Should doctors strike?

There is to be a further strike by junior doctors in England next week. They will not work between 8 am and 5 pm on 26 and 27 April. In previous strikes, cover for emergencies was maintained; this time it is ‘all out’. (The strikes, and the challenges of the new contract, don’t apply in Wales, Scotland or N Ireland.)

The strikes come as negotiations between junior doctors and the Department of Health have broken down. The negotiations were about a new contract, which both sides agreed was necessary. The sticking point for the doctors was the reclassification of hours of duty; where previously certain times were classified as ‘out of hours’ and attracted extra ‘overtime’ payments, these hours have been reduced. There is to be a 13% increase in basic pay, but overall most doctors won’t earn more. The new contract is said to be ‘cost neutral’.

In addition, what seems to have been a late development is the need, according to Mr Jeremy Hunt, the Health Secretary, to concentrate on weekend provision, to give the English NHS seven-day working. Of course, emergencies have always been covered for seven days. Mr Hunt bases his view on the reported ‘weekend effect’, where patients admitted at weekends have a greater chance of dying than those admitted during the week. This claim has been vigorously challenged, not least by the authors of the original academic paper.

It does seem that the Department’s aim is for there to be a greater number of junior doctors working at weekends. There won’t be an increase in junior doctor numbers, so presumably there will be fewer of them available during the week, as doctors’ hours overall are to be reduced. Quite how this will improve medical care throughout the seven days isn’t at all clear to me.

Mr Hunt has also said he will ‘impose’ the new contract, though in recent days this seems to have changed to ‘introduce’. Meanwhile, there is a legal case before the Courts seeking clarification of whether Mr Hunt has the power and authority to do this.

Once junior doctors contracts have been ‘introduced’ or whatever, it is the intention of the Health Department to renegotiate senior doctors’ contracts. Junior doctors will one day be senior doctors.

Meanwhile, although it was the British Medical Association who were always associated with ‘shroud waving’ – if we don’t get what we want, patients will suffer – this politicking has been taken up by the Department, saying in effect, if doctors don’t do as they are told, patients will suffer.

Add to this evidence that the working conditions of junior (and senior) doctors are such that many have mental health and addiction problems and marital difficulties, and there is the making of a very toxic atmosphere in what has become a game of ‘chicken’.

Doctors traditionally don’t strike, they are there to help and to heal, to be present and to be ’available, affable and able’. Yet, when they feel that new working conditions will seriously compromise patient care, what alternative do they have when government will not listen?

At present, the general public is behind the doctors and their strike action. How much longer will this continue?

And, as Mr Hunt has previously written about the desirability of privatising the NHS, is this all evidence of further dismantling and ‘death by a thousand cuts’?


  • Graham Parsons

    Provided emergency cover is maintained, of course they should strike.

  • Korhomme

    Emergency cover will be provided by seniors in next week’s strike. Were there to be a major incident, I’d expect that all hands would be available, as usual.

  • murdockp

    This is all very peculiar to observe, in particular for a liberal like myself.

    In summary we have a group of people, who are still in training unhappy at their terms and conditions.

    In most other careers if you don’t like the terms and conditions of employment on offer, you leave and secure employment elsewhere.

    Cant understand why the Doctors think they are special? Most will go on to earn over £100k for the rest of their lives, some up to £500k. The other civil service professions such as fire men, police men etc will never earn what doctors earn.

    In my view the general public have totally misled on this, and if the doctors dont like the terms on offer they should resign and get a job they like as there are plenty people who would kill to be on a training programme that can lead to unimaginable wealth for most people.

    The general public have been hoodwinked on this issue and I have zero sympathy for them.

  • murdockp


  • chrisjones2

    Its because the poor dears may have to tend to the sick at the weekends thereby disrupting their social lives. Who do these patients think they are?

  • chrisjones2

    And we should note that this doesnt happen in NI because there is no effective management here , no intention of moving towards a 7 day NHS and a meek acceptance that if you fall seriously at at a weekend you are more likely to die …..and so it will remain until people begin to complain and sue in large numbers

  • murdockp

    next time you hear their leaders interviewed, they are all upper middle class from the best schools in England, if they had difficult part time jobs instead of daddy’s handouts, they would be more thankful for the fantastic training they are receiving.

