It's not that usual for me to revisit a blog, and it's not so usual to revisit it so soon after writing it, but sometimes I receive comments on the blog that are really worth discussing or talking about, and I relish those. I enjoy that, and I enjoy the conversation and the discourse.
So, one of our relatively regular contributors, Sukhbinder, commented on the 'Not a lot of confidence' blog—you can read this here.
He was suggesting that I had the wrong end of the stick a little bit by not appreciating junior doctors, the work they do, and the fact that they save people's lives on a daily basis.
Sukhbinder's comment was extremely valid because no one in this discussion about the NHS is suggesting that the junior doctors don't do a good job. However, I thought that the answer to this in my thoughts about the future of the NHS might be better not as a comment but as a revised blog so that everyone could see the discussion and the discourse.
I completely appreciate that junior doctors do a wonderful job in difficult conditions, but I don't believe that 22.3% pay rises are the way to fix public sector wage issues.
I have context for this in my own life because my wife is a paediatric oncology outreach nurse, a specialist cancer nurse for Children, a Macmillan nurse, and someone who deals with palliative care and, lethal chemotherapy and other medications on a day-to-day basis.
She corrects junior doctors' mistakes multiple times per week, which would otherwise be likely to kill or seriously harm patients. Therefore, her job is at least as valid as that of a junior doctor.
She is qualified to a master's level in some aspects of her work, and therefore, her qualifications and 30 years of experience stand the test of time.
She will not receive a 22.3% pay rise, and her wages have been under fuelled for as long as those of junior doctors.
My daughter is a physiotherapy trainee moving into her final year of physiotherapy training.
There is no chance that the physiotherapists in the NHS will obtain anything like the pay rise that the junior doctors do, nor will the occupational therapists, radiologists, pathology technicians, or porters. This is where the problem of 'throwing money at a junior doctor wage problem' comes in.
In any organisation (and I love to reflect these situations back onto any organisation), it's tough not to look at things with blinkers on.
If you work in healthcare in the NHS, you will see what junior doctors do, and you will feel that they are undervalued. You can see that spending public money on junior doctors seems like a good idea, but there is a better way to spend that money on the doctors than to give them a pay rise.
If we give the doctors a 20% pay rise, it must therefore be possible instead to have 20% more doctors.
If we use the money to provide 20% more doctors, in theory, the existing doctors would have to do 20% less work for the same money, which, in effect, is a pay rise if their lives are better.
Wouldn't that be a better negotiation or a better discussion?
But of course, we're in an even worse position now, aren't we? What we need is better working conditions in the NHS for every single person who works there, including all of the people listed above and hundreds of thousands of others. This is why culture is way more important than wage rises.
In the article listed here, a BBC correspondent beautifully explains why simply giving major pay rises to very small sections of public sector workers doesn't work.
The GPs now want a bumper pay rise, and the nurses have decided that the pay rise that were already offered is now not enough because the doctors are getting more.
In some leaked WhatsApps from the junior doctor leaders, they've already identified another window of opportunity next year in the pay negotiations. They can threaten to strike again to get even more of a pay rise than the one they've already got (they're looking for 35%).
I have two family members who are junior doctors, one in reproductive medicine and one in anaesthetics. Both are utterly brilliant and work extremely hard. They have worked extremely hard to get where they are, amassing multiple qualifications and levels of experience and putting in loads of hours.
They are not poor, though. They own a flat in London and rent two other houses.
I appreciate that they could be paid more and that their work is probably more important than that of a banker, but they chose the work that they did not for the money that it paid but because they wanted to make a contribution to society. Both of those people were clever enough to go into any sphere of work they wanted, and they chose medicine.
The reason this discussion is important, at least in my world is because this is totally applicable and transferable to running a dental practice.
If one member of the team seems to be so wonderful that they could not be lost to the business and they asked for a huge pay rise, it might be tempting to give that, but the only thing that will happen when that person tells everyone else of their pay rise is that everyone else will come for a pay rise and you will enter into a round of work where everybody wants more and more money which detracts from your ability to look after the patients.
In the article above it's clear that some of this money for the junior doctor pay rises will come out of front-line services; it will not come from the treasury, certainly not its entirety with a 22 billion budget.
This means that we have decided (or our governance has decided) that it's better to pay the doctors more money than it is to put that into culture and environment and structure.
This will not work because the doctor's pay rise will last in their minds 20 seconds before they return to this sh*t awful environment that they have to work in with the terrible IT systems and the massive overworking and the disenfranchised teams, and they will leave for less money somewhere else in a better working environment.
Sukhbinder, I hope that answers the comment.
In no way do I think that junior doctors are not worth their money, in no way do I think that they're not worth a pay rise but everyone who works in the NHS is worth a pay rise and we are broke.
Blog Post Number - 3892
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