大象传媒

i don't think there will be a shortage of GPs becuase nowadays everyone wants to become a GP due to the six figured salary they receive.

now consultants, i think its good to have a sub-consultant level because some people i know are over qualified for their job but they can't become a consultant because there are no jobs.

i think payment by performance is a great idea but who is going to judge? are they going to be fair or biased? thats the problem!

The report also mentions how there maybe other health professions such as physiotherapists that the NHS cannot afford to fund.

I work as a physiotherapist in a large inner city hospital and also have friends and contacts across the country who work in various different healthcare settings.

The story is always the same- we are all understaffed. There are constant initiatives to improve and develop services without the funding behind them. We struggle to provide the basic servcies at times when we are covering for frozen posts due to the staffing cutbacks we have seen this last fiancial year.

There is also a massive surplus of newly qualified physios unable to find jobs-not for lack of need, but due to poor job planning by the government from years back. This situation does not look as if it will improve within the next few years as the already overstretched, overburdened and target driven NHS has even more pressure from job and funding cuts.
Part of these funding cuts are blamed on the 'excessive' pay rises for staff. Our less than inflation pay-rises on already modest salaries are swallowed up by spiralling utility bills and mortgage repayments (if you are lucky enough to be on the housing ladder).

This situation is not exclusive to physiotherapists, the same is happening to nurses, doctors and other health professionals. Knee-jerk reactions to saving money now, never bode well for the future.

If the situation looks bad now the worst is still to come....

Major problems have resulted from the European working time directive. This means that more junior doctors have to be employed, and trained, leaving them without consultant posts when they have finished their training.
Furthermore, the new consultant contract, while offering consultants slightly higher salaries (nothing compared to GPs), has shifted significant control over to managers in the NHS. The NHS will definitely get its pound of flesh from hospital consultants, in a way that it has not been able to from GPs.
Consultant numbers are unlikely to fall, as employment of consultants is not based upon government targets but is defined by the need to meet performance indicators by the trusts. However, trusts may attempt to push consultants harder, to the extent that hospital doctors will be tempted to leave the NHS and practise as independent sector care providers, contracting their services to PCTs and hospital trusts.

I cannot believe this is just another leak!... it's their manner of introducing bad news.!
What it does show is the complete lack of joined-up Government thinking.
The Nurses saw this coming when the condescending Patricia Hewett announced 2006 as the best ever for the NHS in one breath whilst ditching posts in another....really!! how can you have any confidence in such an administration?
They(the government) are attemting to pick & mix clinicians as though they are a team of apple pickers.. maybe they have an agenda based on hiring & firing ..dependent on Treasury whims ,clinicians of all types from the New countries now in the EU.
What a mess!!& this from a socialist Government

The major problem facing the NHS for many years has been the expanding elderly population and increase in services available. With more people needing more treatment, the money was always going to run out. As always, the NHS staff are going to take the hit financially, either through pay cuts or, increasingly, unemployment. What will it take for the Government to be honest and say that we can no longer afford the NHS - how many other countries have a free health care system and don't have health insurance? People in this country are happy to insure their cars, but not their health. This will have to change. In the meantime, the Government have a responsibility to doctors to provide the jobs that they have trained for.

A mess is exactly what you get from a socialist government, you seem surprised.

To say "i don't think there will be a shortage of GPs becuase (sic)nowadays everyone wants to become a GP due to the six figured salary they receive" is fatuous nonsense. The truth is that many GPs are part-time or salaried (ie not partners) so earn nothing like this amount.

As the husband of a hard-working GP I can believe the warnings of an impending shortage. Many women work as part time GPs and the 'debit' side of the job is mounting - eg the pressure of appraisals, the threat of regular assessments (which let's face it few in other professions would welcome - eg journalists!), and the increasing emphasis on financial targets rather than medical judgments about patient care all make the job much less attractive than it was when my wife decided to go into medicine.

Most significantly of all, I can detect a new openness among GPs to work in the private sector where there used only to be hostility to it and a commitment to stay working in the NHS. The goodwill of GPs to stay in the public sector is ebbing away. Fast.

I鈥檓 a Scottish trained junior anaesthetist and intensive care doctor. My wife (research nurse) and unborn 1st child are preparing to leave the UK for good in July. I am not alone, the MAJORITY of my former study group at medical school are either already abroad or are also preparing to leave. The way this government has treated its highly skilled professionals is criminal. With all this uncertainty over our future, give me ONE good reason to stay鈥�

I cannot believe the cuts this government has made in our NHS service, and they are supposed to be FOR the NHS. Again another example of too many highly paid chiefs and not enough indians.

Looks like you've got a bug in the Blog. Not only is this "Entry" there twice, but this one shows as having just one comment when there are four here, and the other one says it has none. Who broke it? :-)

Seriously though, yet another Newsnight splash story on the NHS. When are you going to start taking seriously the real need to cover that vital, huge national resource responsibly? Grow up, please; the NHS has been vital to all our lives for 60 years now, and any thought that it is a nasty bit of socialism that will wither away should surely have been consigned to the bin of political sectarianism years ago. So find a way to report on it, watch it, so that we can be informed as we need in order to participate in the thinking and the planning and the decisions as we have the right to. This isn't some big private business you know! Just getting these splashes about crises, shock revelations, or glipses into internal interest groups tussling, as this story is, are not good enough.

As for your appealing for consultants to contact you so that you can set up another story on such tussles, well... Are you lot all unnaturally healthy, or have you all private medical insurance, or do you all have "professional" neighbours and relatives or something, that it is only the staff and management and political masters that are above your horizon? What about the patients and potential patients, aren't we the central factor in the NHS? All of us, everyone out here in the UK? The government says patients are central to the NHS, so what more justification do you need to cover it that way?

How does this story relate to patient health and care? Are number increases, decreases, disruptions, reallocations, improvements or deterioration, planning, or emergency fixes? The reports hint it is connected with moving services out of hospitals. What is that about? It supposed to be like the middle level clinics you reported in Cuba? What are they moving, to where and why? How come they are still building bigger hospitals then? There's some fake consultation about it, but what is it about? Has it been pre-tested? Why haven't you covered it? Is this all smokescreen for the NHS computing and privacy destruction scandal?

As a longstanding customer of the NHS I find no problem with them when one reaches the Consultant, the trick is getting to him/her!

Let the unemployed Consultance become GPs. The Market will sort it out if allowed to.

when will we ever learn !
nurses and doctors do the job not "consultants" ..
its an insult to doctors and nurses not to allow them access to "consultants" in certain anomolies
where applicable. Consultants and administrators are but another burden
to UK tax payers.
SORT THIS OUT !

peace and love
compton of cherin in crawley UK

Hi, The Conservative spokesman today on 5 Live Radio suggested that when [if?] the Tories are returned to power, they would sort out all the present ills in the National Health Service. Presumably, as the present shortage of cash is due to the enormous cost of the action in Iraq and Afghanistan, which, I understand they wish to continue, is the NHS restoration a pipe dream? I did not catch the name of Tory, but I presume that he is the MP for cloud cuckoo land!

The situation is no different from any other historical happening. Supply and demand fluctuates regularly and planning to meet all the surpluses and deficiencies is an almost impossible task. The aging and increasing population will continue to make demands on the 'caring' professions but qualified personnel will perhaps find it necessary to export their skills. They're fortunate to have these transferable skills, not everyone is in that enviable position.

The only consultants the NHS should be getting rid of are the parasitical management consultants. Vast sums are spent on these people but their only role is to find ways of cutting services and staff numbers. It is a long-standing myth that the NHS is overstaffed. It is exactly the opposite, we are criminally understaffed particularly where it matters most in direct patient care; I know because I and my colleagues have to cope with it every day.
As for this government being socialist, what rubbish. They are out-and-out Thatcherite.

This has been on the cards for a while and will not suprise junior doctors, many of whom already struggle to gain employment in this country at all - never mind in recognised training posts.
The government made their intentions clear when they announced the MMC changes to post-gradate medical training due to be implemented in August '06. The idea was that workforce planning in the various specialties could then be carried out to address demand eg. less training of cardiothoracic surgeons as not required to same extent as in past. The other aspect is that training will be 'seamless' ie less time in training - this will inevitably lead to a two tier consultant level.
For the thousands of doctors who do not get on their desired training programme the other options would be: taking up either a specialty in which they have no interest or a job a where they wil be in a low-paid service provision role with no prospect of furthering their career to consultant level.
The result will be mass movement of doctors out of the UK (right behind all their non-EU colleagues - who have been treated so unfairly despite holding the health service together all these years). They will be replaced by non-language tested Eastern European doctors who are happy to work for less money.
The government aim to push doctors into "career grade" rather than consultant posts. This will enable them to be paid less despite doing the bulk of the work load. It is clearly money motivated and will lead to reduced standards of patient care

When the NHS started, GPs were presented as the bastions to prevent the hospitals from being overwhelmed. This has clearly failed, mainly because GPs are so overworked. GPs have insufficient time or resources to undertake full diagnostic work and so they routinely refer patients to hospitals where scanning and other complicated equipment is installed. The obvious solution is to split the diagnostic function at hospitals from the treatment work, and open diagnostic centres where the surplus consultants can practice at the lower grade level envisaged, eventually being promoted to full consultant status at a hospital.