  • Brian O’Neill

    Hi Patrick, Doctors are voting with their feet. Huge numbers of them are buggering off to Australia etc for more cash and a nicer lifestyle.

    What business would spend over half a million training someone then watch them stroll out the door to another employer? Does not make much sense.

  • Old Mortality

    ‘The other civil service professions such as fire men, police men etc will never earn what doctors earn’
    These occupations are only ‘professional’ in the basic sense that they get paid. However, that it the only sense in which junior doctors can be considered ‘professional’ any longer. They’re just highly skilled ‘health workers’ and are behaving accordingly.

  • Old Mortality

    Indeed, it does not make sense. The only solution is to make them responsible for the entire cost of their training which they can recover according to how much time they give to the NHS.

  • murdockp

    I have no problem with them leaving, however they should have their training fees clawed back if they don’t put in a minimum service period. this is what happens in accounting, law if you leave mid contract.
    Also if society took the Cuban model, they should simply train more doctors, there is no shortage of clever people out there, however the doctors themselves regulate the number of entrants to the profession to keep demand high and supply low for their services.
    The doctors got too good a deal when the NHS was formed allowing them to be public servants and private practioners simultaneously.
    It is about time this was sorted once and for all.

  • Korhomme

    In summary we have a group of people, who are still in training unhappy at their terms and conditions.

    In most other careers if you don’t like the terms and conditions of
    employment on offer, you leave and secure employment elsewhere.

    The NHS is a monopoly employer. There are extremely few opportunities outside the NHS if you wish to continue to practice in the UK.

  • chrisjones2

    ….but they are ENTITLED to it …they are Doctors

  • Korhomme

    The excess deaths for weekend admissions has been used as an excuse for a 7 day NHS by Jeremy Hunt. The cause of the excess deaths isn’t obvious; and an association is not a causation. The political use of this statistic has been widely criticised, not least by the original authors of the academic paper.

    One possible suggestion is that at weekends, most admissions are for emergencies, for there aren’t so many elective (planned) admissions then.

  • Graham Parsons

    Is Maths not one of your strong points?

  • Graham Parsons

    Would you accept worse terms and conditions in your job without a fight?

  • Graham Parsons

    Last time I checked hospitals were open at the weekend.

  • Graham Parsons

    Nothing worse than the smell of envy. The NHS is staffed by doctors and nurses from all over the world most of whom haven’t had handouts. Many new doctors will be paying off student loans for years so nothing to be thankful about either.

    Please continue though.

  • Graham Parsons

    The obvious answer is if it is such an easy well paid job why don’t you study to become a doctor?

  • Graham Parsons

    Doh! They pay for their own student fees. I’m getting the impression you don’t have a clue what you are on about.

  • murdockp

    Nonsense, they do not, the cost of training a doctor can be up to £50k per annum, trainees pay a small portion of these fees and most get NHS support, especially in later years of their training.

  • Graham Parsons

    Post university they do actually work while being trained. Engineering and many other graduates require on the job training following graduation.

  • Graham Parsons

    Or make the NHS a more attractive place for them to work in.

  • murdockp

    Absolutely, I did three years myself before becoming chartered and at no point did I threaten my employer with strike action despite the requirement to work week ends and evenings.

  • whatif1984true

    In all the discussions I have yet to see a clear explanation of the ‘real’ working conditions of Junior Doctors. Are both sides afraid of explaining what they are. I hear that shift working is a total shambles giving a very irregular work pattern. What is a normal month for a doctor, how good/bad are the extremes. I hear that if a colleague is sick or late then doctors must work on. I hear that shift handover is rarely complete at the timetabled time. I hear that doctors will earn less, not once that i can recall have I seen a worked example of how the average junior doctor’s pay will be before and after these new terms. I hear doctors have to pay for their own insurance/exam fees, is this true, how much is it each year. In an average month how many sat/sun days does a doctor work. In an average month how many nights does a doctor work. I hear that A&E shifts/hours are worse than every other Dept. , is this true, how much do they differ? Is it true that a doctor in A&E is paid the same salary, despite these worse shifts, as everyone else. Is it true that all doctors irrespective of their expertise are paid the same salary?
    My thought is that there has been a lot of smoke and mirrors by each side and a remarkable lack of journalistic research/reporting.
    It also seems odd that in such an essential career that there is not an independent body ensuring that contracts are not imposed that strikes are unnecessary. If MPs can have their pay reviewed independently why not doctors, whom we would all regard as many times more essential than an MP and considerably better qualified and experienced for their job than the vast majority of MPs.
    Ultimately there is not an unlimited public purse and I suspect that if you had minimal wage increases but a significant increase in doctor training places to allow for better shifts/hours for existing doctors you might be able to take the poison out of the existing battle.

