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Juniors being ignored on service improvement

By Mike Broad - 27th January 2012 9:43 am

Junior doctors in the NHS are willing and able to help improve health services, but they don’t feel valued or heard, a survey reveals.

The report authors suggest junior doctors are “an untapped NHS resource” at a time when the NHS needs to draw on all the help it can get.

The survey asked juniors a range of questions about their working life, including their views on their role and future.

Ninety per cent of the 1,500 respondents said it was “extremely” or “very important” to feel part of a team in their NHS organisation, with a similar proportion answering that doctors needed to be effective leaders to “a very great” or “great extent.”

But despite nine out of 10 respondents saying that they had ideas for ways to improve services, only one in 10 said they had had their ideas implemented.

Forty four per cent had tried and failed to get an idea implemented or felt unsure how to go about it.

Lead researcher Dr Alexandra Gilbert, department of clinical oncology, St James’s University Hospital, said: “We have demonstrated that the junior doctor medical workforce has both the desire and the ability to start contributing to improvement in the NHS, but feels that the environment in which they work is not sufficiently receptive to their skills.”

When asked how valued they felt, overall, more than 83% of juniors said “not valued at all” or only “sometimes valued.”

Seventy eight per cent felt undervalued by their chief executive, a similar proportion felt undervalued by their employing organisation, while 79% felt undervalued by the NHS as a whole.

While three quarters did feel highly valued by their non-consultant medical colleagues, almost 60% said they did not feel equally valued by senior consultant colleagues, the research in BMJ Quality and Safety finds.

The authors say that their findings indicate that junior doctors are adapting to new roles within the NHS, but feel unable to realise their full potential as agents of change.

They point out that junior doctors frequent rotations between different hospitals, organisations, and specialties enable them to readily spot good and bad practice, and that all doctors on the frontline have a key role in improving the quality of care.

The research concludes: “If the government is to achieve the aim of improving productivity and quality in the NHS on a restricted budget then all employees need to feel valued and engaged to optimise organisational performance.”

Read the report.

Tags: Juniors
Posted in Hospital Dr News | 1 Comment »

Juniors question feedback and supervision

By Mike Broad - 1st November 2011 11:24 am

Nearly a quarter of trainee doctors report that on a regular basis they are forced to cope with challenges for which they feel inadequately prepared, a survey reveals.

The annual survey of junior doctors, by the GMC, which provides a comprehensive picture of the views and experiences of 46,000 trainees across the UK, suggests there’s a need for improved supervision and feedback by consultants.

Twenty eight per cent of trainees report that they rarely or never receive feedback from senior colleagues.

Respondents continue to raise concerns about the Working Time Regulations, which were introduced in the summer of 2009. Almost two-thirds say they regularly work more than the limit of 48 hours a week, while nearly a third claim it’s taking them longer to meet the competences they need in their training.

The GMC is calling on senior doctors, managers and medical educators to help tackle these concerns as a priority. It is consulting on proposals for the approval and recognition of trainers to help strengthen arrangements for support and supervision.

The GMC does point out, however, that most training is meeting its standards. Overall satisfaction with training among juniors is continuing to increase, with 79% of doctors rating their training as excellent.

Niall Dickson, chief executive of the GMC, said: “Overall, trainees continue to be very satisfied with their training, but the concerns they have raised need to be urgently addressed by all those with responsibility for supporting doctors. In these difficult financial times for the health service throughout the UK, it is vital the education and training are protected and that these young doctors are given the support they need not only to provide good care now but to develop into great leaders for the future.”

The research reveals that a quarter of newly qualified doctors did not feel ready to take the next step in their careers.

Dickson added: “The trainee survey is a vital part of our work to support improvements in medical training and to make sure it meets the standards we require. Together with the postgraduate deans we will use these results to support inspections and to provide feedback to those responsible for providing education.”

Dr Tom Dolphin, chair of the BMA’s Junior Doctor Committee, said: “The GMC’s survey reveals some serious concerns about the level of supervision some doctors receive. In the current economic environment training is a soft target. We are concerned that, in an effort to save money, the time consultants can dedicate to training is being squeezed. We must ensure that trainers are given the time to train and supervise.

