Junior Doctors Strikes

[Minstadave]

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.

I thought there was a cap:

https://commonslibrary.parliament.uk/research-briefings/cbp-9735/

Medical school numbers have been pretty flat at about 7k ish for atleast a decade:

The expansion of medical student numbers | Medical Schools Council

www.medschools.ac.uk

 

[heeeed]

There is a limit that each medical school can train, but that isn’t based on BMA. They have no power. I think if you read the arguments in the link you put up it’s also a bit disingenuous to say it was only about negatively affecting pay also.

 

[Minstadave]

There is a limit that each medical school can train, but that isn’t based on BMA. They have no power. I think if you read the arguments in the link you put up it’s also a bit disingenuous to say it was only about negatively affecting pay also.

Currently there are not enough jobs being funded for the cohort coming in.

Training more doctors is pointless if we won't pay them to work when they qualify.

There's a decent number for FY1s going into posts created last minute with no out of hours work to keep costs down. These aren't daft people, they'll just leave to other countries.

 

[Minstadave]

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.

This is true.

We have a shortage of GPs compared to what our population needs.

However, because of stupid schemes like ARRS, practices are not hiring the GPs available (admittedly these are predominantly locums and not cheap, but rates are not what they once were) and instead hiring PAs/ANPs/AHPs/pharmacists and any other bugger who fancies a go at being a GP.

So now we have a shortage of GPs, the locum GPs are leaving for steady incomes elsewhere and the new GPs that are being trained are then leaving too.

 

[tres]

This is true.

We have a shortage of GPs compared to what our population needs.

However, because of stupid schemes like ARRS, practices are not hiring the GPs available (admittedly these are predominantly locums and not cheap, but rates are not what they once were) and instead hiring PAs/ANPs/AHPs/pharmacists and any other bugger who fancies a go at being a GP.

So now we have a shortage of GPs, the locum GPs are leaving for steady incomes elsewhere and the new GPs that are being trained are then leaving too.

Good news, ARRS will now include GPs (I believe)

 

[Minstadave]

Good news, ARRS will now include GPs (I believe)

Only a small proportion of ARRS can be used but better than zero.

 

[tom_nieto]

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

One other side to this is that there aren’t enough foundation doctor jobs for all the current UK medical graduates. You can’t be fully licenced with the GMC without completing that year. I’m not sure it would be worth going through 6 years of university (fun as it was) without a guaranteed placement/job at the end of it.

 

[heeeed]

Only a small proportion of ARRS can be used but better than zero.

The ARRS money is also spent. A PCN would have to make someone else redundant to be able to then employ someone. There isn’t new money

 

[Minstadave]

The ARRS money is also spent. A PCN would have to make someone else redundant to be able to then employ someone. There isn’t new money

They added 82 million so GPs could be hired without the poor PAs losing work. The other 1.4 billion is still being wasted.

So they've not really changed ARRS, just made some extra available for 1000 GPs.

 

[b0rn2sk8]

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

It's capped by the amount of money the government is willing to put into it because it is subsidised in a addition to normal student finance.

 

[arknor]

GPs now...

Why do they do the "only 1 ailment per appointment"

I don't think I've ever taken more than 5 minutes of my 10 minute slot.

if people could discuss as many issues as the 10 minute allows then maybe that would free up appointments and also spot health problems before they begin to eat NHS time on a regular basis due to being left untreated

 

[heeeed]

GPs now...

Why do they do the "only 1 ailment per appointment"

I don't think I've ever taken more than 5 minutes of my 10 minute slot.

if people could discuss as many issues as the 10 minute allows then maybe that would free up appointments and also spot health problems before they begin to eat NHS time on a regular basis due to being left untreated

1) nobody ever has a clue how long 10 mins is (clue: its not vey long)
2) your 10 mins is the interval between the appointments. So there is your time to get from waiting room, sit down, have your history taken, any examination, formulate a plan, issue any medication, arrange any tests, write it all up and then next persons brief notes looked at and called in. That’s a lot to do in 10 mins
3) if you try squeeze more in the at least 1 of several things happen. You go way over 10 mins which makes everyone after you grumpy at the GP. You get 1 think done properly, and a cursory glance at something else, or you get multiple things half done which either means you are back again another time, or things are missed and it’s clinically riskier. Would you like me to properly assess your heart pain? Or do it a little bit, whilst talking about your fungal nail, and how to exercise your sore leg, and that you’ve been feeling down also?

Presuming that you would hold the GP accountable for any errors that happen because you’ve shoe horned multiple things into 1 small slot it’s understandable that they don’t want to do it

4) nobody ever has a clue how long 10 minutes is

 

[chrcoluk]

The problem with the 1 ailment thing is multiple ailments when looked at together might give better treatment, as various conditions e.g. have have multiple symptoms. It is also I think less efficient to do 1 appointment per ailment, as ultimately that patient is going to be ringing up again for another appointment for the other ailment.

