Do NHS Employers understand the NHS?

I continually wonder if the people in charge have any idea how the NHS works.  And I don’t just mean Jeremy Hunt.

What really bothers me about the junior doctor contract offer released by NHS Employers today is that it bears little reality to how the NHS functions.  There are two options for why the wording of the new contract is so inept: 1) that it’s deliberately worded to be inflammatory, or 2) there is a genuine lack of understanding of how NHS staff work.  I find the second option deeply concerning as I strongly suspect that it’s more likely to be accurate.

Why?  It’s because of comments like this from the “Junior doctors’ contract offer: main points” policy paper from the Department of Health today.

“automatic pay increase” I don’t get an automatic increase. I jump through an ARCP hoop every year and have to get signed off that I’ve reached a certain level of training every year.  There’s nothing “automatic” about the ARCP process.

“high flying junior doctors supervising colleagues who are paid at a higher rate because they have progressed more slowly”  Speeding through your training does not equal “high-flying”.  I’m going to take longer to complete my training than my colleagues because I’m taking time to do a PhD. Apparently that means I’m not a “high-flyer”. I’ve had the option in the past to progress more quickly through my training and I’ve chosen not to.  Why? Because I happen to think that experience is important when it comes to healthcare; that there are some things that you need to experience to learn effectively; and that I’d rather spend a bit longer as a junior doctor than steam through and become a consultant with less experience.  That doesn’t mean that I’m not a “high-flyer” – it means that I think that thorough training is more important than a consultant title.  Suggesting otherwise is insulting to those trainees who’ve chosen to seek experience elsewhere than enhances the care that they can give patients in the future.

“Junior doctors will be paid for all hours worked”  I would LOVE this to be true.  A quick look at will show how unrealistic this is.  Am I really going to get paid for every hour that I spend completing audits? Filling in my eportfolio? For every clinic that I attend in my annual leave?  If I stop in to check on a patient after my shift finishes? If a parent wants an update on their child, but can’t get to the hospital until after 6pm?  Am I really going to be paid for that?  No. Because that’s not how the NHS works.  But the simple fact that the Department of Health can release a statement like this just epitomises how little they understand about the service they oversee.

“junior doctors who take time off for academic research…” It’s not bloody time off.  Time off (as I understand from my partner who isn’t a medic) means that you don’t carry your sodding laptop with you all the time; it means that you sleep after you finish nights rather than going in for a supervision meeting; it means that you don’t plan your annual leave around when you can get to the British Library (hello December!); or that you don’t duck out of a very dear friend’s wedding reception to glance over a paper.

“unrelated degree” so who’s going to decide what an “unrelated degree” is then? Personally, I’m not sure that an MBA is going to lead to improvements in patient care in the NHS, but looking at the rest of the plans for the health service, maybe we’ll all need one to navigate through the new business models.  Is sociology a “related degree”? Psychology? Not to mention that it’s incredibly tough to get approval to take time Out of programme anyway – and already has to meet certain criteria… But, you would have to have some understanding of the NHS and junior doctor training to know that.

“financial incentives that encourage junior doctors to work unsafe hours” I am not encouraged to work unsafe hours.  I get given a rota that is determined by HR and that tries to meet the demands of the service in which I work with the limited number of staff available.  I applied for a job in Deanery (what is now the LETB) that covers my training within a fixed geographical area. And that’s it.  That’s about as much control as I get over the hours that I’m rota’d to work. (I work less than full-time because of the PhD thing, but that doesn’t change what the full-time rota would be – just the percentage of it that I work).  If I get sent to a hospital where the rota involves 24-hour shifts or longer days or more nights than I am currently scheduled to work – tough. If the system changes so that rota patterns change (e.g. to provide more cover in busy periods or because the service delivery is changing) – tough. If I get allocated to a placement which doesn’t have an out-of-hours component (wishful thinking), resulting in a significant pay cut – tough.  This is not under my control.  I don’t choose my hours or design the rota or select which days or shifts I can work.  It’s not an incentive because I DON’T CONTROL IT.

So I’m left wondering how it’s possible to write something that has no resemblance to my reality. Thoughts?


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