  • Graham Parsons

    Should have joined a union then.

  • Korhomme

    I can’t answer all your questions. I expect the BMA has circulated details of work patterns etc, but I’m not a member.

    At the same stage after qualifying, all doctors are paid the same basic rate; this covers ‘normal working hours’. There are extra payments for ‘out of hours’ work; how much depends on how many juniors are on a rota.

    In the past, there were yearly pay increments. This is to change; breaks in service will be ‘penalised’. This clearly affects women with children; the equality assessment confirmed that female doctors would be disadvantaged, but thought that it didn’t matter much.

    Doctors (and Dentists) pay is set by an independent pay review body. If the government don’t like the recommendations, they can unilaterally ignore them.

    The new contract is to be ‘cost neutral’ and is also supposed to pay doctors the same as before; this is achieved by an increase of 13.5% on basic pay, but extending the duration of ‘out of hours’. The idea seems to be to make it cheaper to employ more doctors at weekends.

    Hospital doctors don’t pay insurance for their in-work related activities; they may have to pay a bit for extras such as advice. (GPs may have to pay much more.) Doctors are now expected to pay for their exam fees etc; such exams are essential if they want to progress. (I’m not sure if such fees are tax-deductible, as junior doctors are employed and not self-employed.)

  • Jarl Ulfreksfjordr

    Are hours worked on a weekend not part of a normal shift rotation? No other ’emergency service’ attracts enhanced pay rates for working a shift that happens on a Saturday or Sunday anymore than if the working day occurs on any other day of the week.

    In similar fashion overtime worked on any day of the week attracts the same benefit, something like the normal hourly rate plus one third extra paid for each overtime hour worked.

    Increased rates are available for public holiday working, ‘double time’ I believe (2 hours pay for each hour worked).

    Are junior doctors demanding a different settlement than that offered to firefighters, police and paramedics?

  • Zig70

    Doctor should thank their lucky stars I’m not doing their wages. Way to overpaid. Hence the egos. GP’s can get away with referring everything. They are paid more than managers of large companies. Feck in, cheek

  • Zig70

    Doctor should thank their lucky stars I’m not doing their wages. Way to overpaid. Hence the egos. GP’s can get away with referring everything. They are paid more than managers of large companies. Feck in, cheek

  • Graham Parsons

    I’m taking a guess here but I don’t think doctors have to worry about you “doing their wages”

  • Korhomme

    I’m not entirely sure what you mean by a ‘normal shift rotation’. If you mean something like three eight-hour shifts during 24 hours, such as 8am to 4pm, 4pm to midnight and midnight to 8 am, then this isn’t a typical pattern (except in specific circumstances).

    The only true shifts, in this sense, are likely to be found in Intensive Care Units. (I did this long ago; days for a week, then a week of evenings, than a week of nights. I was much younger then, but I was still shattered at the end.)

    Rather doctors in hospitals do a mixture of ‘elective’ and ’emergency’ work. elective work is out-patients, radiology investigations, operations such as for hernias, gallstones and hip replacements. All of this can be planned in advance, it can be ‘managed’.

    Emergencies can happen at any time, though we can expect a flu epidemic in winter, but not which particular weeks; in A&E, Friday and Saturday nights are much busier than, say, Sundays; some planning in expectation is possible.

    But doctors mostly do a mixture of both; elective work in ‘normal’ working hours, during daylight, and emergencies in ‘out of work’ hours. It’s this mixture, done by the same people not another set of workers, that complicates things. (Nurses work more strictly defined shifts; the night shift are different people from the day shift.)

    There’s also a European directive on the maximum numbers of hours that can be worked, taken as an average; doctors may agree to more hours, but cannot (should not) be obliged to do this.

