Is our NHS already lost

SueDonim I couldn’t read your post and not respond. I’m so sorry to hear about your daughter’s health, but pleased to hear that the locum work is allowing her to recover somewhat.
Of course you know that my daughter jumped ship and went to New Zealand, not for precisely the same reasons, but similar. It was a little more complicated because there were other factors at play, but her unhappiness with the way General Practice was going was a big part of it. She now works in General Practice and also in the ED (A+E to us) in NZ.
I’m afraid there is a blind spot with regard to doctors in the UK. Nurses are angels, other medics more or less glossed over, but doctors must give their pound of flesh. My theory is that because we love our (failing) NHS, then we think doctors deserting it are actually the problem. They work for agencies, or private providers, or they escape to other countries where their pay and conditions are better. To where they are respected. There is the theory that because the state educated them, then they, or the employers who dare not to be NHS, owe something to us.
Well my daughter worked for 14 years in the NHS and neither she, nor New Zealand, owe us a penny.

Foxie said I think the real questions are why are there gaps and why do doctors choose to locum?

My dd has chosen to locum for a while because the hospital system had utterly broken her. Her physical and mental health both broke down from working 13 hour shifts and 70+ hours a week. Do people really want to be treated by a doctor who has been on her feet for 12 hours with no breaks and sustained by nothing more than a can of coke, gulped down while rushing between various departments?

The NHS has certainly had its pound of flesh from her. More in fact, as she lost 10 kilos within months, going from a size 8/10 to a 6. She works locum shifts now, directly recruited by hospital trusts, as do many of her colleagues. The alternative to this was for her to leave the NHS altogether and move to academia or elsewhere.

As it is, she is having some respite, being able to choose her shifts and working a more normal 35-40 hour week. She plans to go back into specialist training at some point in the near future.

Wasn’t the shortage of consultant anaesthetists the reason the trainees couldn’t be accommodated? The limit on training places isn’t a political choice at all. There’s no point in studying medicine if there won’t be a consultant to train you.

Doodledog agencies are mainly supplying doctors to the NHS and they will just pass the cost on, that's why I feel the focus should be on "why there are gaps?" Yes, it is a political choice to cap the number of university training places for doctors and we do need to train more but doing that without sorting out the issue of how to increase specialist training places is a bit like building an extra lane on a road for part of a route, at some stage you just get another jam. In 2021, 700 suitably qualified trainee anaesthetics failed to get a training place to continue their training despite there being a huge shortage of consultant anaesthetists. Doesn't make sense does it?

I seem to remember many years ago that University medical schools objected to the opening of new schools in Universities because they thought that increasing the numbers would bring a lowering of standards for admission. It would be good to see some more.
A training scheme for nurses which enabled the very best to become doctors might be a good idea as well.

I don't know how often I have to say it.

I am not talking about doctors being indentured - I am talking about agencies having to pay a levy if they employ a state-trained doctor.

As to why there are gaps - I don't know, and whatever I suggest I will be told that someone knows better. I guess that the reasons will vary from person to person, but it is a vicious circle, and the fewer doctors there are, the worse the conditions will be, so fewer people will want to stay in the profession. OTOH, medical courses are incredibly competitive and far more potential students are turned away than are accepted. There is definitely an opportunity to train more, and definitely talented young people who want to be trained, so it is political will to choose not to do so.

Fleurpepper

foxie48

Doodledog

The bottom line is, we don't have enough doctors and if we want our doctors to stay working in the NHS, then we need to pay them more and give them better conditions of service.

In case it needs repeating, I am not disagreeing with this.

And yes, growstuff, I have also known people get straight to the top of the NHS list after seeing a private consultant, seemingly a lot faster than others who had been waiting on the NHS. Maybe their clinical need was greater - I can't argue for or against that - but if they hadn't paid they would never have even been assessed. What would be the point in paying if this didn't happen?

"Again, I am not taking issue with that. What I do object to is that after costing £230k to train, an agency can come along and take someone out of the NHS pool. It is not about envy, it is about resisting exploitation of public money and assets (the NHS, not the individuals)."
My reply is to your comment Mon 15-May-23 19:10:32. Agencies only exist to fill gaps/needs. Surely we need to think about how we fill the gaps rather than just making it more expensive for agencies to fill those gaps. We employ thousands of doctors and nurses who have been trained by countries which are much poorer than the UK, I think we should start to compensate those countries as we are depleting their health care systems but no-one seems to worry about this!

