Junior Doctor's contracts petition

[jjlynn27]

sidicks said:

I was editing my post while you were replying. I agree!

If you believe the government, the new contracts restrict the permitted hours that can be worked by doctors..

If you believe the government, the new contracts will restrict the permitted hours of existing doctors, while at the same time provide more coverage over the weekends.

All while the posts for existing hours can't be filled. Not even with locums.

If you believe Jeremy Hunt;

http://www.independent.co.uk/news/uk/politics/most...

[sidicks]

George111 said:

The words did suggest that. But at least you agree it's more complex than that.

The words suggest no such thing.

[mph1977]

IanA2 said:

mph1977 said:

IanA2 said:

mph1977 said:

thestew said:

all this worry about the cost of training JDs and them leaving for greener pastures. A quote from a fairly successful British businessman is very relevant.
"Train people well enough so they can leave, treat them well enough so they don't want to".

which is something the NHS is notoriously poor at , however it;s not (solely) a political problem , 1. the problem is actually health professional education and selection 30 -40 years ago combined with 2. the utter lack of understanding of healthcare of the recent generation of lay Management.

1. No

2. Yes

with regard to 1 - yes it is as these are the individuals who are currently the alleged 'Leaders' of clinical practice in academe and in both lay and professional specific management ...

still a few too many stereotypical medical consultants, senior ' operational' ambulance managers who trrained when being 'strong in't arm and thick in t'head was enough to come a qualified ambulance person if you could rote learn the green and blue books , ' good little girls' in Nursing Management whose lack of education is remarkably obvious to anyone who has to interact with them ( and the negative, bullying, cool girls at the back of the bikesheds culture that pervades Nursing )

Apologies I had assumed 1 related to doctors. Not so many Sir Lancelot Spratts around these days.
Agreed ambulance & nursing management is pretty dire. Remember many Trust Boards only have one doctor, but many have two or three nurses. Indeed you would be surprised how many CEO's (particularly in MH sector) are nurses by background. Most organisations are run by folks well qualified in it's core business. Not the NHS.

Trust boards have one Nurse - rare occurance they ever actually care for a patient though ( unlike Docs as Managers) , anyone else from a nursing background at board level is fudging the figures to stay registered in my experience (as if you are in a role that requires registration that can count as 'practice' for revalidation even if you never see a patient) ...

[mph1977]

jjlynn27 said:

sidicks said:

I was editing my post while you were replying. I agree!

If you believe the government, the new contracts restrict the permitted hours that can be worked by doctors..

If you believe the government, the new contracts will restrict the permitted hours of existing doctors, while at the same time provide more coverage over the weekends.

All while the posts for existing hours can't be filled. Not even with locums.

If you believe Jeremy Hunt;

http://www.independent.co.uk/news/uk/politics/most...

In part because of the structure of the working week when it comes to unsocial hours ...

the Employers are told how many Junior Doctors in training posts they are getting , the only element of control they then have with regard to this is how to control their variable pay elements by providing only minimum cover at the higher cost times

We've seen this in Nursing as well with 12.5 hours shifts becoming the norm to avoid having to pay 'late' shifts any night hours and also to prevent EWTD daily rest issues with lates finisihing less than 11 hours before the Day / early shift starts at 0700-0730 ... some placers have resolutely stuff to 7.5 hours shifts despite finishing the late shift earlier meaning greater duplication in the middle of the day ( unfortunately for some grades it doesn;t mean greater productivity as early shift staff go into wind down mode when the late shift walk onto the unit)...

for the same 37.5hours ( which is the standard working week for none medical staff) you get ' 6 for the price of 5 ' by doing 12.5 hour shifts and reducing / eliminating that overlap ...

