Diary of a Junior Doctor 2017

August 1st
Whew. Just got my new contract! Very exciting. I’ve heard good things from government; safer, better paid, more training opportunities. Just coming in to registrar training after a year in research so excited to be back in the hospital. Obviously all this ‘ pay protection ‘ doesn’t apply to me, but never mind! They’ve given me a ‘training agreement’ to sign, allows them to roster teaching on evenings & weekends apparently, sounds great! Signed and sent.
First day tomorrow.

August 2nd
Started today- got given my ‘work schedule‘. I thought I was supposed to go through it with my educational supervisor but they haven’t assigned me one yet. Doesn’t look like rotas I remember. Here is my first week:

Wednesday– Long day 8-21.00
Thursday– Normal day 9-17.00, On-call from home to 0800am
Friday– Night 10pm-0800am
Saturday– OFF
Sunday – Night 8pm – 0800am
Monday– OFF
Tuesday– Long day 8.00- 21.00
Wednesday– Long day 8.00-21.00

Anyway, let’s see how it goes! Had my wife Jane look at it, she’s on maternity leave from surgical training at the moment with our 11 month old, and she wondered how it would work.

August 3rd

Whew! Tough first day. The hospital hasn’t filled the other registrar post yet, so I’m on my work schedule alone. Had both bleeps today, very busy, back and forth to A&E, plus did both ward rounds. Missed teaching and had to leave the training list early to see sick patients on the ward. Handover was a bit odd- one registrar was starting for the night at 8pm, and the other was working 2pm till 10pm. Not sure who was responsible for what. Quite confusing, team members turning up at different times, ended up staying till midnight trying to make sure everyone knew about the patients and plans were in place. Got home at 0100am. Jane not pleased. Rocky start.

August 4th

Had a read of the contract today- apparently I need to be reporting long shifts like last night, and should get paid for work done. Phoned an HR lady, a Ms Massey, who said as work wasn’t ‘approved’ they don’t count it. I asked her who it should be ‘approved’ by and she didn’t know. She told me to send an ‘exception report‘ to my supervisor. Tried again with my educational supervisor- apparently she’s on annual leave for the next week so will speak to her on her return. Anyway, will get some pre-bedtime time with Jack tonight, finishing at 5.00. Will have the on call phone but the trust estimate that should get five hours sleep and work maximum 25% time apparently. Sounds reasonable.

August 5th

Oh my god. Last night was horrendous- called back in to work just as I walked in the door, didn’t manage to stop working till handover, a 24 hour shift! This can’t be safe. I hope all the on calls aren’t this bad. Exhausted. Note to self: try and find this Guardian of safe working I’ve heard about. Got home just in time to take Jack to play group for an hour. He was chuffed to see his dad and mum in the same place for once. Had to go straight to bed when we got home- back to night shift tonight.


August 6th

Eurgh. Saturday. I think. Woke up at 2pm after another busy night shift. No one to hand over to in the morning- had to stay till 10.00 till the next shift person arrived. Apparently a gap in someone’s ‘work schedule’. So I’ve worked 10 hours on a day it says ‘OFF’ on my rota. This is chaos. On another night shift tomorrow. Must get some sort of work review– already! Don’t want to rock the departmental boat but this can’t be safe for anyone.

August 8th

Monday morning. Tried to stay in the hospital after another night shift and find out about supervisors and guardians. No joy with the supervisor- the covering consultant has too much to do with their own trainees they can’t do a review with me. Found out the name of the Guardian- a Mr Angel. Called his office- secretary said he had no appointments till October now, and work reviews are a six week process, and I need to submit in writing. I asked why and the secretary was a bit snappy with me- “Mr Angel is working very hard but covers three hospitals so what do you expect?”. I asked around- the BMA can’t do hours monitoring anymore. Maybe I’ll try them anyway. Don’t know what else to do. Long day tomorrow.

Aug 31st

Wow. Got my payslip today- can’t really work it out but I’m earning less than my 1A banded job two years ago. There’s more coming out for pensions now, I don’t qualify for Saturday uplift because Friday night shifts start on Friday, and the on-call work pay is estimated in advance, so it’s about £2.80 an hour. Driving back and forth at night is becoming dangerous, so I asked for accommodation to be on site overnight- apparently this has to be deducted from my pay, so I now owe the hospital money for every on call shift I work. What the f**k.

My wife’s off mat pay now so we are a bit stuck for the mortgage. I’ll probably have to do extra locum work, but I don’t know where it will fit in these rotas.

