Junior Doctor's contracts petition

[Jockman]

andyps said:

Is the complicated part the everyone opposed to the pay deal talks about the fact that the banding means that some of these hours which will be paid at 33% or 50% extra are currently paid at 20% and therefore it is complicated to explain how they are claiming a pay cut when it is an increase? Just idle speculation because that is a question nothing I have seen has answered.

That is what the chart tells me.

Yes for those currently claiming an uplift of 100% on unsociable hours this is a 15% to 25% decrease for those hours as has been pointed out and so they will only be able to claim a 75% to 85% uplift. Definite decrease but I do not know how this benchmarks against other public sector workers. I would guess it remains more than private sector workers.

For those only eligible for a 20% uplift on unsociable hours the Govt proposal is obviously an enormous increase.

[spaximus]

To save copying everything again, the chart is misleading, but supplied by the NHS employers it would be.
The bandings that are in place take into account that period over which those rates would be paid. The old rotas were worked out and to save having everyone clocking on and off working it was agreed to band people based on the amount of unsocial hours they would be expected to work. They do not get overtime under the banding arrangement, it is built in.

So say a Mental Health Doctor, the vast majority of work is clinic based so the banding would be 20%. A&E would be 50%. It might not have been perfect but it has worked for years well.

The new contract has done away with bandings which is why it is difficult unless you have an existing rota and banding next to a new one with the proposed hours and pay rates to see how it affects that person.

Does anyone really believe if the doctors were getting paid more for less hours they would not be arguing over that part?

The bigger issue is stretching 5 day staff over 7 with no more resource, that is the unsafe bit which has been lost in the way the argument has been driven.

[968]

tdog7 said:

Well this is inconvenient for Jeremy isn't it. A new study (http://www.manchester.ac.uk/discover/news/national-study-casts-doubt-on-higher-weekend-death-rate-and-proposals-for-seven-day-hospital-services/?utm_source=Facebook&utm_medium=Social&utm_campaign=SocialPR) demonstrates what doctors and healthcare professionals have been telling the government all along, that the weekend effect is caused by patients admitted to hospital at the weekend being on average more sick than those admitted during the week. And what do NHS england do when confronted with this, state that this shows why 'more senior doctors are needed in hospitals at the weekend'........which has precisely fk all to do with the junior doctors contract.

Jeremy Hunt has stated numerous times the aim of this contract change is to reduce the weekend effect. He has no evidence it will do so, (and there is now some evidence that it won't), says it is cost neutral - so he's not saving any money by doing it, and in doing so is alienating a whole generation of doctors.

So why do it.......

Interesting no one has commented on this article.

[Sylvaforever]

Perhaps the fk all bit put right minded peole off.

[spaximus]

This is the sort of insanity that is running through the DOH. If you click on the link you will see Bristol Southmead hospital, an over the top designed building with a £250,000 clock, has been fined for missing key targets, especially in A&E.
The hospital is already in a huge deficit so they have fined them £7 million pounds another £23 million pounds at St Barts making the situation worse.

This money will be re-invested and spun as extra no doubt. On what planet do these people live on where taking money away is seen as helping?

http://www.bristolpost.co.uk/Southmead-Hospital-fi...

[spaximus]

968 said:

tdog7 said:

Well this is inconvenient for Jeremy isn't it. A new study (http://www.manchester.ac.uk/discover/news/national-study-casts-doubt-on-higher-weekend-death-rate-and-proposals-for-seven-day-hospital-services/?utm_source=Facebook&utm_medium=Social&utm_campaign=SocialPR) demonstrates what doctors and healthcare professionals have been telling the government all along, that the weekend effect is caused by patients admitted to hospital at the weekend being on average more sick than those admitted during the week. And what do NHS england do when confronted with this, state that this shows why 'more senior doctors are needed in hospitals at the weekend'........which has precisely fk all to do with the junior doctors contract.

Jeremy Hunt has stated numerous times the aim of this contract change is to reduce the weekend effect. He has no evidence it will do so, (and there is now some evidence that it won't), says it is cost neutral - so he's not saving any money by doing it, and in doing so is alienating a whole generation of doctors.

So why do it.......

It depends on who reads it and how they want to report it. The Mail, says it proves more people die at weekends and anyone who has pointed out the opposite are shot down in the comments. In the other papers they are reporting it as the opposite. To most right minded people it does show that the claims Hunt made were not true and as even those who wrote the report he chose to cherry pick from before, what they found should not be used to conclude anything.
This new report that has had peer review, suggests what Hunt has said is untrue factually. As this was a main plank of his argument it seems pretty obvious that at best he was misinformed or he knew and lied.
Interesting no one has commented on this article.

[tdog7]

Sylvaforever said:

Perhaps the fk all bit put right minded peole off.