    The UK also has fewer doctors than may other developed countries. See, for example:

  • Korhomme

    doctors themselves regulate the number of entrants to the profession to keep demand high and supply low for their services.

    The numbers of medical students are determined by governmental working parties who base their decisions on the expected future demands (and, we might expect, on the financial resources available).

    There is therefore a ‘numerus clausus’ as the Continentals would say, a limitation on the numbers of potential entrants. Students who apply for many other courses there aren’t subject to this restriction, though their numbers are often markedly eroded by examinations.

  • Jarl Ulfreksfjordr

    All the emergency services react to the ’emergencies’ that are their respective raison d’être whilst providing cover for their version of “elective” work.

    Thus firefighters maintain their fire trucks, visit properties to inspect fire prevention equipment, investigate the causes of suspicious fires etc. When the 999 balloon goes up off they rush to the emergency.

    Police officers manage traffic, patrol crime hotspots, attend pre planned events, and when a bomb goes off, or a major accident happens off they go to deal with it.

    Neither fires or criminal incidents can be planned for, other than having systems in place ready to ensure people can be mobilised when required, they are emergencies after all.

    To cope with their responsibilities the fire and police service have their staff work a shift pattern that provides cover 24/7 and organise to ensure expected incidents are dealt with. The occurrence of a fire, albeit an ’emergency’, is surely not so unusual for the fire service? Imagine the situation if every house fire required firefighters to work overtime.

    Are medical emergencies so off the page that the NHS manages them by having crucial staff deal with them “out of hours”?

    If that is what you are saying then the management of the health service is as inefficient as the worst media stories suggest; and it is probably high time the government does push for restructuring (doctors included).

  • Korhomme

    Surely, the primary role of the fire service is fire fighting and rescue; and the primary role of the police is to keep the Queen’s Peace. Both of these include elective and emergency work, though the balance differs.

    In medicine, there are specialties such as dermatology (skin diseases) where there is almost no emergency work; and others, such as fractures, where almost all the work is emergencies.

    Mostly, during daylight hours, there is far, far more elective work in medicine generally than emergencies, though this can be variable; more staff needed in daytime than out of hours. This could be hard to reconcile with the needs of training, for all junior posts are technically training.

    There’s also the ‘continuity of care’ in medicine, which I don’t see applying in the same way to the other services you mention, whose activities are likely to be much more ‘short-term’.

    What do you mean by ‘off the page’?

  • eireanne3

    correct me if i am wrong – but won’t all senior doctors – hospital registrars and consultant physicians and surgeons be working?

    They will do their utmost to ensure emergencies are attended to though outpatients appointments and check-ups will probably need to be rescheduled

  • John Collins

    Absolutely true and the same applies to doctors from the ROI. i have worked in the HS in the ROI all my working life. Does any of the posters above have any idea of the length, and level of training, put in by somebody training to be a GP or Consultant. Some bright spark above suggested a manager of a company should get a higher salary that a GP. Would this MD have spent about six year being changed from one hospital to another, so as to train in different disciplines, after seven years initial training. I do not think so. Then when in practise one false diagnosis, if the consequences were serious enough, could end in him been struck off the medical register. By contrast senior bank officials, politicians or indeed senior policemen, in different jurisdictions, can walk away with huge lump sums and pensions, after displaying gross incompetence.

  • Korhomme

    Registrars are ‘junior’ doctors. Only consultants, and a few others who aren’t in training, won’t be striking.

    I expect that many hospitals will have to cancel much of their elective work such as outpatients etc.

  • Korhomme

    I asked a colleague who is still in practice whether my summary of the position was accurate. He thought it was, but reminded me of something I should really have mentioned.

    The new contract is felt to discriminate against women doctors, who may have career breaks in order to raise their children. The government had an equality assessment of the new conditions; that said, to paraphrase, that yes there would be inequalities for women doctors but it wasn’t really important. Hmmm.

  • Doctor M

    As a Northern Irish trained junior doctor working in England, I hope I am qualified to contribute to this discussion and give a different perspective. I have trained for five years at medical school (accruing 30k of debt) and eleven years after medical school and am training as a subspecialist. I am a BMA member and will be on strike next week but I can also agree with some of the Government’s arguments.

