Doctors and the 7 Day Week

[Xordium]

No, a 7 day service isn't in place. My gran spent 6 months in hospital over Christmas, weekends there were plenty of nurses and junior doctors, but no consultants. For 6 months. That is atrocious. She always had to wait until a Monday to be properly seen after any scares at the weekend.

Oh, and shift patterns. No need to work 7 days, work 5 and overlap people..

There would have been a consultant on call. I've never seen any ward where there isn't consultant cover over the weekend or the night - never. This country or others. Not once.

Once again people seem to overlook the fact there is the amount of people with the skillset to actual cover. Unless you are willing to pay for that across the board what you are asking is impossible.

Most anaesthetists and surgeons spend years developing a narrow skillset of expertise in specific things. That is what they do - everyone else leaves them to that because they get enough practice as it to keep their skills up. You stop that you dilute the skills and you increase the chance of adverse incidents. You also have to remember that if you was to perform surgery 7 days a week for routine operations you would have to increase the intensive care and high dependency provision accordingly. There is not the staff there to actually support what we have at the moment let alone increase.

 

[heeeed]

The fact that we are having the discussion shows how bad the problem is xordium. The politicians will end with a lot of public support as on the very surface it sounds appealing to the electorate, and also sounds safer. Those who work, or have worked in the service now how the reality is very different

 

[anything I don't mind]

I think you've got your notion of cause and effect wrong. If GPs are so underworked and overpaid relative to other medical specialties, why then, can they not find enough trainees to fill all their training posts? 1 in 3 to 1 in 4 remain unfilled the last time i heard.

Gp staff are overpaid and overworked. I think we should differentiate between gp and hospital staff. They are not the same. Hospital staff already work on weekends as far as I understand it. Its the gp staff that are never open and don't work weekends. Do nurses in hospitals work more than 40 hours a week excluding overtime? I know its shift work buy not sure if they get days off?

If they cant find people to do the job then hey should look at the barriers to entry and the fact that the work is none stop because its free there is never ending demand from the customer/patient side.

Surgeons should not have to work weekends in my opinion because it is an advanded skill and in the private sector they would be setting their own employment terms because their skill is in such a demand. Compared to a gp nurse or doctor who have it easy at the moment in terms of what their value would be in a free market.

 

[estebanrey]

I think the point she made was that for similar money she could have forgone 5 years at university with all it's associated debts, not have to work nightshifts, 12+ shifts, on call duty, or have responsiblity for the care of some very sick people.

Surely a large part of being in the medical profession is the genuine desire to help people? If her point is that she and her colleagues are only doing it because they drew up a cost/benefit analysis in sixth-form and it seemed like a sweet deal at the time, I'd say we have bigger issues attracting the right people than nit-picking over working hours.

 

[balky12]

The point was people don't know if the actual care is good or not they don't have the capacity to make that judgement ...

Just don't bitch if you or your dearest get ill and the service isn't there for you. The service these days is pretty poor I've seen it.

It's a bloody good job you are here. Guess everyone is unable to make up their own minds from their experiences. What would all of us do here if we didn't have you telling us what to think.

As for the personal attacks; bit of a stretch. I said you sounded jolly.

Just don't bitch if you or your dearest get ill

And the well off who think they can solve it by going private lol

Can you blame me?

I'm glad life is fine for you, but at least cheer up then?

 

[Greebo]

This brings back memories of the "conversation" between my gf and the local gp in the pub one night where he was kicking off about having to work 50 hours a week (albeit for £100k per annum) and my vet gf was working more hours and 1 in 3 weekends plus night cover of 2 nights a week for £40k per annum.

 

[Minstadave]

Surely a large part of being in the medical profession is the genuine desire to help people? If her point is that she and her colleagues are only doing it because they drew up a cost/benefit analysis in sixth-form and it seemed like a sweet deal at the time, I'd say we have bigger issues attracting the right people than nit-picking over working hours.

No one does medicine for the money period. There's far easier ways to make money if you're bright enough to do medicine.

The wage should reflect the crappy hours, stress, risk, responsibility and level of training. It should also be enough to keep doctors in the country and in the profession.