I'm sorry if my swear word upset your delicate sensibilities, and I will refrain from any unpleasant language in this post so you can read it.

However, I think its far more likely people have ignored this report as it is an inconvenient truth for them.

Jeremy Hunt stated in parliament that he couldn't sign up to a pilot of the new contract as it would delay solving the weekend effect. He never had any evidence his contract would improve weekend care, and now we have evidence that it will have no impact on the weekend effect, as the patient population is fundamentally different at weekends. He really should acknowledge he made a mistake, take a step back, and renegotiate a sensible contract without conflating the issues and trying to paint junior doctors as greedy.

So I'll ask again, if this is all cost neutral, why does he feel so desperate to push it through?

[sidicks]

tdog7 said:

So I'll ask again, if this is all cost neutral, why does he feel so desperate to push it through?

Because he thinks that is the best thing for the NHS and the customer (even if that might not actually be the case)?

[mph1977]

sidicks said:

tdog7 said:

So I'll ask again, if this is all cost neutral, why does he feel so desperate to push it through?

Because he thinks that is the best thing for the NHS and the customer (even if that might not actually be the case)?

becasue despite the claims of the BMA the 4and a half day NHS is alive and well for acute hospital inpatients ...

[tdog7]

mph1977 said:

becasue despite the claims of the BMA the 4and a half day NHS is alive and well for acute hospital inpatients ...

You are wrong obviously, the NHS works 24/7, 365 days a year.....but even if we ignore that fact, Hunt has now clarified that this contract change is not about 7 day elective services, but improving emergency care out of hours. Improving emergency care out of hours doesn't need a new junior doctors contract, it needs more nurses, more radiographers, more porters, more Occupational therapists, more physios, more pharmacists. None of which is affected by the junior doctors contract.

[tdog7]

sidicks said:

Because he thinks that is the best thing for the NHS and the customer (even if that might not actually be the case)?

I hope that's the case, but how can he be so sure of his conviction when everyone with any significant experience of health care is telling him he's wrong. The Academy of medical royal colleges, the patients association, nearly all the staff who work in the NHS. I genuinely don't understand how a politician can turn round against all those who have experience of healthcare and tell them they're wrong and he's right.

[loafer123]

spaximus said:

To save copying everything again, the chart is misleading, but supplied by the NHS employers it would be.
The bandings that are in place take into account that period over which those rates would be paid. The old rotas were worked out and to save having everyone clocking on and off working it was agreed to band people based on the amount of unsocial hours they would be expected to work. They do not get overtime under the banding arrangement, it is built in.

So say a Mental Health Doctor, the vast majority of work is clinic based so the banding would be 20%. A&E would be 50%. It might not have been perfect but it has worked for years well.

The new contract has done away with bandings which is why it is difficult unless you have an existing rota and banding next to a new one with the proposed hours and pay rates to see how it affects that person.

Does anyone really believe if the doctors were getting paid more for less hours they would not be arguing over that part?

The bigger issue is stretching 5 day staff over 7 with no more resource, that is the unsafe bit which has been lost in the way the argument has been driven.

Seriously? So everyone gets paid for the hours that role might be expected to work, whether or not the doctor actually does those hours?

No wonder they don't want to lose the current system...there are probably lots of doctors being paid for hours they don't work whilst those doing ridiculously long hours are underpaid.

[mph1977]

tdog7 said:

You are wrong obviously, the NHS works 24/7, 365 days a year.....but even if we ignore that fact, Hunt has now clarified that this contract change is not about 7 day elective services, but improving emergency care out of hours. Improving emergency care out of hours doesn't need a new junior doctors contract, it needs more nurses, more radiographers, more porters, more Occupational therapists, more physios, more pharmacists. None of which is affected by the junior doctors contract.

Nurse staffing on inpatient units doesn;t change hugely between weekdays and weekends , and where it does it's usually becasue 'office' days can;t be scheduled on the weekend for sisters and charge nurses , and that the number of weekend shifts allowed for sisters and charge nurses is determined across the directorate or service group ( aim being to have one available per directorate / service group to be a token navy blue presence to deal with snotty rellies who demand to see a sister / charge nurse despite the fact the staff nurse looking after the patient / or IC Shift is likely to know far more )

then there is the stuff , some of which dates back nearly 20 years that is finally coming as the norm in terms of certain psychomotor skills rather than them being 'a doctor's job'


Portering staffing allocated to emergency / urgent care and ward work doesn;t change a great deal if at all between the week and the weekend

some clinical areas all ready have physio /OT input on weekends

most hospitals provide inpatient pharmacy services for at least part of the weekend and will provide TTOs for specified units

radiography ways of working depends on how things are organised and the levle of locla intransgience to making better use of the assets ... also the changes in pre-reg and preceptorship standards with regard to CT and psychomotor skills previous seen as medical or 'advanced practice' roles .