It is all very complex. Agencies make huge sums of money, and who are the owners? Gaps are created, then fill in by their mates, making large sums on the way, on the back of the NHS, our back. It does not happen ot of thin air- and it is all linked.

I certainly think that new doctors and nurses should be obliged to work for the NHS for a number of years post full qualification and training.

I think the real questions are why are there gaps and why do doctors choose to locum? Agencies only exist because they fulfil a need. fwiw hospitals prefer to engage doctors to locum direct rather than going via an agency. They only use agencies when they have to.
How many years should doctors have to work for the NHS post grad before they can work in the private sector and would you include doctors who leave clinical medicine to go into research or other allied fields?

fwiw I was pointing out the hypocrisy of employing doctors who have been trained at the expense of third world countries whilst complaining about doctors, trained in the uk, being poached by private companies or working abroad, but if you don't see the connection, then you don't!
I do see the connection, and as I said, worrying about one thing doesn't mean that you can't also worry about another.

foxie48

Doodledog

The bottom line is, we don't have enough doctors and if we want our doctors to stay working in the NHS, then we need to pay them more and give them better conditions of service.

In case it needs repeating, I am not disagreeing with this.

And yes, growstuff, I have also known people get straight to the top of the NHS list after seeing a private consultant, seemingly a lot faster than others who had been waiting on the NHS. Maybe their clinical need was greater - I can't argue for or against that - but if they hadn't paid they would never have even been assessed. What would be the point in paying if this didn't happen?

"Again, I am not taking issue with that. What I do object to is that after costing £230k to train, an agency can come along and take someone out of the NHS pool. It is not about envy, it is about resisting exploitation of public money and assets (the NHS, not the individuals)."
My reply is to your comment Mon 15-May-23 19:10:32. Agencies only exist to fill gaps/needs. Surely we need to think about how we fill the gaps rather than just making it more expensive for agencies to fill those gaps. We employ thousands of doctors and nurses who have been trained by countries which are much poorer than the UK, I think we should start to compensate those countries as we are depleting their health care systems but no-one seems to worry about this!

It is all very complex. Agencies make huge sums of money, and who are the owners? Gaps are created, then fill in by their mates, making large sums on the way, on the back of the NHS, our back. It does not happen ot of thin air- and it is all linked.

I certainly think that new doctors and nurses should be obliged to work for the NHS for a number of years post full qualification and training.

No it hasn't been a deliberate choice, that is incorrect. You can only train more doctors if you have the trained staff in hospitals to support their clinical training. It is not possible to increase training numbers when there is already a staff shortage. The idea of increasing access by offering a five year medical Apprenticeship is interesting, I'm all for widening access but tbh I wonder how many hospitals will have the extra staff capacity to take part. fwiw I was pointing out the hypocrisy of employing doctors who have been trained at the expense of third world countries whilst complaining about doctors, trained in the uk, being poached by private companies or working abroad, but if you don't see the connection, then you don't!
" The following was taken from www.bma.org.uk/news-and-opinion/medical-degree-apprenticeships
While we welcome innovative approaches to education and training, there must be no illusions about the limited impact medical degree apprenticeships will have in solving the dire NHS workforce crisis. A dramatic increase in traditional medical school places to meet the projected future demand on the health service is needed without delay.

The Department of Health and Social Care has confirmed that the 200 apprenticeships included in the HEE pilot programme will sit outside the current restrictive Government cap on medical school places. The BMA has estimated that the medical workforce in England is currently short of 46,300 doctors when compared with the average doctor to population ratio in OECD EU comparator nations. The medical training pipeline is already stretched to its limits, with lecture halls at capacity, limited numbers of clinical placements, and falling numbers of medical academic staff.

It will take many years to put in place the supporting structures needed to train the thousands of additional medical students needed, following a Government commitment to invest in more medical school places. A rapid decision to significantly expand, and increase investment, in medical education and training is urgently required."

Worrying about one thing doesn't mean that one can't worry about something else.