 

[Minstadave]

This brings back memories of the "conversation" between my gf and the local gp in the pub one night where he was kicking off about having to work 50 hours a week (albeit for £100k per annum) and my vet gf was working more hours and 1 in 3 weekends plus night cover of 2 nights a week for £40k per annum.

How senior a vet is your GF? A GP on 100k is at the top of their career in a partnership and has taken on the running of the business and risk associated with it.

No disrespect to vets but it's a totally different ball game.

 

[Xordium]

Guess everyone is unable to make up their own minds from their experiences.

Which was my point. The layman is able to make up their mind that their experience was good but will miss out whether their experience was suitably effective.

I note you didn't actually bother addressing any of my points and carried on with the personal connotation.

 

[Greebo]

How senior a vet is your GF? A GP on 100k is at the top of their career in a partnership and has taken on the running of the business and risk associated with it.

No disrespect to vets but it's a totally different ball game.

To be fair, even if you ahev reached the top of your career as a vet and are a partner then you dont get paid as much as a doctor or gp. Equally you will never earn as much as vet as been a dentist.

But she isnt a vet for money reasons, its a vocation. And not sure it is a totally different ball game. Okay its an animals life vs a persons life but thats it. In fact Vets have a much higher suicide rate than doctors mainly due to the stress and pressure of the job. And dont get me started on the timed when she has worked 36 hrs solid. GP's have a great life IMO and want their cake and eat it.

But GP's, even employed ones, seem to gripe and moan about hours worked and its almost impossible to get a gp to come do a home visit out of hours now.

 

[Minstadave]

Home visits are very practice dependant, my wife's practice does loads for utter tosh, mainly because the old folk quite like the doctor popping in like the good old days or or people don't want to pay for a bus/taxi.

Home visits are incredibly inefficient, a GP can see 6-8 patients in an hour in the practice but 1-2 an hour doing visits depending on travel time doing visits. That's why many practices will try to cut them down.

 

[Xordium]

GP visits at home out of hours is not a efficient utilisation of resources in the vast majority of cases. If you are that ill you can't physically get yourself to a walkin centre then really you need to be assessed at an actually centre attached to an A+E in my opinion. If you aren't that ill you don't need the GP at home.

 

[PikeyPriest]

To give some idea of what the work load and rotas are like ill give some comments from my perspective (early years surgical registrar).

Average days are meant to be 8-5. Usually that means being in from 7:20 to consent for operating days or 7:45 if its MDT. Finish time in reality varies. If its clinic you tend to finish on time, but theaters days vary enormously depending on specialty. I`m on breast surgery at the moment and due to the backlog of cancer work our lists are overbooked so we tend to finish anything from 6:30-7:30, though have finished after 9 before.

Oncall wise I`m on a 1:10 rota, which means over a year:
-25 to 32 oncall weekdays (monday to friday) 8am-8pm but then have to handover to night team so usually get away 9pm
- 5 or 6 weekends 8am - 8pm as above
-35 to 42 night shifts 8pm - 8am again, getting away anything from 8:45 until 9:30. (to put this in perspective the tube drivers are striking as they may have to work up to 14 night shifts in a year and worry of the impact it will have on their family life)

I can only speak from the surgical side, but on weekends I see every single surgical patient in the hospital on a saturday and sunday, getting the consultant to review if required. Consultants usually cover 12pm friday until 12pm monday, which makes their workload incredibly varied. Some weekends they do a ward round and stay in their office until the afternoon if nothing is happening. Equally they can operate all night on a saturday, do a ward round sunday and still be operating on a sunday, but vary dependent on what patients present.

The proposals put forward basically want to cover the following:
1) `Social` hours extended so that any shift that finishes by 10pm at night is viewed as normal hours rather than anti-social (not sure if it is 7 or 8 at the moment).
2) Any saturday working between 8am-10pm will be classed as normal social hours with no higher rate of pay
3) Scrapping of banding while increasing base pay (though they wont give any value on what the new pay will be, but it is very likely to be lower as pension contributions come from our base pay, so will mean unless they increase our pay, we will get a pay cut). Pensions wise this is on the back of 2 pension contributions increases in 5 years.

