Doctors and the 7 Day Week

There is general lack of doctors ranging across the profession with respect to both General Practitioners and Hospital Consultants in some fields. The real difficulty is that although a national shortage, some areas of the country are suffering from massive under staffing. For example, in my area Stoke-On-Trent, there is a significant lack of GP's as it's just not seen an attractive area to come to train or study whilst where I trained in Birmingham partnerships don't come around very often and it's incredibly competitive. It's widely accepted that doctors will tend not to move very far from where they trained in medical school so some areas of the country will suffer more than others, most notably Scotland and the South West are particularly bad.

Medicine isn't easy (either as a trainee or qualified). If the government want doctors and trainees then they need to make it an attractive career. Money isn't the driving force for the vast vast majority of doctors but nonetheless they do a demanding degree and job and as should be rewarded with fair pay and conditions.
 
There's no denying that there are doctors, nurses, consultants, anesthetists, radiographers, pharmacists, etc working at the weekends. But what you can't say is that the NHS operates at the same level over weekends (including those extended by public holidays) as it does Monday-Friday. And I'm not talking clerical, I mean medical.

That is what is meant by a 7 day NHS.
 
WillyNelson said:
There's no denying that there are doctors, nurses, consultants, anesthetists, radiographers, pharmacists, etc working at the weekends. But what you can't say is that the NHS operates at the same level over weekends (including those extended by public holidays) as it does Monday-Friday. And I'm not talking clerical, I mean medical.

That is what is meant by a 7 day NHS.
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Agreed. Its only a "skeleton" staff on a weekend and causes unecessary costs.

My gf snapped both her tendons the other year. Ambulance to local hospital in London(she was away on business) and casts put on with a referral letter to her local hospital. I picked her up and drove her to Darlington.

Arrived 9 am. Got seen. got seen by junior doctors boss, then senior boss, then students. The broke the casts and each one had a feel as nobody beleived that she had snapped both tendons as its unheard of depiste her having a letter from the other hospital stating that. They decide to have a CAT scan to make sure so she was left in a ward all day while she waited on her scan (in a lot of pain). Roll of 5pm when doctor doing his rounds, ask him about scan and he new nothing about it. Went to check and came back and said she hadnt been booked in at the scan and they have gone home and so has all the cast people so they couldn't recast her till Monday and she would have to stay in the bed all weekend. Thats a stupid waste of money when until she came into the hospital with casts on she was fine to be at home.
 
I think it's really unfortunate when you hear cases such as the above but any 7 day system would have to also include everybody else that works in the NHS including secretarial roles, catering, porters etc otherwise it just wouldn't work. This will take resources away from the weekdays and just mean you have a less effective system spread over 7 days. It doesn't have the funding to hire enough staff at all levels for 7 day cover.

Emergency and acute care services already have high standards 7 days a week.
 
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shadow_boxer said:
I think it's really unfortunate when you hear cases such as the above but any 7 day system would have to also include everybody else that works in the NHS including secretarial roles, catering, porters etc otherwise it just wouldn't work. This will take resources away from the weekdays and just mean you have a less effective system spread over 7 days. It doesn't have the funding to hire enough staff at all levels for 7 day cover.

Emergency and acute care services already have high standards 7 days a week.
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As I ahve said, this must come at a cost. And that should mean more taxes. Its okay to say we want/need a 7 day NHS but if thats what people want then they need to pay.
 
SuperG said:
There is a lack of GP's but not due to recruitment process. Many graduates from medicine, who once after had experience in hospitals turn to GP practices for work. Many women in medicine change their career path to become a GP because of the more favorable hours.

If they want to claim a shortage of GP's then this is definitely due to owners of the GP offices. They will decide how they want to manage their finances and how many GP physicians to take on.
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The lack of GPs are very much due to recruitment problems. as I mentioned earlier only 51% of the training places in my locality were filled for GP training, because young doctors are choosing not to go into GP training. You also have a significant amount who do their GP training with the intention of working abroad. Why do you think that is? The working conditions have become toxic in GP land and young doctors are well aware of this. There are many practices busily failing because they have been unable to attract new GPs and have to rely on locum to run a service. If they don't they will be in breech of contract and the business fails as their contract is removed, and if they do continue to use locums long term they are financially unviable. You also show a lack of understanding by stating medical graduates who had experience of hospital turn to GP practices for work. It is a separate specialty. All GPs will have had experience in hospital and much of their training is in hospital in a number of fields. You cant suddenly become a GP on graduation.
 
Greebo said:
As I ahve said, this must come at a cost. And that should mean more taxes. Its okay to say we want/need a 7 day NHS but if thats what people want then they need to pay.
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Lol, the NHS is more or less 20-30£B in the hole, a VAT increase by 4% would cover it... :p.

...for a while as it's a never ending need for more money.
 
I guess i'm lucky in my town i can get an appointment within 2 weeks if i'm picky of the time and day, or within 8 hours if i'm not.

If people stopped running to the doctors every time they get a blocked nose it'd help, you should only be going if it knocks you down for a week, employers need to note this as opposed to following the policy of 'omgyouroffsickforadaygetmeadoctorsnote!!', and people need to stop abusing sick leave to allow that to happen. Same goes for a&e, only go if you're likely to be dead or nearly dead by the time you could get to a doctor.


Of course everything i just said wont happen, because of how humanity works, but it would fix things. The important bit of the nhs still (thank god) works on weekends as that letter shows.
 
adolf hamster said:
I guess i'm lucky in my town i can get an appointment within 2 weeks if i'm picky of the time and day, or within 8 hours if i'm not.

