General / Off-Topic junior doctors - any facts?

[CMDR Heisenberg B. Damned]

sorry, I don't get it, JDs say overworking them with long shifts is dangerous for patients (agreed) and if the new contract has better limits on JD hours, how are the new contracts worse for patient safety?

Seriously how are you expecting JD's to work less hours and yet cover more hours?

But it goes further than that, the link Yaffle provided (thanks) has some new information I wasn't aware of. Yes the initial data that this is based on showed that people admitted at weekends are more likely to die. It also had this in it:

"It is not not possible to ascertain the extent to which these excess deaths may be preventable. To assume that they are avoidable would be rash and misleading."

Now they had no breakdown of elective vs emergency but that new information I mentioned was further work on the data to provide that extra information - there was still a higher rate of mortality with people admitted at weekends. However, that tells us nothing, so that quote stands. There has been no proper checks into the cause of these deaths. Could be lack of staff at weekends, could be that people admitted over weekends are just more likely to be at deaths door. We don't know because no analysis has been done.

It's also not clear if these figures are for people dying at weekends or just those admitted at weekends. I think it's the later but that leads to other questions as well, how does this impact people in hospital over weekends but not admitted at weekends?

Further the solution to this issue, changing contracted hours and payments for JD's, hasn't been trialed. There is no information to show it helps at weekends and there is no information to say it doesn't affect weekdays adversely.

The truth is if you want extra cover you need to employ more staff, as that radio show said that will likely mean staff across the board, pharmacists, pathology, porters even clerical staff and IT. The list goes on. We can only get the healthcare service we pay for and this imposition without trial was only ever going to make the staff involved feel undervalued and want to leave. Looks like a number of them are, at great cost.

Now I suppose that could be an honest mistake, in which case incompetency, or it could be deliberate undermining. Either way I don't blame the BMA for trying to hold onto the doctors pay and conditions.

The final sentence in that programme is about funding, and quite telling:

"I just don't see how it can be done on current funding."

 

[beelbeebub]

Thanks for that link to the radio show Yaffle, very informative!

Seriously how are you expecting JD's to work less hours and yet cover more hours?

No, I'm not, that would be stupid.

You are lumping 2 separate things together.

"JD's working less hours and yet cover more hours"​

If the new contracts mean JDs can work less hours (or more specifically their peak hours will be lessened, it appears the average hours are staying similar at 40-46.) how is that a bad thing?

Trying to get the same number of JD's to cover more days would be a bad thing, but that is not the new contracts. That would be any new rota that was imposed.

But the JDs are striking because "the new contract puts patients lives at risk" yet haven't explained how a contract that reduces hours a JD can work, is worse for the patients.

If they were striking because the new rotas being imposed increased their working hours (regardless of the pay situation), or that hospitals were reducing the numbers of JD's on duty at a given time (in order to spread their available JDs over 7 rather than 5 days) then I would see how that directly impacted patient safety (and support blocking that action).

But I don't see (and if anyone can provide info, such as the new hour limits are easier to bypass because of some small print arithmetic juggling like the averaging period being extended or something) how the new contracts, in themselves, are bad for patient safety.

In fact, if the peak hours (and shift patterns) are better in the new contracts I don't see how that can be a bad thing at all for patient safety and so why the JDs are striking over it (and not the rotas or doctors on each shift)

But it goes further than that, the link Yaffle provided (thanks) has some new information I wasn't aware of. Yes the initial data that this is based on showed that people admitted at weekends are more likely to die. It also had this in it:

"It is not not possible to ascertain the extent to which these excess deaths may be preventable. To assume that they are avoidable would be rash and misleading."

Now they had no breakdown of elective vs emergency but that new information I mentioned was further work on the data to provide that extra information - there was still a higher rate of mortality with people admitted at weekends. However, that tells us nothing, so that quote stands. There has been no proper checks into the cause of these deaths. Could be lack of staff at weekends, could be that people admitted over weekends are just more likely to be at deaths door. We don't know because no analysis has been done.

It's also not clear if these figures are for people dying at weekends or just those admitted at weekends. I think it's the later but that leads to other questions as well, how does this impact people in hospital over weekends but not admitted at weekends?