Sept 5th

Exhausted- we’ve had two resignations in my department, one first year and the other training registrar. No ones replaced them yet. Got called in to cover a shift this Saturday – Ms Massey told me it was expected for us to cover, and didn’t qualify as a locum. She gave me a day in lieu, but can’t tell me when I can take it. Missed Jacks birthday. Pretty gutted. Sent ten ‘exception reports’ in the last few weeks and no response. Where do they all go?

Sept 6th

Got hold of my educational supervisor- she seems nice enough, agreed the rota is looking dangerous but has already sent exception reports and work reviews off and awaiting replies. She doesn’t know who to escalate to either. She tried to make ‘pay amendments’ already but HR won’t accept them. The medical director is trying the Guardian but Mr Angel has just gone off sick with stress, and there’s no replacement as yet. Off the record everyone’s quite unhappy. Jane is looking at going back to work but it isn’t looking like with childcare we will be able to manage both of us, and it seems if we went part time we’d only get ‘allocated leave‘ so no chance of ever arranging time together and if we went part time we’d get paid less per hour than full time. That can’t be right? For the same work?

Sept 14th

This is getting dangerous, I’ve tried to raise it with my on call consultant– a locum this week, no clue what I’m talking about. No one is in charge of our hours and every week the rota is filled with gaps and odd hours. Our patients don’t know who is looking after them at any given time, we spend whole nights working flat out without rest, with no one to report to. People are dropping like flies now- I have had two locums on every shift for the last week.

In the meantime my work review is now ‘closed‘, as ‘rostered’ hours are within contract. I can appeal if I want. I tried to get some leave but my ‘allocated’ leave was overruled due to lack of staff, and I can only take leave on ‘normal’ days which is usually once a week. We cancelled our holiday plans. I missed Jack’s birthday and haven’t been at home with the family, awake, for a whole weekend for six weeks. It’s getting tough with Jane.

Oct 1st

I managed to get through to the new Guardian- this one is one of the board of directors at my hospital. He’s rejected my appeal for a work review, citing ‘exceptional pressure’ on the hospital. He gave me an appointment to resubmit in 6 weeks- I pointed out I will have moved to my next job by then. He didn’t care. I snapped. I can’t do this anymore.

Oct 10th

I spoke to the BMA today- they don’t have any powers beyond issuing reprimanding letters, which they already have. I’m burnt out, I feel jet lagged every day, I don’t even care about my patients any more. I know this isn’t safe- so I have handed in my notice. Jane has got a job in surgery in Vancouver, so we are out. Will it help the patients? No- but staying isn’t helping either. If they want to collapse the system, then it’s too late to do anything about.
If only we’d stopped this when we had the chance.
Juniordoctorblog.com

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70 Comments

  1. You can’t.It is so wrong for you all to have to work such long hours,nobody can be expected to.You need time for a life.Sadly there will be many in your situation who will have to relocate.The Public are on your side.Too many Politicians don’t live in a real world like the rest of us.Good luck for the future,sad that it has ended as it has for you.

  2. Then consider the case of doctor Chris Day. His consultant training number removed for reporting unsafe staffing levels and a judge ruling that junior doctors are not protected by whistle blowing legislation. If that ruling stands then any junior doctors could have their training number removed just for submitting exception reports. But at the same time we would be breaking the terms of our contract if we don’t report unsafe practises. It’s impossible to win.

  3. JDB Edit: Flagged as potentially fake. Independent verification of user pending.

    We can get involved in rota design so this doesn’t happen! But for some reason BMA not keen to make it better for juniors and have discouraged this. Didn’t we know it would be challenging when we signed up to do medicine? If you can’t handle it then leave.
    (I know this will get loads of negative comments but I don’t care. If you can justify taking full walk out and know why we are striking then go ahead and slate me)

    1. If this is the best trolling supporters of the changes can manage it shows how desperate it is. “I know it’s terrible but if we all work really, really hard maybe it won’t be quite so bad”.

  4. Feeling a horrid sense of dread and nausea after reading this. This is not at all far from the truth of what the new contract could mean for doctors in specialty training. I never signed up to giving up my life for the job. I signed up to a profession that allowed me to use my brain whilst helping people and being remunerated comfortably for that. I am not a robot or a slave. More importantly, I have other options. It might well be a waste of tax-payer’s money but my quality of life is worth more. I will resign if this contract goes through.

    1. You have put this so well, i am a first year medical student and feel exactly the same way. I hate the way every one seems to expect doctors to give up EVERYTHING for medicine- that is not a sensible or healthy approach and can not, in my opinion, bring any happiness. I love medicine and want desperately to help people in every way I can but I will 100% be heading to Australia if this contract goes through.

