I'm a junior doctor on strike in England, back for another AMA

There's a lot of people who think that this is the beginning stages of the Conservative's plan to privatise more of the NHS: Impose these contracts, cause the services to collapse, and then argue that more privatisation is the best way to go.

Do you think that this is the case or are people just overreacting?

It's a real concern of mine. I don't believe the government are fools, I think they know what they are doing.

Student Nurse here just chiming in to say we all completely support the Junior Doctors, with loads of us joining the picket lines. I was wondering what you think the implications for the new nurses and other staff would be if (and I certainly hope not) the contracts happen?

If the government impose changes on us, I think the agenda for change (AfC, the contract other allied health professionals are on) will be next.

It's likely the government will attack anti-social working premiums, just like they have for junior doctors.

I'm really sorry that the government decided to take away the student nurse bursary, I think it's ridiculously short sighted. We've got a shortage of nurses in the UK and without the bursary less people are going to be able to train to become one.

The government consultation on the student nurse bursary can be found here - https://consultations.dh.gov.uk/workforce/healthcare-education-funding/consult_view

If you could, could you do a ELI5 on the whole situation and how it's affected you?

It's gotten pretty complicated over the last year but I'll try.

Government want us to work more for either 1) less money or 2) the same amount of money. The government have wrongly misrepresented statistics to try and make their argument stronger. The government no longer want to negotiate and have imposed the contact on us - this is them standing up and saying "I'm big, you're small. I'm right, you're wrong, and there's nothing you can do about it".

The contract is disliked by everyone apart from the government. The junior doctors dislike it. The Royal Colleges (people in charge of our training) dislike it. Patient groups dislike it. Senior doctors dislike it.

I have never felt more demoralised. I applied for a job to start in August, I was successful and got my first choice job in my first choice area - but because of everything that's happened, I don't know if I'm going to actually start the job.

I love my job, but I hate what this government are trying to do to us.

"I'm big, you're small. I'm right, you're wrong, and there's nothing you can do about it".

solid matilda reference, unless the movie was referencing something else, in which case I am happier thinking it's from matilda.

Jeremy Hunt is literally Mrs Trunchbull.

Has any of the strikes and protests helped in any shape or form and how can we as the general public help? And what kind of doctor are you if you don't mind me asking

I think they have helped. They've certainly helped junior doctors get our side of the story across and counter some of the misinformation the government puts out - we don't get paid overtime, there is no such thing as danger money, it's not all about Saturday pay.

I'm in the second year of the Foundation Programme. This is a general training scheme which junior doctors do on leaving medical school. We rotate around different jobs every 4 months, at the moment I'm working in Gastroenterology.

I've been successful in my application to go into further medical training - that's what I'll be doing from August.

I get that junior doctors are going to strike but why aren't the senior doctors going to strike? Doesn't the contract that the government want to impose affect them as well? For example they would have more patients to tend too and it might be an overwhelming number of patient. Sorry if I'm asking too many questions btw

Senior doctors (consultants) are on a different, separate contract. As such, they can't go on strike over the junior doctors contract.

You're right though, the junior contract does affect them. It affects everyone working in hospitals, and that's why we've got their support. My senior doctor and allied health professional colleagues know that a negotiated contract which is safe and fair is the best outcome.

I live near one of the areas where there is picketing. How can I help the people picketing? Would they appreciate free donuts or something?

Yes, if they are anything like me, they would definitely appreciate free donuts.

If you're near a picket line, stopping for 10 minutes and talking to the junior doctors will really lift their spirits.

Do you honestly, honestly believe this is a battle you can win? I support you guys completely and I hope you do but looking at the opinion polls what you've got is a well supported strike in terms of numbers but without much depth of feeling. Basically, most people support the doctors, but they also don't care that much. And opposition is likely to harden the longer the dispute goes on (a fact the government are very well aware of).

What's the path to victory here? When would you, personally, accept defeat?