Further the solution to this issue, changing contracted hours and payments for JD's, hasn't been trialed. There is no information to show it helps at weekends and there is no information to say it doesn't affect weekdays adversely.

The truth is if you want extra cover you need to employ more staff, as that radio show said that will likely mean staff across the board, pharmacists, pathology, porters even clerical staff and IT. The list goes on. We can only get the healthcare service we pay for and this imposition without trial was only ever going to make the staff involved feel undervalued and want to leave. Looks like a number of them are, at great cost.

Now I suppose that could be an honest mistake, in which case incompetency, or it could be deliberate undermining. Either way I don't blame the BMA for trying to hold onto the doctors pay and conditions.

The final sentence in that programme is about funding, and quite telling:

"I just don't see how it can be done on current funding."

I agree, if you want to extend the opening hours of the NHS, you will need more staff. As I said, I would oppose any attempt to simply "redistribute" the existing workforce to cover weekends. If you need to cover weekends, you will need extra staff.

However, the question of "keeping weekends special" has a big impact on the costs of doing so.

If it costs me 500k (100k a day) to staff my hedgehog hospital for 5 days but weekends are "time and a half" it will cost me another 300k to cover the weekend, even if I hired an extra 2 days worth of staff (i.e. my existing workers don't work any harder).

If I made weekends "core" then I could hire 2 days of extra staff for and extra 200k.

Yes I know it's a simplistic model, but it shows the reason for wanting to eliminate the "weekend".

 

[Arry]

Doctor tells me its raining - I put on a jacket and my boots and grab an umbrella.
MP tells me its raining - I look out the window to check.
The bottom line is, who do you believe...but more importantly, who would you trust?

Both are quite happy to put their hands into your chest and pull out your heart out: Trouble is, one would be thinking; 'KALI MAAAAAA!!!'

 

[CMDR Heisenberg B. Damned]

Thanks for that link to the radio show Yaffle, very informative!

No, I'm not, that would be stupid.

You are lumping 2 separate things together.

"JD's working less hours and yet cover more hours"​

If the new contracts mean JDs can work less hours (or more specifically their peak hours will be lessened, it appears the average hours are staying similar at 40-46.) how is that a bad thing?

Trying to get the same number of JD's to cover more days would be a bad thing, but that is not the new contracts. That would be any new rota that was imposed.

Ah so the contracts fine but the only realistic way of covering the hours would be new rota and that rota shouldn't be taken into consideration.

But the JDs are striking because "the new contract puts patients lives at risk" yet haven't explained how a contract that reduces hours a JD can work, is worse for the patients.

I'm not Junior Doctor (well not any kid of Doctor) but as I understand it key restrictions on hours worked that punish employees that overwork JD's are being removed. That will almost certainly lead to overworked Doctors and be equally bad for patients as a consequence. Regardless of any core hours reduction.

Trainee GP's are also have/had a supplement to provide them with an equivalent wage to a hospital trainee doctor, from what I've read this could reduce trainee GP's pay by up to a third.

Did your sister have any inkling that evening and weekend work would be part of being a landlord? You see JD's signed up for a certain set of conditions - this contract will reduce pay and alter conditions that they signed up for. Now I suppose you could argue that if everyone worked for nothing in the NHS it'd be really cheap - that doesn't make it fair. This is a subset of that. Worse terms and conditions and worse pay will impact on how attractive a career as a JD is and how many people want to work as a JD in the NHS.

However, the question of "keeping weekends special" has a big impact on the costs of doing so.

If it costs me 500k (100k a day) to staff my hedgehog hospital for 5 days but weekends are "time and a half" it will cost me another 300k to cover the weekend, even if I hired an extra 2 days worth of staff (i.e. my existing workers don't work any harder).

If I made weekends "core" then I could hire 2 days of extra staff for and extra 200k.

Yes I know it's a simplistic model, but it shows the reason for wanting to eliminate the "weekend".

Again no proper data to say weekend work is specifically needed. No guarantee that it'll work in changing the mortality figures. Yes it will pay an individual doctor less so you could afford more doctors but that totally ignores supply and demand. Even if you took out the unsocial hours part of the new contract I'd expect the other areas that impact on pay and conditions would be enough to make a large number of JD's look for work elsewhere.