Also, if the government had to pay a levy for every immigrant doctor it might make them more inclined to train more of our own. It has been a deliberate choice to restrict the number of trainees - a choice which could be reversed if there were a will.

Doodledog

*The bottom line is, we don't have enough doctors and if we want our doctors to stay working in the NHS, then we need to pay them more and give them better conditions of service.*

In case it needs repeating, I am not disagreeing with this.

And yes, growstuff, I have also known people get straight to the top of the NHS list after seeing a private consultant, seemingly a lot faster than others who had been waiting on the NHS. Maybe their clinical need was greater - I can't argue for or against that - but if they hadn't paid they would never have even been assessed. What would be the point in paying if this didn't happen?

"Again, I am not taking issue with that. What I do object to is that after costing £230k to train, an agency can come along and take someone out of the NHS pool. It is not about envy, it is about resisting exploitation of public money and assets (the NHS, not the individuals)."
My reply is to your comment Mon 15-May-23 19:10:32. Agencies only exist to fill gaps/needs. Surely we need to think about how we fill the gaps rather than just making it more expensive for agencies to fill those gaps. We employ thousands of doctors and nurses who have been trained by countries which are much poorer than the UK, I think we should start to compensate those countries as we are depleting their health care systems but no-one seems to worry about this!

The bottom line is, we don't have enough doctors and if we want our doctors to stay working in the NHS, then we need to pay them more and give them better conditions of service.

In case it needs repeating, I am not disagreeing with this.

And yes, growstuff, I have also known people get straight to the top of the NHS list after seeing a private consultant, seemingly a lot faster than others who had been waiting on the NHS. Maybe their clinical need was greater - I can't argue for or against that - but if they hadn't paid they would never have even been assessed. What would be the point in paying if this didn't happen?

Glorianny

growstuff

Nellybrook

Surely the queue jumping is seeing the consultant privately for diagnosis, not the treatment that results from subsequently being put back into the NHS queue.
My experience with a private neurologist, whilst not having the funds for private MRI etc, was that my GP would have to refer me back to her through the NHS system like any other Tom, Dick or Harry.
No preferential queue jumping, though she did say to bring her letter with her findings to the appointment!
You don't go to the top of the list as I understand it

Well, that's odd because I know somebody who had a hip replacement two weeks age after waiting only three weeks. She saw a consultant privately, who then put her on his NHS list.

This is now completely against the rules. It used to happen a lot. But NHS guidelines now say that there has to be a completely separate arrangement for any NHS treatment. To the extent that you cannot even mix say a cataract operation and pay for private lenses rather than use NHS ones if you are being treated under the NHS.
^there must be as clear a separation as possible between your private treatment and your NHS treatment^

I have no idea why this person was considered a priority. However, I do know for a fact that she persuaded a friend to drive her over 100 miles to see a private consultant and then received an appointment for the op with the same consultant paid for by the NHS just three weeks later. I have no doubt that her hip caused her pain, but no worse than other people who have to wait for months, if not years.

If agencies had to pay a premium to employ a doctor, they would just pass that additional cost onto the hospital employing the locum. Hospitals only employ locums because they cannot offer a safe service without them. It's basic economics, if hospitals had the staff they needed they wouldn't employ locums, if there were lots of locums looking for work, the cost to hospitals would reduce. The bottom line is, we don't have enough doctors and if we want our doctors to stay working in the NHS, then we need to pay them more and give them better conditions of service.

Good post Doodledog.

maddyone

GSM doctors pay the state back for their 3/4 years at university. They pay their student loans just the same as other students. The final two years of their time in medical school is spent in hospital, working. That’s why they don’t have to pay any student fees for those years. Of course they’re still learning, but they are also working.

As I said upthread, all students pay back the same amount. Some will pay more than their courses have cost, and others will pay significantly less.

I don't see that as a problem, as I believe that all subjects are important, and if some cost more to study than others, many students would be unable to study in line with their talents. Also, contributing to the training of students who will go on to be the next generation of specialists in various subjects is what taxation should be about - we all pay in and then take out when we need to, in this case by contributing to the training of the people who will go on to treat us when we are ill.