    Our present contract is complex and dates back to the times of junior doctors working more than 72 hours per week. It was designed to penalise arrangements where doctors were working unsafe hours. It has been successful in that regard. Juniors earn a salary for a 40 hour week and a supplement to reflect the overall amount of hours and intensity beyond that. Currently European law restricts doctors to 48 hours per week in work. This can mean being on call from home for many hours more than this. Presently junior doctors in training earn between £22000-45000 plus a supplement of up to 50% for hours beyond 40.

    Within the current contract, if paid the 50% supplement a doctor could be asked to work every weekend but would still be limited to 48 hours of work. Weekday working would suffer. This will be no different in the new contract unless the total number of hours worker is increased (illegal). This new contract is not about weekend working!!

    The basic salary will rise under the new contract but supplements will fall. Pay progression will reduce. Higher basic salaries will result in higher pension contributions hence lower take home pay.

    Yes, junior doctors pay for GMC fees (£405/year) indemnity (£750 this year, mandated by GMC despite being NHS employed and indemnified, rising steeply every year). Royal College fees (£350/year) out of salaries. My professional exams have cost £2000 in total, paid by me. I have paid to attend numerous training courses in my own time from my own pocket.

    I am very happy that we provide excellent services at the weekend, both in England and NI. We could do some things better. In my soecialty we recently improved weekend access. We see no more emergencies than before but a lot more time is spent dealing with those who don’t have emergencies and could realistically wait until Monday without detriment. This service required an extra doctor to be hired at great expense as all our doctors are working to their hours limits. This would not change under the new contract.

    Nobody goes into medicine for the money, or if they do they soon realise otherwise. Neither do they expect to work 9-5. We have a very rewarding job, but the pressures are growing and we are now a profession at breaking point trying to deliver a world class service on one of the smallest health budgets in the developed world to a public with increasing health needs and a government giving them unrealistic expectations of what can be provided! And yes, the other health professions will be next in the firing line! Staffing costs are the biggest barrier to further private sector involvement in the NHS allowing them to pick off the most profitable parts leaving the public purse to underwrite the expensive unprofitable provision.

    To those above who think it’s all middle class English boys, I find that insulting having led the trainees in my Royal College and having worked in a part time job throughout my medical school training!

    I don’t think doctors are entitled to anything, but I do think that we need to have an attractive package to retain the best, highly trained professionals. The government has chosen to ignore the independent pay review body, or instruct it not to recommend a pay rise, in recent years. As a result the country is now haemorrhaging medical talent.

  • Zig70

    Actually, in a way they do. They are paid from the public purse, then they require public support to make a strike effective. I don’t think they have that. Some of the sob stories show they are out of touch with normal working conditions. The sense of entitlement you get from some of the facebook rants, that’s gotta help.

  • Zig70

    The private doctors wages are higher in the south. Not sure you are right on pay being a barrier to privatisation. From BBC website According to figures from the NHS Employers Organisation, the average total salary for a doctor in training is around £37,000. Not sure that includes extra hours pay. Very generous by any standard.

  • Doctor M

    That figure will include all extra hours payments. Yes we are paid well but my take home pay hasn’t changed much over the past 10 years due to the introduction of 48 hour limits (largely on paper rather than in reality), changes to pension contributions, 10 years of subinflationary or no increase in salary, increases in training fees, the list goes on.

    The key message is that it’s not just about pay. Most of us are happy with our salaries though our peers are in a lot of cases earning much more in other industries. We aren’t happy to see it reduced significantly in a lot of cases but of bigger concern is the reduction in safeguards over hours and rest.

  • Jarl Ulfreksfjordr

    I could expand on the anology between other emergency services and doctors. It is crude but nevertheless effective. For example “specialalties” exist in the other services: fire investigators, fraud investigators, etc

    As for fire and police staffs’ activities being “short-term” the mindset that such an argument is drawn from is flawed. Firefighters and police don’t just sit around waiting for an incident to occur, deal with it and then return to their previous state of rest.

    ‘Off the page’? So unusual that although a possibility a rather remote one. I used the term following what I took from what you posted; that elective work was accomplished within normal hours and emergencies were dealt with out of hours (I’m understanding ‘out of hours’ as ‘overtime’ working).