  5. Ahhhhh. The propogation of fear.
    How quaint a story. I don’t mean to sound condescending but I also hear that the da vinci code is entirely true as well (it’s just as plausible)

    This is a fictitious account of what it will be like in over a years time in the future.
    What about the bombs coming in from north Korea? Or the fact we will be overrun by terrorists running our government, that bit was left out as well!

    As much as those of you who are student doctors (and believe whole heartedly what you have been told by other student doctors etc) the fact is that this is all about money.

    Doctors work long hours already, they have been doing it for years, but as soon ands someone says they are costing too much, then you all make a fuss about the hours you are working.

    My point? You are happy to work the long hours, and dangerous shifts, as long as you get paid enough for it. But as soon as the financial incentive is gone then you complain.
    So, you are happy to put a price on patients lives. That’s what the strike action is about. Not the hours worked, but the fact that you no longer get overtime for them.
    I don’t know any successful organisation that says you can just choose when to do overtime, or as much overtime as you want. It makes no sound logic!!!!

    Welcome to a land where money doesn’t grow on trees.
    Welcome to the real world.

    1. Not a choice to do “overtime”. There is a rota, you are allocated your shifts and you work them, simple as that. You don’t choose which weekends you work or how many long days you do, you are given your shifts and are expected to work them.
      The example rotas that have been published by nhs employers that will come in to effect with the new contract are wildly different to what we work now.
      The switches from day to night shifts are much more frequent than they are currently – hence the increased ‘jet lag’. (currently you would do 3 or 4 or 7 night shifts in a row, which gives you a chance to adjust your sleep pattern. One or two night shifts at a time doesn’t allow this).

      If you click on the links throughout the piece you will see the sections of the new contract that evidence the potential situation outlined in this article.

    2. Ah yes “the real world” – clearly dealing with life and death decisions at work is all fun and games then eh?

      Though I agree with you about the second paragraph.

    3. “Welcome to the real world.”

      Where people who take the time and effort to study for years on end to learn the skills and knowledge to save people’s lives, who then go on to work far too many hours without a social life and away from their families, AND then are expected to work hours on less than the minimum wage; where people would be better paid and better treated working at Mcdonalds.

      The real world.

      Good one Keith.

    4. Keith you haven’t a clue what you’re talking about. Doctors don’t get paid more for longer hours, their actual hourly wage goes down the more hours they work. Idiot. But there’s no point wasting time trying to educate wilfully ignorant morons like you. Crawl back into your hole you troll .

    5. Keith, Can I ask what hours you work? The rota described is the one that the government has published on their website – it is completely unlike any rota that is currently being worked.
      Under the current contract doctors regularly stay late to sort out patients there is no financial benefit to them from doing this. There is no payment for “overtime” in the current contract – the proportion of mandatory hours on your rota that is out of hours is used to calculate an extra payment. There’s no ability to choose or not to choose to do this work.

      The main point is that the contract will lead to doctors being spread more thinly, damaging their ability to provide a safe service. Plus the irregular hours worked will be a nightmare.

      The additional point will be that as well as working that rota we’ll be expected to study for exams in our own time.

      We already pay for our own training, even the terrible e-portfolios to record our training. Revision courses and the exam fees with our own money.

      Nobody is claiming money grows on trees but if you can point me to any currently working group that would be happy to take a 30% pay cut then please let me know.

      Incidentally I’m one of those signing up to enter a registrar position in August – I’m seriously considering withdrawing my application.

    6. Yes. . It IS the real world…. you work and you get paid…. and if your conditions are worsened by an enforced contract and the money is reduced then off you jolly well go… somewhere better… and not micro-managed by politicians who would be happy to make a fast quid by flogging it off to their chums…. let’s see how you manage then when yr Mum breaks her hip.

      1. On the whole, I would prefer my mother not to be treated by someone who, if a doctor, sees nothing wrong or objectionable in that final comment.

      2. The pressure that the zealot Hunt has placed junior doctors under is far worse in terms of the likely treatment to be available if the sheer number of young doctors leave.