Wouldn't it be better to get rid of managers instead of nurses and consultants. I'm sure the NHS worked better before we had them.
Sack the managers and bring back the Matrons.

I find it hard to believe these "leaks". We voted a labour government in and it seem to me that there is a concerted effort in every quarter to discredit them. History shows the an alternative government will only make things substantially worse!!

It really beggars belief. The UK is the most underdoctored in Europe ( except for Romania) ant they are talking of reducing the numbers of consultants! There is however going to be a shortage of GP's a problem, which will be exacerbated by the reduction in training posts available. The estimate of 1,200 short is laughable. In order to provide the service talked about by Patricia Hewitt and her cronies we would need about another 10,000 GP's.

So where has all the money gone in the NHS? Think Connecting for Health: Community matrons; sure start; targets; management initiatives; health care reform and continual micromanagement from people who have not a jot of understanding about health care.

But never mind, legions of managers and administrators are being prepared to leap into the breach with ever more innappropriate plans and protocols to replace clinical staff and drive the remaining doctors and nurses into perpetual despair.

As for the salaries of GPs? Well deserved and overdue.

I question the basis upon which the premise that there will be a surplus of 3200 consultants in 2010-11. Either they are predicting the demand for consultants will reduce because fewer people will be ill and requiring their services, or they anticipate there will be an over appointment of consultants to meet the current backlog and to meet Government imposed targets.

In my view targets are totally inappropriate for medical care. The medical professions will deal with as many patients they can within their contracted hours and more in very many cases. It is their vocation. Government set targets distort decisions beyond the rational. Government control imposes a bureauracy on the NHS solely to provide statistics. Money that could be better used elsewhere.

Managemment must be local, constrained by financial budget based on a rate per capita (resident and migrant).

We already have a rank of Sub-Consultant. Its called Senior Registrar. To think that creating another rank is going to solve the problem is extremely naive and will only add to the cost burden.

If there is an excess of medical staff why is it that there is still a long waiting list for some operations.
A friend has been told she needs a hip replacement, she is in continual excruciating pain, however, her consultant has informed her that she will have to wait at least six months for the operation.
Overstaffed? Or as can be the case, too much private work?

"I understand hospital consultants earn upwards of 拢90000 per year. I suggest we halve their pay (they would still earn 3 or 4 times as much as most of the people they treat..."

what utter nonsense! After training for 15 years and developing knowledge that would make a doctor an invaluable asset you believe we should punish Consultants by halving their pay?! As a medical student I see how hard doctors work including Junior Doctors who work >70 hours a week for less than 拢25,000 a year, thus ignoring the european time directive for the benefit of the patients. Perhaps the government needs someone who can actually balance the accounts to prioritise the books and give the NHS the money it needs to treat the people who elected the government in the first place.

Higher taxes are not the answer, better management of what we have is.

I am completely mystified, one day the NHS has too many Consultants,Nurses GPs etc., and then
they are crying out for more from the newer member countries of the EEC.In my opinion another 'tier' of
medics will just complicate and add to the expense of the NHS.
I believe that GPs are streched enough, and they are happier sending patients to Consultants who they know
and have confidence in.
I most areas of life the 'simple'solution is the most effective. Adding more work to the GPs or another 'tier' will increase the paperwork and bureaucracy,which will leave the NHS open to more errors.

There is no doubt that medical unemployment is on the near horizon, if not actually already here in some specialities. There are fully qualified doctors who can't get jobs NOW. eg cardithoracic, orthopaedic and ENT surgeons.

There are definitely people in or near to the DH who believe that it is acceptable to spend large sums of money training specialists, only to have them unemployed. The belief is that this would weaken the power of doctors and focus their minds.

There seems to be a definite process of blaming doctors (and their pay) for the ills of the NHS.

Shunting some of the brightest UK secondary school pupils into dead-end jobs is going to produce a VERY dissatisfied workforce.

I also don't think that patients yet appreciate that the NHS is rapidly becoming a cheap and cheerful, dumbed down service. You will find it more and more difficult to see a doctor, let alone a fully qualified specialist.

Just a few thoughts.

I think that there will be a major staffing crisis across all areas of the NHS in the years to come. The focus is continually on the front line staff but it must not be forgotten that a large burden of the redundancies in the NHS are being met by support staff such as technicians,physio's, ward clerks, IT, admin & clerical. In the hospital which I work departments have reduced their admin support levels to the bare bones where only the basics are being done and the trust is relying on existing staffs 'good will' to do the rest which is fast running out. This is pretty serious when you talk about payment by performance as without the admin staff and 鈥榖ean counters鈥� as they have been so wrongly labelled by the media, who is going to record and collate consultants performance so they can be accordingly rewarded? In one department a lot of activity that consultants are doing is going unrecorded as they have sacked most of the admin staff that use to collect it and type it in to the computer, complete and utter madness.
What needs to happen is that Tony Blair and his cronies should stop meddling at ground level with the NHS and let the consultants and doctors treat, the managers manage and the staff , frontline and support, care for the patients. If the public do not stand up and be counted this time and remove these people from office there will be no NHS for us and our children only private healthcare in the hands of shareholders accessible only to the wealthy (and Tony and Gordon naturally).

If the Cabinet and their junior ministers were to be paid by performance, they would all be owing us money!

#23 by Peter: Excellent contribution. And my most recent experience was all too similar in that, although there was hardly any wait, 5 nurses stood around doing nothing but chatting for the entire time, except one took the blood pressure of each new patient as soon as they arrived - a useless exercise so soon after stress of travel. Yet we know that, at night, one solitary nurse can often be left with responsibility for dozens of patients. Either the staff are badly allocated, or they get to choose cushy jobs.

So if there is to be a surplus of consultants in less than 3 years, why does it take 3 to 12 months now to see a consultant????

After coming top of their classes, after coming top of their country, after getting Firsts, after working 70 hour weeks on a pay equivalent to their managers' secretary, after sitting and passing exam after exam, year after year until they are 28, after having to relocate every six months, year after year, to different parts of the country as part of their training (thus destroying friendships and relationships), after spending 10 years with little time for anything but work, I am seeing junior doctor friends and colleagues around me contemplate life with a hefty mortgage, unpaid student loan debt and a vocation which has taken out roughly 12 years of their life, disintegrate to pieces. They no longer know what the future holds. The people who were out partying as they were struggling to make the grades are now probably employed and probably earn more.

Why do we suddenly think that these predictions are valid? I have been witness to several waves of predictions about shortages and then oversupply to be followed by another shortage of IT experts from DTI. These were inevitably wrong!

When we take into account the aging population and their higher medical needs, it seems to me we would require more qualified staff - especially very well trained consultants able to use most uptodate technology.

Now, it is entirely possible that the document refers to the 'dinosaur' type consultants sticking with the 'old' ways - if so, get rid of them!

Having followed closely the changes in our local PCT, I am clear that there is an enormous fluidity in the system, from structures, through processes used to serve (my word, not theirs) patients to actual locations and delivery of necessary services. Instead of Learning by Doing with small trials, this is a typicall socialist '5 year plan' effort with high potential for failure already built in!

Consultant numbers are a smokescreen! Do not fall for that one.

We never hear that there are any shortages or surpluses of NHS managers. Could it be that managers are looking after their own interests very effectively while using medical staff to meet the demands of their political masters for budget cuts?

The government鈥檚 poorly thought out strategies in form of 鈥淢ODERNISING MEDICAL CAREERS鈥� will be the beginning of the end for the NHS in not too distant a future. The British system of surgical and medical training had always prided itself in producing some of the most competent specialists in the world albeit a very long and admittedly challenging length of time to reach consultant status. The end-result, at least in my area of interest in plastic surgery was highly skilled and experienced consultants. Subsequent to the drastic introduction of the MMC scheme, junior doctors two years after finishing medical school will enter a specialist training scheme to become the junior consultants of this country鈥檚 future, many of whom will be grossly under-trained and inexperienced; but of course this will satisfy the government鈥檚 statistical achievement of the surge in the number of 鈥渟pecialist consultants鈥�. In addition this does not come at a fair price to the hundreds of trainees like me who have spent years and hundreds of thousands of pounds to become eligible for the previous specialist training scheme. We have all been given an ultimatum to enter the MMC scheme before the new batch of trainees enters the competition in August 2007. If unsuccessful in obtaining any of the meagre number of specialist training slots, many junior doctors will change career directions entirely, or head to other countries such as the US or Australia. If this is not classed as foolish 鈥減lanning鈥� or discrimination I am lost for words for an alternative description.

