Category Archives: Junior Doctors

Many junior doctors have told me they are aware that their seniors are disengaged from the managerial process, and they often comment that if they focusssed on “significant Events” they could spend all day filling out forms and never seeing a patient.
What hapens to change the altruism which almost all doctors have when they qualify?
How does a MRCP qualified doctor feel about being made to do 6 months medicine in a GP training scheme?
What do they feel about management and the changes ongoing in the NHS?
Why would they go abroad? What is it about the foreign systems and opportunities that appeals?

The facts, What doctors earn – except that GPs are self employed and you wont know their overhead/expenses/debts which will vary by GP and by practice.

BMJ has helpfully published the latest data on GPs (BMJ Aug 30th article by Tom Moberly

Data chart: what doctors earn

Authors: Tom Moberly

Publication date:  30 Aug 2017


In 2016, the mean annual pay for all doctors working full time in the UK was £78 386, according to figures published by the Office for National Statistics (ONS).

The ONS data show that 78% of doctors work full time. For the remaining 22% who work part time, the mean annual pay was £46 277. Across all doctors, working full time or part time, the mean pay was £71 455.

Separate figures on doctors’ earnings are published by NHS Digital, and these figures provide data on the earnings of different sections of the workforce.

These figures show that, in 2014-15 (the latest period for which these data are available), the mean earnings for GPs was £101 500. This figure is for income before tax, but after expenses, for salaried GPs and partners working under either general medical services or personal medical services contracts.

For consultants and other hospital doctors, NHS Digital has published data on earnings in the year up to March 2017. These show that the mean earnings for consultants were £111 563. For specialty and associate specialist doctors they were £69 336, and for all doctors in training, mean earnings were £49 318 (£55 629 for those in higher specialty training, £47 420 for those in core training, and £36 122 for those on the foundation programme).

The ONS data show that, between 1997 and 2016, mean pay across all doctors increased from £36 849 to £71 455.This equates to an average annual increase of 3.5% over that period.

What doctors earn

Consultants £111 563
GPs £101 500
Specialty and associate specialist doctors £69 336
Trainees (higher specialty training) £55 629
Trainees (core training) £47 420
Trainees (foundation programme) £36 122

Source: NHS Digital. Note: GP data are for 2014/15; other data are for 2016/7.

Tom Moberly UK editor BMJ

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The Training of doctors…. unfortunately it is too late to recover in even the 5 years promised by government… Decommissioning of operations

A Times leading article alludes (correctly) that undergraduates are less value to the state than graduates who enter medical school. But Zawad Iqbal in “Doctors’ training needs streamlining before it’s too late” does highlight the problem of declining standards, and lowest common denominator medicine. The problem with the new GMC suggestion is that too low a standard may be deemed acceptable in order for us to have enough doctors in the short term. The fact that NHSreality would never have chosen to start from here is omitted. Long term rationing of medical school places, as well as too many undergraduates and too few graduates is to blame. A ten year program of capacity management may be undermined if we admit too many overseas doctors suddenly.. On the other hand, if the bar is set high enough… OK, I forget, nurses can do the job of a GP can’t they? NHSreality feels it is already too late, and it’s going to get worse… (Katie Gibbons reports from Kent: NHS operations postponed to save cash). Decommissioning is going to get worse still.

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In a letter to The Times 3rd Feb 2017 Prof Derrick Wilmot of Sheffield writes: on DOCTORS’ TRAINING..

Sir, A medical licensing assessment for doctors is long overdue (“Doctors face tough new test on basic skills”, Feb 1). There is a similar situation for dentists. A third of the dentists entered each year on the General Dental Council’s register qualified at an overseas university. UK graduates are not tested by a common examination but by the individual university dental schools, which do try, mostly with success, to maintain sufficient quality and commonality. Many of the overseas new dentists entering the UK come from EU countries and cannot be tested. Brexit is the ideal opportunity to introduce a new robust common assessment for all doctors and dentists registering in the UK.

Recent years have seen a frightening increase in medical and dental litigation. Evidence for an association is weak but if a basic clinical education is lacking problems surely lie ahead both for the practitioner and, more worryingly, for the patient.