    7. Keith can I respectfully say you have no clue about what you’re saying.
      I’m a senior Reg, as such my pay is “protected” and from next year I will be working “less hours”. If hat was all there is to he contract why would I be such a vocal supporter of the IA?
      This contract is unsafe, we are seeing dropping numbers of juniors already and hints are going to get worse.
      As for “student doctors & real world”, I’m bloody 37yrs old, an ex-military officer and now surgeon (amongst other jobs). I have worked 91hr weeks as part of my job for over a decade. I think I’m in a position to say I’m likely to know more about he real world than you.
      I’m still a “junior doctor” and may be forever if I decide to not take up a consultant post if that contact is rubbish too. “Junior doctor” is a title not an indication of age or experience.
      Try substituting VP of a company to get an idea. It covers everyone who has graduated and this not a student doctor to those who have worked in medicine their whole lives but are not a consultant/GP

    8. Hi Keith see you wrote this at 8.39 am not on a busy shift then?? Oh sorry if you are a 9 to 5’er you haven’t started work yet! In early eh? Well done , bet the boss is impressed , oh well all the better for a big fat bonus.Bet you supported the bankers bail out as well , after all that happened in your “real world” shame they used up all the tree grown money. Oh well you probably won’t need the NHS ever so that’s ok

    9. I’ve never read a more nauseatingly ignorant comment – you should be a hospital administrator or consider going into politics.

    10. Good story getting in the way of the facts, or is it the facts getting in the way of a good story? Either way I bet you’ve got everything crossed you don’t need NHS care in the near future. But I reckon there’s better insurance policies out there for you Keith. In the mean time, my advice for what its worth; keep everything crossed.

    11. Actually Keith, it isn’t about the money, it’s about the patients. Doctors would make more money if the NHS was privatised, but we are fighting to keep our NHS because it shouldn’t be that only those that can afford good quality care get it.

    12. These are not student doctors. Junior doctors are all trained doctors up to consultant and GP level. They have studied, trained and worked for many years and deserve good pay and conditions. They are in the real world and your life may well depend on their skills in the future.!!

    13. No Keith. Those of us who worked as juniors in the 90’s remember 80-100 hr weeks. Were we well paid? Hard to say as I never left the hospital to spend any money.
      They would conduct ‘diary card exercises’ to monitor our hours only when 2 people were on leave meaning that the average of those 2 (0) plus the others working 80 hr plus weeks was magically under 56hrs to meet compliance!
      At some point in the 90’s action was taken and we started to get teaching and training when we were awake to be able to make use of it , and then the budgets were cut for this and it fell by the wayside.
      Wood pulp has been used in the manufacture of bank notes, and this is not a far fetched picture of how things are going to work out.
      Unfortunately, you will have to pay more for doctors as you will have to lure them back from North America, Australasia, Europe and the middle east where they seem to be appreciated.

    14. Im not a junior doctor im a nurse but i work along side these doctors everyday…. i just want to point out the use of “duty of care” when doing your rostered shifts…. and the fact that overtime is never expected in this environment… if your patients deteriorate as your shift is due to end…. you cant just walk out on them…. and say “well my shifts finished so fuck it” you stay because thats a life of, say someones mum. And if it were your mum…. would you want the doctors and nurses caring for her walking out as she slipped into a critical situation because “their shift was over” i think not.

    15. Just to be clear we cannot choose the hours we work or when those hours are. My training requirements and service provision mean that I have to do a mix of nights/week days and weekends and I am contracted to do 48 of them on average per week.
      This is unlike other professions such as nursing where you can choose to only work nights or days or more weekends and thus mean you can work fewer hours for the same pay.
      “Overtime” only applies when I work more hours than this. And if I voluntarily or am pressed into doing so to cover the service then yes I do expect to be paid a fair wage.
      The supplement I currently get paid to work nights and weekends is there to account for the fact that a)I am missing out on social time and rest and b) that working nights is proven to be detrimental to my health in the long run.
      I am more than happy to not work long and dangerous shift patterns and get paid less. But I am not willing to work either the same hours and patterns I do now for less or more hours for the same money.

    16. Keith…junior doctors are not student doctors some of them have been in “training” posts for 10 years or more. There has never been a choice of overtime you just work the rotas you are given and you cannot opt out.
      It is people like you who comment on things you think you know very little about that make us feel like we are hitting our head off a brick wall.

  6. This will happen come August! Although i knew being a doctor would be difficult i in no way thought i was signing my life over. And yes working long hours can be incentivised by more pay- we need something to keep us going- nobody has that much goodwill that they will work like a dog, continue beig demoralised and then not stand up and fight when their pay is being cut! Some ridiculous comments on this post. I salute my colleagues who have left medicine and moved abroad…no matter what anybody says we need to look out for ourselves because nobody else will and if that means leaving a job in the NHS for greener lands then so be it.

  7. Well thats absolute nonsense isnt it? Just like every other human being, there are drivers for carrying out tasks – some want career progression, some want job satisfaction, some want enough to pay the bills, some want to save for a new house….some want all those things and some people want other stuff etc etc. What noone is happy to do is be treated like a piece of meat. In the past some of the things in that article probably would have been overlooked because those things I mentioned were being fulfilled. Now thats not really the case and its not surprising to see people realise that its been a long time farce. You can posture and wheeze all you want but its a highly trained set of professionals you’re expecting to work for WAY less than the national minimum living wage on anti-social shifts, along with minimal personal life and a poor work life balance.

