Junior Doctors Strikes

[Fubsy]

@Minato I'm not saying they should clock off at 5.

My industry is 24/7. If the GP is required to be working from 0600-2200 for example, then have shifts. Some work early, some work late. Employ more GPs. It's possible - it's about funding and incentives to make that possible - if it's offered and not taken, then what can be done?

However, I actually like that GPs have the freedom to do what you describe above.

 

[Minato]

@Minato I'm not saying they should clock off at 5.

My industry is 24/7. If the GP is required to be working from 0600-2200 for example, then have shifts. Some work early, some work late. Employ more GPs. It's possible - it's about funding and incentives to make that possible - if it's offered and not taken, then what can be done?

However, I actually like that GPs have the freedom to do what you describe above.

In the universe where funding is increased to make that possible, then yes we can do a lot of fantastic things and really transform the healthcare service.

Unfortunately we're in the universe where practices are forced to hire an unqualified and dangerous physician's assistant and make them work as a pretend doctor because their salary is free (paid for by a ring fenced government pot), as opposed to an actual doctor that they'd have to pay from the practice budget.

 

[Fubsy]

In the universe where funding is increased to make that possible, then yes we can do a lot of fantastic things and really transform the healthcare service.

Unfortunately we're in the universe where practices are forced to hire an unqualified and dangerous physician's assistant and make them work as a pretend doctor because their salary is free (paid for by a ring fenced government pot), as opposed to an actual doctor that they'd have to pay from the practice budget.

They are not forced, they are incentivised to do this because "opposed to an actual doctor that they'd have to pay from the practice budget."

As always, money makes the world go round, or not in this case.

 

[Minstadave]

@Minato Employ more GPs.

The previous Gov actually discouraged employing GPs and promoted noctors, leaving many struggling to find work.

There was an announcement today that a small amount of ARRS money could now be used to employ doctors.

 

[Fubsy]

The previous Gov actually discouraged employing GPs and left many struggling to find work.

I know this. Just blaming the bloody Tories all the time doesn't magically make it all better.

Practices have been incentivised to not spend their money on GPs but on 'cheaper'* alternatives to plug gaps in care coverage. This is some weird way of trying to find efficiency savings where it shouldn't be. The GP is for GPs, maybe nurses - so they should be staffed by GPs ffs.

*in the long run, I don't think it is as mistakes will happen and further cost at hospitals incurred.

 

[Dis86]

The previous Gov actually discouraged employing GPs and promoted noctors, leaving many struggling to find work.

There was an announcement today that a small amount of ARRS money could now be used to employ doctors.

The problem is though that we are still not training enough.

 

[heeeed]

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.

I don’t know of any that are taking on extra work outside of their main role. There are a couple over our patch who have managerial roles in a portfolio to the ICB, however they are all doing less clinical sessions, but your standard GP isn’t doing other stuff other than recovering to rinse and repeat

 

[fez]

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.

I know its very un-PC to say it but there is a massive link between the quality of an area and peoples behaviour when it comes to public services. The people who don't bother to show up for appointments will also be the first complaining about the state of the NHS and whose fault it is. Hint, its not theirs, no sir.

There would also be an outcry from the bleeding hearts telling us that this unfairly targets the poorest of society. Nope, it targets the people who give least ***** about society. Everyone has phones. Everyone can set reminders. My GP sends out reminders by text. If you can't make it, just call, it takes 30s.

I'm just sick of all the issues we have and none of the solutions are related to addressing the core problem. Its always treatment rather than prevention. No expectations or consequences on the individual. Its always someone else to blame.

 

[Minstadave]

The problem is though that we are still not training enough.

We train loads, many of them leave immediately after completing training for Canada/Aus.

 

[arknor]

I know its very un-PC to say it but there is a massive link between the quality of an area and peoples behaviour when it comes to public services. The people who don't bother to show up for appointments will also be the first complaining about the state of the NHS and whose fault it is. Hint, its not theirs, no sir.

Was just at my GP in a poor area, loads of refugees/2nd/3rd gen brits

5732 minutes wasted during the last year by non attendance
according to a sign on the wall.

I'm not sure if it's up to date though, might have been put during covid period cos the number rings a bell like deja vu.



I was in my Dentists the other day, someone phoned up with teeth ache.

the receptionist said
"You've had 2 cancellations so you aren't on our books anymore as far as we are concerned"


MAybe GP's should do the same but 3 strikes..

 

[bigmike20vt]

We train loads, many of them leave immediately after completing training for Canada/Aus.

I am not sure how it works so pardon my ignorance but surely the answer there should be to offer "free " training but with some form of lock in period where they have to work in the NHS for a set number of hours before they can leave....... or if they really do want to leave they have to cover all of their would be training fees etc along with a penalty fee on top..

and then make sure that only a certain percentage of would be doctors / nurses are self funded, that way essentially making sure we at least get a minimum amount of productivity out of the staff we train.

 

[Dis86]

I am not sure how it works so pardon my ignorance but surely the answer there should be to offer "free " training but with some form of lock in period where they have to work in the NHS for a set number of hours before they can leave....... or if they really do want to leave they have to cover all of their would be training fees etc along with a penalty fee on top..

and then make sure that only a certain percentage of would be doctors / nurses are self funded, that way essentially making sure we at least get a minimum amount of productivity out of the staff we train.

Pretty much what every business I've ever worked for has as a clause. Typically 5 years or you pay back the training cost with it decreasing per year.