My problem with the proposals:
1) Jeremy Hunt is using the emotive factors of weekend mortality to argue the case for the change. The workload in medicine and surgery is not uniform over the week and this makes comparing admissions very difficult. In a weekday I can see 20 GP and A&E referrals with minor ailments and discharge most the same or next day. On a weekend we get far fewer GP referrals, but those we see tend to by more unwell as people otherwise tend to wait until a weekday appointment. Throw in the effect of services not being accessible at weekend from hospice/nursing home on call doctors..etc and it's easy to get a higher mortality population in. This effect of increased mortality at weekend is seen internationally, even in the US with its large private health care budget. So is it fair to put the blame at not enough doctors being in hospital?

2) There are times during oncalls that you do get stretched with sick patients and emergency operating. I've not worked at a hospital who's surgical department hasn't felt that we should still try to have more cover to deliver a better service at weekends so that these difficult periods don't interfere with patient care. But Jeremy Hunt's changes aren't about giving a 2nd surgical SHO oncall or Registrar for busy units, its about running additional clinics and elective (non-urgent) operations. I fail to see how having a urology, breast and hernia list take place on a saturday will help me deal with a sick patient in A&E resus. All it will do is place a larger burden on the already skeletal oncall team in terms of dealing with any issues or complications. What we really need is better access to radiology, OT/Physios, pharmacists (to reduce drug errors), porters (so we dont wait 60 minutes for someone to go for a scan or have to waste time taking patients ourselves) so that we can make faster diagnoses and get patient mobilising and home after surgery on the weekend it appropriate.

3) If consultant A and his registrar do a list of hernias/gallbladders/bowel resection..etc on a saturday, who will then review the patients the next day? Either the consultant has to come in on their day off, or leave it to the oncall registrar destroying any kind of continuity of care. If you work a saturday and then get the monday off, who will then review the patients on the monday? This idea that working on a saturday will give better overall continuity of care has lots of holes. It's common to see consultants at the weekend reviewing their patients if they have had any major operation and if there is a post-op problem, they will come in to see them and operate if required even if they aren't oncall.

4) I feel I already work a lot of anti-social hours that make attending family, friend events and seeing my fiance difficult. I dont feel that changing our contracts without any discussion is a fair way to go about any such change either. No one will also say how many saturdays we will be required to work, but if saturday is `normal social` hours then technically we could be told to work as many as is asked. Trying to take leave at present is a nightmare of juggling oncall shifts with colleagues so that theatre lists and clinics are covered and this will only get worse with more weekend working.

From the above I`m not convinced saturday working will help the people its `meant` to help in anyway and will be at the expense of worsening what is already a poor work/life balance for many hospital doctors.

*edit* wow, wall of text im afraid. Been oncall last night, so I`ll apologise in advance for any spelling/grammer mistakes.
Also, "I've never met a poor doctor" - what a stupid comment to make. I've not met a poor lawyer or architect either. It's not really shocking that a profession with high entrance requirements that demands high unsocial hours with the need for further audits, research and courses in your free time pays well.

 

[Greebo]

There is such a huge differential now between medical staff in hospitals and GPs though.

My local GP offers no out of hours surgery or doctors on call. Its ring 111 after 6pm.

They work open a maximum of 8 till 6 Mon to Friday (and even then each doctor doesnt work those full hours). That then puts pressure on the local A&E as basically after 6pm at night or at weekends its off to the hospital.

On the other hand hospital doctors seem hugely overworked already. Junior doctors doing 80 hr weeks (exempt from WTD) which nobody would stand for in any other profession esp for the meagre wages paid.

So if people want 7 day a week cover its going to cost to pay for extra staff to cover on a rota basis.

 

[tamzzy]

Gp staff are overpaid and overworked. I think we should differentiate between gp and hospital staff. They are not the same. Hospital staff already work on weekends as far as I understand it. Its the gp staff that are never open and don't work weekends. Do nurses in hospitals work more than 40 hours a week excluding overtime? I know its shift work buy not sure if they get days off?

If they cant find people to do the job then hey should look at the barriers to entry and the fact that the work is none stop because its free there is never ending demand from the customer/patient side.

