NHS Rant

[tamzzy]

pray, tell, how much should us, servants doctors earn then?

my on-call shifts are 1 in 2 (ie 7 12.5h day shifts and 7 12.5h night shifts every 4 weeks) in addition to my normal 8-5 working days to make up the rest.
this is my pay slip for reference.
£26.37/h gross pay.

this is me after working 6 years, and as a medical registrar covering ~450 patients during on-calls, granted, with (up to, not always guaranteed due to rota gaps) 3 other more junior medical doctors.

 

[Dis86]

Unlimited access to higher rate paid overtime? Don't know you're born son!

 

[tamzzy]

Unlimited access to higher rate paid overtime? Don't know you're born son!

let me google that for you...

 

[Dis86]

let me google that for you...

Is that overtime at a higher rate than basic pay?

 

[tamzzy]

Is that overtime at a higher rate than basic pay?

that's agency rates aka bank shifts aka locum shifts.
over and above the EWTD 48h/wk limit already contracted to work.
and legal limit of 56h/wk ie an extra 8h/wk if one chooses to do an extra shift.

here's the amount of gaps there are for the next 10 or so days for just the acute medical take (one speciality)...
oh did i mention. this is just 1 hospital...

 

[shadow_boxer]

This is hilarious. Let's have a dig a greedy junior doctors and blame them for sucking the money out the NHS and it's systemic failures. Of course, they chose to do medicine so shouldn't be paid well and should all be doing it out of the goodness of their heart. Not as if they have families, mortgages and £60k+ of student loans to pay off! If my local mechanic charges labour rate of £70 per hour I'd be pretty chuffed but God forbid an A&E registrar asking for that for looking after everything that gets chucked into A&E, overnight, away from his family, medical defence costs and threat of criminal prosecution for an honest mistake. (That's as a locum picking up Rota gaps not their basic pay). No doubt doctors get paid well and why shouldn't they. I can't imagine many doctors go into medicine thinking about earnings.

 

[Minstadave]

let me google that for you...

These aren’t the new September London caps are they, they might actually be lower?

£42.50 an hour for a registrar! Hold my beer son, I’m off to work! We just about fill SpR Paeds shifts for £65 and hour currently but even then I had to act down last weekend to cover an SpR gap, that cost more and I don’t even feel bad.

 

[tamzzy]

These aren’t the new London caps are they, they might actually be lower?

i think so (london rates are lower)

We just about fill SpR Paeds shifts for £65 and hour currently

recently, the rota gap % for med registrars at a large west mids trust was >30%

 

[neviditelny]

To be fair, with the amount of work Doctors have to do, not only while on duty but also with further studies/exams etc to get to higher positions and up to date, who wouldn't want to get paid well for it? That is something I also think is weird in NHS, how for example nurses can climb the ladder so quick without hardly any need for further training/studies while as a Doctor you got some pretty damn heavy exams coming at you.

 

[Energize]

She has tried all different type of pain meds and all different diets too, nothing really has a positive inpact.

I doubt she has tried ketamine. It is being increasingly prescribed for chronic pain however. It has a rapid effect and high efficacy in all types of pain.

 

[Minstadave]

I doubt she has tried ketamine. It is being increasingly prescribed for chronic pain however. It has a rapid effect and high efficacy in all types of pain.

Along with a significant side effect profile in adults, kids love it though!

 

[heeeed]

Indeed. I have a 23 yr old girl who has had a cystectomy from ketamine use that I look after

 

[SexyGreyFox]

As an example, when we have a patient being admitted to my ward, we have a 30-odd pages document with assessments that needs to be done with each patient. And to add to that, my ward have 32 beds, and we quite often have a turnover of 10-15 patients a day (sometimes even more).

It's called a Nursing Risk Assessment Booklet at our place followed by Plans Of Care Books plus all the other sheets such as Comfort Rounds, Bristol Charts, MEWS, Prescription Sheets and so on.
It's a wonder Nurses ever get to talk to a patient.
Our Maternity are now entering everything into a computer system called K2MS which is taking a lot longer.

 

[neviditelny]

It's called a Nursing Risk Assessment Booklet at our place followed by Plans Of Care Books plus all the other sheets such as Comfort Rounds, Bristol Charts, MEWS, Prescription Sheets and so on.
It's a wonder Nurses ever get to talk to a patient.
Our Maternity are now entering everything into a computer system called K2MS which is taking a lot longer.

We have 3 versions of those books, A&E and the Acute Medical Booklet have a 48 hour admission book which is being used while the patient is in their units, but as soon as a patient is moved onto the proper wards we start either a Medical Admission Book or a Surgical Admission Book depending on what specialty the patient will be under. The admission books contains both the risk assessment and care plans which then have to be repeated every 7 days for each patient (luckily not many of our patients will be with us for that long time). Comfort rounds will also be in this booklets. Bristol Stool Charts and NEWS are all done electronically now on a Ipod based system called VitalPac (which in some ways makes it better and easier with the vital signs). The prescription sheet/drug chart is a separate bit of paperwork. Then we have the radiology transfer forms to fill in every time a patient have to go for a CT or X-ray.

 

[SexyGreyFox]

We have 3 versions of those books, A&E and the Acute Medical Booklet have a 48 hour admission book which is being used while the patient is in their units, but as soon as a patient is moved onto the proper wards we start either a Medical Admission Book or a Surgical Admission Book depending on what specialty the patient will be under. The admission books contains both the risk assessment and care plans which then have to be repeated every 7 days for each patient (luckily not many of our patients will be with us for that long time). Comfort rounds will also be in this booklets. Bristol Stool Charts and NEWS are all done electronically now on a Ipod based system called VitalPac (which in some ways makes it better and easier with the vital signs). The prescription sheet/drug chart is a separate bit of paperwork. Then we have the radiology transfer forms to fill in every time a patient have to go for a CT or X-ray.

