Proof of calculated pay cut

With all the fuss about misleading calculators, I sought to look at my own rota and work out from first principles as to whether my "pay" would be, as suggested, equal or not.

Current Contract

My current rota template is this:

It's a fairly standard 1 in 6 rota. It works, and we're happy working in this pattern. It's banded a 1A.

Therefore, current base pay is £34402 as a CT2. With a 1A supplement (50%), my gross pay goes up to £51603.

New Contract

The unsocial hours are recategorised as above. Now here's the fun. Using the rota template, I will slot hours into each category.

	Week 1	Week 2	Week 3	Week 4	Week 5	Week 6	Total (Total/6)	Enhanced hrs
Mon-Fri 07-22hr, Sat 07-19hr	12	45	48	54	4	36	199 (33.17)	33.17
Sat 19-22hr	-	-	-	1	2	-	3 (0.5)	x1⅓ = 0.67
Sun 07-22hr	-	-	-	12	3	-	15 (2.5)	x1⅓ = 3.33
22-07hr	36	-	-	-	27	-	63 (10.5)	x1½ = 15.75
Total	48	45	48	67	36	36	280 (46.67)

As mentioned, it's a working rota and seems to fit within legal limits.

The sum of the total hours therefore equals 52.92. The new proposed basic pay is £37400 equating to an average hourly rate of £17.98.
Therefore 52.92 x 17.98 x 52 = 49477.

Therefore, my counterpart next year working the exact same hours in August 2016 will be earning a gross pay of £49477.

This is a pay loss of £2126. That's a lot of money considering I have to pay £420/month for staff accomodation which I'm not entitled for reimbursement. This money lost is equivalent to about 5 months of my rent!

However, please let me know if my calculations are wrong (!!)

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Source: http://www.nhsemployers.org/~/media/Employers/Documents/Need%20to%20know/JD%20A4%20booklet%20FINAL.pdf

Trading NHS doctors for a cheaper alternative

Jeremy HC*nt is a clever man. He requires a £20billion "efficiency" saving by 2020, but this has nationally been managed at local level by axing masses of administrative workforce. Not to mention, deliberate incompetence in HR staff in failing to replace medical personnel. This amounts to the requirement for short-term recruitment for locum doctors instead. Overall, a monetary inefficiency. Who wins? Locum agencies.


Now that he has pushed through the en-face undercutting new August 2016 job contract for junior doctors, there is indeed an additional trick up his sleeve. The use of Physician Assistants.

The National PA Expansion Programme is recruiting 200+ PA's from the USA to relocate them in the UK to replace junior doctors. However, there are some very striking shockers!

In the USA, a typical program is 3years of training (~£10k-£60k depending on where you train in USA) , to then apply for the NCCPA exam.

As far as I know, my duties as a trainee is to teaching and supervise my fellow Foundation Doctors.
All doctors take medical histories, assess and examine patients, initiate and interpret investigative studies, and mak management plans. Certainly when the Consultants are around, I present my case to them. However, it is highly unfair that I do not get a scheduled and protected study period. Fitting my academic work has to happen in my evenings and days off.

This is where things really begin to annoy me. £50k starting salary, with greater annual leave entitlement. Starting salary for an FY1 will be £22k (if assuming 1.5x banding, this will be £34k). It's not until a Year 1 SpR (ST3) that you will be on par with a PA. Where's the sense in that.
Besides, are my GMC or RCSEng or even relocation fees paid for? Not at all.

Don't get me wrong, I for a long time have mentioned that PAs should be employed to assist in clinical teams. However, they should not be replacing the FY1/SHO. They should be there to support the phlebotomy and nonsense administrative tasks to allow the junior doctors to actually train to be a doctor.

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Ref: https://www.jobs.nhs.uk/xi/vacancy/dadc67164541975f6a966bbe95dcd6c4/?vac_ref=913883690

NHS wars- doctors strike back

So in the latest political gambit it seems Jeremy Hunt's vision of the NHS is far from what he already understands. This weekend has seen my fellow colleagues around the country posting #ImInWorkJeremy to prove the NHS is staffed with doctors at weekend. So here's my letter to you Mr Hunt...

