide that healthcare is something that everyone was going to have. To see stuff like this happen really makes the world seem like less of a nice place.
     
  11. Sechrima

    Sechrima Disappeared

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    I think Brits are still the largest group of immigrants arriving in Australia each year, so you're already competing with them.
     
  12. Paranoid Android

    Paranoid Android Groundskeeper

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    I was mostly joking I'm an immigrant myself whose stealing good ol' 'straylian jobs. If this had happened ten years back it would have been a good thing, for AUS at least. However at the moment we've got something of a glut of junior doctors and medical students about to graduate. In fact the job market for recent graduates in the medical field is looking pretty depressing.
     
  13. Socialist

    Socialist Professor

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    Jesus fucking christ. Even if you put aside every other change, this is criminal. You can't have someone who just had an 80 hour week making decisions about someone's life on a Friday night. Goddamn.
     
  14. TMD

    TMD Groundskeeper DLP Supporter

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    There was scheduled to be an open forum tonight between massively pissed off junior doctors /medical students and NHS England (the employer responsible for the new contracts) while a demonstration would be happening at the same time in central London. The meeting was to allow open debate, questioning and a chance to get our point of view across and for NHS England to respond in a straightforward manner away from any TV cameras or reporters to avoid the usual spin/lies/bullshit.

    NHS England pulled out 3 hours before the meeting was due to start. Looks like the demonstration just got a lot bigger. If anyone is in London and free, look for the mass of people in scrubs.
     
  15. TMD

    TMD Groundskeeper DLP Supporter

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    It's protest day today. First thing was waking up to this on my twitter feed: https://twitter.com/jk_rowling/status/655330615793950721.

    JKR supports us, which is awesome. Not so great was going on BBC News to see our utter cunt of a health secretary claiming that all the doctors who are about to call for his resignation have been 'mislead'. We'll see who has mislead who when he faces the cabinet ombudsmen for his outright lying to the public about deaths at the weekend. This is basically it. If this fails, a strike is the only option left but that likely won't achieve anything because of how weak the turnout will be (any doctor with emergency care responsibilities cannot strike, otherwise their medical license will be terminated.)

    Do or die today, if anyone is in London between Waterloo and Parliament square please come down and join the thousands in the protest. It will make a difference, I promise.
     
  16. ScottPress

    ScottPress The Horny Sovereign Prestige

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    I feel for you guys. I had a long argument over the last week in the YT comments (yeah, I know...) with some dude who shot down every factual argument with potshots at my YT name and calling me out for being a leftist neo fascist, which was a first for me. Other people (one med student and one jr doc) joined in, dropped some brutal numbers and this prick still held on to his view of doctors as greedy and emotionally manipulative for essentially killing people because they have the gall to not work 24/7 for a minimum wage. I especially liked his comparison how doctors are no better than street cleaners. In principle, both professions serve society yadda yadda, but seriously, fuck that guy.
     
  17. TMD

    TMD Groundskeeper DLP Supporter

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    ScottPress it's shocking how affected the general public is by media spin. We've had patients in my hospital come in on a Monday to A&E who really really should have come on Saturday when the problem first happened (broken bones, chest pain were the examples I saw personally). When asked why they didn't come/call an ambulance, they said they were scared they would die if they came on the weekend because they heard there are less doctors to look after them, and higher chances of dying.

    I confess I nearly smashed some shit up. The rhetoric used by the health secretary and thrown out by mass media is literally endangering peoples lives. Doctors are there 24 hours a day, 7 days a week without fail. Yes mortality rates are slightly higher on the weekend, because there are no elective cases on the weekend. All the routine checkups, come in for an appointment type stuff happens monday-friday, which means the only cases on the weekend are emergencies. And guess what, critically ill patients who come in on the back of an ambulance have a higher chance of dying!

    When the government talks about a 7 day NHS, it means extending the routine non-emergency elective stuff to include Saturdays and Sundays. However, the health secretary and PM are confusing the public by mixing this idea and the idea of higher death rates on the weekend (deliberately) to try and drum up support for fucking over doctors. The only reason why we can't have elective routine cases on weekends isn't because doctors aren't there (they are), it's because theres very few support staff. There are less radiographers, less porters, less lab technicians and making all those lot work on weekends would cost tons of money which they refuse to provide. It's just a joke.

    Another joke is the increasing frustration among the doctors at the lack of progress with the public. Many are moving towards the opinion of "if i'm not valued for my ridiculous level of skill here, get paid less than a manager at KFC, and the public thinks i'm a greedy twat who earns £100k when actually I get paid £23k why don't I just go abroad and have the public feel the exact same way about me - but I get paid well and valued for my skill instead?" The NHS isn't dead yet folks, maybe stick around for a little longer and see if we can fight this? If the new contract is imposed i'm all for fucking off and letting Jeremy privatise everything.

    All in all, those embers of hope are dying pretty fast. Thanks for your support though. Literally every doctor/med student i've met and spoken to says if it wasn't for members of the public expressing solidarity and support it wouldn't be possible to carry on trying.
     
  18. ScottPress

    ScottPress The Horny Sovereign Prestige

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    Maybe you guys should all get the fuck out as soon as possible after graduating. A big finger to the idiots. Have the country educate you and then leave. Maybe once the stupid cunts start dying for lack of doctors, people will find the wisdom to value medical professionals as they should be.
     
  19. Zerg_Lurker

    Zerg_Lurker Unspeakable DLP Supporter

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    There are measures in place to prevent that sort of brain drain; debt, contracts/agreements with the government? and what have you. Never mind the fact that plays right into the hands of the those trying to dismantle the NHS.
     
  20. Blorcyn

    Blorcyn Professor DLP Supporter

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    The thing is, the stupid cunts in the daily mail section (and I do take a perverse sort of pleasure in reading their comments and winding myself up) aren't often the ones getting ill, not really.

    You meet soo many lovely people on the wards, more than the wankers, definitely.

    I never realised how crap the bbc is until now though. For example, go on their current story on the deaths 'caused' by weekend doctors and their quotes from the paper concerned and the DoH and tell me it doesn't sound like their is categorical proof that the deaths are explainable.

    There's already such a shortage in really key fields and it's only going to get worse. It's so disheartening. And many people just aren't being told, or don't accept that their doctors may possibly be more trustworthy than a Politican despite years of evidence to the contrary.

    I'm going to the rally in newcastle this Saturday, one of many that's being held. I don't feel this will resolve before strike action, and I'm cynical that it won't resolve, in the end, in our favour.