I've just seen a VitalPac icon come on my screen.

What also makes me laugh is how every hospital has got it's own books and ways of doing things.
Not often but I get to see another hospitals records and nothing looks the same, you'd think the NHS would buy from one cheapest supplier but obviously not.
Only this week I found out another stupid thing.
You have obviously seen the big A2 charts that they use on wards such as ICU, CCU, SSCI, NICU, PICU etc. These now get sent offsite to be scanned digitally but all the departments have got a different place they use
I suggested we buy our own scanner and pay a Band 2 to scan them all day.

 

[neviditelny]

I have actually never seen any A2 charts being used in my hospital. We do on the other hand use big white boards for patient name/bed allocation and for our discharges/pharmacy duties etc.
I can't understand why not more things are done the same way within the NHS. It is really weird that every hospital seem to use their own paperwork etc all depending on what university they work with and so on. Why not make all paperwork the same across all the NHS? It would make it easier, simpler and more convenient when transfering patients between hospitals or moving staff between hospitals.
The same in regards of uniforms. Why is there not a decision saying that "this is the uniform ALL band 5's will use in the NHS, this colour uniform for the CSN's" etc. It would make it better for everyone I believe.

 

[Deus Ex]

Has she tried prokinetic agents to stimulate gut motility like metoclopramide, domperidone, prucalopride, and tried SNRI's to help the pain in the gut?

Anyway, ask about those with your specialist if you haven't tried them.

Can you give LT metoclopramide or domperidone, I thought it was contraindicated. The only 'safe' one I know is erythromycin, until you get C.Diff.

To be fair, with the amount of work Doctors have to do, not only while on duty but also with further studies/exams etc to get to higher positions and up to date, who wouldn't want to get paid well for it? That is something I also think is weird in NHS, how for example nurses can climb the ladder so quick without hardly any need for further training/studies while as a Doctor you got some pretty damn heavy exams coming at you.

Exams we pay for

Contracts should have had compulsory overtime implemented so a&e cover is provided without having to haggle with locums, so basically its covered under normal contracts. This is probably what should be done with every new recruit moving forward, which I think they tried to do recently when we had those protests from the junior doctors. Doctors are they doctors "to save lives"? If I remember right the union leader resigned after that ashamed that the negotiated deal was still turned down.

By the way its all too easy to shoot down what I am saying but you welcome to come up with something alternative, or is it the case you think there is nothing to be done and you would simply keep everything as it is?

When I was a trainee I worked 46-48 hours a week +5 hours more CPD and portfolio, frequently losing 3-4 hours staying late We also had manditory teaching which was on a wednesday 1pm-5pm fortnightly. While I was on my 12 week A&E rotation I worked exactly 3 weeks 8-4, the rest were evenings and nights (4-12, 8-8, 2-10 etc). It meant I came to teaching 1pm-5pm during nights sometimes because the education department were completely out of touch. I did roughly 55-60 hours a week. I got £2200 a month for this pleasure, I rarely got to spend it though.

How the **** are you going to make me do more compulsory overtime? How many more hours can i do safely?

I'm a locum now, night and day difference, I get to go on holiday with my loved ones, my pay is 75% more and I can pay for useful training courses (ATLS £750 after tax). I work 48 hours a week and get paid for 45 as I get these magical 30-45 minute breaks deducted I don't take.

During the winter I remember literally hanging bags of Augmentin and fluid on borderline-septic patients in the A&E waiting room. The NHS cannot cope with the large volume of complex elderly patients who require great care and skill when treating.

 

[neviditelny]

During the winter I remember literally hanging bags of Augmentin and fluid on borderline-septic patients in the A&E waiting room. The NHS cannot cope with the large volume of complex elderly patients who require great care and skill when treating.

Not to mention the amount of time in the hospital they need waiting for social care, care home placements or just for someone to be able to get hold of their next of kin's to arrange a future discharge etc.

 

[heeeed]

How the **** are you going to make me do more compulsory overtime? How many more hours can i do safely?

I wouldn’t try and explain. Some people think it’s right that you be treated as an endentured slave. Interestingly they are often the ones who would want you hung out to dry when systemic failures happen

 

[chrcoluk]

Thanks for that info, its a good read, nice to hear from both sides.

However if we been real here most of the uk population would love to be earning £30 an hour, doctors do the studying and to say they not reaping the awards at £30 an hour is a misstatement.

However those caps do get breached, they a target thats been failed to be hit.

I accept that if you used to more favourable terms and they now less favourable its hard to stomach. But again it beats been made redundant.

Moving forward I would like to see not so much further drops, I am happy for the 2017 rates to be maintained or even slightly increased to match inflation but for doctors to agree to commit to NHS contracts (so locums become permanent doctors) and agree to have unsociable hours as part of their contract (your contract is confusing but if I understand you right you have 14 extra shifts of which 7 are unsociable). There seems to be too many locum usage in the system right now.

The issue I think is mainly the locums demanding a kings ransom to cover the gaps, once thats resolved then the cash can get released, and general NHS improvements made I feel.

On the GP side of things a ton of stuff can be done to improve efficiency, it just needs doctors to accept more modern working practices like email and video conferencing.