Emeritus Professor Derrick Willmot of Sheffield University, and past dean, Faculty of Dental Surgery, Royal College of Surgeons: Doctors’ training needs streamlining before it’s too late

The news that thousands of newly qualified doctors aren’t confident enough to perform basic tasks such as taking blood is a real canary in the coal mine moment — a warning sign that the way we teach doctors urgently needs to change.

Part of the problem is that the basic structure of medical training hasn’t changed in more than a hundred years. The General Medical Council sets the standards for undergraduate medical education and supervises the training and education of students. But the content and length of a medical degree varies widely, depending on which institution you attend, and the different medical schools are allowed to set their own criteria for licensing doctors.

There is no common standard to practise in the UK. Doctors from the European Union can work here if they’ve passed relevant exams in their own country. Doctors from other parts of the world are given a separate test, resulting in a confusing system with no overall benchmark.

So it’s a relief that medical regulators now want to introduce a standard test. But that’s still some years away and frankly it’s not enough. We should seize the opportunity to conduct a bigger and more wholesale review of how we train our doctors and whether these decades-old methods are up to scratch.

What doctors needed to know ten years ago is often a world away from what they need to know today. Basic science and clinical science remain the core modules on medical courses but healthcare delivery is becoming ever more important. As well as introducing a common approach to basics such as taking blood samples and performing lumbar punctures, areas such as data analysis, IT skills and interpersonal ability must play a bigger role in medical training.

One of the biggest opportunities being missed is in postgraduate medical education. This is because postgraduate training falls under the NHS rather than a university or medical school. Our doctors need to keep learning new skills if they’re going to give their increasingly well-informed patients the best treatments. The doctor of the future will not necessarily carry a stethoscope around his or her neck but will more likely be one of a specialist team working alongside health technicians, pharmacists and nurses.

Rather than introduce a new standard test for doctors after they have qualified, they and their patients would be better served if medical schools standardised the courses they begin at 18.

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Nursing degree applications fall by a fifth – a two tier service is evolving by neglect.. State basic, and Private enhanced.

Most of the doctors feel that Nursing took the wrong course when they tried to push through the degree increments and “Agenda for change” demands in the first decade (2004) of the century. GPs as self employed businesses resisted most as our funding was not future proofed. Those who capitulated are regretting it now. Stephanie Jones-Berry reports in “Primary Health Care”.and Greg Hurst reports in The Times 17th December: Nursing degree applications fall by a fifth despite the Agenda for change”  This decline is a disaster for those of us in our sixties and seventies who hoped for the quality of nursing care our parents received. Continuous neglect, rationing of training places in medicine, and over borrowed nurses-in-training, and Agenda for change has led to government preferring to hire nurses and doctors from abroad, at cheap rates of pay, rather than train our own, with whom patients have cultural affinity and good communication.

A two tier service is evolving in Medical and Nursing care, by neglect: state basic, and private enhanced. It would be better this change was managed and overt..

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Applications for nursing degrees have fallen sharply since the government withdrew their funding via bursaries and forced students to pay for their courses with loans.

Universities said last night that applications for nursing, midwifery and allied health courses were down by about 20 per cent compared with this stage last year. In some institutions applications have halved.

Shortfalls in applications were worse in London and the southeast, among mature candidates and in specialist fields such as learning disability nursing, occupational therapy and podiatry. There are fears that some small courses may become too expensive to run if numbers dip too low.

It is too soon to judge if the fall will mean fewer student nurses starting in September next year but universities are considering contingency plans to avert a shortfall in nursing graduates, including accelerated two-year postgraduate nursing courses.

Vice-chancellors are planning a campaign with health bodies to encourage more people to train as nurses, which is likely to run well beyond the normal deadline for university course applications next month to encourage candidates to make late submissions or apply through clearing in the summer.

Some caution is needed with the figures as the Universities and Colleges Admissions Service says year-on-year comparisons are complicated this year because calendar dates mean we are two or three working days behind last year’s cycle, and university applications generally are running behind last year’s figures. But the drop in applications for nursing, midwifery and allied health subjects is twice that of other courses, according to a survey by the vice-chancellors’ body Universities UK (UUK).

Ministers claimed that ending the bursaries would create 10,000 more training places, as costs are met by students taking out loans rather than direct government funding. It would be an embarrassment if numbers fell.

Janet Davies, head of the Royal College of Nursing, said her organisation had consistently raised concerns to the government that its decision would result in a drop in applications. “Our advice fell on deaf ears. The government went ahead in gambling on the future of the nursing workforce,” she said.