 

[chrcoluk]

The previous Gov actually discouraged employing GPs and promoted noctors, leaving many struggling to find work.

There was an announcement today that a small amount of ARRS money could now be used to employ doctors.

Seen a video of a unemployed GP, was asking Sunak a question about the problem of replacing GPs with less qualified staff.

So interestingly it seems it may not be as simple as a GP shortage as this GP couldnt find work.

 

[heeeed]

Seen a video of a unemployed GP, was asking Sunak a question about the problem of replacing GPs with less qualified staff.

So interestingly it seems it may not be as simple as a GP shortage as this GP couldnt find work.

There still is a massive shortage of GPs overall. The problem is the sticky plaster approach (or deliberate attempt to torpedo depending on how cynical you are) from the last government when they were proving they couldn’t recruit and retain enough to maintain the service we had was to offer other healthcare professionals instead. These were funded via a different mechanism that strictly prohibited using the money for GPs. All of the funding has gone via a mechanism outside of proper funding of practices. Because the funding has dropped there is no money to hire new staff for a practice and therefore they don’t and you get the ridiculous situation that there are GPs unemployed when even if they all had jobs there would not be enough of them

I think everyone is aware of the rampant inflation of the last couple of years which put increase costs on a GP practice like any other business. This year practices were offered 1.9% uplift, and the previous 5 years they got 2.1%. This didn’t even get close to covering the increased costs let alone allow pay rises for our staff. Normal businesses will charge their customers more, we can’t do that. We have our contracts imposed on us every year, and due to clauses in it even when we are in dispute and say it’s not fair and adequate for the work they simply say tough that’s what you get.

The only way we have as a business to survive is therefore to cut our costs and therefore do less. Last year my income dropped 17% (not ‘allowing for inflation’ an actual drop) due to inflation costs and the perverse way that the same government that gave me a 2.1% uplift was also able to mandate that I give my staff between a 5-6% pay rise depending on their roles, because we employ our staff on good terms with model contracts for our GPs and agenda for change for all others. They all got their pay rises and as a guy in his late 40’s I had to borrow money from my parents for the first time since being a student to pay my tax bill. The good news is that this next coming tax bill will be a lot less than normal due to my pay cut! I have increased the sessions I work now to make personal finances work and when we had a salaried leave after having a baby we haven’t replaced her.

GP practices have been going bust for years now. We actually took one over locally 5 years ago because it was essentially on fire and we had no option.

This isn’t caused by the BMA @Dis86. I have no love for the BMA, but I recently joined it again for the first time since being a student just so I could vote and have my say on this ballot as NHSE simply hasn’t listened for nearly all my working life as a GP

 

[Dis86]

@heeeed so you don't think the BMA voting to restrict the number of people that can be trained is a contributing factor?

 

[heeeed]

When have they restricted training? I don’t believe they have that power anyway. They vote on all sorts of nonsense proposals as a trade union when they have their conference, that doesn’t make it a policy for government. Do you think the government listen to them on that and ignore everything else? Also when they did vote and I did a quick google was 2008. The situation is very different now. We weren’t haemorrhaging doctors to other countries or choosing to drop out of medicine in the same way then as we are now. It was also around the time of the MTAS debacle where doctors couldn’t get training posts after qualification and there was worry that more students would worsen that situation (this was another short sited work force planning issue back then that caused this issue) It was a long way from a unanimous vote anyway.

As said I haven’t been a member since student days. It’s the government that has caused this, and the government need to look at some potential solutions

 

[Dis86]

2008. They feared that by increasing the number of students trained it would negatively impact income. They also voted against new medical schools. They've never voted to lift the cap since.

BMA meeting: Doctors vote to limit number of medical students

Delegates at the annual BMA conference voted by a narrow majority to restrict the number of places at medical schools to avoid “overproduction of doctors with limited career opportunities.” They also agreed on a complete ban on opening new medical schools. David Sochart, from Manchester and...

www.bmj.com

 

[Minato]

2008. They feared that by increasing the number of students trained it would negatively impact income. They also voted against new medical schools. They've never voted to lift the cap since.

BMA meeting: Doctors vote to limit number of medical students

Delegates at the annual BMA conference voted by a narrow majority to restrict the number of places at medical schools to avoid “overproduction of doctors with limited career opportunities.” They also agreed on a complete ban on opening new medical schools. David Sochart, from Manchester and...

www.bmj.com

There is no cap.
Medical school numbers have increased hugely.
The numbers of doctors being trained has increased hugely.
It's concerning as they're opening medical schools at ex polys now and all sorts of riffraff are getting places with A and B grades rather than straight A*s. Quality is dropping.

If the BMA are somehow restricting numbers, they're doing a very poor job and need to work harder.

 

[msmalls74]

y

 

[Dis86]

There is no cap.
Medical school numbers have increased hugely.
The numbers of doctors being trained has increased hugely.
It's concerning as they're opening medical schools at ex polys now and all sorts of riffraff are getting places with A and B grades rather than straight A*s. Quality is dropping.

If the BMA are somehow restricting numbers, they're doing a very poor job and need to work harder.

Got a citation in there not being a cap as literally every source I can find says there is. It was raised during covid but reinstated again afterwards.

Government defends medical student number cap

Competition is fierce for doctor training places, but ministers say limit on numbers must stay.

www.bbc.co.uk