“We cannot afford to be complacent about the quality of training and supervision as it will have direct impact on the quality of healthcare that can be delivered to patients in the future.”

Ben Dean, an orthopaedic registrar, who carried out a survey on training for Remedy UK earlier this year, commented: “The issue with supervision is very complex. The supervision of training is something that has been affected by reduced hours and the consequent shift systems, hence reduced continuity of both patient care and training.

“Certainly increasing hours would help as it would improve supervisor training continuity and increase the experience gained by trainees. But people also need to regulate training properly.”

Tags: GMC, Juniors, Training, WTD
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FY1 death prompts call for hospital rest facilities

By Francesca Robinson - 6th October 2011 9:48 am

Junior doctors are calling for better overnight rest facilities after a FY1 doctor crashed her car and died while driving home from a night shift.

Dr Lauren Connelly, aged 23, was travelling on the M8 motorway when she lost control of her Vauxhall Corsa which careered down an embankment and ploughed into a tree. She died at the scene.

It is understood she had just come off duty at Inverclyde Royal Hospital.

Dr Tom Dolphin, chair of the BMA’s junior doctors committee, said there had been increasing reports in the last six months of trusts removing on-call rooms on the grounds that staff on full-shift rotas should not be sleeping while on duty.

Since the advent of the European Working Time Directive doctors have increasingly been made to work full time shifts instead of traditional on-call rotas.

“The tragic death of Dr Connelly has brought this problem again to our attention and we are going to be looking at it again,” said Dolphin.

The JDC issued a joint position statement with the Academy of Medical Royal Colleges’ Trainees’ Committee in 2006 which condemned the removal of on-call rooms. The committee now plans to re-issue the guidance and the problem will be discussed by the JDC negotiating team sub committee at a strategy weekend towards the end of the month.

“This was one of the issues we had already planned to look at this year as part of one of our work streams,” said Dolphin.

“What tends to happen is that when jobs change over in August juniors are told the on-calls rooms are being refurbished and then strangely they never re-open. This is underhand and mean spirited on the part of employers. Employers are taking a hard-line approach because they think that doctors are taking advantage of the situation or trying to pull a fast one.”

Dolphin said when the contract was negotiated no-one anticipated that there would be such a comprehensive move to shift work as opposed to an on-call arrangement.

“In some places we have done quite well in negotiating with employers to replace on-call rooms but in other trusts they have been less willing to listen.

“This will be on the agenda for our next meeting and will be something we will want to raise with NHS Employers,” said Dolphin.

A survey of 1619 specialist registrars by the Royal College of Physicians in 2006 found that juniors were at increased risk of road traffic accidents when driving to and from work. It revealed that 264 (16%) had an accident when commuting - 134 when driving to work and 130 when returning from work - 74 after a day shift and 56 after a night shift. The researchers commented that international research showed that returning from a night shift is more risky but even driving to work can be a hazard if the driver is already exhausted.

The RCP’s recommended solution was that three nine-hour shifts was the safest rota pattern to provide 24-hour cover.

A report in 2005 on fatigue and anaesthetists by the former Association of Anaesthetists of Great Britain and Ireland (AAGBI) highlighted a study by the Royal Society for the Prevention of Accidents which found that falling asleep at the wheel accounts for up to 20% of serious accidents on motorways.

It warned that the attitude of the courts to drivers who continue to drive when tired has hardened following the Selby road/rail crash in 2001 when a driver fell asleep at the wheel causing 10 deaths.

The report asked: “Would a doctor who continues to practise when sleepy be similarly viewed by the courts and what responsibilities would the employer have?”