Steve West, vice-chancellor of the University of the West of England and chairman of UUK’s health policy network, said that the numbers were down. “We want to ensure . . . we get the right message out that there are fantastic career opportunities in nursing.”

Vice-chancellors say that mature students are likely to find it harder to take on a student loan of £27,000 to fund their degree and worry that potential student nurses may not fully understand that they will only start repaying once they earn above £21,000.

A Department of Health spokesman said that it was too early in the application process to predict reliable trends, adding: “We are committed to increasing the number of training places for homegrown nurses, as well as making sure there are more routes into nursing including through apprenticeships.”

The RCN is concerned the effects on the future workforce will be exacerbated by Brexit and an ageing population.

To date many midwives and nurses have not been able to “demonstrate they can communicate effectively”. Communication and cultural barriers in health acknowledged. Litigation results..

In an undercapacity market who can blame the nurses or doctors? £190m is “comeuppance” for politicians. NHS nurse recruitment from EU ‘too aggressive’!

Not enough nurses or doctors? Or are we just inefficient? The situation is a disgrace and a scandal, and needs a war like atmosphere of honesty to address it…

London GP services crisis pending… Overseas doctors will probably fill the vacancies. Watch for private GPs and Private A&E departments in the capital…

Not enough doctors – just keep lowering the bar & reducing the funding

A third of A&E doctors leaving NHS to work “in a non toxic environment” abroad

 

Will you be more likely to die with a male doctor? Patients less likely to die if doctor is female…

The report by Kate Gibbons in in The Times and other newspapers on 20th December 2016 is an interesting read, and it has statistical power. “Patients less likely to die if doctor is female” is reprinted below. The study needs to be reproduced in the UK’s 4 services, where junior doctors are mainly female, and see if it applies. Justification of the bias in selection would be retrospective, and some consolation to those on waiting lists. If they do get admitted they are at least more likely to return home.

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Yusuke Tsugawa was the original author in JAMA Internal Medicine October 13th 2016, and the article has free on line access. There were over 1.5 million patients analysed for nearly 60,000 physicians. The gender distribution of the physicians is not mentioned, but as they have graduate entry we can assume it is equal male to female, (unlike the UK where undergraduate entry results in 80% females).  The report is about internal medicine and there is a readmission rate of around 250K patients in 30 days. The potential total lives saved in the USA would be 32K if this is valid and reliable, and is accounted for by a difference of 4% in outcomes. It says nothing about quality of life, cost, or future care needs.

Elderly hospital patients treated by women doctors are less likely to die than those in the care of men, research has indicated.

A study found that people aged 65 and over who received hospital care from a male doctor had an increased risk of dying within 30 days.

Female doctors were less likely to flout national care guidelines and had better communication with patients.

The study, published in the journal JAMA Internal Medicine, was the first to examine how gender differences could affect mortality rates.

Analysis of more than a million patients aged 65 and over who had been in hospital for a variety of conditions, including diabetes, cancer and heart failure, found that those treated by a female doctor were on average 4 per cent less likely to die prematurely than those with a male doctor.

The researchers at Harvard University found that the differences were most significant for patients who had more severe conditions.

Yusuke Tsugawa, the study’s lead author, said: “The difference in mortality rates surprised us. The gender of the physician appears to be particularly significant for the sickest patients.”

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The long term results of rationing midwives and doctors in training…

Two items in the news today (Sunday Times – Sarah Kate-Templeton 15th October 2016) reveal the long term results of rationing midwives and doctors in training. When you control the supply side completely, and have many years notice to plan, this is irresponsible government. It represents a collusion of denial. Market forces are giving the government a problem, but they control the market..

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NHS breaches (forced to bust) pay cap for locum doctors

NHS hospitals have had to pay up to £155 an hour for doctors despite a cap introduced last year on the amount trusts could spend on agency locums.

One hospital in the north of England paid more than £10,000 a week for three locum agency doctors. Two locum agency doctors between them racked up more than 4,400 hours over a year, which equates to them each working more than eight hours every weekday.

This weekend NHS Improvement, the hospitals regulator, warned that while the government cap had succeeded in reducing the amount the NHS spent on agency nurses, trusts were still overriding the limits, sometimes paying double the permitted agency rates…..