[tdog7]

mph1977 said:

Nurse staffing on inpatient units doesn;t change hugely between weekdays and weekends , and where it does it's usually becasue 'office' days can;t be scheduled on the weekend for sisters and charge nurses , and that the number of weekend shifts allowed for sisters and charge nurses is determined across the directorate or service group ( aim being to have one available per directorate / service group to be a token navy blue presence to deal with snotty rellies who demand to see a sister / charge nurse despite the fact the staff nurse looking after the patient / or IC Shift is likely to know far more )

then there is the stuff , some of which dates back nearly 20 years that is finally coming as the norm in terms of certain psychomotor skills rather than them being 'a doctor's job'


Portering staffing allocated to emergency / urgent care and ward work doesn;t change a great deal if at all between the week and the weekend

some clinical areas all ready have physio /OT input on weekends

most hospitals provide inpatient pharmacy services for at least part of the weekend and will provide TTOs for specified units

radiography ways of working depends on how things are organised and the levle of locla intransgience to making better use of the assets ... also the changes in pre-reg and preceptorship standards with regard to CT and psychomotor skills previous seen as medical or 'advanced practice' roles .

I'm confused mph.....you said the NHS works for 4 and a half days, and now are saying that all the above staff groups are equally available at the weekend as during the week?

The point I was making is that the barrier to improved services at weekends is not the junior doctors contract, something acknowledged by David Dalton who headed negotiations for the government. In fact he said the junior doctors were the group of employees whose working practice would have to change the least to achieve the '7 day NHS' (although no one really knows yet what the 7 day NHS is yet, is it 7 day elective services, or 7 day emergency care which already exists).

I work 1:3 weekends. The problems I encounter are rarely to do with not having doctors (junior or senior) available at the weekend, they relate to the pharmacy only being open until 12 midday, the on call radiographer struggling to cope with demand from the whole hospital, the nurses being so overrun they don't have time to take a meal break.

I would love to have increased numbers of all healthcare professionals, across the week, as anyone who works in the NHS knows the staff on the frontline are doing everything they can to keep things afloat. I also acknowledge that this requires further investment, perhaps investment the british public (and certainly the current government) don't want to make. I also think that despite this, the NHS provides amazing emergency care 24 hours a day 7 days a week already. The point I'm making, is that if you are someone who thinks it doesn't, the problem certainly isn't the current junior doctors contract.

[crankedup]

sidicks said:

tdog7 said:

So I'll ask again, if this is all cost neutral, why does he feel so desperate to push it through?

Because he thinks that is the best thing for the NHS and the customer (even if that might not actually be the case)?

Many a politician and business person have come unstuck by being so arrogant and bloody minded.

[tdog7]

loafer123 said:

Seriously? So everyone gets paid for the hours that role might be expected to work, whether or not the doctor actually does those hours?

No wonder they don't want to lose the current system...there are probably lots of doctors being paid for hours they don't work whilst those doing ridiculously long hours are underpaid.

Quite the contrary. The job is allocated a banding supplement based on the average number of hours worked per week on that rota, and the number of those hours that are unsocial (nights and weekends). Whenever a doctor is rota'd to work, they work. Now most job plans are based on doctors routine working hours being 8am - 5pm, and the out of hours work on top of that. In reality, most doctors are required to be at work earlier than 8am, and in surgical specialties more like 7am. The work is also rarely done at 5pm, and so most doctors stay late to ensure their patients are cared for, usually leaving at 6pm onward.

[loafer123]

tdog7 said:

loafer123 said:

Seriously? So everyone gets paid for the hours that role might be expected to work, whether or not the doctor actually does those hours?

No wonder they don't want to lose the current system...there are probably lots of doctors being paid for hours they don't work whilst those doing ridiculously long hours are underpaid.

Quite the contrary. The job is allocated a banding supplement based on the average number of hours worked per week on that rota, and the number of those hours that are unsocial (nights and weekends). Whenever a doctor is rota'd to work, they work. Now most job plans are based on doctors routine working hours being 8am - 5pm, and the out of hours work on top of that. In reality, most doctors are required to be at work earlier than 8am, and in surgical specialties more like 7am. The work is also rarely done at 5pm, and so most doctors stay late to ensure their patients are cared for, usually leaving at 6pm onward.

Thanks for the explanation. Doesn't this mean that some doctors may be doing hours they don't need to and others aren't being paid for the extra hours they work?

Why wouldn't you just clock in and out like the retail, leisure and manufacturing industries?

[tdog7]

loafer123 said:

Thanks for the explanation. Doesn't this mean that some doctors may be doing hours they don't need to and others aren't being paid for the extra hours they work?

Why wouldn't you just clock in and out like the retail, leisure and manufacturing industries?