AAGBI advice on managing alertness:

1. Minimise sleep debt by maximising sleep prior to on-call

2. Nap whenever possible

3. Overcome sleep inertia by increasing light levels, stretching, walking briskly, being relieved from duty and taking refreshment

4. Alert colleagues if microsleeps/nodding off occurs and ask for relief

5. Whenever relief is available take a break

6. Drink caffeinated drinks

7. If working next day nap rather than working through

8. Nap before driving home

9. Post working on-call sleep rather than party to pay off sleep debt. Go to bed earlier than normal.

Tags: Juniors
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Hospital doctors’ pay scales for 2011/2012

By Mike Broad - 15th September 2011 4:12 pm

In summer 2010, the new Chancellor announced a two-year public sector pay freeze from 2011/12.

Consultants were already experiencing a pay freeze in 2010/2011, so their pay will not rise over a three-year period.

The corresponding freeze in the value of clinical excellence awards will also continue. CEAs will be subject to change, and are likely to be reduced, following a review by the Pay Review Body which will report to the government in summer 2011.

NHS staff earning less than £21,000 will receive a flat pay rise worth £250 in both of the next two years. The Chancellor said the measures would save £3.3 billion a year by 2014-15.

While foundation year doctors, house officers, senior house officers, specialty registrars, specialty doctors, associate specialists and salaried GPs in England received a 1% pay rise for 2010/2011, they are now subject to the pay freeze.

Doctors are also awaiting the government’s response to a review of their pension benefits, with the likelihood of their contributions being increased for inferior benefits.

In 2009/2010, all doctors received a 1.5% pay rise.

Consultant salaries 2011/2012

Threshold 1, years completed as a consultant 0, £74,504, period before eligibility for next threshold one year

Threshold 2, years completed as a consultant 1, £76,837, period before eligibility for next threshold one year

Threshold 3, years completed as a consultant 2, £79,170, period before eligibility for next threshold one year

Threshold 4, years completed as a consultant 3, £81,502, period before eligibility for next threshold one year

Threshold 5, years completed as a consultant 4, £83,829, period before eligibility for next threshold five years

Threshold 6, years completed as a consultant 9, £89,370, period before eligibility for next threshold five years

Threshold 7, years completed as a consultant 14, £94,911, period before eligibility for next threshold five years

Threshold 8, years completed as a consultant 19, £100,446

Clinical excellence awards for consultants

Level 1 £2,957

Level 2 £5,914

Level 3 £8,871

Level 4 £11,828

Level 5 £14,785

Level 6 £17,742

Level 7 £23,656

Level 8 £29,570

Bronze/Level 9 £35,484

Silver/Level 10 £46,644

Gold/Level 11 £58,305

Platinum/Level 12 £75,796

Nature or nurture: what kind of doctor are you?

By Caroline Whymark - 17th March 2011 11:37 am

Of course we are all different. Presenting with back pain will get anti-inflammatories from a GP, exercises from a physiotherapist, an operation from a neurosurgeon, and an epidural from a chronic pain anaesthetist. But how do we choose our career? Or does it choose us? Whichever, it seems to be in grained from an early stage.

Recently I examined in the clinical OSCEs at the medical school. It was a memorable day for reasons I hadn’t really anticipated. It was a big day out from my comfortably familiar hospital - the West End ambience, the public transport and great people watching opportunities (second only to the Tropical Paradise at Center Parcs).

It was also a fantastic, insightful learning experience about the roles we play within medicine and the assumptions we make about others.

There were immediate observations about several students. I was shocked at the amount of cleavage displayed by many of the candidates. I was surprised both that some of the men had omitted to shave on the morning of their exam and also that many did not yet need to. But I was more intrigued by the clinical styles on display.

Several students gave a performance indicative of branches of medicine to which they may be best suited. The actor patient at my station had an acutely hot and painful ankle. The students who concluded the ankle was not broken but deserved an x-ray I could see as future orthopaedic surgeons. Those who declined to offer a diagnosis until all the tests were back I marked as potential physicians. The budding psychiatrists explored how the patient felt when the pain came on and the sensible ones headed for General Practice displayed a pleasant manner, prescribed anti-inflammatories and rounded up the consultation swiftly.

I was amused by one student who spent the whole time with his head cocked to one side looking under the table and directing his history taking towards the actor’s ankle as if looking for more clues.