Dear Mr Hunt,

Your vision of a 7-day NHS is something all doctors want. However, the message you've portrayed to the media and what the public percieve of us is truly damaging to the huge efforts and personal individual investments we doctor put not just into our career, but personal life too - all for the sake of doing the greater good the general population.

I would first like you to clarify where you received your statistics and how you have concluded what you claim.
The study by Freemantle et al (http://jrs.sagepub.com/content/105/2/74.full) states that patients admitted as emergency on a Sunday vs. Wednesday has a hazard ration of 1.16. HOWEVER, and this the big BUT, the same paper quotes "being an inpatient in hospital on Sunday, regardless of the day of admission, was associated with a lower risk of death (on that day) than Wednesday ....Similarly, Saturday was associated with reduced risk of in-hospital death compared with Wednesday..."

The above image sums up well the false claim you have made. Patients admitted on a weekend day have a higher risk of subsequent mortality, but this will not be because of lack of doctors. We already see the day of death is higher during the week. Therefore your publicly announced argument is a political LIE.

More likely is that social care services and GP services are unavailable at weekend, so the ill patient who has been struggling all week finally gives up and ends up in A+E at the weekend. They are self-selected as sicker patients.

May I add, elective admissions generally do not occur at weekends except for minor day case procedures and local anaesthetic cases. However, with government targets, many Trusts run Waiting List Initiatives (which I hope you are aware of) where surgeons, nurses and ward nurses are paid extra to run additional sessions in order to save a waiting list breach. However, often the staff of these sessions are occasionally with locum surgeons and nurses. Again, this self-selects a substandard care.

Further, if you were to be unwell anywhere in this country, you will go to an A+E department and you will be in the vicinity of an A+E Consultant. Followed by your specialty Consultant. Consultants, Registrars and Junior doctors staff a hospital day and night. Doctors includng Consultant already work weekends! However, services are spread thinner, granted.

I ask you this, how do you intend to construct the new Doctors Contracts to comply with European Working Time directive? If you want more doctors at weekends, will you pull staff from during the week?

Additionally, do you realise physiotherapists, occupational therapists, pharmacists, specialist lab technicians, porters, cleaners, radiographers all run reduced/no services at weekends. They are all NON-doctors who are essential to running of a hospital during a normal day, facilitating care and discharge. Social Service do not operate at weekends either. Ploughing more doctors into a weekend will NOT make the hospitals run more efficiently or reduce mortality without the rest of the NHS services fully running at weekends too.

Finally, I will end this by asking you closed questions:
- Will you make a national apology for the misinterpretation of the statistics you have stated?
- Will you make a national apology to doctors for further destroying there ever so reducing morale under govermentment schemes?
- Will you state a plan on how you will run a 7-day NHS with which the ESSENTIAL allied health professionals and social services are available and fully functional at weekends?

Your kind regards,

Mr Steth

ARCP - absurd reviews of clinical pointlessness

That time of year when all trainees, myself included, frantically upload everything and harass our consultants for pointless tickbox-worthy workplace-based assessments for the sake of satisfying various all mighty judges who see you nothing more than a piece of meat in a foodwrapping factory. So long as you have all the correct labels, you're fit to go out to market!

I know many who have failed this year, or received "inadequate evidence presented to progress" on the basis of the most trivial things. I personally require more consultant level WBAs; but does this judge me as a good doctor? If my consultants haven't bothered to validate a WBA or meeting because they conveniently keep forgetting their login details, is that really a reason to penalise us trainees? The deanery should be investigating the technology-incompetent supervisors.

Particularly in surgical specialties, much responsibility is delegated to the registrars so I often will discuss cases directly with registrars rather than consultants. Additionally, it's rather out of my control when on the numerous occasions consultants will say "sorry find me tomorrow instead".