    I can only assume you have a limited idea of what youre on about with the reference to “student doctors”, which fits absolutely no category of person from 1st year university through to consultant/GP. I can also advise that whatever braintrust decided doctors were “costing too much” were absolutely factually wrong – evidenced by the fact they had to artifically lower locum fees by around 50% (you know, the free open market rate…..) that was over budget because they dont treat full time staff well enough to fill rotas appropriately.

    Money doesnt grow on trees, but it usually arrives with hard work. Maybe we should all just quit and go to the private sector and let market forces find doctors when theres an extremely small workforce to fill all the necessary jobs for good healthcare. It would be interesting to see if they “cost too much” when waiting lists are 18 months. You’d probably take issue with that too I assume?

    1. Spot on Barry. We should all resign en masse and sign up with locum agencies and let the market forces decide on. At least we will be renumerated fairly and appropriately then.

  8. I think some of the comments here slating junior doctors for wanting to be paid for the hours they work is ridiculous. Imagine trying to force any other professions to work more hours for less pay….. Sure as hell doesn’t happen with tube drivers who can just as easily be replaced by automatic systems. How in the world can some people truly justify saying, work more, work overtime, but don’t get paid….. No other employee in a different area of work, I.e. Factory work, would allow this. At the end of the day, being a doctor while there is some lifestyle choice to it, it is after all a job, a career, and one should get paid for their job. I’d love to see those slating doctors to take a pay cut to provide more of whatever service they provide in their jobs…..

    When you add into the mix all the other rubbish that comes with a medical career, little say of where you work, being placed sometimes hours drive away from home or loved ones, unable to see your partners, apparent days off because you finish work at 9am after a long night, consisting of trying to gain some semblance of normal life pattern. The ridiculous costs that are needed to even be able to say you are “employed”, while leaving little else aside if you have a family to care for.

    I think junior doctors are entirely Entitled to strike all out and resign if necessary. Going private may even mean doctors would be better off as a whole. It is the public who rely on the nhs who would lose out. And any undoubtedly bad press about any ill effects or deaths that occur during an all out strike, remember, it is not the fault of junior doctors, it is the fault of the government for forcing them into that position to begin with. There will be far greater risk to life and limb should this government force the profession to its knees and resignation.

    1. Every job I’ve ever had in the private sector has required me to do extra hours at zero extra pay. You receive a salary and that’s it, but are expected to be “flexible” when the business requires.

      That said I fully support the Junior Doctors, I only found this comment: “Imagine trying to force any other professions to work more hours for less pay” a bit misinformed.

  9. I remeber ridiculous working hours like this in my days as a house officer/SHO. It was dangerous then and even more so now with the higher pressures involved. How I wish this was just a sick joke but sadly this is the reality we are living in. And to add to it all the lawyers will be baying for our blood to crucify us for every minor error we make….

  10. Dear UK Junior Doctors,

    Come and work in Australia with me, they treat us reasonably well here…40 hour working week and reasonable pay for training doctors.
    It’s a good place to bring up a family – because you can actually see your children outside work
    It’s not perfect, but worth considering.

    Or…consider applying en mass for jobs in the retail outlets within the hospital or as cleaners or porters. This type of bullshit shananigans shall surely only need to continue until this government is shooed along by the next…

    Best wishes to you all.

    And to Keith the troll…I was taught that beings like you belong under bridges.

  11. I’m a regular hospital patient suffering from 2 chronic health conditions, one of them an uber rare disease that only specialists tend to know about. The forced contract scares me witless. Patients like me already fall thru cracks because of time and resource pressures. Doctors work til they’re ready to drop and are expected to carry on into danger hours. Not only do they end up feeling crap but we end up dying because of tired mistakes or being overlooked. Substandard treatment is now par for the course and I can honestly say I don’t feel safe anymore. It’s frightening and will only get worse.

    Take whatever action you can. Us patients are behind you all the way. We need you working efficiently and we’ll, not exhausted and demoralised!

    1. Yes of course. It costs approx £132,000 (1) of tax payer money to train a first year doctor and £1-2000 per year thereafter. So after four years I owe the tax payer £140,000.
      Of course you wouldn’t mind if I claimed back all my training costs- £5,000 for my exams and registration fees.
      Plus the 10% pay for all the extended hours when I stayed late to look after a sick patient. Four years at 30k average- that’s £12,000.
      Plus I’d like to claim on the four quality improvement projects I’ve produced- one a major IT project In a DGH (£150,000) and three smaller (£20,000) management projects. So that’s £210,000 that the private sector would’ve charged, and I did for free.
      Plus all the free teaching of students I’ve given over the years- three national courses, two local courses, hundreds of hours of ward teaching. Conservative estimate: £50,000.

