Caporegime
- Joined
- 8 Jan 2004
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- 32,603
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- Rutland
Primary care is broken, I'd never work as a GP in this country. Can totally understand them wanting change.
Junior Doctors Strikes
- Thread starter Dr House
- Start date
I’m not really sure I get the whole working to rule thing. Since when did it become acceptable to be expected to do unpaid over time? Or even paid over time week in week out.
I’m contacted 37 hours a week and on average I work 37 hours a week. I’m flexible and respond to business need but I also take back any additional time taken from me in that process.
I’m open to doing paid overtime, I’m not at all open to doing unpaid overtime. If my employer wants me to work more than my contracted hours, then I’m afraid they need to pay me, it’s as simple as that.
That paid overtime isn’t also unlimited and often isn’t sustainable for long periods.
If you need a substantial part of your workforce to do overtime every week, then you need a bigger workforce.
I’m contacted 37 hours a week and on average I work 37 hours a week. I’m flexible and respond to business need but I also take back any additional time taken from me in that process.
I’m open to doing paid overtime, I’m not at all open to doing unpaid overtime. If my employer wants me to work more than my contracted hours, then I’m afraid they need to pay me, it’s as simple as that.
That paid overtime isn’t also unlimited and often isn’t sustainable for long periods.
If you need a substantial part of your workforce to do overtime every week, then you need a bigger workforce.
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Soldato
- Joined
- 23 May 2006
- Posts
- 7,927
i care about the people I support in my job as well... but I am not paid enough to routinely have to go beyond my paid for hours.
now and then, sure.... but I won't let work take the ..... too much
At some point you have to say I can’t do more without having an adverse effect on the patient safety. As a profession we have been saying it for more than a decade, and desperately taken on more in an attempt to meet demands, but the reality is this has had risks to patient safety and has burnt out many hard working doctors.
I don’t know what the government can do to try and fix this complex issue, but shouting about it has done nothing, so drawing a line in the sand is the only option as essentially we have been complicit with their disinvestment by just doing more.
The plan is to drop down to safer levels of work. Not to not work. As patients you need to consider this actually being in your own interests
But they are paid.
The issue with this is nearly every GP I know works part time. They typically do 2 - 3 days a week. I'm sure you will have a similar experience of knowing a lot of part timers.
It was also the BMA that limited the number of doctors that could be trained so they've made the rod for their own back because they wanted to keep salaries inflated and are now complaining about the logical outcome of that.
They aren’t paid for overtime. My day as a GP partner is around 11-12 hours on average. It used to be I got home at about 6 o’clock like many workers, but over the last decade this has built up to being 8pm I leave the building before my commute. The only reason I now see my kids at bedtime is because they have grown up and are older and don’t go to bed as early. Throughout most of their lives I didn’t see them in the mornings before going to work, or before they were asleep other than my days off.
Our contract offers an all you can eat buffet as far as NHSE is concerned for a little over £100 per head.
I know a lot of part timers. They work more hours however than most people consider full time. Is that really part time? I do 8 clinical sessions a week. That’s 4 days. Am I a part timer when I do perhaps 48 hours on those days and then other work on my ‘day off’ for running the business?
100%.
I'd go further than that, and say people who work additional hours for nothing are devaluing themselves.
The only thing with the line of work though, say you are a paramedic, treating some serious injury, and watch says 5pm, I'm off now good luck.
It's a mess.
Is a vase that's been smashed into tiny pieces but then gaffer taped together really broken?
There appears to be many reasons why such a system has fallen apart, and for someone that isn't in the industry and only sees it from the outside they appear to be, in no particular order:
Funding
Population increases
Population demographic changes (people living longer with more complex needs)
Restrictions on training new GPs
Part time working on NHS contracts. Other days private.
Increase in people living unhealthy lifestyles.
Just off the top of my head.
I think people do exceptionally well considering, but everyone has limits. It appears a change of government is about a good a time as any to scream out for more help.
A part time GP working 3 days a week still works more hours than a typical 5 day "full time" worker. And with far greater intensity. And an extreme level of clinical risk.
Depends on your definition. But if a service is not there for people 'full time' then it would almost certainly be thought of as part time and it would make sense that longer days are worked to cover it.
I've noted you have commented on the BMA essentially being the main cause of this utter crapfest btw!