It seems amazing to me that bankers threatening to leave is taken so seriously the government spends tax payers money defending obscene bonuses but can treat those who save lives as just a meaningless statistic who will have to put up with whatever contract is imposed on them.

 

[beelbeebub]

Ah so the contracts fine but the only realistic way of covering the hours would be new rota and that rota shouldn't be taken into consideration.

Nope.

Right now the JDs can work unsafe hours. That is part of their campaign

A new contract has been proposed that will reduce those hours. That should be a plus for patient safety.

The fact the powers that be want to extend the NHS opening hours and thus require more man hours (or a cut in the number of hours per patient) is separate.

The reason for the strike is "the new contracts put patient safety at risk" not "7 day opening puts patients at risk"

I'm not Junior Doctor (well not any kid of Doctor) but as I understand it key restrictions on hours worked that punish employees that overwork JD's are being removed. That will almost certainly lead to overworked Doctors and be equally bad for patients as a consequence. Regardless of any core hours reduction.

I have heard this, but not been able to pin down any evidence other than hearsay on social media. If you have any source for this assertion it would be great! That's exactly what I've been looking for. Right now all I can find I stuff from the NHS (the BMA site is members only), which indicates the hour limit protections are stronger (i.e. less hours, fewer consecutive nights etc).

Trainee GP's are also have/had a supplement to provide them with an equivalent wage to a hospital trainee doctor, from what I've read this could reduce trainee GP's pay by up to a third.

I have heard this also, but also the nhs/gov (and their info should be good enough to survive any prospective legal challenge, they might lie by omission or weasel words, but not outright lie) info indicates an estimated 1% would see an income fall.

Again, I come back to the BMA aren't striking "because JD pay is being cut"

Did your sister have any inkling that evening and weekend work would be part of being a landlord? You see JD's signed up for a certain set of conditions - this contract will reduce pay and alter conditions that they signed up for. Now I suppose you could argue that if everyone worked for nothing in the NHS it'd be really cheap - that doesn't make it fair. This is a subset of that. Worse terms and conditions and worse pay will impact on how attractive a career as a JD is and how many people want to work as a JD in the NHS.

of course she did, everybody knows the hours in hospitality are somewhat inhospitable.

You make a good point about signing up for one set of conditions and being switched to another. I am not in favour of imposition.

However it's not as if JDs signed up for a Monday to Friday, they already work weekends and nights (as their many social media posts evidence). The new contracts don't make them work days the otherwise wouldn't. The balance of pay for various days might be shifting but the times they might work aren't.

Again no proper data to say weekend work is specifically needed. No guarantee that it'll work in changing the mortality figures. Yes it will pay an individual doctor less so you could afford more doctors but that totally ignores supply and demand. Even if you took out the unsocial hours part of the new contract I'd expect the other areas that impact on pay and conditions would be enough to make a large number of JD's look for work elsewhere.

The debate about the need for, or even meaning of, a 7 day NHS is separate. Some of the NHS is already 7day, A&E, maternity etc. Do we need 7 day in other areas? 7 day chiropody? 7 day hearing services?

The radio show Yaffle posted did highlight some areas that could do with more cover, lab services for example.

It seems amazing to me that bankers threatening to leave is taken so seriously the government spends tax payers money defending obscene bonuses but can treat those who save lives as just a meaningless statistic who will have to put up with whatever contract is imposed on them.

Yeah well bankers.....

I don't disagree with most of your points, but my original aim was to find some facts to back up the BMA/JD claim that the new contracts would put patient safety at risk.

So far I have found several things that would put patients at risk, but not any in the contract (unless you can find a reference for the weakening of safeguards, I know they are changing some safeguarding but nothing that would specifically trump the reduction in hour limits).

I'm not against the JD strike per se, i'm uneasy about strikes in general but they do have the issue of not really being able to switch employers. Personally, I prefer work to rule but that's not so practical when lives are at risk if you go home on the dot. what I do want is some actual facts. I've been bombarded with stuff on social media, where the tone has been very emotional, long on pithy sound bites short on facts. It all feels very one sided. I just like facts over spin. Now we have the EU referendum, I'm going to have to start digging all over again, the chances of getting clear facts will probably be near zero!