      So happy to pay back. You owe me £137,000.

      https://juniordoctorblog.com/2015/09/24/how-to-lose-doctors-and-alienate-the-profession-a-masterclass-by-jeremy-hunt/

  12. I am totally on the side of the junior doctors on this but was quite surprised in reading the blog how similar the rotas and working conditions are to the police. The difference is, they have no right to strike and have a federation that’s as much use as a chocolate fireguard so have just had to put up with pay cuts, imposed changes to pensions & working conditions, difficult work/life balance, not getting paid for overtime, being denied leave 11 times in a row (as my husband has been), only getting 2 official public holidays (and then only getting extra pay if the shift starts on that day – nightshift on Christmas Eve into Christmas morning gets you nothing). So, in conclusion, more power to the junior doctors! I hope the outcome is that the government realises that they can’t treat any public sector workers in this way and expect to get away with it.

  13. Come and work in South Africa for a month and you’ll realize how easy you have it. First year interns average 300-320hours a month, for 240 hours pay. And regularly do 30-36 hour shifts every 4-5 days not including wArd rounds on a weekend. But it must be really tough in the UK with all the high levels of violence, hiv, and tb

  14. The bottom line is that the government want to privatise the nhs.all the costs are in drugs staffing and equipment. Privatise and medical insurance companies will be paying the bills via joe public. It’s impossible to have improvements in medical care and drugs without a cost. For10years the government of any party has changed the rules.
    Joe public want a caring system with Drs who aren’t too tired to make decisions and nurses who are not running 2wards.

  15. To all the Junior doctors and other nurses, paramedics etc, believe it when I say the public are with you on this and I hope the ignorant trolls or their families never have to call on the services of our exhausted, stressed-out and underpaid medical professionals.

  16. Fight on, doctors. The government and the government’s media will throw everything including the kitchen sink at you, but the vast majority of the public, going by frequent polls, understand completely what’s at stake here. We are behind you.

    Yes, the plan is to fully privatise the NHS in England and Wales, and they’ll start on the rest of the raft of hospitals professionals next. They think that if they can get the doctors to capitulate, the rest will be easy. Hunt has not the slightest clue about what healthcare actually means.

    If the worst comes to the very worst and you do decide to leave, consider coming to Scotland. We’re nice and friendly and we value and respect our health service which is in public hands. We can always use new doctors, as we’re expanding NHS Scotland by the day. And think of the fantastic landscape! The fresh air! The chance to do a job you love and have a decent life too.

    You all deserve so much better than what’s being dished up. Good luck.

  17. It has become clear to me that this government have set about a path in motion to privatise the NHS. In forcing new consultant and the forthcoming junior doctor contracts, which will likely cause a mass exodus and forcing strikes, they now have their scapegoats.
    When it all comes crashing down, and it will if this continues, privatisation (or some two tiered system with those who can and those who cannot afford) will be the ‘only answer’… blame the doctors will be the cry as Mr Hunt points his crooked finger.
    I am a locum doctor at the moment, as I have just moved location and want to try out a few jobs before settling down again. My ‘free market’ value is a hell of a lot higher than it would be in this contract. If I wanted to I could walk out the door as the clock strikes 5pm and collect more money than those working longer and more unsociable hours in the current contract, let alone the forthcoming one. I have no doubt that if this privatisation path continues then it won’t be the doctors who lose out! So those who say this is all about money are spectacularly naive.
    The NHS in many ways is a victim of it’s own success. To put it very simply: the more successful it is at keeping people living longer the more it then costs to look after said people and the more demand rises. The 60 year old overweight smoker who would have died of an MI 30 years ago is now receiving state of the art interventional care and then ongoing secondary prevention and thus he lives long enough to develop COPD, diabetes and dementia; eventually requiring nursing home care; mostly all of this at the states expense. There has been vast underfunding of social care which in turn has put pressure on hospital beds. Carers of the nation are wonderful people and without them the NHS would already be bankrupt.
    It’s not the fault of the doctors or nurses or midwives or auxiliaries or physics or OTs or porters or social workers or health visitors or pharmacists or dieticians or anyone else you might find under the hospital roof… even managers! It is the Tory government that the majority voted for in England. Pull down the mask of this charade, designed to scapegoat honest and hardworking medical professionals who have dedicated their working loves to caring for us all by offering them a real term 30% pay cut with unsafe working conditions, and you will see the most shameful of Tory agenda’s.