    The point I was trying to make is that surely an emergency medical incident is to be expected within a hospital full of sick people? That being the case it appears rather strange to me to manage emergency care as an overtime activity.

  • whatif1984true

    Can someone please explain how it costs 100,000 per year (5 year course) to train a doctor. Surely the medical course intake in QUB is 100+ per annum (i am guessing). If each student spends 30? weeks at uni and attends 20? hours of teaching that means that each hour of teaching costs.
    100,000 divided by 30 and again by 20 gives £166 per hour per student.
    Whilst all the students may not attend all lectures/teaching as one body, £166 x 100students gives an average £16,600 cost of a one hour lecture/teaching as an average even if teaching was split into groups of 10 that would still be £1660 per hour.
    I understand the above is very crude but £100,000 x 5 years still seems unlikely to me.
    From a business point of view if the students pay £4000 per year fees then over the 5 years that is £20,000 paid leaving a notional £480,000 funded by someone multiplied by 100 students over 5 years that is £48,000,000 someone is putting into the kitty to train one intake of doctors.
    Journalism on this subject is remarkably poor/nonexistent. Does no one question these figures?

  • whatif1984true

    Thank you. Are the fees/insurance tax allowable ie you do not have to pay them out of taxed income? You say that indemnity rises steeply , can you show how eg year 1 to year 10? Using your figures it means that over a 10 year period from graduation you had costs of about £1600 each year or is that over stating the average of gmc, indemnity, training, RC fees? Does every dr have these expenses or is your specific speciality?
    Will the new contract change your monthly pay?

  • whatif1984true

    It is important as I think women are a very high percentage of new doctors. Is the discrimination a matter of not getting due to age because a part timer has less experience on average?

  • whatif1984true

    There are therefore huge gaps in our understanding of the working life of a Doctor. This will become an extremely emotive topic for everyone as this conflict lengthens.
    It seems some Doctors do work which is close to 9 to 5 whilst others at the extreme of A&E have the maximum out of hours, night shift, weekend, public holiday working. The ones most affected will surely be those in positions like A&E which is the one area Doctors are staying away from and which already has a big shortage of Doctors.

  • Korhomme

    My information comes from the media. Perhaps Doctor M who’s much closer to things than I am could explain. The Indy reported:

    The Department of Health’s Equality Impact Assessment of the controversial new contract, which was published in full this week, found that aspects of the new contract would “impact disproportionately on women”, with particular disadvantages for single mothers.

    However it concluded that on balance the contract was not
    discriminatory and the adverse effects could be “comfortably justified”.

  • Korhomme

    Thanks for that. Could you please explain how the new contract discriminates against women?

  • Korhomme

    I’m not trying to denigrate the Fire and Rescue Service in any way.

    Consider two scenarios; in the first, a fire destroys someone’s house. The Brigade takes a few hours to extinguish the fire. A report may later be necessary, for insurance purposes, and perhaps to inform Building Regulations.

    In the second, someone is admitted with a life-threatening illness. He or she will need initial assessment, special tests such as radiology; and assessment by an anaesthetist; and an operation in a fully staffed theatre; and perhaps a period in intensive care; and recovery in a ward; and, perhaps, the involvement of Social Services to confirm that this someone may go home; and out-patient visits to ensure that all is well.

    I’m suggesting that the inpatient management takes days to weeks, while putting the fire out takes hours.

    See Doctor M’s comment abut how rotas etc are actually organised; you might well get the impression that so much effort is used trying to ensure that rotas are ‘compliant’, effort which could be more productively employed.

  • Theelk11

    Nobody is entitled to anything.
    You work a shift on a Saturday night in A&E then you might be entitled to an opinion on something you clearly know nothing about.
    Of course you are also perfectly entitled to display your jealousy of the medical profession for us all to see.

  • Doctor M

    The new contract discriminates against women and anyone who takes time out of their clinical training for research, teaching, management training etc in that pay progression is based on stage of training rather than seniority. Therefore maternity leave reduces pay progression, as does doing a 3 year research programme.

    There has been a long tradition of junior doctors enhancing their training with research and other activities, producing a well rounded workforce with experiences outside of hospital medicine. This will be lost.

