The costs and returns: facts and figures

Chris Smyth in The times 26th April reports: So who is right? The rival arguments

….More than 11,000 extra doctors will be trained over the next five years but they need to be employed on the right terms. …

In a graphic in The Times 26th April 2016 comparisons are available. According to the Times graphic 26th April 2016 it costs:

£508,000 to train a consultant, £385,000 to train a GP, £80,000 to train a nurse’ £70,000 to train a Physiotherapist

Earnings 10 years after graduation are:

Medical Male  £55K, Female £45 K, Economics Male £44k & Female £38K, Law Male £30K and Female £26K, Nurses and Midwives Male £28K and Female £22K

Average lifetime earnings are also shown, as are Pensions on retirement, under the present system (which is far less generous than it’s predecessor but is better than most others). You can download the graphic for clarity..

Counting the cost

Sources: Personal Social Services Research Unit; IFS; HSCIC Earnings Survey; Government Actuary’s Department.

Chris Smyth in The times 26th April reports: So who is right? The rival arguments

Government case
No one seriously disputes that care isn’t as good at weekends as during the week and the government has a duty and electoral mandate to fix this. Arguments about whether this claims 11,000 lives, 6,000 lives or some other figure shouldn’t distract from the need to tackle a real problem.

More than 11,000 extra doctors will be trained over the next five years but they need to be employed on the right terms. Compromises were offered on 16 areas of disagreement in the new contract, and the BMA was willing to talk about 15 of them. It was the BMA’s refusal to discuss any change to Saturday pay that led to the collapse of the talks.

The BMA agreed that the current contract was outdated and should be changed. After more than three years of talks the government was advised by Sir David Dalton, one of the most respected chief executives in the NHS, that there was no realistic chance of a negotiated settlement and the uncertainty was damaging the health service. Junior doctors are well-paid professionals and will become very well-paid consultants or GPs. The contract will not cut the total pay bill and no current junior doctor working within legal hours will get a pay cut. This is not about saving money.

Automatic annual pay rises for time in service are unfair and ought to be linked to performance. The government has offered protection for those who take time out for research or to raise a family. Maximum working hours will actually be cut.

BMA case
Anyone who has ever been in a hospital knows that junior doctors already work seven days a week. The health secretary has insulted dedicated professionals by saying they don’t. Any problems with weekend care are much more about the lack of consultants, diagnostic tests, other support services and social care.

If the government wants more doctors working at the weekend, it will have to pay for more of them. Otherwise care during the week, already overstretched, will suffer. Britain spends less than comparable countries on healthcare and the government should not pretend that the NHS can offer more without more resources. When the BMA agreed to negotiate a new contract in 2013, weekend care was not mentioned as a problem. Hospitals are making changes to working patterns to improve treatment at weekends without the need for a new junior doctor contract.

The BMA still has concerns about work-life balance. It is false to claim Saturday pay is the only point at issue. The government’s own equalities assessment says women, especially single parents, could be disadvantaged. Doctors need time for a family life and paying more for weekend work acknowledges it comes at a cost.

Junior doctors voted 98 per cent in favour of industrial action. If even a small proportion of junior doctors abandon an already-struggling NHS to work abroad, the impact on patients will be disastrous.

There is an issue between treating someone as a professional and as a tradesman. Your plumber will come out of hours, but at a price.

It is interesting that there are still too few applicants for Wales and Scotland for Medical Training posts, and they have the old contract. This may change next year if the strikes continue – and emphasises that there is no “NHS” – something WHO agrees with.

The way to control a profession is by overcapacity. Germany and Holland have done this for years, and once there is an inevitable loss abroad, the competition to stay becomes more intense. Also the pressure on pay rises is less.

We have neglected capacity in the Medical Profession for years now, depending on imported doctors from overseas, and especially from countries who can least afford to lose them. We have also prejudiced against male students coming into medicine by undergraduate rather than graduate entry. We have allowed the better suburb schools to win most of the places and these students have no intention of working in the shires or in rural areas.

Adverse selection is needed in recruitment, but it would also help to re-structure medical schools so that their “graduate” entry students were trained based in a community (DGH and GP based), using on line learning supervised by their Deanery.

Continuing to ration medical school places is wrong. With 11 applicants for every 2 places we might have 5 times the number…. Why not?

This entry was posted in A Personal View, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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