Doctors who choose to go into medicine with a view to ending up as a consultant specialist spend around 20 years training, taking exams and undertaking doctorates in many cases. Not only is this expensive to the NHS, but very expensive to the doctors themselves, who typically have to spend 拢2000 per year of their own money to be registered, members of specialist colleges and go on required training courses. Furthermore, those who undertake a doctorate are often unpaid for a substantial part of it (1 year in my case). This personal expenditure has previously been rewarded by near guarantee of job security and fairly good remuneration once a consultant, but if this is to go, then the economic balance starts to look rather dubious. Furthermore, since these doctors are required to be extrememly high achievers, they have the option of choosing alternative careers with better pay, far less training and now probably better job security.
A factor I've not so far mentioned is job satisfaction, which is clearly a motivating factor in medicine. Yet the prospect of not being a consultant and therefore unable to have significant opportunity to develop one's own plan as to how best treat individual patients and develop the service you provide is contrary to this job satisfaction we seek. The posts that are likely to offered to many unemployed consultants are staff-grade posts without consultant responsibilities or autonomy and with lower pay.
The overall result of this is that for the first time in the 12 years I've been in the medical system, the complaining by doctors is no longer just whinging, but serious contemplation of choosing alternative careers. Is this the brain drain the government are aiming to acheive?

The European Working Time Directive and Modernising Medical Careers have been forced upon the medical profession much to the displeasure of those who work at the coal-face.
The problem is that by their nature health care professionals are "good and nice" people who are not trained to voice their opinions on a political stage.
The lack of investment and interest in junior doctors' training has led to the introduction of MMC, which will force many doctors into posts which they have no interest in, because there is so much competition for the posts they have been trained to do. This is the positive side, many doctors will be unemployed, wasting the funding which has gone into their training, or will go abroad, also a waste of tax payers money.
In typical fashion to prevent a backlash, the government has allowed a short term increase in the number of registrar training posts available, and it is almost certainly the impact of these doctors coming through in 2-4 years time which will produce a proportion of these 3200 doctors without consultant posts.
For people to say that consultants are overpaid is ridiculous. These are highly trained professionals who make life and death decisions and are totally devoted to their vocation. They, if anything are underpaid when compared to similarly trained individuals at the top of their careers in banking and the legal profession.
I wish that doctors nationwide would stop whispering to each other about their displeasure at the way that we are treated as a profession and shout it out to those who matter. Other countries' medical professions have before now gone on strike to make their voice heard.

Hi, Further to my last comment, in the local Epsom & Ewell Guardian, Chris Grayling, the local MP is urging residents to fight against the closure of our local NHS hospital. He cites as an example, the case of a child who broke his arm. The ambulance man refused to take him to the above hospital, which has a recently constructed A & E Department, but insisted on taking him to Guildford, twenty-six miles away! This, of course, would have made it very difficult for his parents to visit him. In a Conservative constituency it would appear that residents are not represented in Parliament - hardly democratic? I'm sure that a more forceful MP would have more success, as Mr. Skinner did in Mrs. Thatcher's days. Why does Oliver Letwin, the Conservative MP for Dorchester, succeed? A close relative who lives there tells me that there is virtually no waiting list for the excellent NHS medical services in that area.
Perhaps the population density is much higher in north Surrey - but we all pay the same for the NHS.

Having read the previous postings, it saddens me to see that the general public don't get it. The NHS is not a business to make money, it has been exposed to spin of the utmost degree by this government to guarrantee the quota of consultants. too many people in secondary health care use the term of consultant without being medically qualified.

The hierachial form of medicine from Sir Lancelot Spratt and Doctor in the House is non-existent anymore.

If you are ill, do you want too see someone who is capable of making you better, If you need surgery do you want someone to operate who will cure or remove the pain, Or do you want some one who might have read about it in the books , trained in the new NHS under modernising medical career and EWTD, but not have the hands or experience to know when not to operate.

Forget the cash, GP earning 拢100k, consultants earning 拢90k. If we cock up people die, if accountants or stock broker cock up they lose millions and go home at the end of the day. Try doing that when despite your best efforts, someone is so ill they don't make it.

Why do you think hospital and primary health care professional have a high divorce rate and suicide rate, not to exclude alcoholism and substance abuse.

You never hear of managers being made redundant, or for that matter a politican.
Labour are going to get hammered at the next election.
Why do we as tax payers spend 拢500000 training every doctor?.There is ongoing mass migration of highly trained medical personnel to Australia and North America.These proposals will only increase this. They will be replaced by cheaper non english speaking doctors with no checks on their competency. It is already occuring in dentistry. You would never catch me going to a Polish dentist after what I have seen!!!!

After 8 years in University and 2 degrees, I have had to apply every 6 months for a job, each time fearing unemployment (Mainly a UK phenomenon). Is that security? This is unlikely to change the higher one goes. The psychological pressure, WE as 'professionals' face, not to mention trying to build our personal lives and God forbid a family, is immense. I cherish the NHS and because of its idea I became a doctor, the reality however remains that it was probably the biggest mistake of my life. The everyday NHS struggle is already unbearable, coupled with all the insecurities of employment, well...it is just not worth it.
Patients keep me going.

What some people appear to be forgetting is the fact the NHS is in huge debts only because they are trying to save people's lives. This is where the British government falls spectacularly downhill. They spend the money that could be put to good use in the NHS on pathectic things such as war. They aren't trying to save lives; they're destroying them! The vast amounts of money spent on war (where hundreds die) should instead be spent on more reseach, better resources, comfort and most of all: better training for all NHS workers.

Although there has been a consultant expansion over the past 15 years, the UK still lags behind many developed countries in the numbers of fully trained doctors to do the work. However, the nub of this problem is that consultants, like myself, need the FACILITIES to do the job - which are expensive. There is no point training more doctors if there is not a meaningful job at the end of it to deliver your skills.

Patients want fully trained doctors treating them, but there is a clear agenda by the Government to try to 'do things on the cheap' - untrained triage physios trying to keep people out of secondary care, GPs seeing follow ups at 6 weeks after operations they know nothing about, etc. This is dressed up as 'change' or 'modernisation' when it is actually a reduction in quality of care, to try to save cash.

This Government has already placed the NHS in negative equity with wasteful ISTC and PFI schemes.

If they stopped meddling, and tried to properly involve the WHOLE PROFESSION - not just their 'special advisors' - in planning healthcare, the NHS would not be in the absolutely dire straits it is now.

We are going to see another 'brain drain' of trainee doctors to Aus/NZ/Canada etc who will welcome them with open arms.

The Labour government have made a complete mess of the health service since they came to power and no one at the top has taken any responsibility.

I am a UK-trained doctor who relocated to Canada a little while ago. I keep in touch with my colleagues back home and have been disappointed to observe the continuing woes of the NHS. Morale seems low among staff, quality of care is patchy at best and there seems to be little accountability. Everyone seems to recognize that the service offered to the public is barely acceptable, but there seems to be no will to change the way the system works. Many of the NHS docs that I know are eagerly counting the days until retirement. Training is being diluted by the MMC reforms and working hours restrictions, while the concept of what a consultant is is being radically altered and the introduction of a sub-consultant grade is clearly planned for the near future.

I currently work in a large metropolitan hospital. My patients are seen and treated quickly, there is a huge day surgery unit operating flat-out all day. I would be happy for any of my family to be treated in any of the Canadian hospitals I have worked in, which is not something I could say for all the NHS units that I have experienced.

Doctors are paid here on a fee-by-item-of-service basis, and this seems to increase the amount of work being done and improve patient throughput. If I see more patients, my income rises, and if I take it easy for a few weeks, my income drops. My income is several multiples of what I could make in the NHS, tax rates are generous and the cost of living and property is low. It's illegal to run a private hospital here, but that just means I have more time to spend on my own practice.

I work about 80 hours a week and am on call from home one night in nine. I have a reserved space in the hospital car park, and another special space for when I am on call. I dictate all my letters either on the hospital's 24-hour dictation hotline or on my own automated voice-processing system. I have a "paperless office" with an electronic health record system, both set up by at the hospital's cost to my specifications. I can access all the clinical information I need from anywhere in the hospital, in the office and at home.

My chief resident works about 100 hours a week and happily comes in to round every weekend in life. There are no maximum working hour restrictions in Canada. Most of the residents here scoff at the idea of the UK's maximum 56-hour work week (soon to be 48!) and are keen to work as much as possible in their 5-year residency.

I would dearly love to return home to practice at some point in the future, but the thought of returning to the NHS in its current state fills me with dread. My NHS colleagues can't understand why I would even consider coming back to work in the UK's "third world" healthcare system, and some have even offered to switch places with me!

My questions are:

1. Can anyone suggest any reasons for me to return to practise in the NHS or would I be insane to do so?

2. Most UK medical trainees that I know are bright, intelligent and mobile. What's to stop others following in my steps and abandoning the NHS in droves to move abroad or form 'medical chambers' like the lawyers have?

A. Doctor,
CANADA

Re GP and primary care- GPs in partnerships salary depends on providing a good service with the most efficient use of funds- a model the rest of the NHS should take a look at. By the way in response to employing consultants as GPs - GPs are specialists in their own right and consultants do not have the qualifications to work in primary care - GPs could work in secondary care however.

I am a junior doctor. I do enjoy my job, but if anyone out there is considering a career in medicine, I would strongly urge them to reconsider.

If you are a capable of doing medicine you could have a much happier life well out of the NHS (I feel sad saying this).

This is the current governments doing, no one else's.