  • Doctor M

    GMC fees, indemnity and Royal college fees are deductible against tax, so the true cost to us is 20 – 40 % less. These will be at least 1000 for every doctor in training but will vary by specialty (Royal College fees). Exam fees have not been tax deductible but a recent test case has ruled that in some cases they might be.

    Indemnity rises steeply with stage of training, I think it starts out about £200 and this year for me was £750. Indemnity has also risen sharply in the last year as the number of claims has risen 20%!

    We’ve been promised no pay reductions as part of the imposition. That also means no pay increase, either inflationary or for seniority. The change in basic pay versus supplements, means an increase in pension contributions of 3.3% for most I.e. Drop in take home pay. For trainees coming behind us the new contract will pay them several thousand pounds less per year with the gap growing over the course of training.

  • Doctor M

    There are about 250 students per year in QUB. I don’t know the exact figures, but those I’ve heard are £250k for five years of training and I can well believe it. From 3rd year onwards the teaching year is 40 weeks. Most medical students will be in university for closer to 30-40 hours, though some of that will be on the wards but not in formal teaching.

    The increasing use of simulation and the cost of medical equipment to train with is driving up costs. Each trust gets a sum of money for hosting medical students and this funds the infrastructure, training of medical staff who teach, loss of clinical activity while staff teach etc. In Belfast at least this is all accounted for.

    Exams are incredibly expensive to run, especially those involving patients. Our Royal college was losing money when charging £850 per candidate for an exam involving two written papers, an oral and a clinical exam with patients. I imagine undergraduate exams cost similar amounts and undergraduates are examined regularly through the course.

  • Korhomme

    Thank you; and for your comments about student numbers etc.

  • Korhomme
  • Docjitters

    It’s not simply the loss of time-in-sevice increments – it’s the disregard of the reality of training as a junior doctor. In my own speciality (Paediatrics), women can make up more than 75% of trainees. Training requires achieving a number of competencies which generally takes 8 years of full-time equivalent work in addition to medical school and 2 years Foundation Training.

    Our Royal College has traditionally been rather understanding that a lot of us might want to go part-time at some stage to raise children. The pay increments help part-time wages keep pace with the increasing costs of living/training and recognises, to an extent, that time in service regardless of exact ‘level’ = experience = more likely to be autonomous (within their range of responsibility) = more efficient doctor = better value for money for the NHS. Those of us who started this training had an expectation of pay and conditions that would remain vaguely stable whilst being bounced around different hospitals (over potentially large geographical areas) every 6 months to a year for this length of time. Unsurprisingly, the same request for a stable cash flow is made by our mortgage lenders and nurseries (who charge more for for extended evenings and weekends, if they are operating at these times at all)…

    Especially hilarious is page 24 of the government Equality Impact Assessment ( ‘…increased rostering of staff in evenings and weekends (as opposed to during day time in the week) may improve conditions for many Doctors working part-time because they may be able to arrange cheaper and more informal childcare arrangements in the evenings and at weekends if they have family support…’ (as if they won’t have lives or a job of their own) ‘…equally in some circumstances it may impact on those with childcare responsibilities who do not have such opportunities, given the higher cost of childcare at those times, and that they may be disproportionately women.’

    The new contract pay calculator also shows those working part-time may get *less* than pro-rata because of how out-of-hours pay will be calculated (rather than e.g. 3 days per week = 3 days/wk plus 3 fifths usual on-call/weekends/nights = 60% full-time pay)

    So the Dept of Health’s Assessment recognises that women
    are most likely to be disproportionately affected by the changes, makes a ludicrous suggestion that trainees could make do with ‘informal’ all-hours childcare but overall that saving money in the short-term is a legitimate override.

    We are already 12.5-20% down on the number of junior doctors needed to fully staff paediatric units in England. The role is generally rather emotive on a daily basis, expectations high and tolerance for uncertainty and mistakes especially low when it comes to kids. To ask this of anyone and then make it financially impractical to have your own family or e.g. look after your own ageing parents is not going to attract or retain anyone.

    DOI: Male trainee, 9th year qualified, who *had* been hoping to go part-time to see his baby daughter grow up before he misses it all…