I do think if the deaneries want accurate reports of trainees, they should harass random individuals in the department. A 360 degree appraisal is far more informative than pointless CBDs. The deaneries should really push weight on the consultants.

I myself will frequently compete WBAs for my foundation doctors, and i encourage them to send them. It's a shame the consultants can't take on the same attitude.
It is massively hypocritical of Stella Vig and like-minded consultants who refuse to complete them. I refer to my tweet during ASiT 2015 (https://twitter.com/MrSteth/status/572011787966668800)

At the end of the day, it's here to stay. So as they say in Rome, just do it.

NHS Fragmentation

Apologies it has been a while since my last post, much has been going coming that ARCP make-it-or-break-it time!

So the Conservative party has won and it seems the forever spiraling slaughter of the NHS shall continue under government's fingers. Since the disengagement of the prior PCT's to what is now basically consumed as regional money boxes gatekeepered by GPs, it encourages the "postcode lottery." It encourages services to be available or not available depending on your local population.

Added to that is the constant NHS-bashing in the media. The media are heavily to blame for shooting the morale among staff. Doctors, Nurses, Porters, Maintenance staff etc - all working hard and put in the extra effort to make things better for the greater population. However, when staff are being nationally shamed in the media for, what is often their fallibility, then it portrays to the public that the NHS is a untrustworthy organisatino and medical professionals should always be questioned upon their clinical judgement. It's like taking your car in for MOT and not trusting the mechanics advice. I'll let you ponder over that analogy.

It's heartbreaking when I overhear relatives moaning about how their GP is awful or "the specialist was useless and wasn't listening to me." Sure, there are occasional not-so-nice doctors but overall, the NHS provides a service that no other nation can - free at the point of care.

When the NHS was set up in 1948, the general public respected it as a privilege to be able to see a doctor for their illness. My semi-retired GP colleagues tell me, if they made home visits, they were treated like a Priest - the utmost respect with open discussion. Nowadays the government and the public are treating the NHS as a right. The NHS is there to look after every aspect of your health. If you are having respiratory problems because your home has damp proofing issues, yet you can't afford a builder to repair it, then your GP must get involved to sort out our your home to make your chest better - Wrong!

What I'm trying to highlight is that the NHS is being abused by everyone. The demand on it's service far exceeds it's capacity to provide. It will collapse. Privatisation will eat away like a cancer. The NHS is ill, it is suffering, and the next decade will see it become further frail. I look forward to the next healthcare reform bill. Not.

Doctors and double-standards

Over time, I have realised that doctors face the dire end of double standards in many aspects. I'm sure it occurs in other industries too, but whilst doctors are upstanding professionals of society, I picture a Biblical canvas portraying the Israelite slaves against the Egyptian Pharaohs.

I can disclose many examples, those occuring with me and those occuring with my colleagues, but two that stick in mind I will share. 

The medicinal cult I've grown up in favours being proactive and efficient, and such behaviour is expected of me. However, when dealing with the administrative staff, this behavior doesn't exist.

Example 1. 

During an ENT rotation, the bulb from the scope light box had blown and was "in repair" with the engineers for two months, rendering the team unable to perform fibreoptic nasendoscopy whilst on-call: a daily task to diagnose laryngeal pathology. Many emails to Purchasing were sent, who took their time to reply that the bulb was on "back order." Eventually, due to risk of clinical harm,  matters were taking in the hands of the Doctors. One doctor phoned the Bulb Company to ask the current status of the order; the company stated the Hospital hadn't paid their last invoice so they won't be supplying. So the doctor spoke to Purchasing department again, who was then deferred to the Finance department and told the bill has been paid. They instructed the doctor to call the Bulb Company back. Ridiculous! Suddenly, a doctor is taking on the role of the Purchasing/Finance department. 

So quite rightly, the Doctor refused and demanded the pen-pushers in Finance to phone the Bulb Company themselves and explain the situation so that the Hospital is no longer blacklisted.

Example 2.