Given the amount of money wasted by this Government on management consultants, dodgy PFI schemes, poor value ISTCs etc etc, is anybody really surprised?

The NHS has quite clearly hit a major crisis 鈥� it is not a crisis caused by insufficient funding, 鈥榳e鈥檝e never had it so good鈥�, no it is a crisis caused by government policy, meddling and a distasteful attempt to subvert what they see as the illegitimate power of doctors.

The government have embarked on a ideological quest no less misguided than communist farm nationalisation. This quest has sought three things, to create a market within the NHS which is open to private providers, to control down to the smallest detail the activity of the NHS and to displace doctors from their role as the providers of medical care.

Each of these has been done despite clear evidence of increased cost and decreased quality 鈥� it is the antithesis of 鈥榲alue for money鈥�

Examples of how the NHS has worsened despite more money
1) Out of hours in many areas you no longer get to see a doctor, just a nurse or paramedic with some 鈥榚xtended training鈥�
2) A referral by your own doctor is screened by a clerk with no clinical training and redirected to whoever they think appropriate, this person may be a nurse, another GP, a physiotherapist but is increasingly less likely to be the consultant to whom the referral was originally addressed.
3) At night in hospital you become sick, it will no longer be a doctor who comes to see you 鈥搃t will be a nurse. A nurse with some extended training no doubt, who has protocols for managing acute illness but not a doctor.
4) If you are lucky enough to be fit and healthy but need an operation you are likely to get this in a centre run by a company for profit, who will not follow you up and will dump any complications on the local NHS. The centre will use the cheapest materials it can get away with, the cheapest staff and still charge the NHS over the odds for this service.
5) Over the next few years increasing amounts of elective work will be performed by non-medical practitioners 鈥揻rom anaesthetic practitioners to surgical practitioners, physicians assistants etc鈥�

Problem 3 is increasingly happening during the day time too. Whilst our protocol wielding brethren may well be able to cope with many common problems they frequently call on moderately senior doctors to help out. H@N has worked simply because there are now more senior doctors in hospital at night. However a side effect of this is that more junior doctors training is suffering. Point 5 will simply worsen things further. In 5-10 years time who will provide the supervision these non-medics need, who will provide the expertise?

We hear today that in a couple of years time we will have thousands of unemployed consultants, but 14,000 too few nurses. What a surprise 鈥� this is a direct result of government policy and leads to the crazy situation that whilst the headache and epilepsy nurse specialists try to provide 1/3rd of a neurology service between them, consultant neurologists will be unemployed or retraining into their 40鈥檚.

Of course all these reforms have been introduced because they are the 鈥榤ost efficient way of providing health care鈥�. Rubbish 鈥� OOH services were previously provided by GP co-ops which paid their GPs a very good wage but were cost effective and people could see a doctor. 鈥楻eferral management鈥� ends up either requiring re-referral or costly management by non-consultants (see GPwSI paper in BMJ- Hospital at Night is more expensive than previous arrangements. ISTCs have failed to provide cheaper healthcare despite operating on only the easiest patients. And anyone who swallows the line about non-doctors filling medical roles needs only to look at the adverts attached below 鈥� each one offering a salary in excess of most junior doctors.

I鈥檓 angry, I鈥檓 very angry 鈥� I watch as a bunch of new labour punks are happy to arrange for patients to receive substandard care, for more money for the sake of their ideology. I鈥檓 angry that a profession which has, to a large extent, dedicated itself to the provision of excellent care is being systematically undermined. Not content with bringing chaos to a whole region of the world, Tony Blair and chums also want to bring down a profession and a health care system. That is true arrogance, a charge so often levelled at doctors.

I'm in my last few months before qualifying. THere was once a time when lectures about how to apply to posts abroad were attended only by foreign students who had studied in the UK and wanted to return home. Now it seems that when a group of medical students get together ina room one of the key topics of discussion is 'where in the world are you planning on going to'.
Ironically the working hours directive is a big reason to LEAVE, not stay.
In theory it will mean having to increase the number of juniour doctors by 50%, because it will mean there will have to be 3 shifts a day (i.e. 5 x 8 hour shifts week rather than 5 x 10-12 hours). But we know that will; never happen. the idea of the directive is to increase resting periods. But what about the quality and quantity of our work? Its like sprinting 2 miles flat out instead of leisurely jogging 5 miles.
I don't normally complain about police or nanny states, but someone from abroad DIRECTING how much i can work? theres something shady about that.

I'm 38. I took another set of medical exams last month, which, I realised, means I have been taking competitive public examinations more or less every year for 25 years. After a bit of a wander around medical careers, I should shortly be fully trained as a GP.

A couple of weeks ago, the GP jobs sections of the BMJ had two jobs advertised in the entire UK, and they were both locum agencies. No substantive posts offered at all.

It's an interesting position to be in, and I'm well aware there are a lot of people in the same boat. On the other hand, for the first time in a long time, Australia is actively recruiting doctors.

Poor old Tony, the more he tries for a legacy to outdo all other legacies, the more he shows us what a complete pig's ear he's made of everything!

The government is raping the NHS and the medical profession.

They are managing things in a very short term and short sighted manner. The system is crumbling and they are trying to cut costs in the short term by making such dangerous changes that everything good about the NHS will be lost.

Training of good doctors will be lost if HMG has its way with the reform of training and the replacement of well trained consultants by less trained staff grades.

It is symptomatic of a government that works against professions rather than working with them to get things done. This never works in the long term and is doomed to ruin the NHS.

I am a junior doctor in a hospital in the Uk. I love my job and I love the UK, however the way the government is going in dismantling medicine and the NHS I am having to consider emigration or a career outside medicine.

The government is wrecking the NHS and has treated the medical profession with nothing but contempt.

Our training system used to be the envy of the world, with MMC and the governments reforms we can become the laughing stock of the world.

I could have done other less competitive subjects at university and not worked as hard, but I though there would be an enjoyable secure job at the end of the toil. I could have earnt many times my current salary in the city but I love medicine, its not a choice I want to make but the way things are going- you can never say never.

Thanks Tony and Patricia for your wreckless waste of money on bizarre wasteful centralised initiatives that are based on an ideology tadpoles could critique! Thanks for demoralising a generation of juniors who now have nothing but contempt for you and your ilk.

Do you at the 大象传媒 know that junior doctors get paid similiar rates to nurses, and significantly less than nurse practitioners?

This is despite far higher levels of education and much longer training, with far greater job responsibility.

Did you know that junior doctors have to pay for all their training these days, as the study leave budgets are gone.

Did you know that I earn under half what all my friends earn?

The media goes on about the harshly treated nurses but junior doctors are being silently exploited and now there is no light at the end of the tunnel- we used to dream we could become consultants- now we may get a short term contract as a staff grade, thanks but no thanks!

Anne Scott wrote: "So if there is to be a surplus of consultants in less than 3 years, why does it take 3 to 12 months now to see a consultant????"

I know someone, and hear there are many more, still waiting after seven years. And I reported it to the NHS queue monitoring and statistics office three years ago too. They said there are exceptions allowed, but couldn't explain. It is something to do with cascades of waiting lists for waiting lists, when there is restricted funding and the centre don't want to let anyone else get the business. Local administrations are allowed to decide their own priorities, and protect local centres. The only way around which is to move, if you can discover where is better. They can use the same powers to block treatment outside the area or elsewhere in Europe. More consultants, indeed more appointments by the same consultants apparently are limited by that funding. The consultant in that case spends his "spare" time chairing national committees and being an officer of international groups, telling others how to treat the patients he has waiting on his list for years. Don't treat the figures as completely reliable.

I left the uk a year ago.
I saw the upcoming NHS disaster coming about 2 yrs ago when I realised that the plans to modernise uk training was an utter joke.
I left everyone I know behind:
a) to get much better quality training
b) because I couldnt bear to work in such a disjointed, illogical system, designed by people who have not the first clue on how to manage and deliver healthcare.
I had planned to come home to the uk after completing my training, but I doubt I will - the NHS is in a 1000 times worse state than when I left.

The plan is to artificially create a surplus of staff in order to reduce wages. The waiting lists are maintained for this purpose. There is plenty of untapped workload in the system that is not going to be addressed as
extra work = extra staff = extra cash

I am a final year occupational therapy student. Theory and practice seem to be getting further apart in terms of the resources available to us when on placement - and I know qulified OTs who are just as frustrated about the lack of resources, and the frozen posts as recently qualified staff looking for a job. As one of the above posters mentioned, there seems to be a lot more interest in working abroad - meaning that by the time (or if) posts are unfrozen, there may be nobody suitably qualified to fill those posts.

Peaches Geldof earnt 拢250,000 last year, Jonathan Ross 拢6million, MoD budget has risen by 拢5 billion to approx 拢40 billion per year, city workers have huge bonuses, footballers earn 拢100,000 per week, The Blairs allegedly have a 拢3 million mortgage.

Your health is your most important asset. If the public want a decent market based healthcare system then it will have to start paying for it. Remember NHS dentists, opticians any-one ?

What would be do without leaked government reports or the few 'crumbs' prized out by the Freedom of Information Act.

