A Big Smile

[Sqad]

http://www.dailymail.co.uk/news/article-2524355/Senior-NHS-doctors-refuse-work-weekends-face-sack.html

CAn you just imagine a top NHS consultant being "sacked" for not working weekends?
Even in the unlikely eventuality that he would agree......he would want " more money on the table."

The first sacking would bring a call for consultants resignations from the NHS which may or may not work. Could the politicians risk this.

Many areas in many specialities have just one consultant....do you want him/her to work 24/7?

[emmie]

no, however many people in other professions work weekends, some have to, some may do it to earn more money, if consultants are not able to then perhaps we need more, private practice doesn't seem to have a problem as i can attest.

[LazyGun]

No, I cannot see them being sacked. Nice rhetoric though, and a brilliant way to bring consultants on side- threaten them with the sack if they fail to comply :)

There is an issue over mortality rates and staffing at weekends though.

[carrust]

The consultants seem to be able to work evenings & weekends when they're doing private work...........

[emmie]

they are working in private practice at weekends perhaps.
sacked, well they could try, but be prepared to have the GMC down on those who try.

[Sqad]

emmie

\\\\but be prepared to have the GMC down on those who try.\\\

You mean the BMA. Well the BMA couldn't care less about the Consultants there are more for the GP's.

BUT.....could the Politicians cope with a mass resignation of Consultants just before an election.......I don't think so.

Lazygun

\\\There is an issue over mortality rates and staffing at weekends though.\\

There always has been.......I could give you astonishing anecdotes about staffing.

[LazyGun]

@Sqad - I know there always has been, and I have a few anecdotes of my own :) More to the point, the epidemiological evidence shows the problem - one not confined only to the UK, but repeated in the US and Italy and other countries too.

Changes need to be made. Some are already happening. The massive advances in automation within Biomedical Sciences means that many Trusts have already effectively moved to a 24/7 pathology service.

Imaging and Radiology lag behind, and certainly working out some way of offering more senior cover at the weekends should not be beyond the wit of man :)

[Sqad]

Lazygun.......it is not the backup services that seem to be at fault......it is the Clinical sides.....medicine and surgery and that is where the life threatening mistakes are being made.
The computers and modern technology are advancing and being installed, but it ids a "human, clinical decision" that is the final move.....not an academic one.

[emmie]

probably, was thinking of doctors governing body.

[pixie373]

It's about time they realised there were 7 days in a week. Many businesses manage with shifts and rotas for weekends. I'm sure pay deductions and increases will work as well as they do for everyone else. Our GPs seem to take turns anyway for the out-of-hours service. How do they work that out?

[emmie]

we have a really poor out of hours doctor service, one time i had to pay a call, and its a distance away, one doctor was on call...

[jake-the-peg]

This has to change and if a few 'admirals have to be shot from time to time to encourage the others' so be it.

This is a personal anecdote but I don't think it's particularly unusual and more to the point I don't think it's particular to the NHS compared to private treatments

My wife was in hospital last year with cancer and she atrted to suffer from a pleural effusion - fluid in the lungs - this started to get worse but unfortunately it was the weekend. No consultants about and nobody taking responsibility.

Finally a junior doctor had her down for x-ray and saw pretty solid white lungs - and was trying to get someone to drain her 'first thing on Monday' was the first response - Thankfully the junior insisted 'No not Monday - NOW!'

Now as I say I don't think this is specific to the NHS - Consultants tend to mix their NHS and private work and don't like working weekends in either case.

But we can't allow them to continue to get away with this - People's health conditions can become a problem 24x7 not 8x5 and we need proper cover at all times.

I don't think the consultants have as strong a hand as sqad thinks they do.

If they don't need NHS work they won't be doing it - most will be supplimenting their NHS work with Private practice and not the otherway around.

In any case the status quo is not acceptable the NHS is here for our benefit, not for the benefit of the consultants

[emmie]

agree about the private practice, when o/h was in for his treatment the consultant was off playing golf and not to be disturbed..,

[Sqad]

pixie

\\\ Many businesses manage with shifts and rotas for weekends.\\\

and you have hit the nail on the head........the NHS is not a business it is a Public sector establishment, not in competition with any other sector and doesn't have to show a profit or evidence of good management.

In the old days...60's 70's there was a "Firm" and this consisted of Consultant, Senior Registrar, Registrar and Houseman and the firm was on duty 24/7 for it own patients.Over the years this has changed and one cannot lay the blame entirely on Politicians, being due to EU directives and pressure on the government by the BMA.

It is more complicated than I have suggested, but i hope that you get the picture.

Bring back the "Firm."

[Sqad]

JTP

\\\\\Finally a junior doctor had her down for x-ray and saw pretty solid white lungs - and was trying to get someone to drain her 'first thing on Monday' was the first response - Thankfully the junior insisted 'No not Monday - NOW!'\\\

That is totally unacceptable.....i agree. However in the 60's and 70's the junior staff had more experience than they do now and it was "meat and potatoes" for a junior to drain a pleural effusion....one didn't need the expertise of a Consultant......that is how one gains experience.

\\I don't think the consultants have as strong a hand as sqad thinks they do.\\

That is a big call JTP.

[jake-the-peg]

No the 'firm' was not on duty 24x7

The Juniors were on duty 24x7 and junior doctors worked 60 hour straight stretches and put patients lives at risk while consultants played Golf!

The problem is still the same

Juniors not wanting to take responsibility during weekends but wanting to defer till the boss was about.

Nice try at blaming the EU though

[jno]

if you go to A&E at the weekend apparently you're 12% more likely to die. If doctors can't think of a way to sort this (except "pay me more"), the government should.

[Sqad]

Well JTP....you are correct.....the situation IS the same for Consultants, but the difference is now that the juniors are inexperienced...then...we gained experience as we worked linger hours and "loved it."

To wait for a Consultant to come and drain a pleural effusion?....nonsense...and yes, at weekends and evenings Consultants do private practice, they are called Part Time Consultants and take a drop in pay, but maintain their workload for the privilege........unlike GP's who increased their pay AND their workload.

[AliceTickband]

my view on this is that if they refuse to work weekends curtail the availability of nhs space and equipment they use for their private work and remind them very loudly who financed their training!

[emmie]

our GP services needs revising, perhaps they should open the doors at weekends, as many people seem to end up in A&E at weekends, because they couldn't get a GP appointment, closed, or no one answering the phones, or reception understaffed as ours seems to be

[LazyGun]

I can point you in the direction of many clinical colleagues who will identify the lack of support services, such as no MRI or CT at weekends, or no histopathology cover to aid in renal pathology diagnoses, or no immunology cover to help determine rare heritable disorders. Some of their comments are not justified by clinical need or by economics - not sure it makes sense to have weekend working for histopathology myself - but certainly the imaging availability is an issue at virtually all District Generals right now.

Fortunately the technology has caught up a bit, and now automation, new testing protocols and computerisation etc all allow for a 24/7 service for pathology and there is no real reason that MRI/CT scans should not be available 24/7 either where necessary.

The reasons why the mortality rate is higher at weekends has been documented and is multi-factorial in nature, although I think most studies seem to concur that lack of senior clinical staff at weekends is the most important issue.

Fact is, many aspects of healthcare within the NHS and indeed outside of the NHS run on a 5 day week, when it should be considered as being a 24/7 service