But training a doctor cost £230k each in 2016 (I don't know the current cost, but that was the figure quoted when Jeremy Hunt mooted the idea of expecting all medical graduates to work in the NHS for 4 years to make more of a contribution than their fees do) - far more than training a student whose course doesn't require equipment and/or supervision by expensive senior colleagues. Lecturers in clinical subjects get paid a lot more than others (there is a bonus on top of the usual pay grade), so even if the students never used a machine, and didn't need to be supervised, they would be costing significantly more than, say, a Business Studies or Maths student.

Again, I am not taking issue with that. What I do object to is that after costing £230k to train, an agency can come along and take someone out of the NHS pool. It is not about envy, it is about resisting exploitation of public money and assets (the NHS, not the individuals).

What is the difference between my son's employer having to pay to 'poach' him from his previous employer, or my son having to agree to pay back the cost of his postgrad professional qualifications if he left before an agreed period, and the same expectations being made in the medical profession? (not that it's relevant, but he also had to pay back a student loan )

Glorianny

growstuff

Nellybrook

Surely the queue jumping is seeing the consultant privately for diagnosis, not the treatment that results from subsequently being put back into the NHS queue.
My experience with a private neurologist, whilst not having the funds for private MRI etc, was that my GP would have to refer me back to her through the NHS system like any other Tom, Dick or Harry.
No preferential queue jumping, though she did say to bring her letter with her findings to the appointment!
You don't go to the top of the list as I understand it

Well, that's odd because I know somebody who had a hip replacement two weeks age after waiting only three weeks. She saw a consultant privately, who then put her on his NHS list.

This is now completely against the rules. It used to happen a lot. But NHS guidelines now say that there has to be a completely separate arrangement for any NHS treatment. To the extent that you cannot even mix say a cataract operation and pay for private lenses rather than use NHS ones if you are being treated under the NHS.
^there must be as clear a separation as possible between your private treatment and your NHS treatment^

I tried to buy another pair of custom-made orthotics as only one pair is allocated per year and but was told it is not possible to buy an extra pair. ☹

growstuff

Nellybrook

Surely the queue jumping is seeing the consultant privately for diagnosis, not the treatment that results from subsequently being put back into the NHS queue.
My experience with a private neurologist, whilst not having the funds for private MRI etc, was that my GP would have to refer me back to her through the NHS system like any other Tom, Dick or Harry.
No preferential queue jumping, though she did say to bring her letter with her findings to the appointment!
You don't go to the top of the list as I understand it

Well, that's odd because I know somebody who had a hip replacement two weeks age after waiting only three weeks. She saw a consultant privately, who then put her on his NHS list.

This is now completely against the rules. It used to happen a lot. But NHS guidelines now say that there has to be a completely separate arrangement for any NHS treatment. To the extent that you cannot even mix say a cataract operation and pay for private lenses rather than use NHS ones if you are being treated under the NHS.
there must be as clear a separation as possible between your private treatment and your NHS treatment

maddyone

GSM doctors pay the state back for their 3/4 years at university. They pay their student loans just the same as other students. The final two years of their time in medical school is spent in hospital, working. That’s why they don’t have to pay any student fees for those years. Of course they’re still learning, but they are also working.

And they certainly get their money's worth out of them when they're training on the job.

Those two years are a net cost to the NHS which they don’t repay though - the suggestion is that if they move to the private sector the employer should repay that cost, or if they move abroad the doctor should do so (which they could probably negotiate with their new employer). I don’t think that’s unreasonable.

Incidentally it cost me approximately ten thousand pounds a year to keep my daughter at medical school in London. Perhaps the NHS should pay me back!

GSM doctors pay the state back for their 3/4 years at university. They pay their student loans just the same as other students. The final two years of their time in medical school is spent in hospital, working. That’s why they don’t have to pay any student fees for those years. Of course they’re still learning, but they are also working.

Whether or not private patients get moved to the top of the NHS lists is not what this discussion is about. It’s about whether private hospitals should pay some sort of debt to the NHS (meaning government) for having the audacity to employ doctors trained in our universities in the doctor’s own time.

maddy, a non-medical graduate merely owes the state repayment of their student loan. A medical doctor receives much post-graduate training at the expense of the state. You can’t compare the two.