Its quite hard to explain without a rota in front of you. Essentially all hospital doctors are paid to be at work from 8am - 5pm Monday to Friday (other than A&E which I'll explain later). These doctors also participate in an 'on call' rota. On call is a bit of a misnomer, as it implies you might've to work, but you might not. In reality 'on call' hours are busier than non on call. Most hospital doctors are resident on call, meaning they are at the hospital for their on call shifts. A small percentage are 'non resident' meaning they can be at home, unless they are called in, but have to be available to come in or give advice over the phone throughout their shift.

We could have a system whereby doctors clock in and clock out, but I guarantee you, if this were to exist, the additional pay the NHS would have to give to doctors for the hundreds of hours they do each week which are currently unpaid, would bankrupt the NHS rapidly.

Currently the number of doctors required on the on call rota is decided by the hospital, based on their workload.

Its true that some doctors do better out of the current system than others. Those who are no resident on call do well as they may be at home for a whole shift and be paid the same as those who are at the hospital for a whole shift. However, the proposed contract is even worse, massively undervaluing non resident on call work - don't forget, that these doctors have to be available to give advice or come to the hospital straight away if called.

The nature of the work also means that some shifts are busier than others. On occasion, I get to sit down during a 13 hour night shift, sometimes even have something to eat, but far more often I don't stop from 8pm until 9am the next day.

A&E is slightly different in that everyone is on a rota with various shift patterns.

[loafer123]

tdog7 said:

loafer123 said:

Thanks for the explanation. Doesn't this mean that some doctors may be doing hours they don't need to and others aren't being paid for the extra hours they work?

Why wouldn't you just clock in and out like the retail, leisure and manufacturing industries?

Its quite hard to explain without a rota in front of you. Essentially all hospital doctors are paid to be at work from 8am - 5pm Monday to Friday (other than A&E which I'll explain later). These doctors also participate in an 'on call' rota. On call is a bit of a misnomer, as it implies you might've to work, but you might not. In reality 'on call' hours are busier than non on call. Most hospital doctors are resident on call, meaning they are at the hospital for their on call shifts. A small percentage are 'non resident' meaning they can be at home, unless they are called in, but have to be available to come in or give advice over the phone throughout their shift.

We could have a system whereby doctors clock in and clock out, but I guarantee you, if this were to exist, the additional pay the NHS would have to give to doctors for the hundreds of hours they do each week which are currently unpaid, would bankrupt the NHS rapidly.

Currently the number of doctors required on the on call rota is decided by the hospital, based on their workload.

Its true that some doctors do better out of the current system than others. Those who are no resident on call do well as they may be at home for a whole shift and be paid the same as those who are at the hospital for a whole shift. However, the proposed contract is even worse, massively undervaluing non resident on call work - don't forget, that these doctors have to be available to give advice or come to the hospital straight away if called.

The nature of the work also means that some shifts are busier than others. On occasion, I get to sit down during a 13 hour night shift, sometimes even have something to eat, but far more often I don't stop from 8pm until 9am the next day.

A&E is slightly different in that everyone is on a rota with various shift patterns.

Thank you for a very interesting explanation.

How many hours would a non-A&E on-call rota be each week, on average?

[tdog7]

loafer123 said:

Thank you for a very interesting explanation.

How many hours would a non-A&E on-call rota be each week, on average?

Most doctors in acute specialties (including A&E) are working a time-tabled 48 hours a week on average, averaged over the length of the rota. My rota cycle lasts 7 weeks. In that 7 weeks I have to do 1 week of night shifts, and 2 weekends. There are weeks in the cycle when I will be working 90 hours in a week, and weeks when I work far less - the hospital has to give me hours back to compensate for these busy weeks so that my average doesn't go over 48. This average doesn't include any unpaid hours that are needed, such as coming in at 7am instead of 8am for example, which most doctors in surgical specialties will be required to do, as their operating list will start at 8:30am, and before that they will need to see all the elective patients for that list, as well as ensure any acute admissions are seen. So its easy to see how the average can go up to closer to 60 hours per week, and the worst weeks close to 100 hours.

On the old contract, every so often, doctors had to undertake something called diary carding, where they would clock in and clock off for a 2 week period, and their pay be adjusted to the hours they are actually working. Hospitals found to be working doctors more than 48 hours a week on average would be fined. No individual doctor had to complain, and the work of the whole team was assessed. One of the things doctors fear most about the new contract is that this system is being removed. Instead there will be a trust appointed 'guardian' to whom individual doctors will have to complain if they feel they are working excess hours. This puts the onus on individual doctors to say they are having to work too hard - career suicide in medicine! It also means the 'Guardian' will have to make the decision to fine the hospital they work for, something they will undoubtedly be under pressure not to do given that the vast majority of trusts are now hugely in debt.