This is evidence that the NHS is simply obeying its true political masters who are out of touch and out of control.

It is no longer a Health Service issue. It is a political matter - and that is where the solution is to the contemptible mess lies.

It is near impossible to be treated by a consultant in the NHS.
When I did manage to see one a few years back, I was told that I could be put on the waiting list for my operation..OR..I could pay and be in the local private hospital at the weekend having my surgery.
I chose to pay (I was in considerable discomfort) and put the charges on my credit card. I am still paying it off now.

Consulants need to prioritise NHS patients. That is simply not happening.The system is crazy.Private patients come first.

A colleague who has an enlarged prostate has been told that the only way he can guarantee knowledge of who will be operating on him is to pay. Otherwise, he will not get a consultant, may end up with a locum and will not know who is operating on his manhood. I wonder if Tony Blair would take that same risk?

As a full time London GP working in the inner city/deprived area I can assure you we've NEVER seen the six figure salary so highly publisized & have taken a fall in earnings since the new contract.
Demand keeps rising-the "targets" keep changing-we don't do any private work which accounts for the alleged high salaries as the NHS/public work is immense-recruitment is still difficult in these areas where the average client is unemployed/non-UK/asylum seeker-refugee or simply low income.Balance your reports-or you'll scare off those still considering the job which takes 10 years to train fully for!

"Shunting some of the brightest UK secondary school pupils into dead-end jobs is going to produce a VERY dissatisfied workforce."

The NHS already does this to thousands of experienced doctors. But because the majority of these are foreigners there is no big outcry. These dead-end jobs now need to be filled by UK graduates and we are told that the system is suddenly in crisis. Yeah right.

I think the only issue that brought about this complain is low salary payment. To obtain the consulants at work, we should offer them a good salaries. otherwise they will full fill their dreams.

The NHS is in a shameful state!

At great public and personal expense I was trained and developed into a highly qualified Intensive Care Nurse, a job I was very good at and enjoyed immensely, but who couldn't get a job because I dared to have a family and had the 'cheek' to ask for a family friendly shift pattern.

So I left the acute sector to be a Practice Nurse in a GP surgery where the requirements, it seemed was to leave any element of free thinking and initiative at home. The government and the surgery wanted me to tick boxes and achieve targets (points mean prices) regardless of the needs of the patient. Something I was not content doing, because in my view the attainment of a fully ticked set of boxes is not caring and indeed not the nursing I embarked on.

I have now left the field of practical nursing and am now a Nurse Lecturer at a University where I have the pleasure of teaching the next generation of nurses who will have no jobs at the end of it. Yet they still employ reams and reams of administrators and be-suited drones, while claiming they have no money.

I work as a nurse practitioner in general practice. the NHS is falling apart around my ears. we have half the services we had 10yr ago.

shutting hospitals and saying that will improve services? how?? my patients cant afford to travel.. and now they are threatening to charge us to drive our cars...!

there are not enough nurses or doctors working at the coal face, there seems to be a preoccupation with collecting data (why are we being paid to ask everyone their ethnic origin?. Managers abound- but they dont actually deliver patient care. waiting times in a&e are artifically reduced with holding wards.. walk in centres see patients without access to general practitioners. private practice seems to be on the increase.

I dont know what the cure is but the problem isnt caused by my salary!! nurses earn very little.. a policeman or teacher earns more than a staff nurse. (and teachers dont have to work weekends or night duty!).

T

I have been an NHS consultant for 18 years. In that time I have seen a service which provided across the board expert care at a hospital of the patient's choice (GPs could refer to any unit in the UK in the 'bad old days') disintegrate in to a protocol driven lowest common denominator service, where doctors are seen as the problem, not as the solution.

This all started in the days of Kenneth Clarke, and has been continued under Labour. However there is little point in playing the political blame game, the problem is what do we do about the mess?

So. To the report. Previous contributors have already mentioned the nonsense of current medical manpower planning. The slow motion train crash called the European Working Time Directive, the new educational system called MMC. I used to have trainess who would stay until a case was finished, who would see a day's work through, who were allowed to stay and see the interesting cases if they came in out of hours. Now it's me that works from 8:30am until 3am the next morning, with three different trainees due to thier shift patterns. How on earth will they learn?

An excess of consultants? A shortage of nurses? Absolutelly correct. There is already a DESPERATE shortage of nurses who are prepared to work on Wards and do real nursing. Ward work, where patients recover, and where a good nurse with constant continuing hands on care does far more for the patient than I do, is the core of patient treatment. But this part of nusring care has been systematically destroyed. Wards are now seen by senior nursing staff as too nasty and difficult to work in. Beneath them.

The new career paathway is the nurse practitioner, doing work previously done by a doctor. Now, don't get me wrong, I work with nurse practitioners and many of them are superb, doing a difficult and valuable job. However senior nurse managers and hospital managers have siezed upon this role as a cheap answer to all their problems. Send a nurse off on a few weeks course, and then put them in charge of a service, or the delivery of an aspect of patient care for which they are simply not qualified. It's not really the NPs fault, more that of a target driven management culture that does not see patinet care as important, but the protection of a completely arbitrary balance sheet.

A few questions. Who are the NPs answerable too? Who examines the quality of their care? Where is their professional accountability? Where does the patient get redress if there is a problem? This aspect worries me. I am very tightly regulated, both by the hospital and in law. I have a diciplinary body which can and will take action if a complaint is made. What does a patient do if an NP makes a mistake? I suspect not a lot, as there will be a cry of 'it's not our fault, we followed the protocol' But the reason you have expereinced senior medical staff, with all our training, is to know when the protocol is wrong.

There may well be an 'excess' of consultants if this route continues to be followed. Patient care will suffer very badly. Innovation in medical care, previously pioneered by doctors and nurses because they saw a need for a new development and just got on with it, will cease. Medical care will be dictated by managers to a polital agenda desigend to preserve someone's 'leagacy', whatever that means.

And the brightest and best of the students I am teaching this afternoon will be encouraged to leave this sinking ship. What a waste.

i don't understand comments like "Consultants should prioritise NHS patients"

Consultants see private patients in non-NHS time. A consultant should be able to do what he likes in his spare time - if he choses to spend it using his skills operating as opposed to being with his family how does that affect NHS patients?

If anything, the waiting list is shorter as some people jump ship and go private. If they stopped doing private, you'd probably wait longer even for NHS work.

The disgraceful state of the NHS is a monument to all those (of whatever political shade) who wrongly believe that the State can run anything properly.

The NHS is a substitute religion and a political bribery tool, to win votes. As either, it is failing to work.

There should be a nation-wide, serious discussion on what we would put in place if the NHS did not exist. Costings should be given, and above all, it should be pointed out that THERE IS NO SUCH THING AS A FREE LUNCH. In one way or another, we all pay for the NHS.

I agree with many of the comments posted by my junior doctor colleagues above. The current generation of doctors-in-training has had to pay all their own university tuition fees (average debt 拢25k and rising), has to pay for medical training as there is no study budget, has had their career modernised into oblivion, their roles usurped by nurse practioners and is now being told there will be no consultant jobs at the end of it all. Really, it can come as no surprise that there is a distinct lack of goodwill towards the NHS and government. I am taking my skills and enthusiasm to New Zealand this summer, because the alternative of staying here is too depressing to contemplate.

I am a dental student, i would like nothing better than to work in the NHS. I believe it is a fundamental right for everyone to have access to an NHS dentist. However the government has just changed the contract. I will get paid the same amount of money for 1 filling as for 28, no one can think that makes sense even if it doesn't take 28 times as long it will take 28 times more expensive filling material. This is the real reason dentists are leaving the NHS, the system is unworkable. But the government wins- no more expensive NHS dentistry, it's all the greedy dentists fault and people buy more pliers for when they get toothache.

The subconsultant grade is a reality - it is clear that the new training programme being implemented this year (MMC) is a dumbing down of doctors' training. In my speciality, neurology, the training period has been cut from 7 years to 5. Take into account the changes expected due to the European Working Time Directive and it is clear that no amount of supposedly improved training efficiency can counteract the loss in training time.

Professionals throughout the NHS who have invested money time and energy in their careers are to find themselves looking for work elsewhere.

The government can dress up the resulting loss of service with spin and shiny brochures but the reality will hit home in complications and death rates - a timebomb with a slow fuse.

The NHS of the future has fewer, less qualified and less experienced people delivering care than we have at present. When the public realises this private insurance will boom and the NHS will die. Old Labour brought us the NHS and New Labour has destroyed it.

All very predictable comments I'm afraid. You'd probably get the same from any large scale organisation - including the 大象传媒. Just provides more fuel to those who want to knock the NHS or the Govt. As a Consultant myself, I do not see the NHS 'falling apart around my ears' as the above, just the groans of a oil tanker being truned round. 85,000 more nurses, 27,400 more doctors, lowest waiting list since records began, 62,000 more operations a year now compared ten years ago. Sounds like reasonable progress to me - and the many thousands like me that form part of the silent majority working happily in the NHS. Cover that - 大象传媒!