So, do we end up in a career suited to our personality or does our personality change to fit in with the vocation we choose? I pondered this at lunchtime. There we were, a diverse group of medics and actors. One group were lively, grabbed the seats, lunged greedily at the food and had loud jovial conversations. “Saw you in that soap the other night. You were rubbish! Ha Ha Ha! How much did you get for that? Are you coming out for a fag?”

The other group lined the room, reservedly helped themselves to a small plateful of food then struggled to simultaneously hold the plate, a cup of sparkling water and a conversation whilst eating. They made introductions, polite chit chat, called each other ‘old chap’ and reminisced. “Oh I say, I haven’t seen you since you were a Registrar at the Royal. How’s the family now? Where did you get your consultant job?”

Medics are often seen as stereotypical. Do actors find it equally difficult to break free from such assumptions? To see ourselves as others see us is difficult though fascinating and I’m sure our thespian colleagues have never considered the need for a multi-source feedback assessment.

Tags: Juniors, OSCE
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New code sets out recruiters’ responsibilities

By Dr Ayesha Rahim, former deputy chair of the BMA's junior doctors committee - 16th February 2011 1:41 pm

Does this conversation sound familiar?

Mum: “How’s your training going?”

Me: “I’m starting a new job next week.”

Mum: “Where’s that, then?”

Me: “Well, I’m not exactly sure.”

Mum: “Are they giving you a pay rise?”

Me: “I don’t know yet.”

Mum: “Dear me. Well, can you come home for dinner next Saturday?”

Me: “I’ll have to get back to you, as I haven’t had my rota yet.”

Mum: “You don’t know very much, do you dear?”

Recruiters have got away with vague job adverts and woolly offers for far too long. It is not just an inconvenience. The lack of proper information can lead to a huge amount of stress and anxiety - try arranging childcare when you don’t know in what hospital you will be working or details of your rota.

In 2008, the BMA decided to challenge the Employment Agency Standards Inspectorate, an organisation that regulates employment agencies, to find out whether deaneries were employment agencies in the eyes of the law. If they were, deaneries would have to supply all these basic details about their jobs before we actually start.

The EASI confirmed that postgraduate medical deaneries are employment agencies. Great news, we thought, but sadly in May 2009, the Department of Business and Skills moved to exempt junior doctors from the protections of the employment agency regulations.

But the issue did not go away. The BMA responded strongly to this consultation stating that deaneries should not be exempted. As a result of this response we managed to kick-start talks on the development of a code of practice to nail down the basic level of information required for junior doctors when applying for training programmes.

This code of practice has now been published. It currently applies to postgraduate medical recruitment in England and Wales only. Negotiations are ongoing in Scotland and Northern Ireland. The code sets out the responsibilities of recruiting organisations, telling them what information should be included at each stage of the process, from job adverts through to offers of employment.

The code of practice should put an end to junior doctors being kept in the dark when moving jobs. But given the winding road we have gone down to get what are pretty basic rights, it is worth reading the code of practice yourself, should you receive a hazily-written job offer in the future.

Of course, if you actually didn’t want to go round to your Mum’s for dinner, you’ve just lost your best excuse.

Read the code of practice.

Tags: Juniors, Recruitment
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Top 10 issues for junior doctors in 2011

By Dr Eleanor Draeger, deputy chair of the BMA's JDC - 10th January 2011 11:26 am

Wholesale reforms in the NHS and attacks on our pay will ensure that 2011 is a tempestuous year for junior doctors. In the first post of 2011, I’m identifying some of the big issues that lie ahead. If you have questions, or strong views on any of these issues, please leave a comment:

1. Pay increment freeze

NHS Employers has proposed to freeze NHS staff pay increments for two years. We have taken legal advice and are in discussions with the other health unions to try to achieve a united response to this, but are not minded to accept the proposals.

2. Training and education reforms

The government’s white paper Developing a Healthcare Workforce raised a few eyebrows when launched, late last year. It plans to move away from a coordinated UK-wide approach, to a more local system of organising training and education which could threaten national standards and erode the quality of training.

