Why The Government Will Win

So, over the last few years, I've become more jaded with my job. I see consultants becoming increasingly overworked, stressed and constantly succumb to political clinical targets, rather than for the greater good of their patients.

Sure, a decade ago, the EWTD slashed legal working hours overnight, but the workforce doesn't increase in the same rate. Hence, a massive influx of overseas doctors and locums.

Hospitals around the country are being centralised, with the overall effect of squeezing more out of departments with an already finite resources. Take the example of Barnet and Chase Farm Hospitals in North London. Chase Farm was a hugely expansive hospital over 20years ago, having acquired surrounding cottage hospitals whilst being a tertiary centre for Urology and Head and Neck Surgery. Over the last 10 years, it has crumbled with land being sold off to private firms, and services, including closure of their A+E, being transferred to Barnet Hospital and North Middlesex Hospital. What's the result? North Middlesex recently nationally shamed for their A+E service (or inability to cope!) and Barnet being a smaller hospital struggling to meet their targets.

With the junior doctors contract dragging on, this has erupted a lot of bottled frustration amongst the frontline medical staff. Doctors are leaving. Period. Nursing numbers have been slashed as cost saving measures also. Every aspect of clinical provision has been chipped away.

What's the net result? Increased locums and inefficiencies which is very expensive. This leads to increased deficits on the balance sheet. So to economise, services are downsized, merged, and moved elsewhere.

This is a continual process, which is a net result of chronic underfunding, understaffing and poor planning. I fear there is little we can do to save the NHS. It's cracks are crumbling every second of our shift.

So here come big private firms from abroad. They have abilities to inject cash, and staff and resources. They will leach off NHS income, and cop the risk of negative equity. Take the example of above, if VirginHealth decide to build themselves a new A+E at Chase Farm, it will improve the services for patients in North London. Virgin can employ overseas staff for pure service provision. They will take the money from taxpayers and line the pockets of Richard Branson (and probably Jeremy Hunt.as part of his under-the-table master plan). Who needs to pay National Insurance when we could just pay monthly direct debit to Mr Branson with the promise he'll take care of our injuries and illness if we land up in his A+E.....

Photos of life as a junior doctor

Here is a collection of bizarre and crazy photos of conditions us doctors put up with in the NHS....

If you would like to contribute, please submit via Clicking Here

Finance director refuses to authorise a new lock

Bed for sleeping at night when on-call

Drs Mess: Stale, dusty and always cold

Low Morale among Junior Doctors: The unofficial report

It turns out from Parliamentary debate that Prof Dame Sue Bailey has been asked to lead a review into the reasons for low morale with junior doctors. I thought I'd save her the hassle. Having worked in the NHS several years as a doctor, as a medical student, and during sixth form, I would say I have pretty extensive experience.

The Doctors Lottery

Like myself, doctors apply to a national job application and depending on their performance, will be allocated to work anywhere in the country. Obviously, there are very popular areas and areas where no one wants to move to. I myself am still living out of my car with my suitcase, and effectively am a gypsy.

In specialty training, trainees rotate within a region, and this has implications on family life. Partners have to live away for extensive time periods, difficulty with childcare, or the family unit has to move home completely.

It is a lottery as there is no geographical stability. For some it's a new start, but for some, it's constant instability.

Relationships between junior doctors and their employers/medical colleagues

Doctors rotate departments, or even hospitals every few months. This requires learning new IT systems, navigating a new hospital, learning the local protocols and pathways. The Trainer-Trainee relationship is irrelevant as the majority have no firm structures. 

In addition, we are all working for the same employer: the NHS. Why can't there be a central NHS staff record which will have all our contact details/immunisations and CRB status etc. This would make processes much easier for HR and doctors prior to induction.

Training vs Service Provision

This is difficult to get the balance. Different trainees have different training needs: a core Trainee will want a different learning requirement to a GP Trainee in the same specialty.

Currently, the biggest barrier I see is poor staffing. In the last 3 hospitals I've worked at, my department has been deprived of 1-2 SHOs. This has impact on training, because the remaining SHOs are just about managing the workload, but can't escape the ward/oncall to sit undisturbed in clinic or assist in theatres.

Trainees should be given adequate guidance from Trainers on where and when training opportunities are. However, trainees also need to make the conscious effort to seek these learning opportunities too.

Accommodation

I've seen both great, satisfactory and also downright disgusting accommodations and on-call rooms. 

What we/the BMA have to decide on is what we as Doctors should be expected to put up with. A room which has furnishings unchanged since 1970s but is warm with running hot water and no mould is, practically speaking, "acceptable" by national standards. Whether we as doctors should put up with that, is a different issue. Cohabitant insects is not mentioned in the standards, sadly.

NHS accomodation is cheap, and you get what you pay for. It's a room to sleep. It's not a pimp pad.

If there are particular concerns, and I've seen them on facebook, speak to the landlord or Estates immediately and professionally. Chase up the query. Ensure it is resolved in a timely manner.

Annual Leave

Another bug-bear is the ability to book leave. The ease of booking varies between departments and hospitals. For registrars, advanced notice is need in order to cancel clinics etc. SHOs and FY doctors are responsible adults and should be able to work out among themselves to ensure adequate staff provision. 

A+E departments tend to roster leave days, which is unfair. Leave is a contractual entitlement, and should be honoured; otherwise, it can be considered as charitable hours.

Bureaucracy

I have so much annoyance for administrators and various managers in the NHS. Having to submit endless forms and requiring multiple irrelevant signatories. It is easier to pay a parking fine than to apply for a parking permit. It is easier to pay your road tax than to fill in a Datix form. 

The trouble I see, non-clinical staff are narrow-minded in their job role. They love to have forms and generate lots of paper, for no good reason. 

If there is a broken door, forms have to be filled in and one has to wait for an unspecified time to have it repaired. 

Meals

I hate canteen food. It is a privatised sector of the NHS and their sole purpose is profit. Food is limited, tasteless and still expensive.

It is worse when on call, when there is sometimes no way to get a decent hot meal. I've done many night shifts hungry, surviving on tea and toast from the ward kitchens and free biscuits from the friendly nurses.

My 10 point plan for improvement:

1. National NHS staff record, shareable upon request to specific organisations
2. Increase rotation time in hospitals to allow Trainees to build relationships with the hospitals/trainers
3. Allow trainees to swap jobs/hospitals with other trainees, without pointless bureaucracy
4. Promote doctors involvement in IT systems
5. Access to free meals when on call
6. Set a standard requirement for oncall rooms and accommodation
7. Improve staffing levels
8. Doctors should write departmental handbooks for their departments to handover to prospective trainees
9. Trainers should provide a standard working week timetable for trainees to identify theatre/clinic sessions for learning opportunities
10. David Cameron - keep your mits off my NHS!!!