Surgeons should not have to work weekends in my opinion because it is an advanded skill and in the private sector they would be setting their own employment terms because their skill is in such a demand. Compared to a gp nurse or doctor who have it easy at the moment in terms of what their value would be in a free market.

nurses in hospital are contracted to work 37.5hours a week (ie 3 full shifts), on top of that, they can choose to work bank shifts to top up their income

i dunno. an average GP receives £136 per patient they cover. is that a lot? i'm pretty sure your (as in, your in general, not you) pet insurance costs more than that.

some GPs do work weekends and nights. it's called GP out-of-hours (or whatever it's called in your area).
and this is what happens when a weekend service is rolled out - http://www.thetimes.co.uk/tto/health/news/article4467897.ece - not many people attend

Surely a large part of being in the medical profession is the genuine desire to help people? If her point is that she and her colleagues are only doing it because they drew up a cost/benefit analysis in sixth-form and it seemed like a sweet deal at the time, I'd say we have bigger issues attracting the right people than nit-picking over working hours.

well so having a vocation and profession means paying doctors peanuts? so should ocuk sell stuff at cost because they are a group of overclocking enthusiasts?
i know what you're going to say: ocuk are a business - its different. but not really.
it's like walking into their shop and saying: you have to sell me stuff cheap because you like overclocking and so do i. - doesn't quite make sense

and besides, its not about the working hours. it's the so-called health secretary calling the doctors unprofessional and blocking change to a "7 day NHS". most doctors already do this and most doctors support this.

don't forget having senior cover means you need the infrastructure to support this. ie: having porters to move the patients, having radiographers to operate the scanners, radiologists to interpret these scans, interventions by their respective departments, phyisotherapists, occupational therapists, social workers, discharge nurses, pharmacists, social care that works weekends to facilitate these discharges.

it's like saying: i want a bigger army. so i'll get more generals, but no more soldiers. doesn't quite make sense right?

the question is - if you want more cover, how is the state going to fund it?
a) forcing your current workforce to work longer, more unsociable hours? oh right, so much for patient safety then, eh? and what about staff being, gasp, actually human and having a family/social life outside work?
b) have a pay cut to try and hire more? but then who in their right mind would join an industry which is high intensity, notorious for burn out, has a high propensity for mistakes due to overwork and can land one in jail/criminal record/struck off?
c) privatise
d) a+b +/- c = gg

 

[Xordium]

It's not even about funding it's about whether the capacity skillwise is there to support it no matter how much money you chuck at it. The simple fact is the skills are not held in sufficient people to actually make it work. People are treating consultants like the end game when really that is when you just continue on learning with a degree of independence and exploring what you can really do. This is the overlooked factor. People seem to think that if you create extra posts then they can be filled and even if they are then that won't have negative consequences. Skilled nurses and radiographers can't just be just bought in that takes years of training.

 

[Minstadave]

They work open a maximum of 8 till 6 Mon to Friday (and even then each doctor doesnt work those full hours). That then puts pressure on the local A&E as basically after 6pm at night or at weekends its off to the hospital.

It's not off to hospital, it's off to the out of hours GP or walk in centre. The country doesn't need hundreds of GPs on call out of hours, it's wasteful.

 

[Minstadave]

It's more the non clinical risks compared they take on outside the clinical work, you have to hire and fire, deal with disgruntled employees, property maintenance, financial management, you have achieve performance targets and manage your IT infrastructure. You even have to get up if the fire alarm goes off at nights, stupid things like that.

Being a GP partner is becoming a nightmare, I know several partners who have given up and have gone back to being salaried GPs.

 

[Greebo]

It's not off to hospital, it's off to the out of hours GP or walk in centre. The country doesn't need hundreds of GPs on call out of hours, it's wasteful.

There isnt that option where i live. If you go to the NHS website the nearest WIC is the local hospital.

Like i said the official out of hours for the local surgery is ring 111 or 999.

 

[Greebo]

It's more the non clinical risks compared they take on outside the clinical work, you have to hire and fire, deal with disgruntled employees, property maintenance, financial management, you have achieve performance targets and manage your IT infrastructure. You even have to get up if the fire alarm goes off at nights, stupid things like that.

Being a GP partner is becoming a nightmare, I know several partners who have given up and have gone back to being salaried GPs.

So same as any small business then????