[alfie2244]

mph1977 said:

In part because of the structure of the working week when it comes to unsocial hours ...

the Employers are told how many Junior Doctors in training posts they are getting , the only element of control they then have with regard to this is how to control their variable pay elements by providing only minimum cover at the higher cost times

We've seen this in Nursing as well with 12.5 hours shifts becoming the norm to avoid having to pay 'late' shifts any night hours and also to prevent EWTD daily rest issues with lates finisihing less than 11 hours before the Day / early shift starts at 0700-0730 ... some placers have resolutely stuff to 7.5 hours shifts despite finishing the late shift earlier meaning greater duplication in the middle of the day ( unfortunately for some grades it doesn;t mean greater productivity as early shift staff go into wind down mode when the late shift walk onto the unit)...

for the same 37.5hours ( which is the standard working week for none medical staff) you get ' 6 for the price of 5 ' by doing 12.5 hour shifts and reducing / eliminating that overlap ...

I see from your profile that you "tidy up the messes that people make" may I ask if these messes are within the NHS?

[turbobloke]

sidicks said:

George111 said:

The words did suggest that. But at least you agree it's more complex than that.

The words suggest no such thing.

Agreed.

[mph1977]

alfie2244 said:

mph1977 said:

In part because of the structure of the working week when it comes to unsocial hours ...

the Employers are told how many Junior Doctors in training posts they are getting , the only element of control they then have with regard to this is how to control their variable pay elements by providing only minimum cover at the higher cost times

We've seen this in Nursing as well with 12.5 hours shifts becoming the norm to avoid having to pay 'late' shifts any night hours and also to prevent EWTD daily rest issues with lates finisihing less than 11 hours before the Day / early shift starts at 0700-0730 ... some placers have resolutely stuff to 7.5 hours shifts despite finishing the late shift earlier meaning greater duplication in the middle of the day ( unfortunately for some grades it doesn;t mean greater productivity as early shift staff go into wind down mode when the late shift walk onto the unit)...

for the same 37.5hours ( which is the standard working week for none medical staff) you get ' 6 for the price of 5 ' by doing 12.5 hour shifts and reducing / eliminating that overlap ...

I see from your profile that you "tidy up the messes that people make" may I ask if these messes are within the NHS?

at the time of writing yes it was as my 'real life job' 37.5 hours a week as well as volunterring both operationally and in strategic management for a large CQC registered charity, currently I work for a private sector organisation doing NHS funded work.

[NoddyonNitrous]

[thestew]

George111 said:

Yes he did here a page or so back:

"I've got a similar problem at work, too much to do and not enough time to do it, as I see it my options are: a) buy another new building, equip it with more of the same machinery that I already have, and employ more staff, or b) move from a single shift pattern to a two or three shift pattern and make better use of the facilities I already have. Is it so different for the NHS?"

nope it should be fairly similar, but if you just split your current work force into two shifts you would still have the same number of employees doing the same number of hours, so productivity would be the same (probably less on the night shift due to tiredness). I would imagine most traffic through the hospitals are on weekdays so there could be potentially more waste fully manning up for 24/7 operation.

[Countdown]

^^^ The £23k is basic and doesn't include overtime/unsocial hours.

[turbobloke]

thestew said:

George111 said:

Yes he did here a page or so back:

"I've got a similar problem at work, too much to do and not enough time to do it, as I see it my options are: a) buy another new building, equip it with more of the same machinery that I already have, and employ more staff, or b) move from a single shift pattern to a two or three shift pattern and make better use of the facilities I already have. Is it so different for the NHS?"

nope it should be fairly similar, but if you just split your current work force into two shifts you would still have the same number of employees doing the same number of hours, so productivity would be the same (probably less on the night shift due to tiredness). I would imagine most traffic through the hospitals are on weekdays so there could be potentially more waste fully manning up for 24/7 operation.

Missing the point there - equipment lying idle is a waste of valuable resources that patients could and would benefit from if available for use 24/7. There was an example on this thread from a PHer not long ago.

[968]

thestew said:

nope it should be fairly similar, but if you just split your current work force into two shifts you would still have the same number of employees doing the same number of hours, so productivity would be the same (probably less on the night shift due to tiredness). I would imagine most traffic through the hospitals are on weekdays so there could be potentially more waste fully manning up for 24/7 operation.

Except nearly all rotas have big gaps in them. In addition you need more staff to work two extra days, otherwise the already stretched staff who work in excess of their contracted hours, routinely will be even more stretched.