 

[CMDR Heisenberg B. Damned]

I have heard this, but not been able to pin down any evidence other than hearsay on social media. If you have any source for this assertion it would be great! That's exactly what I've been looking for. Right now all I can find I stuff from the NHS (the BMA site is members only), which indicates the hour limit protections are stronger (i.e. less hours, fewer consecutive nights etc).

No idea why you can't access the BMA site I have no problem getting on it but this is a quote from one of the points on their opposition to the contract:

The contract should protect patients and doctors, which it currently does through the banding system, which penalises employers who overwork trainees. The Doctors' and Dentists' Review Body (DDRB) recommendations would remove the banding system

 

[beelbeebub]

No idea why you can't access the BMA site I have no problem getting on it...

The BMA site is accessible but try to get a briefing on the new contracts or information on the banding and you have to be a member (see here). Essentially you and I can't see the same data the JDs see to make up their minds.

...

The contract should protect patients and doctors, which it currently does through the banding system, which penalises employers who overwork trainees. The Doctors' and Dentists' Review Body (DDRB) recommendations would remove the banding system​

Trying to find info on "bandings" is hard, as the BMA site stuff is members only, however what I have been able to see is that it appears a banding is a % of your basic salary that is paid on top to compensate you for long or anti social hours.

There is actually some really useful background on bandings from this article in the Guardian back in 2001 when there last was a kerfuffle over JD contracts.

Spoiler

As far as I can see before 2001, the way JD pay was structured meant that the hourly rate for overtime was lower than the normal rate. Clearly this is a massive incentive for a hospital to work 1 doctor for 70hours rather than 2 doctors for 35hours.

Around this time the European working time directive (EWD) came in and that was going to limit JD hours at first to 56hours (average) lowering to 48hours in 2009.

In order to help enforce the EWD, the banding system was introduced

The new pay deal, which came into force on December 1 2000, provides hospitals with clear financial and contractual incentives to reduce hours and work intensity......
Any junior doctor whose working pattern is "not compliant" with the new deal - ie those working more than 56 hours or with insufficient rest periods - will now be paid a "band 3" supplement worth 62% of their salary. Those who are compliant, but who work between 48 hours and 56 hhttp://www.nhsemployers.org/~/media...know/JD 2016 at AT A GLANCE FINAL 190216.pdfours will receive a 50% "band 2" supplement. These supplements will rise in December 2001 and again in December 2002, so that a junior doctor who is still working more than 56 hours in two years' time will receive a supplement worth 100% of the basic salary.

There is actually a very detailed flow chart, here (page 40) with details how to work out the banding.

Essentially a 40hrs per week average, 9-5 M-F was the "standard" going outside those hours would incur a "banding" charge from 20% (for going outside the 9-5 M-F) to 50% for those with a 48hr but anti social week. Anyone working more than 48hours got a 100% top up (double you basic pay). Some who worked 48hours but very anti socially got 80%.

So the stick for the hospitals was to make any JD employed for more than standard hours became more expensive.

The key point was the current contract (post 2001) had guidelines for hours worked (i.e. no more than 40) but allowed more hours to be worked as long as the employer paid more. The idea being that the stick of paying more would prevent long hours being worked.

My understanding is that the new contracts put hard limits on the hours worked i.e. employers must obey the limits rather than relying on an "if you break the limits it will cost". There is an explanation here scroll down to working hours and patterns.

Rather than rely on the accounts department to prevent overwork by stinginess, the new contract relies on an "independent guardian" per trust whose job is to make sure the trust is obeying the rules and to trigger works schedule reviews if breaches of the rota are occurring. Now you could argue that if the "independent guardian" was rubbish, that would provide less protection against overwork.

There is this (again NHS) briefing paper that summarises the new contracts. If this holds true (i.e. they are not outright lying) it would seem to offer both safer work limits and a plausibly robust system of policing them (especially if the independent guardian was say a BMA rep).