Good luck to you and all your colleagues, by the way, and sorry if this appears pessimistic.

As a doctor I have a duty to protect my patients and speak up when patient safety is at risk.

I believe the imposed contract will adversely impact patient care by: 1) Worsening continuity of care 2) Increase gaps in rotas due to junior doctors leaving 3) Reduce the quality of training (and therefore worsen patient safety for years to come)

For me, I would define winning as achieving a negotiated contract which is safe for patients and fair for doctors. I believe we can achieve that. I was really hoping Jeremy Hunt would accept the cross party pilot plan - it would have allowed testing of the imposed contract and allowed him to save face and de-escalate the whole affair.

I would personally accept defeat on August 2nd if the contract hasn't changed. If I'm forced to sign that unsafe, unfair contract it will be a great personal defeat.

( and don't worry, you don't sound pessimistic at all)

What's your favourite "Doctor, Doctor..." joke?

"Doctor doctor I feel like a pair of curtains ** Well pull yourself together!"

Although my current favourite medical joke is: "What blood group is Father Christmas? ** Ho-Ho-Ho negative"

Do you think it's time that Cameron/Osborne became the focus of the protest rather than Hunt? Hunt is just the face of the changes, and the driving forces is from the PM and Chancellor.

Hopefully this will put a smile on your face, Cassetteboy vs Jeremy Hunt: https://youtu.be/uK7DRJx9nbU

For those that don't know, Hunt is the minister responsible for Health.

I find it concerning how quiet Cameron has been on the whole topic. I can't imagine Hunt has been coming up with this policy on his own.

Junior doctors have recently been accused of trying to topple the government and it's claimed that the BMA are radicalising us all. I don't believe that, I don't feel radicalised (but then maybe I wouldn't if I was...).

I think we need to remove politics from the NHS. It's too important to be at the whim of the revolving door of Westminster. We've got an independent Bank of England to set interest rates, why not have something similar to look after health and social care?

If you have walked out on your patients, are they safe? Yes. I would not be out on strike if I didn't think my senior doctor colleagues and allied health professionals could provide safe and effective care.

Doesn't that undermine your position? If the government can provide safe and effective care without you and your colleagues, why do they need you?

I don't believe it does undermine our position.

In order to provide the urgent and emergency care today, routine care had to be suspended.

So that means outpatient clinics have been cancelled and elective operations have been re-scheduled. That can not be done indefinitely.

We have the full support of our senior colleagues and allied health professionals - many of them came to visit us on the picket line today. They know that if this unsafe, unfair contract is imposed in its current state that it will be unsafe for patients and cause a mass exodus of junior doctors.

I would never want to do anything which would harm my patients, I am glad that my senior colleagues and allied health professionals are able to provide cover. It is unfortunate that in this dispute between junior doctors and the government that I have very few ways to impact upon the government.

Also, without junior doctors there are no senior doctors of the future.

How is the government allowing you to strike since you are considered an essential service? I'm not sure how it works over there, but in Canada if you strike and the government considers you an essential service you can be terminated.

That's not the case in the UK. For more info on industrial action in the UK, have a look here: https://www.gov.uk/industrial-action-strikes/overview

What are your plans if the strike continues for an extended time? Are there other options to continue your residency?

If I wanted to continue my training in medicine I would look at moving to Wales, Scotland or Northern Ireland - areas of the U.K. not imposing the contract.

If you're qualified doctors and you don't like the contracts they're offering you why can't you all just threaten to go work for a private hospital or migrate within the EU and get a better deal somewhere else?

I could work privately, generally people see a consultant (a doctor who has complete their training, usually about 10 years in length) when they go private. I've only been a doctor for 2 years so I doubt anyone would want to pay to see me privately.

I could work abroad. I only speak English so working in Europe would be tough. I'd be much more likely to move to Wales, Scotland or Northern Ireland - these are other countries within the UK which are not imposing the new contract.

