Junior Doctor's contracts petition
Discussion
tdog7 said:
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.How many hours would a non-A&E on-call rota be each week, on average?
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.
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.Why wouldn't you just clock in and out like the retail, leisure and manufacturing industries?
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.
Just to add one other reason why they dont operate a clock in and out system, that is equally critical as the cost, it would actually provide evidence of the dangerously and illegally worked hours. At the moment there is plausible deniability with only carefully selected check rotas.
If I was in charge of the health service, I would leave the junior doctors contract well alone. The problem with the guardian system is just one. The main issue is that the government claim they need to change the contract to increase the number of doctors around at the weekend. But they also say they will reduce the number of hours doctors have to work. If you have the same number of doctors, with more working at the weekend, but all working less hours overall, logic dictates that you have to move doctors from the weekday to the weekend. We are already stretched on weekdays, this contract will make things far worse, and will not eliminate the weekend effect. To make matters worse, if just a tiny percentage of England's junior doctor workforce decide to leave because of this contract, which will happen if its imposed, the gaps in rotas will get even larger. In our 7 week rota, we should have 14 doctors, we have 10. This is not unusual.
In general, the health service is getting great value for money out of its doctors, both for their contracted hours and the number of unpaid hours they contribute through good will to the system. If I health secretary I would be working with those people asking them what are the barriers to improving care, not telling them, then ignoring their opinions and then patronising them in the media (doctors are in no way being misled by the BMA!!) For example, as I mentioned in my post, a big problem at our trust is the pharmacy is only open until 12 midday on a saturday. This means anyone who is going home at the weekend needs to get all their medication prepared by then, or they can't go home. This is madness, pay the money to keep the pharmacy open and you'll recoup it in savings from earlier discharge. For clarity, not having a doctor around has never, in my 10 years of working as a junior doctor in the NHS been a barrier to discharge at the weekend. No pharmacy has. Not physio assessment has. No occupational therapy service has. No social care package has.
In general, the health service is getting great value for money out of its doctors, both for their contracted hours and the number of unpaid hours they contribute through good will to the system. If I health secretary I would be working with those people asking them what are the barriers to improving care, not telling them, then ignoring their opinions and then patronising them in the media (doctors are in no way being misled by the BMA!!) For example, as I mentioned in my post, a big problem at our trust is the pharmacy is only open until 12 midday on a saturday. This means anyone who is going home at the weekend needs to get all their medication prepared by then, or they can't go home. This is madness, pay the money to keep the pharmacy open and you'll recoup it in savings from earlier discharge. For clarity, not having a doctor around has never, in my 10 years of working as a junior doctor in the NHS been a barrier to discharge at the weekend. No pharmacy has. Not physio assessment has. No occupational therapy service has. No social care package has.
Edited by tdog7 on Saturday 7th May 18:10
Tdog7 has explained better what I as a non Dr was trying to. He also has articulated the very same reasons my Daughter has said for people not being able to go home. The care package seems to be the biggest one. Many feel that this is for one reason, money. Once discharged the council bears the cost of care, as it is social rather than medical. If by delaying they keep a person in hospital, they save money so drag their feet.
The CE of Manchester now has much great financial control and said she would be in favour of giving some of her budget to the council to speed up the release of people well enough to go home.
The CE of Manchester now has much great financial control and said she would be in favour of giving some of her budget to the council to speed up the release of people well enough to go home.
Thanks for the input tdog7, very helpful for additional understanding.
I have another question, have the BMA at any point in the negotiations which did take place before the statement that the contract would be imposed ever suggest that money be put into extending the opening hours of the pharmacy (or other similar issues) that, whilst incurring a cost, would save money that could then be used to help other moves towards a more thorough 24/7 NHS?
I have another question, have the BMA at any point in the negotiations which did take place before the statement that the contract would be imposed ever suggest that money be put into extending the opening hours of the pharmacy (or other similar issues) that, whilst incurring a cost, would save money that could then be used to help other moves towards a more thorough 24/7 NHS?
prg1 said:
You would have thought that the BMA may have suggested working just to Doctors contacted hours for a period of time to highlight the unpaid overtime given.
This approach was suggested. A group of doctors even setup a web page encouraging doctors to log additional unpaid hours to demonstrate how much additional work was being done. The approach you suggest, 'working to rule' has been used before by healthcare professionals. I think midwives did it in 2014 in a pensions dispute. But as a form of protest it's pretty ineffective, mainly because you cant just stop an operation at 5pm and walk out. You can't abandon a sick patient at 5pm as that's when your shift finishes, you can't just drop things at 5pm as it just leaves more work for the on call team to do. The only people who suffer are your colleagues. The strikes were disruptive to elective services, without putting patients in danger, so were thought to be a more effective form of protest. andyps said:
Thanks for the input tdog7, very helpful for additional understanding.