 

[Werewolf]

1) nobody ever has a clue how long 10 mins is (clue: its not vey long)
2) your 10 mins is the interval between the appointments. So there is your time to get from waiting room, sit down, have your history taken, any examination, formulate a plan, issue any medication, arrange any tests, write it all up and then next persons brief notes looked at and called in. That’s a lot to do in 10 mins
3) if you try squeeze more in the at least 1 of several things happen. You go way over 10 mins which makes everyone after you grumpy at the GP. You get 1 think done properly, and a cursory glance at something else, or you get multiple things half done which either means you are back again another time, or things are missed and it’s clinically riskier. Would you like me to properly assess your heart pain? Or do it a little bit, whilst talking about your fungal nail, and how to exercise your sore leg, and that you’ve been feeling down also?

Presuming that you would hold the GP accountable for any errors that happen because you’ve shoe horned multiple things into 1 small slot it’s understandable that they don’t want to do it

4) nobody ever has a clue how long 10 minutes is

Yup

10 minutes sounds "a lot" to some people, right up until they've actually tried to explain a problem and answer some questions with a GP about anything at all complicated.

When my mum was ill with Alzheimer's the GP we were seeing for her was great, and every appointment to check how my mum was doing/deal with any medical issues she'd always give us a note to give to the receptionist basically saying "I want this patient to have a double appointment with me in X weeks" specifically because the doctor knew how long it could take to deal with my mother and that it wasn't something "simple" like a throat infection so a double appointment gave the time to deal with it and not always get behind schedule.

Going back a year or so my dad had an appointment, IIRC it tied the GP up for about 20+ minutes as she ended up writing a note for A&E telling them to admit him and his observations/history etc (we were in for about 10 minutes then waited for about 15 for the letter). IIRC this was during one of the strike and there were delays for ambulances, otherwise I suspect she'd have had him taken in by ambulance (as it was he got put in resuss for about 12 hours whilst they got his heart rate down and a bed on a ward).

IIRC at one point our GP had 15 minutes slots, but that's going back a long time.

 

[heeeed]

I agree there are benefits in getting multiple things done in 1 appointment. The problem is there is no way to know beforehand if needed from the surgery side. Some patients will book double appointments knowing they have a lot of things which helps, but most people don’t and just assume they can get it all done. You can often manage it, but it’s one of those things that stretches a broken system that little bit thinner again.
The system is a long way from perfect and there are nowhere near enough doctors to provide what people want, nor would there be the funding for them if you could pluck them from thin air.

How would you feel if asked to get 3 units of whatever you do for a job in 1 unit of work time? How about if you were asked to do that 32 times in a day?

 

[Werewolf]

The problem with the 1 ailment thing is multiple ailments when looked at together might give better treatment, as various conditions e.g. have have multiple symptoms. It is also I think less efficient to do 1 appointment per ailment, as ultimately that patient is going to be ringing up again for another appointment for the other ailment.

I suspect the GP's will deal with more than one if they're probably linked, but they won't usually deal with say your acute throat infection and your chronic knee problem that is needing another scan at the same appointment unless they're either running ahead, or it's able to be done quickly.

I've tended to find most of the GP's will ask "anything else" and either try and sort it there if they think it's easy or linked, or ask to book another appointment.

Mind you it possibly helps I've inherited my dad's philosophy when it comes to medical appointments, "get there early" as it means if they're running fast/someone hasn't turned up they'll often call you in early and possibly spend a little more time.

 

[chrcoluk]

I do think we need to get rid of the targets that started the "only can book same day" nonsense, I would much rather have an appointment in 3 months time compared to ringing every day and being told "nothing available" for weeks on end.

 

[heeeed]

I’m not sure it’s the targets as such tbh. We personally run a blend of options. We have bookable up to 4 weeks in advance. Some only book able in advance with a doctor say so, some urgent on the day and some embargoed for all bookings but open up a few days ahead so can be semi urgent or if not used add to the urgent on the day.

The models of telephone or online triage on day or massive queues of “you’ll be called at some point today” are all just ways for demand management and it’s a symptom of things being too busy

 

[Minstadave]

GPs now...

Why do they do the "only 1 ailment per appointment"

I don't think I've ever taken more than 5 minutes of my 10 minute slot.

if people could discuss as many issues as the 10 minute allows then maybe that would free up appointments and also spot health problems before they begin to eat NHS time on a regular basis due to being left untreated

You dont have your 10 minutes, thats just the spacing between appointments. Some people will have 1 problem that takes 45 minutes or more to sort and other problems are quick. Just because one patient has a quick problem sorted in 5 mins means there is time going free.

Its crap, but that's the current state of GP.

 

[Nevakonaza]

Doctors definitely don't get paid enough considering the hours and responsibilities.

While I agree to a certain extent, They chosen this path.
Imo anything to do with Healthcare you're in it for the joy of helping people get better, If its purely for the money they are in the wrong job.

These junior doctors certainly didn't mind standing out protesting while their patients had to have their surgery's/Treatments cancelled, Often ones that people had waited years for and was quite urgent...these are the ones who are clearly not in the roles for the right reasons.

Same with already established Doctors, They've become very lazy since Covid.