Last year the NHS spent more than £72m on agency, overtime and bank midwives, according to a report by the Royal College of Midwives (RCM). The RCM says that, for the same cost, 3,318 full-time midwives could have been employed.

The report found that, in December 2015, NHS hospitals spent an average of £50.58 an hour on agency midwives….

Mothers face 30-mile trips to give birth

Hundreds of mothers booked into their local maternity units have had to give birth in towns more than 30 miles away because the hospital closest to them had temporarily closed.

The maternity units were either full or too short-staffed to admit the women. During one closure of maternity units at Cambridge University Hospitals NHS Trust, which lasted for 3½ days, 22 women due to give birth in the city had to have their babies in a range of towns including Norwich, Ipswich, Bedford and Harlow, Essex.

In Chester, women due to give birth had to travel to hospitals up to 32 miles away in north Wales.

The Royal College of Midwives will highlight the problem at its annual conference this week.

Jon Skewes, a director of the royal college, said: “Senior midwives are telling us that they are having to close units because of staffing shortages and the increasing demands on the services that often simply do not have the resource to cope.”….

Poor Paediatric workforce planning and career structures

Other countries have drop out rates, but the UK is particularly bad for Paediatrics and A&E medicine (Emergency departments). Comparisons to other countries are irrelevant when they recruit graduates to medical school compared to undergraduates in the UK. The dominance  of women at undergraduate recruitment, combined with their preference for paediatrics as an initial training path, means that too few complete and become competitors for consultant posts.

I am informed that the training is too long compared to other countries, and there is a focus on time served rather than experience or ability. There are also long hours in hospital just at a time when a woman might be planning / expecting to have a family. Paediatric workforce planning has been a disaster.

Add to this the fact that half of GP trainees miss out on a paediatric rotation, and readers will appreciate why the demand on paediatricians is so great. When there is so much competition for medical school places, this has happened because  of short term rationing of training places, as well as misguided manpower planning, poor training programmes (GPs could do 3 months Paediatrics) and a hierarchy which, once they reach the top, seem unable to change the route they had to take.

Time we cut our cloth to suit our means.

Martyn Halle and Robin Henry report in the Sunday Times 14th August 2016: Babies ‘at risk’ as NHS runs short of paediatricians

The country’s most senior paediatrician has warned that chronic staff shortages are putting children and newborn babies at risk.

Neena Modi, president of the Royal College of Paediatrics and Child Health (RCPCH), said: “We already have fewer paediatricians than comparable European countries. If we don’t act soon, we will fall even further behind and will struggle to find paediatricians to run some services.”

A report by the RCPCH to be published this week will show that more than half of paediatric units are understaffed and 89% of clinical directors fear their paediatric services will become unsustainable in the next six months.

Modi, who works at Guy’s and St Thomas’ hospital in London, said she feared the situation could get much worse as many of the services used by children were seen as a soft target for cuts.

She warned that the impact on children of 40% reductions in neonatal care and extra cuts of £7m to public health services in 2016-17 would be severe and could lead to rises in the rates of childhood obesity, sexually transmitted diseases and neo-natal deaths.

Among the services facing cuts are sexual health education and programmes to stop drug misuse and tackle obesity.

“These are key areas of public health where for relatively small investment we are getting good returns. The government really needs to listen to these concerns,” she said.

Modi said cuts to the Public Health England training budget had contributed to a 20% shortfall in the number of junior doctors needed to train to become the next generation of paediatric consultants.

The RCPCH study found that more than a quarter of general paediatric posts at senior trainee level were vacant. Dr Simon Clark, the RCPCH workforce officer, blamed the “imposition of the highly damaging new junior doctor contract” for a fall in morale and recruitment.

He said the RCPCH had made a number of immediate recommendations to tackle the problem in the short term but that in “the long term, more care should be delivered in the community by multi- disciplinary teams of paediatricians, GPs and nurses”.

His comments were echoed by Nigel Edwards, chief executive of the Nuffield Trust charity. “This is one among several examples of serious miscalculations in long-term planning of the NHS workforce,” he said.

“The simple fact is that we have not trained as many paediatricians as we need in the current system, given the rise of part-time working and the exacting standards we expect.”

Last week, Edwards warned that the next few years would see “widespread hospital closures” as the NHS sought to save tens of millions of pounds.The Department of Health said: “We’re helping the NHS cope with increased demand by recruiting more staff, with 9,100 extra doctors and 11,200 more nurses on our wards since May 2010.”

