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?

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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Its relationships that matter – more than a career in a brutalising profession

When people don’t feel cherished or cared for, and if they are employable,  they vote with their feet. When I went to my first job interview outside London the hospital offered me very good married accommodation, and by the time the interview came around I had been shown the accommodation and had a dig in the ribs from my wife and a thumbs up – as well as you had better get this job.. There is no junior doctors mess. 80% are female…. Continuity of care has gone. Over-management is endemic, and yet change is improbably slow. Fear and bullying abound.. Absenteeism in non doctors is one of the highest in the world.. There are other countries and jurisdictions who will cherish them, and some close at home with the old contract. No wonder over half could quit. The same errors have been made in General Practice, once the envy of every health minister in the world…

Dennis Campbell reports 25th April 2016: Junior doctors: ‘over half could quit NHS England over Hunt’s contract’

Survey finds negative impact on childcare and relationships are key reasons that could drive trainee medics away

More than half of junior doctors are thinking about quitting the NHS in England in protest at the contract Jeremy Hunt is forcing on them, a survey has found.

The research said difficulty in arranging childcare and the impact of even more anti-social shifts on doctors’ relationships with their partner and children were the key reasons for widespread disillusionment.

More than 52% of the respondents said they were likely to or will definitely give up medicine, or are considering moving to Wales, Scotland or abroad to avoid working under the health secretary’s new terms and conditions from August.

Respondents were asked how they would continue their career if the contract compelled doctors below the level of consultant to work more at weekends, overnight and in the evenings than they already do.

The contract Hunt is set to impose on trainee medics in England will extend the hours that count as part of their normal working week from 7pm-10pm on weekdays and include Saturday from 7am-5pm for the first time.

In all, 72 (6.84%) respondents said they will leave medicine. Another 206 (19.58%) said their future was uncertain, but they were likely to leave medicine.

Seventy-nine (7.51%) said they were considering a move to Wales or Scotland, where the devolved governments are agreeing new working patterns for junior doctors by discussion.

A further 199 (18.92%) said they were considering moving to Australia, New Zealand, Canada or another country.

“This survey turns any assertion that work-life balance will be improved for junior doctors under the new contract on its head,” said Dr Sethina Watson, a trainee anaesthetist and mother of four in Bristol, who carried out the survey. More than nine out of 10 of the 1,056 respondents were junior doctors, and 40% were either married to or in a relationship with a medic.

Watson said: “Jeremy Hunt’s rush to impose the contract threatens to create a potential timebomb that could explode as early as August as thousands of junior doctors struggle to find childcare or quit their jobs.”

The findings echo the concerns already raised by a series of leading doctors – including bosses of many medical royal colleges in a letter to David Cameron on Monday – that the revised terms and conditions for all junior doctors in England will deter recruitment and exacerbate the worsening shortage of medics.

Watson initiated the survey after the Department of Health’s equality impact assessment of the contract admitted that female junior doctors, including those who have children or other caring responsibilities, would lose out as a result of it.

The DH had not responded to a request for comment by the time this story was published.

Non doctors are not so lucky…

The history of denial in GP recruitment: over 50 years. The result of a sustained collusion of denial.. It’s going to get worse..

The government announced on Radio 4 today 7th April 2016 that it would recruit 6000 (not 600!) (Belfast Telegraph says 400) GPs from India. Medical Schools in India produce 80% of their doctors privately, 20% are state funded. The only criterion for entry to private medical schools are to achieve grades (almost all do) and then to pay. Whilst the UK has had 11 applicants for every 2 places given, we complain of a shortage and 10 years later we will still have to put up with doctors with less than adequate language and cultural awareness. The whole point of GP training and its rigorous application process was to avoid poor standards and communication. There is a history of denial in GP recruitment: over 50 years: the result of a sustained collusion of denial.. Without political leadership and honesty it’s going to get worse, especially in the unpopular areas… Even the Kings Fund and Chris Ham has been in denial and ducked the longer term solutions.

Sarah Knapton reports in The telegraph 7th April 2016: NHS to recruit Indian doctors to plug gaps in GP services whilst Rosina Sini for BBC News explains the effect of morale: Junior doctors’ strike: ‘I am moving to Australia permanently’ . The Times offers: Indian doctors to plug gaps in overstretched surgeries. In Scotland there is ‘Worst in a generation’ crisis for GP services – One in four practices has at least one vacancy

13th Jan 2014: GP Recruitment and Spending in Wales: The GP spending share of the health budget has plunged from the highs of 2005-2006

20th February 2014: Denial by Mr Hunt: Describing GP recruitment as a ‘crisis’ could be worsening the problem, warns Health Minister

27th March 2014: Fresh concerns raised about GP recruitment after figures showed more than 40% rise in number of GPs over age of 55 in past decade

26th May 2014: Choice is not all it is made out to be – without overcapacity including GP recruitment

9th July 2014: Doctor’s warning over “perfect storm” GP recruitment crisis

15th Jan 2015: NHS chief brands GP recruitment strategy ‘crazy’. Now that government has abandoned it, is General Practice is a key election issue

The GP recruitment farce – Mr Hunt never said the 5000 would come from the UK!

GPs reject MBAs. It’s no wonder… GP recruitment scheme offering MBAs scrapped after it attracts no GPs…

GP recruitment – and leadership opportunities?

GP trainee map reveals stark north-south recruitment divide

Health services are “vacant” – and have many GP vacancies despite oversubscription to Medical School over many years

Medical Schools: your chances – applications-to-acceptance ratio was 11.2.

Chris Ham (King’s Fund CEO) ducks the real issue. Short term problems are his agenda – not longer term solutions.

At best these doctors will plug gaps in unpopular areas. The worst aspect is that they then block jobs for 600 British Doctors – in 10 years time. This perpetuates the unethical policy of enticing doctors from countries who need them. Is Mr Hunt planning to send them back after he provides adequate manpower capacity? Does he intend to attract 600 per annum?