Junior Doctors Strikes

[Minato]

The charts comparing earnings are also disingenuous as the "baseline" is a combination of all earnings. So the fact that the top few % of earners in the public sector have seen massive pay increases over the past 15 years while the rest of us worker bees have barely kept our heads above water is handily ignored.

I would suggest that the main things we should be doing for Junior doctors is essentially giving them the offered pay rise and removing any debt burden they have accrued throughout their training... as long as they continue to work in the NHS. ie. you could reduce the amount owed by £10k / year of work or something along those lines. That alone is a not insignificant effective pay increase and honestly, working in medicine shouldn't saddle you with debt.

Both sides of this debate are cherry picking statistics and numbers that suit their arguments. I would love to see how much the average salary has decreased in real terms if you took out all the top earners and the finance sector. I think it would be eye opening.

With the greatest of respect, it's equally disingenuous to compare doctors pay with the "average salary". Doctors, top city lawyers, bankers, FAANG tech employees, dentists, judges, actuaries etc are not average workers. The argument that because Dave that got a U in GCSE maths or Becky that has an Level 2 NVQ in health and beauty aren't getting paid fantastically, so top-tier professionals should suffer poor pay equally is nonsensical.

And when you compare like for like, as per the social contract that I alluded to above, doctors pay has always been a step behind but comparable to equivalent level professions. Until the complete decoupling over the last decade.

 

[b0rn2sk8]

Hes not suggesting that, hes suggesting that people from the UK are using the UK system to get trained and then they go off abroad to earn far more.

The irony is that they don’t escape their student debt, their higher wages means they actually repay it back and much faster.

You're correct. The only issue is that bonuses are not guaranteed whereas wages and employer pension contributions are. Not sure how that could be taken into account though.



In terms of the private sector, the first one (pension) is nonexistent as well so there is that.

Sure if you work in a low end job it may be but not in an equivalent professional role.

Point taken on bonuses but you’d have to look at averages, again in equivalent professional roles.

No ones saying they need to get the same increase every year but over the course of a decade they should roughly land in the same place on the growth graph.

 

[Minato]

You do also have to factor in that as a doctor you have basically 100% job security….

I'm afraid this is no longer true. There is a massive issue with unemployment currently across several levels in the NHS.
Hundreds of newly graduated doctors were left without jobs, as the posts hadn't been funded.
And many GPs are also paradoxically struggling to find jobs due to another hare brained Tory scheme called ARRS, where every staff group EXCEPT GPs can get funded.
Finally, due to aforementioned influx of international medical graduates, many doctors are unsuccessful in getting into specialty training posts and are struggling to find year-long jobs in ther interim.

https://www.pulsetoday.co.uk/views/dr-burnt-out/not-enough-gps-thousands-of-us-are-now-unemployed/

Unemployed GPs on Teesside 'turning to charities' for help

A representative of GPs on Teesside says unemployed doctors need help paying their bills.

www.bbc.co.uk

Behind-scenes NHS problems leave new doctors without jobs

The NHS needs more doctors so why have some medical students been left in limbo waiting for a job?

www.bbc.co.uk

 

[Richie]

No ones saying they need to get the same increase every year but over the course of a decade they should roughly land in the same place on the growth graph.

no one wants to see their wages eroded and I have some empathy for people that do. However, that being said, rejection of a 22% increase is just ridiculous.

@Minato - if you are ok to state (I understand if you don't) - how much does this proposed increase mean to you in gross pay and employer pension contributions (in pounds and pennies terms)

 

[fez]

With the greatest of respect, it's equally disingenuous to compare doctors pay with the "average salary". Doctors, top city lawyers, bankers, FAANG tech employees, dentists, judges, actuaries etc are not average workers. The argument that because Dave that got a U in GCSE maths or Becky that has an Level 2 NVQ in health and beauty aren't getting paid fantastically, so top-tier professionals should suffer poor pay equally is nonsensical.

And when you compare like for like, as per the social contract that I alluded to above, doctors pay has always been a step behind but comparable to equivalent level professions. Until the complete decoupling over the last decade.

Its also disingenuous to compare it with the top earners in other fields because they are paid that much due to the ridiculous money those industries make. There are a huge number of insanely smart people in research and academia earning **** all due to the lack on money in those areas. FAANG is also a good example as they get paid very well because they are raking it in. Software developers on the whole in this country don't earn that well vs a lot of other highly paid professions. Its just a small subset do. Its just another example of the growing gap between the have and the have nots and the common factor is those at the very top are eating very well at the expense of those lower down.

I think the difference is that while doctors pay hasn't kept pace, those other industries have taken off in value. Public healthcare isn't an industry that generates money so its never going to do well by comparison.

Out of interest, what do you think would stop someone disappearing off to Aus etc? If they are getting paid over double UK wages, what would change their minds?

