Doctors striking again

4 days in April

Can’t wait. 
 

Dear Doctors,

Thank you for your patience. Last week we saw tens of thousands of doctors participate in a 72 hour full walkout on the back of the biggest national mandate in a ballot for industrial action seen by unions.

One would have thought that Steve's main pre-condition of no strikes during talks would have meant he'd have been ready on Thursday. Doctors, he was not. Nor was he ready Friday as we suggested in one of our letters.

Steve Barclay sent us a series of dates and times of which we accepted 4 on the understanding that this would be some form of "intensive" negotiation. Steve's secretary sent us an informal email backtracking and asking for the 27th which prompted our repeat letter explaining we had accepted 4 dates.

They responded on Tuesday saying they can do Wednesday, but shifted the timing from 0700-0900 to 1600-1800.

When we rearranged our lives to suit them they said: Actually, it's going to be 1600-1630, oh and it can't be virtual, it must be in person. You can imagine our surprise (none) when they turned up late to the meeting too!

We  have demonstrated exceptional flexibility and reasonableness, but more than that, Mr Barclay has been demonstrably unreasonable.

At the talks was a DHSC communications officer, someone from HM Treasury, someone from the cabinet office, an Industrial Relations officer at the DHSC, Mr Barclay, Mr Quince, Mr Barclay's SpAD, and Mr Barclay's PA.

As Mr Barclay was talking, I went to use my phone to communicate with our professional negotiator over IM and Steve lost his composure; we heard in his voice his panic "are you ok Rob?!". I explained our negotiator will do the talking and handed over to them who put across our opening position on all things Full Pay Restoration.

Steve described it as unaffordable and unreasonable but refused to give an opening position himself.

Then, in the middle of the talks, he brings up the topic of "Engagement Principles" of negotiations; bizarre and incompetent given the order of events as we've started negotiating. Laughably one protocol is that "Meeting papers and data relevant to discussion should be circulated in good time before the start of the meeting".

Another component was that the content of the meetings is confidential. This is unacceptable to us. We’re not stupid; of course they’re going to be briefing the media along the way just like they always do and indeed did hours after the meeting. They have betrayed so many people so many times that we do not trust them. We are a democratic union. Communication, feedback, and direction is important to us. Doctors of the BMA are the power of the BMA. You are what gives the negotiators leverage and strength. We are grassroots doctors, it is unconscionable to cut off the grassroots component. They have tried in the media to assassinate the character of BMA representatives to divide you from us and now they have tried to gag BMA representatives to divide us from you.

They call us militant, we call ourselves organised. United we stand.

Steve reiterated that our deal was unreasonable and that he couldn't continue the talks, but before he left, I looked him in the eye and told him that he's quibbling over pounds when we're talking about an actual workforce crisis that has led to huge excess deaths. He kept referencing the AfC deal and I asked him perfectly candidly if he really thought that deal would do anything to address the nursing crisis; he didn't answer the question and they all left but not before Steve asked us to reflect on the day.

Because of Steve’s actions, we have no option but to call for further strikes.

He doesn’t understand that this is a profession critical issue.

He doesn’t understand that Full Pay Restoration is really important to doctors.

He doesn’t understand that we are serious.

Doctors, you must demonstrate your willingness to fight for Full Pay Restoration and so to the picket lines we must take.

Agree Chimp being well run so far. I have my doubts but the leadership team is resolute it seems. 
 

im actually on leave so will have to have a chat about taking strike action rather than leave albeit being able to swap back to leave if the strike is called off. 

From a purely political perspective do you think the Tozzas think there are many votes to be lost?  Most people striking or supporting the strikes won't vote Tozza anyway.

GP services - which most people use (if they can) aren't affected.  As Chimp has pointed out, emergency services will also still be provided.  Elective care is affected so the political calculation is who will the people affected by elective services blame?  The Tozzas or the junior doctors who bumped their consultant because they want a 35% pay rise?

Elective services are a huge part of the NHS. And GP services will be affected, albeit to a lesser extent since most major practices will have a trainee or 2 running their own list. 
 

If you’re waiting for a hip for a year and you get bumped it’s not going to be great. 

Would be interested to understand if any of the doctors on the board know if NHS Trusts will rely on the contractual terms in the consultants' contracts to stop them doing private work during the strikes so they can properly cover the NHS need?

All the national consultant contracts include clear provisions that set out the relationship between NHS work, private practice and fee-paying services (Schedules 6 and 9, England and Northern Ireland; Section 6, Scotland; Addendum Chapter 9, Wales).