This government, if it had half a brain, would realise what an utter dogs dinner they have made of trying to modernise the NHS. I am tired of being squeezed to do more & more with less & less (staff, resources etc) I want to work alongside my talented colleagues of all grades, not create suspicion and derision by being given chunks of their job to do & provide some kind of service on the cheap. The Nursing Hierarchy has covertly gone along with this - we get trained for one job & if we are lucky to get a post, we find out it is not what we ever trained for. Senior experienced nurses who ought to be out on the wards supervising learners & the untrained and getting involved with care giving are instead successfully buried under a pile of paperwork.
I support without reservation the comments and concerns of each and ALL my colleagues who are despondant and despairing of the disintergrating service around them. Partcularly offensive is the amount of wasted money on management consultants & the white elephant intergrated IT system. Equally I am concerned by the hit taken for redundancies everywhere but management, especially senior management. Let them be next please or they will be making the beds and bathing folk whilst I work at tescoes.

This governemtn should be made to explain themselves to the electorate.

As a trainee GP in the NHS I am one of the lucky ones because I am not currently embroiled in the joys of MMC (modernising medical careers), which my friends from medical school describe as a nightmare. Basically the time taken to reach the end of training will reduce dramatically and there are not enough training posts. You also have to jump through more hoops and spend less time actually doing what doctors are supposed to do.

When working in A+E last year, the problems with the current government's management of the NHS were highlighted by the 4 hour waiting time issue. The government introduced as a target that all patients should be seen and through A+E in 4 hours. according to them, this has been a great success, and yes, if you do have a broken finger or earache you get seen a lot quicker than you would have 10 years ago. In a lot of ways it has improved patient care, and it is a nice measureable outcome that the government can quote a lot. However the problem with such targeted financially driven targets is that they solve one visible problem but create a whole raft of others. The trust needs to hit its targets to get money, so it employs a fleet of "bed managers" to fiddle beds and get on the backs of the doctors and nurses who have not reached their diagnosis at 3 hours and 30 minutes. I'm not blaming them - it's their job. Then if the patient doesn't actually need admission but just observing for a few hours (eg someone unconsious from alcohol), you have to get them out of A+E, so have to waste a bed or send them to the A+E observation ward (a sort of twighlight zone dumping ground). And sometimes you just need more time to decide which speciality is appropriate, get all x-rays and blood results to make the clinical decision. Add to all these problems the fact that now the general public have started to realise that they can be seen quite quickly in A+E, so some (not all) will abuse the service with complaints such as "bruise on arm after having blood taken", "fake tan staining hands", "suspicious mole on scalp" (all genuine cases). This just puts more and more pressure on the department. The thing that really ground me down was when I thought about how much of my busy working day was actually wasted time preventing patients from "breaching" the 4 hour wait.

This is the problem with incentivised targets. They are blunt instruments and sometimes because of the pressure you are put under, they can become more important than the patient in front of you. It can be the same in general practice to a lesser extent - hitting the cholesterol target can become more important than the fact that the fact that the patient's quality of life is affected by the medication they are on to achieve this. All of these carrots and sticks do end up eroding professionalism and the art of medicine.

It seems to be a bad time to be a doctor in the NHS. The government likes to shift blame to other people and doctors seem to get a lot of it. The poor workforce planning, attacks on professional autonomy and continual pace of change and uncertainty are demoralising all clinical staff. Even over the 3 years since I graduated and started working in the NHS I have seen a big difference in morale, especially of junior doctors. We don't know what our future will be. All I know is I don't plan to be a GP working in Tesco!

The NHS is is being dismantled piece by piece as it slowly grinds to a halt. Tony and his acolytes have interfered to the nth degree and are trying to turn doctors into the latest bogeyman. Hence publishing conflicting figures/ statistics, blaming doctors for being 'greedy' and too powerful, etc... The government would rather employ more management consultants to tell clinicians how to do their jobs, rather than ask those clinicians how best to improve things.
I have worked as a nurse within the NHS for over 21 years and it is the patients who keep me going. Goodwill is a finite resource and one not recognised by these turncoats and incompetent oafs in the government.

just a note about nurse practitioners..

'real' ones are educated to masters level (and we have usually paid for our education). some even have doctorates!! The NMC regulates us, and is currently looking at forming a register for Advanced nurse practitioners and you will need to be educated to masters level to go on the register. In order to maintain registration we have to undertake a certain number of education each year and prove we have done this. I maintain a portfolio of all education I undertake (much as doctors do) which the NMC can ask to see. I'm currently undertaking a masters in respiratory medicine... I've got 16 yrs training behind me, most of which I have paid for myself. I am accountable to the doctors who employ me, and am just as likely to be sued if i make an error. which is why I am a member of the Medical Defence Union.

I would work in a hospital, at the bedside, if the resourses were there to do the job properly and the pay was adequate. I work in general practice, where I am autonomous and responsible for my own practice.

I've been in the NHS 30yrs now.. and have seen it fall apart.

As a junior doctor I am sick and tired of being portrayed as a money grabbing arrogant waster. I came from a deprived area and a comprehensive school. I work bloody hard in a demanding and stressful job where peoples lives hang on my ability to make the right decision at the end of a 13 hr shift. I do this day in day out for over 48hrs per week and I get paid significantly less than all my mates that went into dentistry/banking/accountancy/law etc.
I try to keep my family life going, despite no access to part time work so I can see my two young children or my (also doctor) husband.
I try to keep paying my mortgage, despite no job security - (thanks to modernising medical careers I am having to reapply for my current post)
And now I hear that I probably won't have a job at the end of it. Great.
When my daughter was seriously ill a year ago it was a team of consultants that saved her life. I hope that some of my colleagues are willing to sacrifice their family lives on the NHS altar to provide the same service in years to come.
Personally, I am thinking of retraining as a teacher. Screw medicine, I am sick of being treated like a piece of rubbish.

An angry mum and junior doctor.

NHS is dead RIP. Joe public have to open their eyes and see what we who have been working in there have knwon for a long time.

It will cost us alll a lot more in the long term and I agree with comments made that with an aging population, increases in the numbers (and expense) of services we can provide the cash had to run out. Now with politicians leading the way and asking for a 66% payrise to reach the reputed cash level of a family practicioner perhaps all of us working in the NHS should also make these demands as well. Whats good for the goose should be good for the gander. Finally I also see an health service of more clock in clock out fashion. If you gonna treat the people that work in it like dirt don't expect them to stay and work for free, break the EWTD etc. At some point everyone will say they extra hours worked have to be paid back. Im

I gained a first class degree in Biomedical Science this year. I chose this degree because it was a requirement in order to train to be a Biomedical Scientist, one of the team in Pathology Laboratories whose hard work helps the diagnosis of around 80% of patients. At the time I started my degree, there was a national shortage of Biomedical Scientists. In addition, it was a career I really wanted.

Having gained my degree, I now find that there have been a grand total of two trainee posts this year in my area.
One of the most widely-used national NHS job websites now gives only a total of around 100 jobs for the entire country on a search for the keyword 'laboratory'.

How are many diagnoses to be made if there are no trained laboratory staff to carry out diagnostic tests?

I started in the NHS as a junior doctor in 1972, having qualifed from Kings College Hospital Medical School. I trained and practised as a GP from 1973 to 1986, when I decided to work in the pharmaceutical industry as a change. In 2003 I returned to General Practice as there was a call for qualified docs to return to the NHS and I was bored with my lucrative but rather sterile job.

I am dismayed by the fatuous enthusiasm for crackpot ideas involving half-baked management theories and starry-eyed idiots who will embrace any crazy stunt for short-term glory at the expense of long-term results. This sort of lunacy did for Andersen's accounting and Enron, and before long PFI and similar potty schemes will do for the NHS.

I weep for the loss of the dedicated enthusiasm and energy which went into the NHS from my generation and our forbears. Their contribution has been treated as worthless, and so our successors, not surprisingly, have decided not to make a similar one. The NHS and the country as a whole is the poorer for that. Meanwhile those responsible for this chaos continue to squander money on unproven ill-conceived projects while the fabric of the service is allowed to wither on the vine. I shall retire soon, and I fear for the care of my contemporaries and me when we come to need it in our declining years.

with reference to post no 76 by sean o'callaghan (if name genuine)

Obviously not a medical consultant as your name does not appear to be registered with the GMC.

Could you be the former IRA informer who now speaks at Tory party meetings & is keen on privatisation ??

Spin, spin, spin...

The political/mangerial attitude to reporting on staffing in the NHS all boils down to 'number crunching'. I am a midwife, within maternity services there is a system by which individual umits work out the number of Midwives they require, and they employ that number. However, the figure fails to take into account long-term sickness, maternity leave etc. so when this episodes occur there is no cover, the unit is then, effectively, under-staffed. A year or so ago agency staff would have been employed to cover short-falls, not any more, too expensive, cheaper to close the unit for short periods of time or remain open and give poor quality care. However, the unit I work in does not hesitate to use locum doctors to cover sickness and unfilled Consultant vacancies, make of that what you will. On paper though we are not poorly staffed, that would be the Governments comment, grass roots would entirely disagree.
If you wish to see how the recent cut-backs have affected services look no further than maternity services. Some areas have entirely lost their antenatal classes, others are cutting back. Antenatal check-ups have been reduced across the board, visits after the birth at home have also been reduced, with many units now operating drop-in clinics at the hospital. The government are now encouraging women to have homebirths, they are cheaper, but have there been any increases in community funding to facilitate the extra equipment, call-outs etc., stupid to ask really.