Three years seems like a long time to be renegotiating. What are the primary issues that are presenting an agreement through arbitration?

I'm not a BMA rep, just a member and so I wasn't in the negotiations myself but as I understand it, some of the main sticking points were: *Pay for all work done *Strong safeguards to protect patients from tired doctors *Suitable recognition of antisocial working

Do you worry about the effects of this strike, and others where doctors walk out of ERs, will have on the general population? That is, the effect of the medical doctors leaving their hospitals will have on a person who is coming in for emergency care after a serious accident?

No.

If a patient comes in requiring emergency care they will be seen by a consultant. These are doctors who have trained for 10-15 years in their chosen speciality.

They are the people who are training me, they are better at the job than I am.

My GF has just qualified as a Dr and is starting her F1 placements in August. I worry a great deal about what the imposition will mean for her. IIRC she is immediately at a disadvantage as she is a woman and is going to be working dangerously long shifts and more weekends for less money. What also worries me is the lack of whistle-blowing protection she will get. Correct me if I'm wrong but as I understand it the NHS acts as more of a employment agency, rather than an employer and as such were she to report failings of some kind she could be putting her job at risk. Is this right and if so, what can she do to cover herself?

I'm not an expert on this, and I'd advise her to check everything with her local BMA rep.

She'll be employed by her hospital, not by the government/NHS. This makes whistleblowing a bit tricky because to qualify for whistleblowing protection you are required to have worked a certain length of time with an employer. Each different hospital counts as a separate employer. Junior doctors move around so much that sometimes, we don't qualify. (This can also affect qualifying for maternity/paternity leave)

However if your GF sees anything she feels is a danger to patient safety she should notify her clinical supervisor or educational supervisor. She should complete an incident report and ensure the poor practice is corrected. Your GF will have had training on all this and it's a common topic in the SJT (one of the the compulsory exams we sit).

Being a doctor can be very tough, especially in the first year. She'll need plenty of support, I know I certainly did.

Are you getting news/media coverage?

Do you know what the public's opinion is?

We are getting media coverage, it's been in the national news here in the UK.

And we do have public support, here's a BBC News article containing the results of a poll they organised - http://www.bbc.co.uk/news/health-36149312

the UKare behind you.

Two questions why are you posting on here and not picketing the hopsital you work at

Are there any strike breakers amongst your colleagues and what are your views on them ?

yours in unity

The picket line at my hospital was from 8am until 12:30pm. For the afternoon we planned basic life support training sessions and a "Meet the Doctors" event.

There were some, not many. I do not begrudge them for working today. They have their reasons - some didn't feel comfortable with an all out strike, some couldn't afford to lose another day's wages.

But I've not yet found one doctor who wants the new contract.

What is your estimate for the human collateral of your strike? Do you believe you are violating your hippocratic oath? (and do you even do that in England?)

Statistically speaking, people die every day. On these strike days I do not believe there will be an increase in deaths.

We don't swear the Hippocratic oath. If we did, it would prevent us from performing surgery or administering chemotherapy.

The Hippocratic oath is pretty out dated.

I'm from NYC, so is this all part of a ploy by the government to sell off the public healthcare by forcing you to go on strike and sell it all out to their friends like the Royal Mail?

I visited the UK a few years back and most people I met all agreed that the public healthcare was one of the best things Europe had and as an American I have to agree as health costs here are ridiculous unless you're a millionaire.

edit: Royal Mail

That certainly is one of my concerns. It would be very easy for the government to underfund the NHS, watch it start to fail, point out that it's failing and start to sell sections off.

In fact, they've already started doing that. PFI was the start of privatisation, this was a scheme where NHS hospitals would borrow money from private firms to fund expansion of the hospital. Many of the loan contracts have hideous clauses which have ended up costing the hospitals lots of money.