3. Contract negotiations

The BMA is not looking to negotiate a new contract for junior doctors in the current economic environment. But the government of course could have other plans.

4. Specialty training recruitment

Always an issue for junior doctor since MTAS, we will be monitoring this year’s process and planned changes for 2011/12.

5. Foundation programme numbers

It looks like all UK graduates will get places on the foundation programme this year but we will be keeping a close eye on the process for next year.

6. Access to good training

Training is being threatened on many fronts and we will be fighting to ensure that all junior doctors are given access to decent training.

7. Anti-social rotas

Better rota planning is needed to move away from anti-social rotas in which training opportunities are scarce.

8. Rota gaps

Last year a BMA survey showed 1 in 4 doctors were working on understaffed rotas. For advice on what you can do if you are working on overstretched rotas visit the BMA website.

9. Pensions

The Lord Hutton review of public sectors pensions could have a huge impact on our pensions.

10. Pay banding

BMA reps will continue to stand up for junior doctors who are not being paid the correct banding supplements.

Tags: Juniors
Posted in BMA | 1 Comment »

Saddened by destruction of social support network

By Tom Goodfellow - 17th December 2010 11:28 pm

While wandering through the department the other day I encountered a seriously stressed junior doctor. Before continuing, and in case he should read this, may I start be saying to him: “Don’t worry mate, we have all been there”.

His stress was related, I am sure, to the ongoing pressures and frustrations of working in a busy, target-driven NHS hospital. Of course there have always been such pressures, but I do have a lot of sympathy for the juniors these days.

When I was a houseman and SHO we were part of a firm that worked as a team, so there was always plenty of cover and support. We lived together in a Mess or communal flat, so that if you’d had a bloody awful day and been screamed at by some wretched consultant you could let off steam with your colleagues with lots of mutual support and usually lots of beer. Condescending noctors were less of a problem in those days and, by and large, the profession (even juniors) was still regarded with a degree of respect.

These days the wretched EWTD has largely destroyed team working. The rota system means that you often do not see your colleagues for days on end, and are often working with doctors who you do not have opportunity to get to know. The Mess has vanished so there is little opportunity to socialise at the end of the day, and anyway most are too knackered to hang around - they just want to get home to bed.

All this has destroyed the social support network which I think formed a crucial part of medical training in the past.

It is somehow worse at this time of the year. In my day, Christmas on the wards followed a well structured pattern: sister would clear a side room and the windows would be carefully screened to avoid the curious gazes of passers by. During the few days before Christmas it would be transformed into a magical grotto, stuffed full with more food and booze than you can possibly imagine. In those days the drug reps were allowed to be generous with their freebies so brandy and liqueurs flowed freely. On the day itself one would wander from ward to ward being amply replenished at every staging post. Fortunately Jo Public largely kept their illnesses until Boxing Day so the on call work was never too taxing.

But of course the Infection Control Police would never allow this today, and anyway it would not be possible to empty a side room because of the 500 people in ED, suffering from acute surfeit, waiting to be admitted so as not to breach! Even the staff canteen will be closed. So the poor sods on duty will trudge the wards largely alone, grabbing a dry cheese sandwich on the way, while the rest of the world pretends to enjoy itself.

In considering the role of the junior today I am reminded of Stevie Smith’s poem, ‘Not Waving but Drowning’.

Happy Christmas guys, and please don’t drown!

Tags: Juniors, WTD
Posted in Tom Goodfellow | 16 Comments »

About time we had a few less oiks in medicine

By Bob Bury - 5th November 2010 3:21 pm

So, the government is taking steps to keep the oiks out of medicine. Good thing too and just what we expect from a Tory administration (what’s that you say? A coalition with the tree-huggers? Hadn’t noticed).

Some of the junior doctors (and some of the new consultants) I see wandering around my hospital look as if they should be slumped in a Glasgow underpass with a four-pack of Tennants Extra and a dog on a string. And the women are no better, flashing their midriffs and piercings at every passer-by…sorry, mind wandered for a moment there.