If people stopped running to the doctors every time they get a blocked nose it'd help, you should only be going if it knocks you down for a week, employers need to note this as opposed to following the policy of 'omgyouroffsickforadaygetmeadoctorsnote!!', and people need to stop abusing sick leave to allow that to happen. Same goes for a&e, only go if you're likely to be dead or nearly dead by the time you could get to a doctor.


Of course everything i just said wont happen, because of how humanity works, but it would fix things. The important bit of the nhs still (thank god) works on weekends as that letter shows.
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This is why it should cost money to see the doctor at a GP. Personally i have a problem with my foot, my shoulder, my jaw and my nose and i have rashes behind my ears and some teeth problems. I am sure many people are very similar in having a whole list of problems. I bet a lot of people like me never go to the GP about most of these issues because they don't have the time. Some GP have a limit about the amount of problems people can bring up. Of course when GP is free it is going to result in a situation where there is not enough supply. This is like anything that becomes free. As the doctors have so much work they keep asking for more money and use this more work to justify the higher salaries. These higher salaries eventually lead to the problem where it is not possible to hire more GP to reduce the demand that is justifying the higher salaries. Creating a 3 week wait for appointments and often a reduction in standards. This will manifest by making new roles at lower pay brackets that do the same thing but not as well. People being sick and having health problems is a given, it is a constant demand. This is why it needs to have a price.

I have suggested it before, even if they kept free specialist and emergency hospital care but added a fee (ideally based on the competency of the doctor, but even a fixed fee like subscriptions would be better than free) to the GP that would generate more income for the GP and also work as an incentive for the GP to see more patients, it would fix all the imbalances. Plus we could still benefit from the NHS in the form of free health care.
 
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Nights and weekends are rubbish, but this is part of the job. I would be a dermatologist or pathologist if I didn't fancy doing them. Not that either are particularly easy specialties to get into. Scrapping banding might simplify things, and might actually cut down on pay disputes and confusion, but I can't see how this would be put into effect without a pay cut of some kind. Getting rid of the pay scale is also rubbish and won't recognise experience in the workplace. A first year registrar is still on the same on call rota as a very senior registrar who is about to be a consultant. Paying them the same rate makes little sense as the senior trainee will see more patients and run the service more efficiently and require less supervision from the consultant minute to minute.

These are small points compared to opting out of emergency work though. I think this will just encourage a huge number of consultants to take early retirement and potentially drain vast amounts of experience from the system. Acute specialties won't be opting out of emergency work as soon as they become consultants, however I can't imagine anyone wanting to be on a full rota past age 60 - I certainly don't want to be on an on call rota at age 68, I don't think I'd want a 68 year old surgeon operating on me in an emergency.

Jeremy Hunt's words weren't well chosen, I don't disagree with all his points though. I can see how making consultants work electively at weekends would potentially cut waiting times and utilise facilities which lay dormant at the weekend, but the point which has been stressed over and over is that they need the support from a large team to effectively deliver this. Please don't suggest that we're not highly motivated professionals though.

PikeyPriest - where do you work? I'm a general surgical trainee in the West Midlands.
 
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That restructuring of antisocial hours to not include evenings and Saturdays will result in significant paycuts though I would expect.

I can understand expanding the weekend services, I'm not sure everyone being seen by a consultant will make a magical difference, but having access to ultrasound and MRI would. I haven't done adult medicine for years, the weekend service wasn't great but neither was night or even evening cover.

RCPCHs plan for this is to shorten training by 3 years and make everyone a consultant earlier. You'll still be seen by the same person but now the registrar is called a consultant and JH is happy.
 
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That's they way they want it though the illusion of a service. You have health care assistants taking observations they have not the ability to interpret - I've seen plenty of HCA's see obs reasonably within normal ranges but the pattern was worrying eg Cushing's Triad and yet they didn't recognise that, nurses organising care they don't have the depth of knowledge (usually) outside their specific area of focus to decide, and doctors being exposed to autonomous practice far too early.

The problem is there is not the support for what they want both in terms of finance, staff or even beds. It's quite simple really.

I genuinely feel sorry for you lot. Just do the sensible thing and show your country the same devotion and loyalty it showed you when you've done your stretch: http://bma.org.uk/developing-your-career/career-progression/working-abroad/canada
 
A two tier consultancy is just wrong. You are either fit and qualified to consult in your specialty, or you are not. There has already been a shift in the way the on call service for general surgery runs in that a registrar sees all the admissions regardless. Previously an SHO would have done. I'm all for more senior decision making, but do we really need a consultant on the shop floor at all hours in every hospital? Seems like an expensive way to run things. Looking at it another way, how will we train junior doctors if all the decision making is taken away from them? I was quite lucky to have some autonomy as a senior SHO which prepared me a little bit for stepping up (still a hell of a shock!), but now the SHOs barely see patients independently. Our entire system of training relies on direct experience with some degree of autonomy and independent practice. The whole training system would need to change if that was taken away from all but the consultants.

I love the UK, but I'm very tempted to get my CCT and emigrate to Canada! Will try a fellowship first I think.
 
I agree I've always been of the opinion and what I encouraged was that people had to learn from their own decisions. Let's face it it's not like the senior nursing staff are going to let anything stray far from normality is it - be ringing up behind your back in no time! You can't hand hold people all the time or they will never develop the skills they need to make a decision, own that decisions, follow it through and then evaluate it's efficacy.

I agree there doesn't need to be a consultant on the shop floor at all times. In many ways it makes people less efficient. There always needs to be a consultant to bounce ideas off and ask for input from and that is available. Some specialities you do need that input physically more than others but yet again that is already available.
 
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