So unless more staff are employed there cannot be staff spread thinner over 7 days and remain a safe service. Ironically your last paragraph demonstrates why the service is a relatively reduced one on weekends, because demand is higher during the week.

Amusingly the author of the paper quoted by Hunt has sent a complaint that his study has been completely misrepresented by Hunt and could never demonstrate the effect he has used the numbers for.

http://www.independent.co.uk/news/uk/home-news/jer...

[spaximus]

Countdown said:

^^^ The £23k is basic and doesn't include overtime/unsocial hours.

I think you have missed the point. The banding will be replaced by the new contract, that has lengthened the normal hours substantially. So if a Doctor does just "normal hours, unlikely I know the wage will not be much better for a first year F1.

Until all the numbers are crunched against each job rotation there was a banding against, it will be hard to give a 100% answer. I suspect it will not be as bad as shown but the differential will not be huge for some.

[968]

turbobloke said:

Missing the point there - equipment lying idle is a waste of valuable resources that patients could and would benefit from if available for use 24/7. There was an example on this thread from a PHer not long ago.

It isn't lying idle. Theatres are used over night for emergencies and during weekends. Scanners likewise. In order to have theatres working the same capacity over the weekends would require ALL those staff work 2 further days or more staff. There's no way around that and the fact that another 20-30bn will be needed.

[thestew]

turbobloke said:

thestew said:

George111 said:

Yes he did here a page or so back:

"I've got a similar problem at work, too much to do and not enough time to do it, as I see it my options are: a) buy another new building, equip it with more of the same machinery that I already have, and employ more staff, or b) move from a single shift pattern to a two or three shift pattern and make better use of the facilities I already have. Is it so different for the NHS?"

nope it should be fairly similar, but if you just split your current work force into two shifts you would still have the same number of employees doing the same number of hours, so productivity would be the same (probably less on the night shift due to tiredness). I would imagine most traffic through the hospitals are on weekdays so there could be potentially more waste fully manning up for 24/7 operation.

Missing the point there - equipment lying idle is a waste of valuable resources that patients could and would benefit from if available for use 24/7. There was an example on this thread from a PHer not long ago.

yeah but this does not work across the board as i cant imagine many people being booked in non emergency operations at 3 in the morning or an elderly woman coming in for dialysis at the same time. in cases of emergency I imagine any equipment needed to save your life would be utilised by getting people in from on call.

[RYH64E]

thestew said:

nope it should be fairly similar, but if you just split your current work force into two shifts you would still have the same number of employees doing the same number of hours, so productivity would be the same (probably less on the night shift due to tiredness). I would imagine most traffic through the hospitals are on weekdays so there could be potentially more waste fully manning up for 24/7 operation.

Obviously you need more staff if you're running extra shifts but you only bring in extra staff for the work that's forming the current bottleneck. In my case when I add an extra production shift I don't need to add extra salespeople, or accounts staff, or clerical support, or management, and I don't need to pay for extra plant and machinery, building mortgage costs, business rates etc. In theory, by adding two extra shifts I can get up to three times the output for maybe 30% extra costs, and when you're spending your own money these kind of sums make sense.

[spaximus]

turbobloke said:

thestew said:

George111 said:

Yes he did here a page or so back:

"I've got a similar problem at work, too much to do and not enough time to do it, as I see it my options are: a) buy another new building, equip it with more of the same machinery that I already have, and employ more staff, or b) move from a single shift pattern to a two or three shift pattern and make better use of the facilities I already have. Is it so different for the NHS?"

nope it should be fairly similar, but if you just split your current work force into two shifts you would still have the same number of employees doing the same number of hours, so productivity would be the same (probably less on the night shift due to tiredness). I would imagine most traffic through the hospitals are on weekdays so there could be potentially more waste fully manning up for 24/7 operation.

Missing the point there - equipment lying idle is a waste of valuable resources that patients could and would benefit from if available for use 24/7. There was an example on this thread from a PHer not long ago.

There is no doubt equipment is not used at some periods of the day in hospitals. It is the same as in other government funded or tax payer funded service. Gritting lorries are a good example of arms where we do not need them at that moment.