Meltdown. Living with increased risk in Maternity, Paediatrics and Neonatal Health…. and in Ambulances

Making rural hospitals sustainable – It is both quality hospital doctors and GPs we are short of… Please don’t be tempted to reduce standards..

Child health care: adequate training for all UK GPs is long overdue

 

 

We can’t do it all, says NHS hospitals chief; NHS needs to “take a reality check” and limit what it funds, hospitals say

Initially posted under the title “We can’t do it all, says NHS hospitals chief”, Laura Donelly’s article 11th August changed to; “NHS needs to “take a reality check” and limit what it funds, hospitals say” on 12th August 2016. Is anyone listening to Mr Stevens or Mr Hopson, or reading Ms Donelly? We cannot have “Everything for everyone for ever” and so we need to decide what are our priorities for full funding, partial funding and no funding. Since we all pay the same taxes NHSreality thinks this needs to be National for the really expensive services. Liberal philosophy has to be modified in the face of National inequity and reasonable fear… Meanwhile even normally altruistic juniors are disengaged and feel no remorse in continued strike action … An NHSreality check if ever there was one

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The NHS needs to take a “reality check” about what it can provide and take national decisions about which treatments and services should be rationed, the leader of England’s hospitals has said.

The call came as official data showed the health service in the grip of the worst bedblocking crisis on record, while waiting lists are the highest for almost a decade, with 3.7 million people awaiting treatment.

Chris Hopson, head of NHS Providers, which represents hospitals, said politicians and health officials needed to face the fact the NHS could no longer meet all the demands on it.

He said an “honest debate with the public” was needed about what the health service could pay for, as it grapples with the worst deficit in its history, in the face of growing demand.

Mr Hopson said the NHS could not meet waiting targets, maintain quality, and balance its books, with latest figures demonstrating that “something has to give”.

We need a systematic and planned approach to this and we need to build a national consensus about what the priorities are,” he said.

“We can no longer do everything with the money that we have. We have to look at all the options – whether it’s restricting access to some treatments, changing the [waiting] targets, reducing the workforce, letting the deficits slide or deciding that we can no longer keep an Accident & Emergency department open, or that we can’t run two hospitals 20 miles away from each other,” he said.

The senior figure said most hospital chief executives opposed NHS charges for treatment, but many felt that greater rationing of free treatment was required, to prioritise the most essential care.

The data from NHS England shows a near doubling in the numbers of elderly patients stuck in hospital, for want of care at home, or help to get them discharged, in the past five years.

Overall, 115,425 bed days were lost to delayed discharges in June – almost 80 per cent more than the same month five years ago.

Just 90.5 per cent of patients who went to Accident & Emergency departments were seen within four hours, against a target of 95 per cent  – the worst June figures on record.

Ambulance response times were also a record low for the time of year, with just 69.2 per cent of the most urgent calls receiving a response within eight minutes, against a target of 75 per cent.

Charities said a funding crisis in social care meant thousands of vulnerable people were being left in hospital, when they should have been cared for in their homes.

Vicky McDermott, chairman of the Care and Support Alliance, which represents 80 charities for the elderly and disabled said: “The Government cannot continue to ignore the crisis that means that patients are stuck in hospital, when they could be at home.

“The funding crisis in social care is heaping needless pressure onto the NHS.”

Earlier this week NHS managers at University Lincolnshire Hospitals NHS trust said they were considering closing an Accident & Emergency (A&E) department at night after reaching “crisis point”.

NHS England defended the performance, pointing out that June saw the highest number of A&E attendances on record, with a 2.1 per cent increase on last year.

Health officials said some aspects of the performance showed an improvement on previous months.

A Department of Health spokesman said: “The NHS had its busiest June ever, but hospitals are performing well with nine out of ten people seen in A&E within four hours – almost 60,000 people per day seen within the standard.

“We are committed to delivering a safer seven day NHS which is why we have invested £10bn to fund the NHS’s own plan to transform services in the future,” he said.

In recent days, senior figures have raised concerns about growing levels of rationing across the NHS.

On Thursday, health officials in Merseyside announced plans to withdraw one of the most controversial proposals – the suspension of all non-urgent surgery for months.

The plans from St Helens clinical commissioning group had provoked a public outcry.

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