Likewise, we're already seeing sections of the NHS sold off. Areas of the UK now have their community paediatric services or minor injury services provided by Virgin Care.

How can your everyday person who does not work within the NHS support the junior doctors?

Go along to a picket line, let them know you support them. Ask for a sticker or a badge and wear it.

wouldn't doctors make more under a private healthcare system?

Yes, we probably would.

Does "free at the point of use" imply "publicly owned". And if not, should it?

Also do you agree with the basic principle that working excessively long hours is detrimental to patient care and should be discouraged? If not, why?

Private healthcare confuses me. I do not understand how a private company can put the interests of the patient above the interests of their shareholders. I feel that yes, healthcare should be publicly owned.

To your second question, yes, I feel that excessively long hours are detrimental to patient care. I worked a rota recently which had me work 87.5 hours in 7 days. I was not at my best by the end of it.

My partner is finishing up his medical degree in Australia. We are looking at moving to the UK. He is planning to spend his internship, residency and registrarship in Australia, then qualifying for the UK where he will do his basic physician's training and following training there.

Is this a good plan? Would he be better completing, say, his BPT here and then looking to do his advanced in the UK, or finishing his residency here and then doing his registrarship in the UK? Is the UK wanting/accepting overseas doctors?

Is the UK system terribly different to Australia's? Are there any significant cultural differences in terms of medicine and health that we should know about?

Also - though you may not be able to comment on this - given the strike and the situation (he and I are both completely behind the strike/the doctors' position), is it a wise plan for us to be moving to the UK? Obviously we still have a few years to go at this point, so things could change, but this is worrying both of us.

EDIT: We're planning on starting out in England, but may move to another country depending on his/my job opportunities. IIRC, the NHS functions slightly differently in the different countries? To make it easy, best to assume I'm just talking about England.

EDIT 2: Sorry, I know most of my questions are a bit off topic. I came here with my question about the strike and how it might affect our plans first, but then I realised I had a lot of other questions!

I'm not familiar with the Australian system so I'm not sure what you mean by BPT.

Also registrar in the UK is a fairly senior doctor, the last stage before consultant so again I'm not quite sure what you mean by basic physician training.

The UK certainly is looking for more doctors, we have plenty of gaps in our rotas. At the moment, I would suggest applying to Wales, Scotland or Northern Ireland - areas of the U.K. which are not imposing the contract.

From what I've seen online and when I've listened to medical podcasts I think the NHS and Australian systems are fairly similar.

Oh, sorry, I abbreviated basic physician's training.

The Australian system goes internship (1 year, straight after finishing university degree), residency (1 year), registrarship (2 years) and then (for the path my partner is doing; internal), basic physician's training (3-4 years), then advanced training (3-4 years), after which he then tries to become a fellow. (Hopefully I remember that all correctly.)

I will suggest Wales, Scotland and NI to him.

Thank you very much for answering; I know my questions were fairly off topic. Best of luck with the strike - I hope the government changes its mind.

Ok... UK system goes: Foundation programme - 2 years, straight out of uni Core training - 2 or 3 years, starting to specialise Specialist training - 5 to 8 years, fully specialised

After satisfactory completion of specialist training you obtain a CCT (certificate of completion of training) and are eligible to apply for consultant jobs.

am I missing something or what? I mean if a doctor doesn't like their hours at a hospital, why wouldn't you just start looking for another job at a different hospital? If my boss told me I had to start working weekends I'd be sending out my resume like right after our meeting on company time.

For junior doctors the NHS is a monopoly employer. I can't send out my resume.

If I want to continue training as a doctor I have to be on a recognised, validated training programme. If I am unhappy with my rota and leave a hospital, that would count as me resigning from my training programme and I would not be allowed to continue training in that speciality - unless I had extenuating circumstances explaining why I left.

Democracy,Free Speech,Law,Order,Trade,Industry,Health,Education,Etc Do You Accept This<Is The Order Of Priorities?

For me? No.