> As for your last question, all it
> takes is for
> Emergency Physicians collectively, in areas, to say that they
> will work
> exactly to the terms of the new contract. After all, at
> least part of the
> reason for why we're treated so badly by our employers
> presently is because
> some consultants agreed to take on ridiculous amounts of work for no
> remuneration - and many paid for it with their health - but
> it still put all
> of us under pressure to work in the same manner. Of course
> the new contract
> won't work any better that the old one if we all continue to
> be martyrs and
> let management trample all over us.
We can already insist on working to the Working Time Directive (indeed are
required to). Working to the new contract could mean things could be made
very difficult for us- managers can say exactly what work we do and where
and when we do it. Currently we have one tremendous protection against being
included in the numbers (there is no guarantee we will actually turn up for
our fixed sessions- we could be in meetings, teaching etc. This is one of
the reasons the DH was so keen to get rid of the current contract). With the
new framework, these 28 hours a week of direct clinical time can and almost
certainly will be used to reduce SHO hours- so if you're currently resident
on call, don't expect to have any juniors on with you.
> you may not get
> the salary increase you're expecting for five years
> anyway - I understand there is an annual quota for
> putting consultants on the new contract, if it were
> agreed.
Where did you hear this, Steve? A way round it might be to threaten to
resign unless put on the new contract- or indeed resign and then take up
your old post again which would have to be on the new contract. I don't
think it would be too much of a problem.
> It seems to me that a lot of the vocal
> opposition to the new contract is based on fear of
> the government, fear of management and a stunning
> lack of confidence in our own ability to stand up to
> At least the new contract will allow us to
> time-limit our workload. Far too many of us are
> currently working far, far too many hours because we
> feel it is something we must do for the good of our
> departments, hospitals, nurses and patients. Its
> time we had the guts to stand up and say to
> management, "No, I'm not going to do that any more".
> I think this new contract would give us the
> opportunity and the right to do just that.
>
The European working time directive already limits our hours.
> It seems to me that a lot of the vocal
> opposition to the new contract is based on fear of
> the government, fear of management and a stunning
> lack of confidence in our own ability to stand up to them
> I currently work more hours than I should under
> the European Working Time Directive
Which would suggest that in your case at least that fear is justified. If
you can't make your managers comply with health and safety legislation
(where non compliance is a criminal offence), what are your chances of
persuading them to comply with a contract full of loopholes and with no
sanctions for non compliance? And as to getting paid more I would note that
the framework specifically states that there is no scope for payment for
working beyond your sessions (and that initially at least, on call work will
be completely unpaid beyond the first 4 hours- unlike at present where if
you have a reasonably active LNC you can negotiate time off at premium
rates).
Good negotiators will not do too badly out of the new contract (not as well
as good negotiators do at present, but maybe not too badly). For poor
negotiators it will be disastrous.
> What will happen to
> us in A&E when
> the GPs give up care post 5 pm ? It is becoming a 24 hour
> society,
Currently, the PCT has to provide this cover. I can't speak for other PCTs,
but locally they are looking at paying a GP to provide out of hours care
(and paying good money for it). This would take primary care out of A and E
and improve the A and E aspects of training our trainees. Using A and E
consultants was considered (and rejected- unanimous feeling of A and E
consultants was that coming in for critically ill patients or when advice is
needed was fine; spending evenings and weekends dealing with primary care
was not). The new framework would make it considerably cheaper to employ an
A and E consultant to do out of hours primary care than to employ a GP. Make
no mistake about it, the new framework (if accepted) will result in A and E
consultants being employed to do the scut and out of hour for other
specialities (including GP).
> In the larger DGHs, with enough radiologists, medics etc, a
> one in 5 or so
> until 10 pm is not going to be too catastrophic on their
> lifestyle. Might
> even make ours a little easier.
Wouldn't make mine any easier. Tried having medical consultants taking
admission calls. Tends to result in our SHOs being bullied into doing the
full work up on patients before they are admitted and our nurses having to
look after accepted patients until the medical consultant decides they need
admission.
> Hammer out the details, sure. However if / when the deal is
> rejected, I
> can already hear all the other specialties heaving a sigh of
> relief that
> their 9 - 5 lifestyle has been proved sacrosanct, leaving
> us to deal with
> an increased workload with present inadequate level of out -of- hours
> support.
The out of hours for other specialities would be routine clinics and lists,
not emergency work (a trust is unlikely to accept a subacute specialist
dropping a clinic to improve emergency care when they already employ an A
and E consultant to do that).
Matt Dunn
Warwick
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