“Don’t wait to strike when the iron is hot….make it hot by striking…”

It’s the day before the the first Doctors strike in the UK for over 40years….  I came across a post by a Surgical Consultant, whom I had the pleasure of being House Officer for. I remember being tired but loved my job. All the long hours and studying was worth it. It was worth it just to be able to treat patients and make them better.  I worked with fantastic people and the team would regularly stay late, even if it was just to hold a retractor in theatre for several hours. Morale was good…. Fast forward 10 years, things couldn’t be more different. Morale in the NHS was at its highest in 2011. Now, in 2016, it is at its lowest.

We were certainly not #moetmedics, but why shouldn’t doctors be able to save up and go on holiday? It helps us get away from stresses of working in the NHS. It allows us to have a longer career.

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The other day was the first time in my career, I told an A-level student doing work experience in my hospital, not to do medicine. Maybe I’m in the minority, but I feel that the excitement I get from doing my job is rapidly dwindling in the current climate.

I had the opportunity of working in Australia before I manage to navigate through the debacle that was MTAS. I often wonder how different my life would be now had I gone back then? I remember seeing this job advert a day after it became apparent Jeremy Hunt wanted to change the Junior Doctors contract “for the better…”

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If I was a junior doctor now, in Emergency Medicine, I would think very carefully and consider taking up opportunities to work abroad, especially if the government gets its way with the junior doctor contract. The grass isn’t always greener on the other side but it can’t be much worse than in it is the UK currently. Lets be honest, there will always be jobs in UK ED’s. Is going abroad for a year or so really that detrimental to your career? (Of course I realise that there are plenty of other considerations to think about, e.g. family and friends etc.)

We all want a long career in medicine. At the end of the day, my first priority is my family and the life I can give them. My job comes second. Look around you. How many doctors do you work with that exhibit signs of burn out?

There’s no point in reinventing the wheel… here is the very eloquent and impassioned post by Mr Stuart Gould (Surgical Consultant and my mentor many moons ago…)

“Sorry long post but with the strike 2 days away I thought I would add some reflections I. The huge amount of increasingly vindictive rhetoric, media articles and frank misrepresentation of the facts needs clarifying. Eg excess deaths from lack of doctors at weekends? The studies state this simply cannot be inferred from the data. In some hospitals it MAY contribute, but it is not proven and the effect will likely be due to many factors, not a single one. That is almost always the way in medical disasters and problems.

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The pic was take 0730 Saturday morning as dawn is breaking over our hospital car park. I am arriving to be the Consultant Emergency Surgeon for the day. I also worked the New Year Weekend.

But I sort of forgot it was a Bank Holiday then, as the emergency teams are exactly the same on public holidays and on weekends as they are on weekdays.

Yes, my surgical team is exactly the same 365 days a year. As are the medics, anaesthetists, ED and everyone else in acute specialities. Has been the same in the 26 years I have been doing it.

If u need your appendix out or an abscess drained or bowel obstruction relieved or a CT scan on a weekend or Xmas day for that matter you will get it.

This is why I am confused by what the DoH means by 7 day working. Not yet seen a clear definition.

Emergency services? We have them, as above. My hospital and many others already have consultants in the hospital all day and of course available, and in some cases resident, all night.

Those that don’t have consultants scheduled to be in the building have them on call to come when needed. And most will come daily anyway to see the new Pts and review the existing.

If they are not scheduled to do shifts as we do, it is because those hospitals do not have enough of them to have them there all the time at weekends. This is for legal reasons with hours limitations and lack of resource in their numbers. The on call as opposed to resident shifts sort of gets round the hours limitation.

In these days of closure of EDs and massive increase in work intensity in the remaining hospitals, it is probably an unsustainable fix. I doubt there is a consultant in an acute speciality who would disagree the best place for them is in the hospital. But the NHS can’t afford it… Not enough consultants to do it…

We already have a full complement of junior docs at the weekend. So the rhetoric about the new junior contract improving weekend care cannot apply to emergency work.

Yes at weekends we lack many of the ancillary services that facilitate discharges. But the JDC can’t affect that.

Is it about elective work? No reason at all this shouldn’t be 7 days a week. But you need the entire resources of a weekday NHS. The JDC changes of course won’t provide that.

What the junior docs do provide is the essential manpower to keep the NHS running. Both elective and emergency. No possibility of the consultants doing it alone. There are not enough of us.

So they must have a sustainable safe contract that protects them and our patients.

That is what they truly believe the strike is about. No need to go into details here, but 98% voting for strike action means there is no doubt the gov has got it terribly wrong. After all as a profession we may like a good whinge about the latest bright gov idea that isn’t going to work but we suck it up and get on with it anyway as a rule.

And yes it is also about the pay. Or more specifically avoiding what seems to be a major pay cut for potentially working more hours other professions call unsocial, with lack of a robust safeguarding mechanism to protect the hours worked.

Please remember it is not “overtime” they get for nights and weekends. It is an enhancement for the recognised ill effects on health and well being of workers in any profession who do shifts like this. And they have no choice about opting out of emergency cover. Neither do we consultants.

This government will go down in history as being the only one in over four decades to incite the medical profession to strike. It could have been easily avoided. But 50,000 united voices can’t be wrong and this time they will not be silenced. What a shameful legacy for this government. Hopefully a legacy it will be as surely this debacle must mean they never have a hope of being re-elected.

And Pts pls don’t worry. Despite the gov rhetoric you will not be harmed by this strike if you are an emergency. The consultants will be covering our juniors. For the first three days ED depts will work as normal. There are likely to be more beds than usual as much elective work will be cancelled.

It is true to say that in other medical strikes in history, mortality has gone DOWN not up.

Yes elective activity will be cancelled and that is of course a travesty. But I don’t blame the junior doctors. I was one, we went through bad times, but nothing like this.

Their action has to have an impact if the gov are going to listen. All of them will regret and feel bad about the effect on elective work.

But they are simply left with no real choice. I hope the public continue to support them, as to a significant degree they are ultimately doing it for you.

And I hope it only takes one day of this limited action to produce the desired result. A complete reversal on the gov points the profession simply cannot accept.

Sad times. Rather wish I had taken up the job offer in Aus a few years ago. Or the current one for Doha.

But I won’t. Because I believe passionately in the NHS. I think it is the best health service in the world and I will not abandon it.

I hope our juniors get enough support in the coming difficult months to also not abandon it.”

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I love the NHS, it’s one of the best healthcare systems in the world. We are privileged to work in it and our patients deserve to have it and not a privatised system with tired and overworked doctors. We must do what we can to protect it. I have never seen our profession so united. Lets hope this government’s lasting legacy isn’t that it destroyed the NHS…

Remember “Don’t wait to strike when the iron is hot….make it hot by striking…”

KR

N

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