 

[Mr Jack]

I agree but why are you laying the sole blame of the "divide and conquer" approach with the private sector? Doesn't it take 2 to tango?

I've never seen anyone in the public sector trying to argue that private sector pensions should be worse. Moreover, this entire digression began because of the false claim above that private sector wages had also got worse in the time period under discussion and that's true regardless of whether you try and drag differences in public and private sector pensions into the argument.

 

[Minato]

no one wants to see their wages eroded and I have some empathy for people that do. However, that being said, rejection of a 22% increase is just ridiculous.

@Minato - if you are ok to state (I understand if you don't) - how much does this proposed increase mean to you in gross pay and employer pension contributions (in pounds and pennies terms)

I'm ST5 currently (6 years medical school, 2 years FY, 5 years as a specialist, 2 years out of training, 1 in a world leading hospital in the USA, 1 in Australia). Total 15 years of training.

So the new element of this deal takes me from ~£57.5k to £62k. My employee pension contributes will increase to the highest band now, from 10.3% to 12.5%, so I give some of that back automatically. If pay had kept up with inflation since 2008, it should be £77.8k. For reference, just under a decade ago when I was much more junior and not specialised, I earned ~£100k working in Australia for a year with better T&Cs, quality of life, and better hours.

Out of interest, what do you think would stop someone disappearing off to Aus etc? If they are getting paid over double UK wages, what would change their minds?

Far fewer people used to go to Australia etc when I was starting out because the disparity in pay, and also in working conditions was far less.

We used to deliver much better quality healthcare in the past, before austerity and the underfunding. You didn't feel as constrained, defeated, or demoralised by the system as you do nowadays.

People are less willing to uproot their lives to the other side of the world for a 40-50% increase in salary, if they are satisfied in their jobs and working conditions, and feel they're reasonably paid here based on the cost of living. But if they get treated like dirt here, made to move jobs up and down the country every few months without any choice, get paid less than their assistants, and the pay disparity is well over double, in some cases triple/quadruple, and those other countries offer you permanent residency the day you step off the plane...yeah people will keep going.

 

[Richie]

I'm ST5 currently (6 years medical school, 2 years FY, 5 years as a specialist, 2 years out of training, 1 in a world leading hospital in the USA, 1 in Australia). Total 15 years of training.

So the new element of this deal takes me from ~£57.5k to £62k. My employee pension contributes will increase to the highest band now, from 10.3% to 12.5%, so I give some of that back automatically.

What about the employer pension contributions. A poster in here stated it went from circa 14% to circa 23% since 2019.

Rough calculations puts this at an additional £6,300 going into your pension. Does this seem correct?

If pay had kept up with inflation since 2008, it should be £77.8k. For reference, just under a decade ago when I was much more junior and not specialised, I earned ~£100k working in Australia for a year with better T&Cs, quality of life, and better hours.

I assume there was a good reason to come back then? Visa reasons?

 

[jpaul]

And here's some more data from the Financial Times explaining why this is a problem and this deal doesn't go far enough. And why anyone still parroting the "we've all had it hard" line has their head in the sand.

as the Times article also says V so pay is not so important , half a red herring.

But while an improved salary will surely help, the role of pay in the NHS’s retention problem is often overstated. When a cohort of doctors who recently left the UK were asked what had prompted them to go, they were about twice as likely to point to workplace culture, burnout and stress as to financial reasons. This is corroborated by NHS data, which shows that the huge increase in voluntary resignations over the past two years has been driven by people citing problems with their work-life balance

moreover though(& FT doesn't even mention) , native english speaking contribute to dissimilarity between emigrates from UK versus other countries ie. why people go to Australia in spades - because they can
as gmc report survey shows V
I wonder how many remain there permanently(hmmh), but maybe we should just incorporate the uk economic cost into trade negotiations.

 

[Minato]

What about the employer pension contributions. A poster in here stated it went from circa 14% to circa 23% since 2019.

Rough calculations puts this at an additional £6,300 going into your pension. Does this seem correct?




I assume there was a good reason to come back then? Visa reasons?

Re: Pensions I'm not sure. It's a DB scheme, so every year whatever my pensionable salary is for that year, 1/54th of that is taken and added to my "pot". The 12.5% deducted from my salary each month is the cost of membership of the scheme. Each year the pot gets re-evaluated by inflation + 1.5%. So e.g. if I earn £54k pensionable per year, my pot grows by £1k. That £1k will increase by a certain % (I think average 2.5-3%) each year until retirement. I don't quite know where employer contributions comes into it, because it's not a defined contribution scheme like private sector pensions.

I came back because my life, family, and friends are all here and at that time the pay and conditions differential wasn't expected to be anywhere near as bad as it is now.

 

[One More Solo]

where costs of living are more expensive, evens most of that if not all of it out.

Not necessarily, and many doctors would happily have their disposable income eroded if the trade off is better working conditions.