I have another question, have the BMA at any point in the negotiations which did take place before the statement that the contract would be imposed ever suggest that money be put into extending the opening hours of the pharmacy (or other similar issues) that, whilst incurring a cost, would save money that could then be used to help other moves towards a more thorough 24/7 NHS?
I don't know any doctor who wouldn't be happy to engage in this way. The BMA has said on numerous occasions it wants to work with the government to improve care, but the government don't want to listen. They have an untested, unresearched, unplanned, and uncosted solution to a problem (the weekend effect) with no evidence their solution will work, and limited evidence the problem even exists. Doctors have been shouting loud and clear that this contract is not the answer......but the government haven't even entertained the possibility they've got it wrong. Even with the heads of virtually all the Royal colleges employing them not to, the government have pressed on with the imposition,I have another question, have the BMA at any point in the negotiations which did take place before the statement that the contract would be imposed ever suggest that money be put into extending the opening hours of the pharmacy (or other similar issues) that, whilst incurring a cost, would save money that could then be used to help other moves towards a more thorough 24/7 NHS?
Even if you thought the contract was amazing, imposing it is a ridiculous decision, as it will alienate the entire workforce. To take that risk you would hope there are some pretty massive benefits.....problem is only Jeremy Hunt seems to know what those benefits might be.
spaximus said:
Tdog7 has explained better what I as a non Dr was trying to. He also has articulated the very same reasons my Daughter has said for people not being able to go home. The care package seems to be the biggest one. Many feel that this is for one reason, money. Once discharged the council bears the cost of care, as it is social rather than medical. If by delaying they keep a person in hospital, they save money so drag their feet.
The CE of Manchester now has much great financial control and said she would be in favour of giving some of her budget to the council to speed up the release of people well enough to go home.
tyou also have to remember that to a degree it ialso the social care side of things that decides when a discharge has become delayed ... The CE of Manchester now has much great financial control and said she would be in favour of giving some of her budget to the council to speed up the release of people well enough to go home.
Dixy said:
<snip>
tdog some excellent insight in to the facts in your posts.
Just to add one other reason why they dont operate a clock in and out system, that is equally critical as the cost, it would actually provide evidence of the dangerously and illegally worked hours. At the moment there is plausible deniability with only carefully selected check rotas.
If it's seen as 'demeaning' to other health professionals to clock in , god knows what it must be for the almighty doctors ... tdog some excellent insight in to the facts in your posts.
Just to add one other reason why they dont operate a clock in and out system, that is equally critical as the cost, it would actually provide evidence of the dangerously and illegally worked hours. At the moment there is plausible deniability with only carefully selected check rotas.
it;s part of the historical baggage the NHS carries around over status ... fortunately reserved seating in canteens or even a seperate dining room with table service for consultants and managers , limited access to junior staff corridors and extensive provision of 'consultant's car parks' and 'senior management car parks' has gone by the by but that was a reality in many hospitals within the past 15 -20 years if not later ...
loafer123 said:
I completely agree - I learnt more in these last few posts than from the rest of this thread and all of the media sources I have read and watched about this subject.
Indeed. This information would have been useful 7 months ago when the thread was started. You been asleep tdog?mph1977 said:
Dixy said:
<snip>
tdog some excellent insight in to the facts in your posts.
Just to add one other reason why they dont operate a clock in and out system, that is equally critical as the cost, it would actually provide evidence of the dangerously and illegally worked hours. At the moment there is plausible deniability with only carefully selected check rotas.
If it's seen as 'demeaning' to other health professionals to clock in , god knows what it must be for the almighty doctors ... tdog some excellent insight in to the facts in your posts.
Just to add one other reason why they dont operate a clock in and out system, that is equally critical as the cost, it would actually provide evidence of the dangerously and illegally worked hours. At the moment there is plausible deniability with only carefully selected check rotas.
it;s part of the historical baggage the NHS carries around over status ... fortunately reserved seating in canteens or even a seperate dining room with table service for consultants and managers , limited access to junior staff corridors and extensive provision of 'consultant's car parks' and 'senior management car parks' has gone by the by but that was a reality in many hospitals within the past 15 -20 years if not later ...
mph1977 said:
it;s part of the historical baggage the NHS carries around over status ... fortunately reserved seating in canteens or even a seperate dining room with table service for consultants and managers , limited access to junior staff corridors and extensive provision of 'consultant's car parks' and 'senior management car parks' has gone by the by but that was a reality in many hospitals within the past 15 -20 years if not later ...