The key contractual points are:

  • you must ensure that your private practice or fee-paying services do not result in a detrimental effect on NHS patients or services, nor diminish the public resources that are available for the NHS. There must be no conflict of interest between your NHS and private work

Elective services are a huge part of the NHS. And GP services will be affected, albeit to a lesser extent since most major practices will have a trainee or 2 running their own list. 
 

If you’re waiting for a hip for a year and you get bumped it’s not going to be great. 

So we go back to who will they blame?  

I wouldn't be surprised if the Tozzas want to say no forever or give very modest increases to pass this problem to Labour who won't be able to do anything about it either given their spending commitment statements.

I agree that 35% is a difficult figure to put across to the public, but it genuinely does make sense and is actually affordable, coming in at around £1bn/year. That’s why BMA official communications are focusing on hourly pay.

Most consultants realise that a victory for the juniors will benefit them and rearrange those private lists. In reality nights etc are covered by new consultants who won’t have substantial private practices yet. 

That’s why BMA official communications are focusing on hourly pay.

Also very easy to debunk these hourly pay numbers.  As I've said before personally I would pay them but I think the BMA tactics are dreadful. 

£14.09/hour is actually the wage paid to junior doctors - admittedly not “the average” junior, but I don’t think that was ever the claim. There is a separate campaign which lists hourly pay received for different grades

It is a little misleading since I don’t know of many unbanded F1s unless things have changed significantly (which is possible). 
 

That said some of the F1 payslips online seem to have people earning less than I did in 09! 

It is a little misleading since I don’t know of many unbanded F1s unless things have changed significantly (which is possible). 
 

the banding system has been abolished 

I know that but how many F1 jobs have no out of hours? I thought it was mandatory for F1? 
 

It will vary for each individual but it’s not going to change the pay/hour by that much. It’s a ludicrous discussion anyway - there’s no way doctors should be arguing over whether or not we get paid 14/hour or something slightly more than that. It should be unquestionable

That Guardian ad about the hourly pay and Pret workers was a massive own goal. Just made them look like tone-deaf, superior pricks. Baffling how they thought that was a good idea. 

No way can Tories can ignore this though. The NHS moves votes like nothing else (with the exception of a generic "the economy"). 

I thought it was fine. It says something about the nature of UK society that doctors pointing out their hourly pay has fallen so far that it is worse than that of baristas makes people furious at the doctors.

Because it didn’t have the ring of truth to it. It doesn’t annoy me as much as people saying F1s deserve to be paid more than nurses. Not sure I agree when a F1 isn’t qualified. 

To TF’s point about “blame” - I don’t think striking workers will get the blame for delayed procedures and appts. I think it will ultimately be laid at the door of the government. Maybe would be different if we were the only ones striking, but as it is it’s clear that grievances are widespread 

 It doesn’t annoy me as much as people saying F1s deserve to be paid more than nurses. Not sure I agree when a F1 isn’t qualified. 
 

F1s are qualified.

An F1/F2 is the broad equivalent of a trainee solicitor undertaking a  TC. If I am wrong about that, it is the same as someone who has passed the BVC, been called to the Bar, and is now a Barrister, undertaking Pupillage.

F1 in much of Europe is part of medical school. They’re not fully registered and not fully qualified. My understanding is that a day 1 nurse has full NMC registration and can work as a nurse whereas F1 has restrictions. 

In fact, it represents the hourly basic pay for the lowest-ranked doctors, who make up about 11% of junior doctors in general.

It would also only apply to doctors who receive no pay at higher rates, for instance for working nights or weekends. 
 

ie it’s correct 

It would be correct for a small proportion of the striking workers, except for this:

it spreads their annual salary across every week of the year, including the roughly seven weeks that these doctors receive as paid time off—as a result the hourly pay includes pay for some hours when doctors are not working.

...which strangely comes the sentence after the content you posted, which makes your omission all the more confusing.

Nobody can reasonably claim an hourly pay figure which excludes holidays.  Especially when comparing themselves to a coffee barista FFS.

To TF’s point about “blame” - I don’t think striking workers will get the blame for delayed procedures and appts. I think it will ultimately be laid at the door of the government.

By how many voters who would otherwise voted Tozza?

But he actually votes in BMA elections so surely it’s sensible to appeal to him? 
 

This is becoming a 0 sum game and I don’t think the unions are doing too badly. 

Plus weekends and bank holidays. 
 

It came up in the last strikes about salary deductions- you earn over 262 (I think days) since you don’t work every day of the year. And the out of hours can be a third of the pay (or it is in my case). 