Separately, the poster above makes an excellent point around pay restoration. Unless the government commits to a long term plan this issue will rear its head again before the end of the current parliament even if the current deal is agreed. I expect many junior doctors would vote for a worse package now if the trade off is restoration over time. That makes more sense for the country too.

 

[b0rn2sk8]

The employer contribution is an accounting equivalent of what difference they are ‘making up’ over the employee contribution. It’s not a real contribution because public sector pensions are paid out of tax recipes - there is not ‘pot’ that’s invested.

Because there is no pot and its defined benefit scheme, you also don’t get any flexible drawdown. It’s a tax free lump sum plus annuity only or annuity only.

 

[Minstadave]

The employer contribution is an accounting equivalent of what difference they are ‘making up’ over the employee contribution. It’s not a real contribution because public sector pensions are paid out of tax recipes - there is not ‘pot’ that’s invested.

Because there is no pot and its defined benefit scheme, you also don’t get any flexible drawdown. It’s a tax free lump sum plus annuity only or annuity only.

Exactly, employer contribution is just make believe for the individual.

 

[Richie]

The employer contribution is an accounting equivalent of what difference they are ‘making up’ over the employee contribution. It’s not a real contribution because public sector pensions are paid out of tax recipes - there is not ‘pot’ that’s invested.

Because there is no pot and its defined benefit scheme, you also don’t get any flexible drawdown. It’s a tax free lump sum plus annuity only or annuity only.

Exactly, employer contribution is just make believe for the individual.

It's really not though. Why bother stating employer contributions on payslips if it's just make believe?

I hope we are not really going to try and remove pensions from the discussion on public sector pay because, it being quite a large benefit that they receive, it is inconvenient to the "poorly paid public sector workers" argument?

 

[heeeed]

Public sector pensions have also diminished in their value significantly in the last couple of decades also….. I’m not convinced that they therefore help the argument that public sector situation is all that rosey.

As a GP partner I have to pay employer and employee contributions. It’s a very large number for a worse pension than it used to be

 

[b0rn2sk8]

It's really not though. Why bother stating employer contributions on payslips if it's just make believe?

I hope we are not really going to try and remove pensions from the discussion on public sector pay because, it being quite a large benefit that they receive, it is inconvenient to the "poorly paid public sector workers" argument?

I never said it was made up, I just said it was the accounting equivalent. E.g. explained what that number was because it’s a defined benefit scheme which is complete different to a normal pension scheme.

I also haven’t made the argument that pensions should be removed from the conversation either. The opposite actually. All I said is that the employer isn’t paying 2X% into a special pot when they pay their employee, it’s effectively an IOU for a later date.

What I do t actually know is how they have come to that 2X% and I need to understand what it is before I can pass judgement on whether it’s the reality or not.

Public sector pensions have also been eroded significantly also. While they are still defined benefit, the terms are not some gold plated pension you perceive them to be.

So the TLDR is that your response to my post isn’t responding to the points I wrote and infers things which were not there.

Edit: defunded benefit is probably the reality but I meant defined benefit

 

[Minato]

It's really not though. Why bother stating employer contributions on payslips if it's just make believe?

I've never had employer contributions on any NHS Payslip, ever. It's only ever shown my employee contribution (ie the scheme membership fee).

 

[b0rn2sk8]

So I figured I would do the work to find out where the 23% comes from.

Employer contributions and administration levy​

The employer contribution rate from 1 April 2024 is 23.7 per cent of pensionable pay. This is an increase from the previous rate of 20.6 per cent, in place for the period 1 April 2019 to 31 March 2024.

The employer contribution rate is set through a process known as the scheme valuation. A scheme valuation is usually carried out every four years and it measures the full cost of paying pension benefits (to current pensioners). The most recent 2020 scheme valuation identified the need to increase the employer contribution from 1 April 2024.

NHS Pension Scheme - employer contributions from April 2024

Details of the contribution rate payable by employers in the NHS Pension Scheme from 1 April 2024.

www.nhsemployers.org

So in essence, it’s not an employer contribution for existing employees, it’s the % of their pay budget which is being paid to those claiming their pension. Those will be the gold plated ones which people keep talking about, not what the current employees will get.

Here is the report from the last valuation from when it went from 20% to 23%. I’ve not read this.

https://www.nhsbsa.nhs.uk/sites/default/files/2024-04/NHS%20Pension%20Scheme%20Valuation%20Report%202020.pdf

 

[BUDFORCE]

Country is in such a state.

 

[Semple]

Putting it bluntly I think the public need to be asked do you want a world-class healthcare system in the UK - if you do, then it needs to be paid for. If we don't want to pay for it, then we lose all our world class doctors and our healthcare will resemble something like Armenia/Estonia.

Either that or we'll move closer to the US style healthcare systems where doctors/consultants will do majority of their work private paid for by insurance or the wealthy.