The way in which we orgainise health care in the UK is to have specialist services restricted to hospitals, and community medical services as general practice. What we need is more of the continental model - community based specialists. This will solve the forecast of too many hospital based consultants, and too few general practitioners. Community specialists must have accredited training, but location out of hospitals, close to where the patients live. At the moment it cannot happen because the funding is frozen in tight budgets.
We are trying to develop cumminity medical services by using nurse specialists, not a good option because of inadequate training. The forecast is of a nurse shortage, so let us not have them trying to do the job of doctors.
Hospital doctors and general practitioners have received substantial pay rises. They must respond by increasing productivity - ie work done - even if this was not part of the formal deal.

The governmentr has treated the NHS shamefully. It repeatedly told us that Agneda for Change was being fully costed when it was obvious to all accept Dr Reid that it wasn't and then left trusts to get out of the financial mess it caused. Similarly another mess is caused by payment by results which is destroying the NHS because it will cause hospitals to close. In the Alice in Wonderland world of the NHS theses days we were discussing at the trust drug & therapeutics committee on a new treatment which would be an injection rather than an infusion so would be quicker and more convenient for patients. However, manangement piped up that we couldn't charge as much for a injection so although the drug was cheaper the hospital would lose money. So, sod patient choice it's the bottom line that counts. In the end someone else pointed out that if you needlessly detain a patient for 10 minutes by doing a non-intervention like measuring their blood pressure they could have their injection and we can still claim the money.

'Hospital doctors and general practitioners have received substantial pay rises. They must respond by increasing productivity - ie work done - even if this was not part of the formal deal'.

Erm, how?

We told the government how hard we worked. They did not believe us. We told them that if they paid us on a time basis they would lose work. They did not believe us.

We are now paid for the actual work we do, whereas before we did an awful lot 'for free'. And they can't afford it.

Idiots. If they had given us a 10% pay rise and said 'well done all, keep up the good work' we would have carried on doing the work as necessary, and we would not be in this mess.

So now we are not going to work for free. Do you blame us? No-one else does, why should we?

After having spending the last 14 years of my life in the NHS I can say quite honestly it really is as bad as all the above post鈥檚 I worked in IT and for the last ten years I have been involved in projects from patient administration systems (hospital's) to ambulance dispatch systems. even I left in disgust the latest project is little more than a cash cow for all the private company鈥檚 that have signed up for 鈥榗onnecting for health鈥�. The reality of this gross waste of our money is a system which at best will churn out endless figures telling the world how great the NHS is and at worst contribute to killing patients.

IT is a useful tool within any clinical environment provided it鈥檚 recognized as a tool. We are losing site of the fact we train doctors to make clinical decisions about patients and in that field these human being daily are confronted with decisions of life and death, they have to live with the consequences for the rest of there life鈥檚. There is no comparison to this, yet we try and jobs match them against lawyer鈥檚 stock brokers and the likes. Because they earn more than most of us.

The care given by a nurse to a patent in need is priceless to that patent and there family yet nursing is being pushed into the realm of clinical decision making without the safety net of adequate training but the carrot of more money and more kudos why?
(OK nursing is poorly paid)

The number of ambulances on our streets is set to decrease and replace by response cars manned by paramedic with a reduced number of ambulances manned by drivers and EMT鈥橲 this with the closures of A&E departments and other specialist units around the country how is this going to contribute to better patient care?

The NHS has been a political football for long enough. It needs to be taken out of the political arena and give the autonomy. PFI, connecting for health and all the other Heath Robinson cash cow schemes currently running need to be stopped and stopped now.

We need to understand the health service we all want will cost and make no mistake with the advent of better drugs, technology and training there will be a fiscal price to pay but I for one will happily pay that cost. Because it鈥檚 worth every penny

The current government is shameful.

My husband is a registrar. We are so fed up with the NHS that we are off to Australia.

In common with an earlier poster, we also hail from humble beginnings and have "made something" of our lives only for this government to try screwing us over.

They are quite simply the worst goverment we have had in living memory, and they hang in there only through a lack of credible alternative.

I am a GP, and I earn nothing near 拢100K. That figure was artificially inflated by including a substantial amount of superannuation.

This government is constantly spinning against the medical profession, those of us whose entire career will be within the NHS, and whose goodwill is being systematically eroded.
They have spent a fortune on management consultants, PFI, ISTCs, choose and book and NPfIT, but want to blame all the NHS funding ills on the people who are holding the service together.

And then, once we have worked out how to keep treating people despite the latest load of government nonsense, they want to re-reform the latest reforms.
Fundingholding abolished to PBC (the new fundholding): ten years spent pissing people off to go full circle. Classy.

When they renegotiated consultant and GP contracts their policy was that we would "be paid for what we did". Sadly, they didn't realise that we did a huge amount for very little: out of hours being a prime example.

It is a complete shambles, and Mrs Hewitt, frankly, doesn't have a clue what to do next.

Just on a footnote to the pervious point I made: wine and grammar don鈥檛 mix and this government is doing a truly monumental hatchet job on the health service

Just on a footnote to the pervious point I made: wine and grammar don鈥檛 mix and this government is doing a truly monumental hatchet job on the health service

It makes me weep when I see the destruction of the NHS before our eyes.It takes a special kind of genius to at the same time massively increase funding and lay the foundations for total meltdown.

Fragmentation of care, dumbing down of care,ill thought out policies, shameful wasting of resources (eg NHS IT system)It is all just absolutely awful.

I am sure that the admindroids and politicians in the government believe the are doing their best, but they need to stop listening to special advisers and listen to patients and staff at the deep end.

Please stop and take a step back and think about the havoc that is and will be brought upon our NHS if these changes continue.

Crippo (90) is so right, when the new contract for consultants came in, imposed rather than negotiated, I had to do a diary exercise to show my hours. I had to do it three times because the powers that be would not believe it.
My old contract was for 11 sessions of 3.5 hours.
The new contract was trumpeted by TB. As a consultant I was described as lazy and I had to be forced to do at least 7 clinical sessions a week.
My diary exercise proved my average sessions were 14.5 at 4 hours 12 of them purely clinical.
The new contract said we must be paid for what we did.
I am no saint and I was no different from the majority of my collegues.
I would have been very pleased to recieve 10% and a pat on the back, instead I get paid for 12 sessions but work 14.5 on average and I am still denigrated by PHewit and her minions as the reason that the NHS is failing.
My hospital has not recieved any more money over the last 5 years and has gained PFI bills. It is now one of the infamous 14 with over 5% deficit (currently 23%). Central directives to fulfill this target then that target with no thought for the contrary effects all described by previous posters.
Now the PCT is telling me to refuse to see patients in my ED because we won't get paid. I refuse since if one dies it won't be my political masters dragged into the coroners court, it will be me.
There have been some benefits from the NHS new money, but not nearly as much as there would have been if there had been some trust of the front line clinical staff. We could have changed the system if allowed. we tried but the targets kept changing, and we kept getting ignored by the cool dudes from centre with the dark suits, clipboards, and madonna like microphones that kept telling us how to do it and then blocking the changes.

i'm prepared to move my family to Australia, New Zealand or South Africa. NHS uncertainty at every level has finally ground me down. With MMC there is no guessing where I would have to live, what speciality I would be in,whether the resources would be there to deliver any sort of standard of care, who I would be working for, or whether I would even have a job at the end of it all. I' ve done the hard bit already (get my kids to school age)so all I have to do is work. It hasn't exactly been easy on these kids either. I worked hours with 2 young kids that are multiples of other peoples working weeks. And don't I feel guilty about it now.

Disgruntled junior doctor who will regret leaving the NHS principle, who always voted Labour in the past but can no longer see a future here.

The DoH is constantly re-configuring the work force. Having spent vast sums of taxpayers money on further education and training for nurse practitioners. The diploma /degree / masters / prescribing etc. The PCT axed the 2 posts.Yes one of those mine. Yet advertising for Physicians Assistants from USA continues. I also wonder if the 大象传媒 will be brave enough to go beyond the sound bite and DO some REAL in- depth analysis with REAL investigative journalism. To the BCC nobles - the British audience are not all muppets.
As for this govt. NHS management inept, incompetent, shambolic a disgrace to Labour party.