TL;DR

The banding system was a method to make overworking JDs more expensive (and thus hopefully discourage it). The new system has lower work limits and uses an independent guardian to police them. Effectively for patient safety to be worse under the new regime, the independent guardian system would have to fail (i.e. the appointed person would have to not do their job)

So given the above I can't see that abandoning the banding system (which was put in to provide protection for JDs and patients) for the new limits and guardian system is worse for patient safety.

Surely it must be said that that the current bandings system is failing as JDs still complain of excessive (albeit lucrative) hours. The aim shouldn't be to compensate JDs for working long hours, but to prevent JDs working long hours in the first place.

 

[CMDR Heisenberg B. Damned]

Surely it must be said that that the current bandings system is failing as JDs still complain of excessive (albeit lucrative) hours. The aim shouldn't be to compensate JDs for working long hours, but to prevent JDs working long hours in the first place.

Or to get rid of additional costs in long hours worked by JD's before privatising takes place.

What are the consequences of JD's working longer hours under the new contract? Are they paid less by any chance?

 

[beelbeebub]

Or to get rid of additional costs in long hours worked by JD's before privatising takes place.

What are the consequences of JD's working longer hours under the new contract? Are they paid less by any chance?

I can't find what happens if staff currently exceed their rota hours.

But for the new contract it looks like working hours outside your rota incurs a 50% increase in the rate of the hours you work as well as triggering a review of the rota

If it's during core hours it's 1.5x1.11= 1.66 times current base pay (1.5x new base pay that is 11% up)
if it's on a sunday it's 1.5x1.33=1.99 current pay (double time near enough)
if it's night work it's 1.5x1.5=2.25 times current pay.

Not sure how those rates compare with now, but those are not bad rates for overtime.

The new approach seems to be much more standard, you get paid for every hour worked. If you have to overtime (and with the best will in the world sometimes that happens) then you get paid for that instance.

As for making it cheaper, that's besides the point. The goal is to reduce the average and peak JD hours to safe levels.

 

[CMDR Heisenberg B. Damned]

I can't find what happens if staff currently exceed their rota hours.

Well this is me being too lazy to go all the way back through the thread to see. Can I ask if you are Junior Doctor?

As I said I'm not a doctor, for the record I have worked in both public and private services. NHS included, although before anyone has sympathy with me I work in IT.

 

[beelbeebub]

Nope, not a doctor.

I'm just trying to get to the bottom of what's going on. You have the gov claiming that the new contracts are better for patient safety and pay is better or the same in 99% of cases. You have the JDs saying that the new contract puts patients safety at risk.

To be honest, the JD side do seem to have been putting out the more lurid spin. For example there were claims from JDs that the new contracts would require them to work 30% more hours for the same pay (this appears to be referring to the increase in the hours defined as core, which is not the same as JD's being forced to work more hours).

Of course there are reasons to be wary of the Gov statements as well, not least the people involved.

The best info I can get is from the NHS, not exactly independent but at least one step from the gov.

from what I've been able to dig up, the old contracts really weren't "fit for purpose", the concept of banding, which seems to have been an attempt to reduce doctor over work, is extremely complex and a bit of a blunt tool.

The new contracts seem more modern in how they calculate pay, a basic pay based on your grade, and then an uplift for hours worked outside of the "core". Over work to be limited by regulation and over watch rather than by accountant.

I haven't been able to see anything (nothing obvious and nothing highlighted by the BMA) that seem outright terrible. It does appear that some doctors on the most extreme banding of 100% might lose out, but that is in part because they won't be working the same long hours, which I thought was the point.

There are of course worries, "7 days opening with the same staff" or creeping privatisation, to name two.

But I am still not convinced that the new contract itself is a danger to patients. This dismays me as that appears to be the JD/BMA line, and if true, it is a disservice to the public. We do need to be warned of dangers to the NHS and doctors should be our trusted "canaries" (or whilstleblowers if you prefer). If the BMA is not being 100% straight with us, if there are other motives beyond pure "patient safety" then this may well erode the trusted status of doctors and we shall all be worse off as a result.

 

[CMDR Heisenberg B. Damned]

I really couldn't disagree much more with regards to patient safety.