  18. My son is an F1 in Liverpool and his week is already worse than this. 30 times he has been the only doctor on 5 wards and expected to deal with emergencies. Hunt plans to make this worse. Hunt must go he is killing people ….. doctors included !

  19. I’m a Senior Dr in Australia and I am absolutely appalled by the roster that has been described here. The hours are onerous, no normal shift worker would be expected to do anything like this , the shifts are all over the place with day and night shifts mixed up together, which is a recipe for sleep deprivation and errors. Another important part of safety in hospitals is supervision of more junior staff and a proper handover of patients when going off shift- well with all the shift gaps and strange shifts being worked, and the lack of consultant supervision you can guarantee errors will go up. I recommend every junior dr who makes an error because of fatigue and lack of supervision report it into the hospital incident management system, which will ensure the causes of errors are sheeted back to these working conditions and may eventually bring this whole mess to its knees. While I feel sorry for the NHS, which the government is clearly trying to destroy, I feel the only sane thing to do is leave. As another poster said, the working week here in Oz is 40 hours, with reasonable overtime expectations and rosters that weren’t devised by a sadist but a fellow medico. It is actually now up to the voting public to mount a campaign to fix this. We haven’t even mentioned teaching. The whole basis on which junior drs are employed at reduced rates compared with what they could earn in private practice, is that they will in return enjoy teaching. We do all of that during the day here, and I have 6 junior drs I mentor and train, so the quality of training in terms of consultant exposure is excellent. I can’t imagine where you could even fit teaching into the schedule you have. Good luck in Vancouver, your making the right decision. To every non medical person reading this blog, the NHS is recognised internationally for the safety, quality and value for money it delivers and is the envy of many other first world countries,that is what your junior staff are trying to protect.

  20. Can someone tell me how the new proposed deal below is worse that what JNR doctors currently receive?

    Salary
    * Average basic salary increase of 13.5 per cent
    * Basic starting salary of £27,000 compared to £22,636 now – 19 per cent
    *Three quarters of doctors receive a take home pay rise.

    Over-time
    * Doctors receive time plus 30 per cent for any hours worked between 5pm-9pm on Saturday and 7am-9pm on Sunday
    * Doctors working one in four Saturdays or more will receive a pay premium of 30 per cent for all Saturday hours
    * Doctors receive time and a half for any hours worked Monday – Sunday between 9pm – 7am

    Working hours
    * Max number of hours worked every week by junior doctors from 91 to 72
    * Max number of consecutive nights a doctor can work cut from seven to four
    * No doctor ever rostered two weekends in a row

    Safe working
    * Every hospital to have a safety guardian to monitor safe working
    * Financial penalties for hospitals that breach safe working hours to be paid to the safety guardian and reinvested in junior doctors education and training

    1. Can someone tell me how the new proposed deal below is worse that what JNR doctors currently receive?

      Yes.

      Salary
      * Average basic salary increase of 13.5 per cent – this doesn’t apply to everybody, and is meaningless on its own. Even alone it’s still meaningless- junior doctors have lost 25% income since 2008 due to the pay freeze.

      * Basic starting salary of £27,000 compared to £22,636 now – 19 per cent.
      -previously pay started at 22,636 in 1st year and 28,076 in 2nd year.
      -it’s difficult to calculate the new terms – it depends on your out of hours work.
      – no out of hours work- £4000 pay rise
      – 1B – just long days- £1600 pay cut
      – 1A- no nights- £420 pay cut
      – A typical F1 will see a mix of the above- but 1B and 1A jobs are commonest.
      – F2
      – No out of hours work- £1600 pay rise
      – 1B – just long days- £5900 pay cut
      – 1A – no nights – £4000 pay cut
      – 1A – nights- £2100 pay cut
      – Take home pay will also fall as greater pension contributions come out of basic not banded pay.
      – After tax, greater NI contributions, pension, and student loan this is a likely drop in monthly take home pay.

      *Three quarters of doctors receive a take home pay rise.
      – this is unsubstantiated. All calculators take into account pay protection and flexible pay premia which are short term and discretionary pay respectively.
      – Without both pay will go down for the next generation

      Over-time
      – there is no such thing as overtime. We are all appalled at the implication.