And walking through the medical school cafeteria you could be excused for thinking you were in a scene from Dante. Are you telling me that these adolescents actually passed exams and are at some stage likely to be let loose on patients? Some of them seem to have trouble with walking and talking (and not just at the same time, either). And, and, and they’re nearly all women! The world, as the Daily Mail would say, has gone mad.

So yes, I’m glad that good old Dave is raising the financial bar a bit. It might mean that we’ll get a few proper doctors back on our hospital corridors, chaps who look as if they wash behind their ears, and who actually own a tie or two. Mind you, there is a lack of governmental consistency here - any new consultant coming to work properly dressed is going to be cut down by the infection control mafia, parroting “bare below the elbow - burn his tie, burn his tie!” as they carry him away for re-programming.

I see that Jerry Nelson has a good idea for utlilising infection control nurses, and it has crossed my mind that all these aircraft carriers we are going to build will need a lot of ballast.

What’s that I hear you say? I came from a council estate? True - but I went to a grammar school (before the mean-minded, mediocrity-for-everyone socialists closed them down), and was taught to behave decently in public and know my place. And anyway, in those (good old) days, even working class children were taught to dress nicely and respect the police and professions.

There’s not enough of that about these days - respect. Don’t see much coming in my direction, certainly. I don’t know why.

Tags: Juniors
Posted in Bob Bury | 8 Comments »

Juniors face massive debts if tuition fees rise

By Mike Broad - 15th October 2010 1:45 pm

Ministers have been warned that medical students could face debts of potentially £100,000 if tuition fees rise - a financial burden that would discourage many applicants from lower income families.

Proposals to allow universities to charge fees of up to £12,000 are contained in Lord Browne’s report, Securing a Sustainable Future for Higher Education. It also recommends that students should pay higher rates of interest on their student loans and an increase in the income level at which these loans are repaid, from £15,000 to £21,000.

While Vince Cable, business secretary, welcomed the report, he is also trying to contain a Lib Dem revolt on the issue - the Lib Dems made a manifesto commitment to scrap tuition fees.

Cable said: “We are looking at his proposals carefully and considering a contribution level of £7,000.”

The BMA estimates that any further increases in tuition fees could result in a prohibitive level of debt for the next generation of medical students.

Graduates are currently leaving medical school with an estimated £37,000 worth of debt under the present £3,290 annual fee. They also have to rely on around £16,000 worth of support from their families over the course of their degree.

Raising fees would increase debt significantly. If fees are levied at around £10,000 for example, this could leave students studying in the UK living with debt of around £70,000, the BMA predicts. However, these are conservative average levels of debt, based solely on student loan debt and exclude credit card, professional loans and other debts.

There is the potential that some students could incur debts up to and beyond £100,000 if fees are set at £10,000 or above by medical schools.

While Dr Hamish Meldrum, chairman of BMA council, welcomed the proposal to raise the income level at which loans are paid back, he was “deeply disappointed” by proposals that “will lead to crippling levels of debt for future medical students”.

He said: “The five-year medical degree is already an expensive undertaking because of its length, costly course materials and an intensive programme of study that leaves students with little room for taking on part-time work to supplement their fees.

“If tuition fees are increased further then students are looking at incredibly high levels of debt that could reach as much as £100,000. At this level many potential students from low-income families would be discouraged from applying to become the doctors of the future. Already just one in seven successful applicants currently comes from the lowest-income backgrounds.”

The BMA is writing to the business secretary in order to ask him to abandon the most damaging recommendations.

Karin Purshouse, chair of the BMA’s medical students committee, said: “We strongly urge the government to look again at the BMA’s proposal for a forgivable loan system for medical students that would allow student loan debt to be reduced for each year a doctor is employed by the NHS. This would truly open up medicine to people from all backgrounds, as well as increase the likelihood that UK educated students would remain in the UK.”

Read more on the forgivable loan system.

Tags: Juniors, Medical students, Tuition fees
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