The problem is that there isn’t a single salary for F1s, it will vary depending on the jobs they do. I earned about £34k in 2014 just after graduation, from speaking to F1s this is similar today. To look at the chart you would think it was just under £40k.

OK, what’s the corrected-for-holidays figure then?

A figure lower than the figure you have said is "correct" despite reading an independent article explaining that it was not correct because it would be higher if paid holidays were taken into account.

DHSC will exaggerate pay, I accept that the BMA also will exaggerate in the other direction. It’s agreed by everyone though that doctors have lost out massively against inflation.

Who studies for the best part of a decade then gives a fook about starting salary?  The whole profession is based around esteem and prestige, and earnings which are jam tomorrow

A figure lower than the figure you have said is "correct" despite reading an independent article explaining that it was not correct because it would be higher if paid holidays were taken into account.
 

I think you mean higher; but OK, I should have read more carefully. It’s still going to be shit though.

any side in an industrial dispute looks like a twot if they use easily provable falsehoods.  This factored in with the 35% thing makes them look like dishonest amateurs.  Which they are 

32 after 5 years.
 

Yes, so “fullfact” could do with some checking of their own as they have made it appear that JDs all get 7 weeks of paid holiday, this is not correct. In particular the most junior and lowest-paid do not.

While we are talking about what should be included when comparing pay between professions let’s not forget that junior doctors pay for their own professional exams (few hundred pounds a go), pay for mandatory Royal college membership (another few hundred pounds), pay for the regulator (yes, few hundred pounds), pay to park at work, work frequent night and weekend shifts, have to move around to progress in training etc etc

It costs £1546  to take the GP exams. That is coming out of taxed income. You must take them to qualify. If you fail a section you’ll pay for that section again (£470 or £1076). Can anyone honestly tell me this isn’t fooking bullshit?

For a GP? Who pays? The surgery? The acute trust? The surgery the dr is going to? What if they’re going to locum? 
 

What about for me? I want to be self-employed at the end! 

Employers should pay for exams post university.  Most law firms will pay for LPC or SQE.  Nurses and any other medic also shouldn't have to pay out of their salaries for professional development costs.

However, think the pension solution given wasn't the right one.  Appreciate that it needed to be sorted to keep doctors working, but a £1 million pound LTA is substantial..Shouldn't have been increased  Surely better to up non-pensionable salary instead? Sure a way to do this could have been found.

For a GP? Who pays? The surgery? The acute trust? The surgery the dr is going to? What if they’re going to locum? 
 

All first attempt professional medical exams should be paid for by the NHS. I don’t really care how that is broken down. But GPs are broadly speaking going to work for the NHS, they are trained in the NHS, therefore the NHS should pay for their exams. Introduce some kind of clawback for people working overseas if you want.

This might also introduce some realism to the cost of exams. £460 for MRCP parts 1 and 2 - an exam which is marked by a computer - is an absolutely ridiculous racket.

32 after 5 years.
 

Yes, so “fullfact” could do with some checking of their own as they have made it appear that JDs all get 7 weeks of paid holiday, this is not correct. In particular the most junior and lowest-paid do not.

Fullfact didn't say all JDs get 7 weeks of paid holiday.  They said this:

However, FY1 junior doctors are also entitled to five weeks’ annual leave, in addition to public holidays, and some other junior doctors are entitled to six weeks. If you assumed that junior doctors did not work on these days and calculated an hourly rate based only on the hours they did work (40 hours in each of roughly 45 weeks), the figure would be higher than £14.09.

and then this:

It would also only apply to doctors who receive no pay at higher rates, for instance for working nights or weekends. And it spreads their annual salary across every week of the year, including the roughly seven weeks that these doctors receive as paid time off—as a result the hourly pay includes pay for some hours when doctors are not working.

"It would also only apply to doctors who receive no pay at higher rates, for instance for working nights or weekends"

 

i thought all junior drs have to work some nights and weekends

When I did foundation all jobs (except GP) had full out of hours. People on GP who needed the cash did locums evenings and weekends. I suspect it was the same for Chimp. 
 

My understanding is that it’s now more common to have some non-OOH jobs in foundation but equally some now have compulsory hospital work at weekends (eg GP). I’d be surprised if someone had more than 1 4 month job without OOH in the first 2 years but it’s possible. 
 

Some jobs have no OOH at all eg Histopathology (which I did before I switched to forensic pathology and went back to full OOH). That’s a minority though and people come in to it knowing that. We do get something like £5k pa bonus for it as well. 

Dr Crypto, what is your comment on roumours spread by very respectable posters on this board that you are, in fact, risky?

I hear the centrist duds are never wrong, so this is some allegation to condend with.