      * Doctors receive time plus 30 per cent for any hours worked between 5pm-9pm on Saturday and 7am-9pm on Sunday
      – previously received banding – this respected out of hours work as all day Saturday and Sunday.
      * Doctors working one in four Saturdays or more will receive a pay premium of 30 per cent for all Saturday hours
      – see above
      * Doctors receive time and a half for any hours worked Monday – Sunday between 9pm – 7am
      Working hours
      – previously nights defined as 7pm-7am
      * Max number of hours worked every week by junior doctors from 91 to 72
      – while welcomed, independent safeguards to enforce this have been removed
      * Max number of consecutive nights a doctor can work cut from seven to four
      – In my experience this didn’t really happen anymore. No one has provided any data on how often it does.
      * No doctor ever rostered two weekends in a row
      – shown to be immediately untrue. Nhs employers put out consecutive rotas. Still has 1 in 2 rotas. This clause is also like saying; no doctor will ever be punched in the face. It’s welcome, but really doesn’t add very much.

      Safe working
      * Every hospital to have a safety guardian to monitor safe working
      – read the above post for the implications of this
      * Financial penalties for hospitals that breach safe working hours to be paid to the safety guardian and reinvested in junior doctors education and training
      – 1) proving breaches very difficult, exception reports system high potential to simply delay response until trainee has rotated
      – 2) the penalties paid by the hospital are a) paid at ‘prevailing rate’ for breached hours work. This is cheaper than hiring locums and easier than hiring more staff and B) paid into the trusts own ‘education fund’ which previously didn’t exist.
      – There is no contractual guarantees or definition as what defines ‘investment’ or indeed ‘education’.
      – What this boils down to is trusts can overwork the doctors they have with no real-terms penalties, and pay themselves for the privilege.

      You forgot to mention all the bits that aren’t part of the government press release.
      – non resident on call pay will be £2.80 an hour plus pay ‘estimated’ by trust. Imagine paying a plumber to be on call overnight, giving advice over the phone, guessing at how much work will need to be done beforehand and paying that amount upfront. Say 1 hour/night at £80/hour. You’ve just got a full time emergency plumber for a 12 hour shift, at £9.50 an hour. For a doctor, prevailing rate is around average £25 an hour- this then works out at £4.88/HR, less than minimum wage. Regardless of actual hours worked, As above.
      – The equalities impact assessment reported this contract was directly discriminatory towards women.
      – ‘Efficient’ rotas generated by this contract were said by Cass business school to risk ‘jet lag’ and may breach employer duty of care.
      – Allocated leave.
      – ‘Exceptional pressures’ and approval requirements could mean you are called in to cover a shift and never paid for it.
      – Annual leave entitlement is falling – ?
      – The contract limits what a doctor can do with their own time, and removes right to work by their own choice.
      – Academics, if not ‘approved’, will lose out doing research. As will any medic switching to a non-shortage specialty.
      – All independent hours monitoring, training safeguards and complaints system has been removed. Any issue can now come with a giant conflict of interest, meaning both exception reporting and whistleblowing for juniors could be compromised.

      I hope that answers your question.

      Juniordoctorblog.com

      1. I would be interested if you could provide a source for that information as it seems highly likely that it has been taken out of context.

        As I understand it the government have said they would protect doctors pay for 3 years so 1% would lose out in their take home pay on day one.

        The “on day one” bit is very important.

        These changes are not just about day one. They have designed to make it cheaper to rota doctors at weekends and anti-social hours for which under the current contract they would have received extra pay.

        Some of the changes will take time to have an effect. For example, the ending of guaranteed pay rises linked to time-in-the-job will mean some doctors find their pay will rise much slower during their time as a junior doctor.

        New doctors graduating from medical school under this contract are going to be worse off than they would have been if they started under the current deal.

        Rest assured; the government hasn’t gone to all this trouble (and doctors to all their trouble) to merely make the 1% of doctors who work odd anti-social rotas worse off. Many more doctors will be suffering a massive real terms pay cut. This is why I asked for your source because I highly doubt the BMA will have made this comment without further context similar to that which I have provided above.

  21. The BMA comment was in the Telegraph last week.

    I actually feel for JNR doctors as I would be very upset if my contracts were negatively changed but striking is not the way to go about it. Its a shame they chose that line of action because it lost them a lot of public support including me.

    1. If you were told you had to work more weekends and night shifts and see your family less in the kind of pattern shown above for 30% less pay, with your union telling you that the government won’t negotiate and will impose the contract anyway… what would you do? Keep working as normal and hope Jeremy would do well by you? Especially when free market locum rates are higher and another country would be happy to have you and treat you right. You say striking is not the way to go about it. What is your proposition… what would you do?

      1. Ben I’m sorry we lost your support. I might suggest that the BMA would never say less than 1% of doctors will receive a pay cut. Apart from it being untrue, it’s also a Government line, not one from any junior doctor.

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