If they are doing that, why the hell aren't they put on a full time contract?
Why would you? Salaried GPs get paid on a sessional basis. 1 Session (an AM or PM session) per week for a year gives you about £10k. A 3 day a week GP will work 6 sessions, and they're responsible for all the work in that time so it'll frequently stretch to a 12ish hour day.
That's just how the contract works.
I would suggest that we perhaps also need to really look at the reason the NHS is falling to pieces under the load and not just from a capacity point of view. Perhaps we need some drastic action to try and stop the rot and reduce the massive burden the population puts on it.
The majority of people are unhealthy and a huge number of people are overweight. When you see the size of the backlog its astonishing. Humans shouldn't be this fragile. People shouldn't be requiring constant medical treatment. Its only going in one direction and as far as I can tell, we are doing absolutely **** all to try and fix the root issue. We have an ever aging and increasingly unfit population who expect ever better and more expensive care. Something has to give and we can't just train more doctors.
The majority of people are unhealthy and a huge number of people are overweight. When you see the size of the backlog its astonishing. Humans shouldn't be this fragile. People shouldn't be requiring constant medical treatment. Its only going in one direction and as far as I can tell, we are doing absolutely **** all to try and fix the root issue. We have an ever aging and increasingly unfit population who expect ever better and more expensive care. Something has to give and we can't just train more doctors.
Do they then "rest" for the other 2 days of the week, or take on other work?
Only reason I ask, is that I personally seek out condensed working not similar to the above as I like to have more unbroken free time, rather than more money.
Soldato
- Joined
- 23 May 2006
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- 7,927
i know it isnt directly related to strike but our GP has a tickertape which resets each month with the number of missed appointment.
You are allowed to cancel an appointment at any point up until just before you are due, so these missed appointments are literally just those people who didnt show up. I accept there will be the odd missed one due to a brain fail... not ideal, but it happens, but the numbers are stupidly high.
given how hard it is to get to see a doctor where i am it cheeses me off no end (our town is infamous in the area for being more broken than most)....... personally i would be ok having to pay a fee to book an appointment which is then refunded when you turn up - or discounted from any medication you need to take.
this clearly would not fix the state of our GPs, but it would be 1 less nail in their coffin imo.
You are allowed to cancel an appointment at any point up until just before you are due, so these missed appointments are literally just those people who didnt show up. I accept there will be the odd missed one due to a brain fail... not ideal, but it happens, but the numbers are stupidly high.
given how hard it is to get to see a doctor where i am it cheeses me off no end (our town is infamous in the area for being more broken than most)....... personally i would be ok having to pay a fee to book an appointment which is then refunded when you turn up - or discounted from any medication you need to take.
this clearly would not fix the state of our GPs, but it would be 1 less nail in their coffin imo.
After 3 10-12 hour days, I don’t know about you but I’d be up for 4 days of rest.
3 10-12 hour days for £60k isn’t even that great of a salary either if you consider the context of the academic requirements (inc student debt), training (initial and ongoing), registration costs, responsibilities, professional risk and personal risk.
Indeed, and if you'd read and understood my post that is what I prefer. (edit: I currently work 14 days/nights a month on a rota, averaging 37 hours a week for context. I can take PAID overtime if it's available)
£60k isn't their salary. That's what they are paid for taking on those sessions as Minato described above. They are free to take that and then have 4 days off a week, or offer up their skills elsewhere for extra funds as they please.
Would GPs take a full-time 37/40 hour a week (5 day week) contract at say £100k per year for example?
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They do a variety of things, it's a very heterogenous group. Some will have childcare responsibilities. Some will do management work e.g. at LMC/PCN/CCG/Trust Board level. Some will take on extra work elsewhere as locums, at other practices, out of hours services, in hospitals. Some will teach at universities. Some will be doing research or public health work. And some will probably be playing video games or gardening in their underwear.
You can't offer a 37/40 hour a week contract for 5 days because it just doesn't work like that. The volume and intensity of the work on working days means you have to work for a number of hours outside of 9-5 to keep patients safe. If you get 100 blood results back, they can't clock off at 5 and put up an out of office message. There could be time critical abnormal results there that need to be acted on. So the nature of the work lends itself to a sessional basis, where you see your patients for the session/day, and action everything about them e.g. scans, tests, referrals.