There's plenty of evidence that the current banding system works. Namely the years of it being in place have had the NHS as, if not the best healthcare system in the world, certainly there are only equivalent levels of efficiency and outcomes. In short there are no better healthcare systems in the world. That's with that system you describe as a blunt tool in place. It appears it works just fine. Although as I said it would cut into profits should a hospital get privatised.

Sure that one aspect of the new contract sounds like it may work but there is no evidence that it does. To describe the BMA and JD's as producing lurid spin on a system that has had such self evident proof against one not even in place yet is ill considered and frankly offensive. Especially when you consider the litany of broken promises and downright lies from the other side of the argument.

So this will be my last post on this thread.

You may want to consider that on the day the new contracts were imposed over 300 JD's started the process of certifying for work abroad. At roughly £300,000 per JD in training costs that's around 90 million. The trend of JD's making that initial application has continued after the imposition at a vastly higher rate than normal.


But really I'm not convinced anything I could say will convince you the new contracts are a danger or that you should trust the Doctors over the Politicians so I bid you adieu.

 

[beelbeebub]

I really couldn't disagree much more with regards to patient safety.


There's plenty of evidence that the current banding system works. Namely the years of it being in place have had the NHS as, if not the best healthcare system in the world, certainly there are only equivalent levels of efficiency and outcomes. In short there are no better healthcare systems in the world. That's with that system you describe as a blunt tool in place. It appears it works just fine. Although as I said it would cut into profits should a hospital get privatised.

I agree about the NHS effectiveness, but how can you say banding is working when the very fact that some JDs are on the still on the upper levels (80%+) means they are still working too much! If banding was working no JD would ever be on greater than 50% banding, yet some are. In addition the fact that the BMA itself thinks that the current contracts are unfit should speak for itself

Sure that one aspect of the new contract sounds like it may work but there is no evidence that it does. To describe the BMA and JD's as producing lurid spin on a system that has had such self evident proof against one not even in place yet is ill considered and frankly offensive. Especially when you consider the litany of broken promises and downright lies from the other side of the argument.

From my digging the claim that "JDs would be required to work 30% more hours under the new contracts" cannot be supported at all. It may be the speaker misunderstood the meaning of extending the core hours banding, but claims like the have been splashed around repeatedly by JDs, yet (unless their BMA briefings have info I've not been able to find) they have no basis. How else would you describe a sensational but wrong claim?

So this will be my last post on this thread.

You may want to consider that on the day the new contracts were imposed over 300 JD's started the process of certifying for work abroad. At roughly £300,000 per JD in training costs that's around 90 million. The trend of JD's making that initial application has continued after the imposition at a vastly higher rate than normal.


But really I'm not convinced anything I could say will convince you the new contracts are a danger or that you should trust the Doctors over the Politicians so I bid you adieu.

I am willing to be convinced if someone can show me where the danger in these new contracts lies, several times I have tried to follow assertions to their source (that's why I started this thread, to find sources) and, as yet, I can't find the clause or concept in the new contracts that points to the central claim that JDs are making.

 

[Arry]

I agree about the NHS effectiveness, but how can you say banding is working when the very fact that some JDs are on the still on the upper levels (80%+) means they are still working too much! If banding was working no JD would ever be on greater than 50% banding, yet some are. In addition the fact that the BMA itself thinks that the current contracts are unfit should speak for itself
From my digging the claim that "JDs would be required to work 30% more hours under the new contracts" cannot be supported at all. It may be the speaker misunderstood the meaning of extending the core hours banding, but claims like the have been splashed around repeatedly by JDs, yet (unless their BMA briefings have info I've not been able to find) they have no basis. How else would you describe a sensational but wrong claim?

I am willing to be convinced if someone can show me where the danger in these new contracts lies, several times I have tried to follow assertions to their source (that's why I started this thread, to find sources) and, as yet, I can't find the clause or concept in the new contracts that points to the central claim that JDs are making.

The danger is because this whole conversation, this whole issue; is distracting everyone from the real issue. The JDs were not the issue with the weekend death rate rise. The report author has stated on TV that the JDs hours are NOT the cause and HUNT is misquoting and trying to manipulate the facts. It was the reduction of consultants at the weekends, that was upping the death rate and most hospitals have now taken the report on-board and made changes to resolve the issue.