In hospitals you need the staff to use them and patients willing to turn up for a clinic at 10pm at night. If it is needed for emergencies they get people to do what is needed then and in the cases we have heard recently if they don't do it, it is usually down to hospital policies. It is not unusual to send patients to a hospital that has specialisation with staff to do things as needed.

In the case of a business having a good sales they could run machines longer. They could do that two ways, set on more staff, or pay overtime increasing their spend.
Neither of these options are open to the NHS as there are caps in place for staff numbers and overall spend. The governmet are good at quoting they have invested X much money, but a huge amount is ring fenced and cannot be spent on care.
You have the absurdity of no money and running deficits because they cannot switch money from one pot to another. yes there are huge problems of mismanagement in the NHS, but this is way above junior Doctors. As identified recently, purchasing is probably the biggest saving to be made. Equipment especially it. When they just formed the CSU's they were all told to use the same software and reporting mechanism. This has been met with resistance as certain CCG's still want the reports in the old format as their systems do not match. Just one example where a firm policy and point would work.
Drugs are also the biggest waste. Patients don't finish courses, companies charge what they can get away with. Doctors who aren't up to speed with generic availabilities, still prescribing the branded ones. The list goes on and on, but keeping this on track, The Junior Dr's and medical staff are not the problem and Hunts treatment of them and the rest to come is shameful

[turbobloke]

968 said:

turbobloke said:

Missing the point there - equipment lying idle is a waste of valuable resources that patients could and would benefit from if available for use 24/7. There was an example on this thread from a PHer not long ago.

It isn't lying idle. Theatres are used over night for emergencies and during weekends. Scanners likewise.

An investigation by Good Health via Freedom of Information requests, back in 2014. revealed wide variations in access to advanced radiotherapy across England with machines lying idle because of a lack of relevant staff.

You can point to theatres in frequent use and some scanners in frequent use at some locations at some times, but the existence of other locations with expensive kit idle over the weekend has already set your cause as lost.

It doesn't need it all to be out of use to make the case.

NHS trusts are not getting the most out of their MRI scanners, extending the range of hospital services provided at weekends is becoming an increasingly important health policy

Guardian article said:

In 2011, a Royal College of Surgeons study into emergency surgical patients and the Dr Foster Hospital Guide both highlighted how the closure of services at weekends was a significant factor in patient outcomes.

As we've seen from the latest dispute, getting fullest use isn't there yet.

Edited by turbobloke on Saturday 13th February 20:36

[thestew]

968 said:

thestew said:

nope it should be fairly similar, but if you just split your current work force into two shifts you would still have the same number of employees doing the same number of hours, so productivity would be the same (probably less on the night shift due to tiredness). I would imagine most traffic through the hospitals are on weekdays so there could be potentially more waste fully manning up for 24/7 operation.

Except nearly all rotas have big gaps in them. In addition you need more staff to work two extra days, otherwise the already stretched staff who work in excess of their contracted hours, routinely will be even more stretched.

So unless more staff are employed there cannot be staff spread thinner over 7 days and remain a safe service. Ironically your last paragraph demonstrates why the service is a relatively reduced one on weekends, because demand is higher during the week.

Amusingly the author of the paper quoted by Hunt has sent a complaint that his study has been completely misrepresented by Hunt and could never demonstrate the effect he has used the numbers for.

http://www.independent.co.uk/news/uk/home-news/jer...

i actually agree with what you are saying, may have puck me up wrong.

[jjlynn27]

thestew said:

nope it should be fairly similar, but if you just split your current work force into two shifts you would still have the same number of employees doing the same number of hours, so productivity would be the same (probably less on the night shift due to tiredness). I would imagine most traffic through the hospitals are on weekdays so there could be potentially more waste fully manning up for 24/7 operation.

The idiocy of comparing hospital to a factory and unskilled workers to doctors is entertaining if unsurprising.

Neither of two dentists that I visit are working with NHS. They own their 'machinery' and their premises. Yet they both only work from 10-5 and Wednesdays from 12-7. No weekends. Ever. Yet you wait at least a month for an appointment. If only they had someone to explain to them that if they worked 24/7 their machinery would be much better utilized.