This is a personal comment on how modernising medical careers will affect me and my future husband.
My fiance is applying for specialist training next year and I am shocked by the way the NHS are treating their doctors. With the new MMC system they are basically treated like cattle, everyone shuffled into a pocket to fill up the placements properly. Logistically this is of course an excellent idea, but it seems like the NHs are forgetting that doctors are human too. The plan me and my fiance had was that he would apply for training wherever I got a place in medical school. But now, if I end up in Cardiff for example, the only specification he can make is Wales. He might end up working in Bangor if we are unlucky, and with my place in medical school I would be unable to move. Getting married and starting a family will be impossible for us unless one of us completely give up our careers.This is making us both despair. The only option as we see it is that he moves to Sweden, where I am from, where this system does not exist (and is working fine anyway). In that case your country would loose an excellent doctor (his consultant has referred to him as the best houseofficer he has ever had) I know many doctors that are feeling the same panic about how the system has changed. Several of them are actually thinking of leaving medicine altogether, since the system does not give them a worthy life. This is not the way to treat people. The NHS should just let medicine be like any other job and not work that enslaves you. My fiance did not become a doctor because of the money, but because he really wanted to help people. I wish the NHS would let him do this without sacrificing his own life. Many doctors have families and this system does not account for that. I am looking at the future with despair.

I would be more impressed with the thoughts of teh Green MEP on energy saving if she could persuade the Brussels community to switch off their office lights a 1130 European Time

IS THIS A WAY NHS WANTS TO RECOVER FROM DEBT?
A OVERSEAS surgeon in UK was suddenly charged criminally for a petty issue travel expenses claim.

NHS (National Health system , uk) found a way of spoiling this bright doctor's career and his life by charging him criminally so he cannot apply to any jobs worlwide or immigrate.This doctor has a clean record with no criminal charges todate??????

NHS should be shameful to the level its stooping.
1. The doctor is entitled for his travel expenses.
2. If NHS has a maximum they can pay , they should pay that much and not pay rest.
3. If there is a dispute then NHS should settle with the doctor and accounts case basis.
4. The abve doctor was so shocked with NHS he offered to give the petty amount back to NHS. NHS did not agree . WHY? Because its a case of racial discrimination in UK.

The surgeons who come from abroad pass additional tests and are best of the best. They work hard in the commuity they live in, travelling , on call, sleepless nights and serving their patients and caring for them. They invest the years of youth investing in the country they live in.

NHS has to explain why it i singalin out overseas doctors for criminal charges. They come from good families. It does not mean that is they are (Unfortunate to choose UK) in UK for jobs or skills, NHS can racially profile them and prosecute them.

These doctors in order to avoid fighting expensive cases plead guilty. It does not mean they are guilty. Its that they dont have the attitude to fight back an expensive battle against NHS.

This is not the only case. Recently an doctor went through same ordeal and he just pleaded guilty and left uk. He was too shaken up to even put up a fight.

Its worth investigating the conduct of National Health System agianst foriegn doctors. Its gross racial discrimination against these foreign doctors. The kind of mental and emotional trauma it causes to these dctors is beyond explainatin.

I would not advise people to go UK anymore. They should choose other countries. Doctors should go where they are welcome and respected.

I have been trained as a surgeon in the UK at a cost to the taxpayer of approx 拢250,000. I have spent the last 7 years post-qualification working hard to achieve certain standards that have always been required of us in order to progress. In addition I obtained extra training in Africa (voluntarily), became published in the scientific literature (I have 18 articles to my name), and improved our knowledge of medicine by undertaking surgical research.

Thanks to the government's new Modernising Medical Careers project, when I come to apply for a job next week, none of the things I have been doing (and have been advised to do) will count.

Instead, all doctors are now faced with filling in a generic form consisting of 10 woolly questions designed to test your 'insight' and 'probity'.

The goalposts have changed. Your doctor will now no longer be judged by how dedicated or hard working they are, but on how well they can spout rubbish on a form.

Out of my particular cohort of trainees, three quarters are facing unemployment in August. Many are leaving the UK, not to make their millions, but simply to be able to pay their rent or mortgage doing the job they are trained to do.

And God help you if you are a foreign non-EU doctor who may be well- established in the UK and given many years' of service to the community - sadly, the likelihood of them getting a post is now slim. This is appalling.

Many of my colleagues are leaving the NHS. They are either retraining or moving abroad. Sadly, I've had enough of medicine, and I shall leave for pastures new just as soon as I can. I hope people will realise that this is a waste of people's time and energies, a waste of taxpayer's money, and (most importantly) a waste of people's lives.

The NHS is only employer for doctors who wish to train in Britain. There is no competition therefore the Goverment can take liberties with our careers and lives. Our duty to our patients does not allow us to strike.

I am a junior doctor. I work one in three weekends, do stints 7 of 13-hour night shifts (with no day off prior to them) and do end up working 12 days in a row quite frequently.
I have never had a bleep free meal and have only left work on time once in my two years as a doctor.

The Modernising Medical Careers fiasco, means that I only have one shot at applying to a speciality of my choice. We are only allowed to pick one geographical location.

Name one other profession where this happens.

For the first time in as long as I can remember I don't want to be a doctor anymore.

Are GPs reluctant to refer patients on a Consultant?

The NHS is something our country should be proud of, yet for 20 years governments have tried to submit it to market experimentation.
Over the last year we've seen the MTAS attempt at 'marketising' medical applications, by assessing the applicant's mastery of nonsense management-ese, bring a level of uncertainty to medicine in this country that has never been seen before.
At the same time, the health service is heamorrhaging money to PFI companies and on ludicrously priced drugs, and to make up for it doctors can't find work and nurses are fired, seemingly on a whim.
Health workers - including doctors, nurses, midwives, physios etc - are not 'cheap labour' to be dispensed with to balance books and meet overheads. They are vital to the health of the nation. Health services must be protected, and that means protecting those who are employed by the NHS over the interests of the PFI, management or pharmaceutical companies who are the only parties involved in the NHS who are right now doing rather well....

Lets remind all those amnesiacs that the dreadful unbalanced shambles that is the NHS was sent on its road to ruin by the last Tory government!!!!--what Blair and co have done is make the situation worse in all areas--crushing staff morale & shoving more self justifying "managers" into the farce-(the "clients" or "customers" or whatever we are now are almost irrelevant)-cameron's claiming to be master of the solution is laughable--

Lets remind all those amnesiacs above that the dreadful unbalanced shambles that is the NHS was sent on its road to ruin by the last Tory government!!!!--what Blair and co have done is make the situation worse in all areas--crushing staff morale & shoving more self justifying "managers" into the farce-(the "clients" or "customers" or whatever we are now are almost irrelevant)-cameron's claiming to be master of the solution is laughable--

# .
# At 03:14 PM on 04 Jan 2007,
# Alex Marshall wrote:something heretical about returning workers to the NHS [ he mentioned matrons , but it could well apply to others ].I havent worked in the NHS for some years , but in australia , which also has a free health service , they are going down the same path of overmanagement . My experience of the NHS was that it was supported by visitors getting training in the UK , whereas many british doctors were heading off to foreign climes, especially australia , new zealand , canada , & the middle east ; so dissatisfaction with the NHS is nothing new.

# .
# At 03:14 PM on 04 Jan 2007,
# Alex Marshall wrote:something heretical about returning workers to the NHS [ he mentioned matrons , but it could well apply to others ].I havent worked in the NHS for some years , but in australia , which also has a free health service , they are going down the same path of overmanagement . My experience of the NHS was that it was supported by visitors getting training in the UK , whereas many british doctors were heading off to foreign climes, especially australia , new zealand , canada , & the middle east ; so dissatisfaction with the NHS is nothing new.

I am dentist. The government seems determined to remove professionalism from dentistry. Professionalism in my opinion is the putting of the patient's interests before one's own; the 'old' definition.
Most dentistry is provided in surgerys owned by dentists. They are small businesses. The current system is driving down what is paid for each item of treatment. Much has been said about high salaries. I left practice because I could no longer make a profit on the NHS and sleep well at night. NHS dentistry is broken. The fees are well below the cost of decent care. To make a living in NHS practice it is now necessary to provide simple, destructive treatments quickly. High quality cutting-edge treatments are not financially viable. This is wrong. Those trying to provide NHS dentistry should have a good hard look at what they do and see if they think it is professional in the old sense. It's time for those in the NHS to say 'no' and do our patients a favour. If not, admit that you're a businessman. Stack it high and sell it cheap but don't pretend to be professionals.

I am a first year medic on the 4 year fast track course. I am also a qualified veterinry surgeon.
During my application to medical school I spent hours looking into MMC. For me, it sounded perfect as I was particularly disillusioned with veterinary.
Unfortunately the current shambles as left me little option but to withdraw from the course. How can I commit to 3 more years of hard study with the possibility of poor job prospects at the end?

I feel very sorry for the junior doctors who feel they have an uncertain future.

Personally I would be looking abroad.

The NHS should come out plain and tell the public that ;they nolonger need foreign doctors.This is because paying for the plab exam and reading to pass it alone is not a very easy thing.Then after one has passed, you will find out that there is no job placement.It is better to scrap the plab thing and tell the world that the NHS does not need foreign doctors anymore.it is very simple.There is no point allowing foreigners to sit for the exams when the NHS knows that there will be no job for them.It is quite inhumane.on the otherhand the NHS can say that ,from now hencefort,foreigners will nolonger have job placements even after they have passed plab.it is now optional for the individual to choose.This will craete an awareness that coming to the uk is just for studies and not to earn a living,if you are a foreign doctor.All what the NHS is doing is to conserve job upportunities for uk graduates.well , it is a welcome idea but they can as well be alittle bit flexible