This distraction is all about money: Reducing the cost of JDs as a whole. It is all about the bottom line and hunts' JDs bottom line cost, will be less, after this contract is implemented.

 

[beelbeebub]

The danger is because this whole conversation, this whole issue; is distracting everyone from the real issue. The JDs were not the issue with the weekend death rate rise. The report author has stated on TV that the JDs hours are NOT the cause and HUNT is misquoting and trying to manipulate the facts. It was the reduction of consultants at the weekends, that was upping the death rate and most hospitals have now taken the report on-board and made changes to resolve the issue.

This distraction is all about money: Reducing the cost of JDs as a whole. It is all about the bottom line and hunts' JDs bottom line cost, will be less, after this contract is implemented.

The weekend death rate is a good example of the lurid spin from the gov side.

This contract may ultimately impact on cost and I would support JDs if their rate per hour were significantly (as in more than a few %, it's difficult as calculating rates now and then is difficult) reduced, or if their gross pay were reduced to unsustainable levels. They are well trained, skilled workers and should be reasonably remunerated. However, if the gross pay of a JD falls from their current levels because they are no longer working the dangerous hours, IMHO that is a good thing, the aim is to make JDs work arrangements safe. Some of the very high pay rates of JD's is, in part, due to the banding payments for working dangerous hours. It's a logical conclusion that if we eliminate "overwork" then the pay associated with it is eliminated.

Imagine a dynamite factory had a pay scheme where, if your job required you to stir the dynamite mixture, you were paid double. So we have workers being paid a really good wage because they were regularly risking being exploded! Then we say, here is the new contract, we've come up with a new method and now nobody needs to stir dynamite and risk going boom. Those workers who were paid double for risking death are now losing that pay. is that a bad thing?

 

[Arry]

The weekend death rate is a good example of the lurid spin from the gov side.

This contract may ultimately impact on cost and I would support JDs if their rate per hour were significantly (as in more than a few %, it's difficult as calculating rates now and then is difficult) reduced, or if their gross pay were reduced to unsustainable levels. They are well trained, skilled workers and should be reasonably remunerated. However, if the gross pay of a JD falls from their current levels because they are no longer working the dangerous hours, IMHO that is a good thing, the aim is to make JDs work arrangements safe. Some of the very high pay rates of JD's is, in part, due to the banding payments for working dangerous hours. It's a logical conclusion that if we eliminate "overwork" then the pay associated with it is eliminated.

Imagine a dynamite factory had a pay scheme where, if your job required you to stir the dynamite mixture, you were paid double. So we have workers being paid a really good wage because they were regularly risking being exploded! Then we say, here is the new contract, we've come up with a new method and now nobody needs to stir dynamite and risk going boom. Those workers who were paid double for risking death are now losing that pay. is that a bad thing?

I have no ides; as like Mr Hunt, you are just spinning your own brand of the facts and examples you wish to be set.

 

[beelbeebub]

How am I spinning facts?
Look up the nhs employers fact sheets I linked to above,
Assuming the nhs employers can be trusted.

Max average hours down to 48/56 with opt out. No higher average allowed
Absolute max per week down from 91 to 72
Number of nights or long days down
Min rest after consecutive nights up to 48hrs
Unpaid overtime now at +50% (think it used to be zero pay)

These are all taken from the nhs employers fact sheet, not Jeremy hunt, not off facebook, not from some bloke down the pub.

This isn't conjecture like what may or may not happen if we leave the EU this is what is written down and anyone can check.

It's like those flipping "next month is Chinese money month because there are 5 Saturdays and 5 Sundays, this happens only once a century" face book posts that everybody just repeats without checking the facts (it happens nearly every year).

The info is here, look at it, then decide of the contract if worse for patients.

http://www.nhsemployers.org/~/media...mary of new JD 2016 contract Final 12 Feb.pdf

 

[Siobhan]

Another update on the whole debacle, from the BBC... no more facts yet, but 3 48 hour strikes...
http://www.bbc.co.uk/news/health-35644659