Did you use a spell checker ?and so was nurses being sacked for getting married but that's not really relevant anymore
Dixy said:
mph1977 said:
Dixy said:
<snip>
tdog some excellent insight in to the facts in your posts.
Just to add one other reason why they dont operate a clock in and out system, that is equally critical as the cost, it would actually provide evidence of the dangerously and illegally worked hours. At the moment there is plausible deniability with only carefully selected check rotas.
If it's seen as 'demeaning' to other health professionals to clock in , god knows what it must be for the almighty doctors ... tdog some excellent insight in to the facts in your posts.
Just to add one other reason why they dont operate a clock in and out system, that is equally critical as the cost, it would actually provide evidence of the dangerously and illegally worked hours. At the moment there is plausible deniability with only carefully selected check rotas.
it;s part of the historical baggage the NHS carries around over status ... fortunately reserved seating in canteens or even a seperate dining room with table service for consultants and managers , limited access to junior staff corridors and extensive provision of 'consultant's car parks' and 'senior management car parks' has gone by the by but that was a reality in many hospitals within the past 15 -20 years if not later ...
much the same as in many private sector organisations 'salaried staff' aren't required to clock in and out but the 'hourly paid scum' are ...
All well and good having a consultants car park but s/he's not going to be much good in a theatre on his /her own with an anaesthetist without some ODPs, Nurses, theatre support workers, CSSD staff and a theatre porter ... all of whome will be fighting to park up to half a mile away in the staff car parking and in some cases beign charged more for that privelege...
by all means have reserved spaces for people who are off-site but on on call...
It's seen as perfectly acceptable that clinical staff who won;t be finishing their shifts until 2000 - 0200 to be unable to park becasue pin striped shiny arses have magic type 's' parking passes which let them into the reserved parking for management right by the building ( can;t have plebian cars in there vs the lease cars of the management becasue they might occasionally have to travel to another site ) while the clinical staff have to fight for parking spaces in the staffparking or risk being 'fined' and disciplined for parking in the public car park or not in a recognised parking space ...
mph1977 said:
'professional' (andtheir assistant grades) staff in the NHS don't clock in and out they are trusted to turn up by the appropriate time and not leave until at least the appropriate time (unless told otherwise by line management) vs. the 'plebians' in support trades ...
much the same as in many private sector organisations 'salaried staff' aren't required to clock in and out but the 'hourly paid scum' are ...
All well and good having a consultants car park but s/he's not going to be much good in a theatre on his /her own with an anaesthetist without some ODPs, Nurses, theatre support workers, CSSD staff and a theatre porter ... all of whome will be fighting to park up to half a mile away in the staff car parking and in some cases beign charged more for that privelege...
by all means have reserved spaces for people who are off-site but on on call...
It's seen as perfectly acceptable that clinical staff who won;t be finishing their shifts until 2000 - 0200 to be unable to park becasue pin striped shiny arses have magic type 's' parking passes which let them into the reserved parking for management right by the building ( can;t have plebian cars in there vs the lease cars of the management becasue they might occasionally have to travel to another site ) while the clinical staff have to fight for parking spaces in the staffparking or risk being 'fined' and disciplined for parking in the public car park or not in a recognised parking space ...
The chip on your shoulder increases in size daily. I haven't worked in a trust in the last 10 years that has separate car parks for management or consultant staff. Apart from anything else the trust take every opportunity to fleece staff members for the privilege to park on site.much the same as in many private sector organisations 'salaried staff' aren't required to clock in and out but the 'hourly paid scum' are ...
All well and good having a consultants car park but s/he's not going to be much good in a theatre on his /her own with an anaesthetist without some ODPs, Nurses, theatre support workers, CSSD staff and a theatre porter ... all of whome will be fighting to park up to half a mile away in the staff car parking and in some cases beign charged more for that privelege...
by all means have reserved spaces for people who are off-site but on on call...
It's seen as perfectly acceptable that clinical staff who won;t be finishing their shifts until 2000 - 0200 to be unable to park becasue pin striped shiny arses have magic type 's' parking passes which let them into the reserved parking for management right by the building ( can;t have plebian cars in there vs the lease cars of the management becasue they might occasionally have to travel to another site ) while the clinical staff have to fight for parking spaces in the staffparking or risk being 'fined' and disciplined for parking in the public car park or not in a recognised parking space ...
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