A surgical trainee recently went on an ATLS Course, and as such, submitted a Study reimbursement of the fees. ATLS is not cheap! However, given that the course was in the last month of his employment with the Hospital, it turns out that the reimbursement will be void since he'll be no longer on the payroll. When questioned, it turns out this is a "common problem."

I find it increasingly frustrating that we on a daily basis have to abide by the GMC Good Medical Practice or face a public shaming and being struck off the register. However, when it comes to measly administrators, their incompetence is overlooked.

Clearly, the problems with the NHS weigh more on the non-clinical staff that support it. Ironically, a manager said to me this week "If you pay peanuts...well, you know what you get!"

Abstract Conferences

Since the MRCS exams have been done and swept under the carpet, my focus has been ticking all those other academic boxes for attending courses/conferences and presenting my projects at them, particularly closed-loop audits (Clinical Governance - light bulb moment!).

It's worth spending your downtime periods, scouring the various specialty websites for a list of there events, and deadlines for abstract submissions. I've realised more and more of my abstracts, are more abstract! Yet, they get accepted; admittedly, before I've even collated the data.

No one really pays attention. Afterall, with the 100's of journals out there willing to accept any substandard publication, you're guaranteed a poster/publication eventually. It's a self-necessitating wheel. In order to progress in surgery, we have to publish/present. In order to publish/present, we have to complete an audit. In order to complete an audit, we have to carry some sort of nonsense excercise whether it is important or not.

Welcome to the future of Clinical Governance I say!

Paediatric minor op reward

So a quiet on call, and I'm referred a young girl (for sake of confidentiality, she was less than a decade old) who was suspected of having a wooden splinter stuck in her finger. The ED doctor said there was pus and being a young patient, he felt she needed the surgeons to tactically remove it.

So I met the delightful girl with her mother. After reviewing, it just needed a bit of local anaesthetic exploration. They agreed.

I set up the minor ops room in ED. Whilst injecting the lidocaine (local anaesthetic), all I could hear was giggles from the child. I looked up to see tears. I assume the object of fear hadn't been experienced, so she didn't know whether to scream or laugh and the sensation of stinging pain and sight of her own blood.

However, success ensued; I removed this wooden log of a splinter, placed it in a specimen pot for her next "show and tell" at school, then bandaged her up.

As I was clearing up, she sprung up and ran over to give me a big hug. Now all I can say is, I nearly became tearful with joy. This is one of the few times I've actually received sincere gratitude from a patient. Usually patients like to complain because they've waited an hour to see me. However, this reward is what motivates me. I'm still joyous today. Happy patients make happy doctors. So thank you little girl for making a doctor happy.

The unsightly shape of training

Had a lengthy discussion with a surgical trainee who is pre-MRCS but post-Core Surgical Training . She's two years out of core training passing her time in LAT jobs.

That's a strange position to be in. Essentially competent surgically, but on paper isn't qualified to be a surgeon. I, on the other hand, look good on paper with my exams and academic achievements etc but honestly feel that as a result of streamlining through the training ticking boxes, I actually can't do a lot of things independently.

It is worrying that I'm not the only one in this position and this trainee expressed concerns that in ten years time, we might be consultants calling each other up for advice on complex patients. With our lack of experience, we will be hesitant on performing complex procedures which our predecessors would have happily carried out.

With this "new shape of training" being proposed, it is further worrying that it will exacerbate the problem. Create generalist consultants early, without the Specialist skills. With increasing emphasis on community/GP growth, there is a lack of focus supporting Specialist skills.

I, sadly, have no faith in the Royal College of Surgeons either to support good surgical training. My local deanery has no interest in cracking whips when i say my surgical training involves typing op notes whilst my consultant operates or being the ward round phlebotomist. My consultants have no interest in teaching our juniors. Where does this leave us?

Well, Mr Steth considers quitting this sinking ship called the NHS as the lack of interest in trainers (from government to local level) risks putting lives at risk. The cultural move is continuing towards employing foreign doctors as service providers. More on my training model in another post.