The NHS a lesson in politics, XIV

The NHS, a lesson in politics: part XIV

Bloody hell kids, did Johann and Hunt personally open up a massive geyser of shit in your living room?

fucking hell, did any of you actually bother to read both the ACAS doc and the original Ts&Cs? Or am I the only one?

Here is a TL;DR:

  • Night shifts are time + 47% (possibly 55% if on call)
  • weekend nights are time + 54% (possibly 62% if on call)
  • ST4s get a 10K basic pay rise (more on that later)
  • Less than full time types get everything pro rata (its the fucking law)
  • Overtime is between time + 50% and time + 125%
  • All call outs in NROC are charged at the prevailing rate (including overtime cases)
  • if everything is cost neutral, and its cheaper to roster on the weekends, where is that extra money going kids? thats right, overtime, nights and NROC, to make up for the removal of the banding

(The percentage uplift for everything above includes the 11% bump in basic pay, except overtime. Skip to the “Rough calculation on pay” to see how I got to these figures)

Those that do the most antisocial work will get paid the most, end of. Those that work the most overtime will get paid the most, end of.

Five words: Pay for all work done.

This means that finally, there is an incentive to hire more doctors. The catch? It requires you to show some leadership, and annoy your trusts so they link your ID card system to your hours monitor.

Why is this an incentive? Well, for every hour of overtime, it cost the trust between 200 & 400% of your hourly rate. You personally will receive between 150% and 225% of your hourly rate. see march Ts&Cs, schedule 5, table 1

This means for the first time its cheaper to hire locums than to death march buster into the knackers yard (go on, read animal farm, its really short)

However this requires 100% hours monitoring. I believe the new settlement specifies proper use of technology (section A paragraph 3) This also includes rostering (more on that gem later)

This is stunning good news.

Why? because the most pernicious thing about being a doctor is the unpaid overtime. Not because its unpaid, but because its actively exploited to avoid training more doctors. The Wife comes home shattered because she’s worked an extra two hours, not because she gets paid less.

What the fuck it TOIL?

TOIL is Time off in Lieu. That means that for every hour of overtime, you get an extra hour back in rest. This means no extra pay, but equally it means no unpaid overtime. Why is this good? Well, (you’ll be demanding a proper swipecard system), every hour spend working late will yield one hour’s time off.

Of course it won’t because that’ll cause a travelling wave of rota gaps.

So why is this good? Because you have the right to choose toil or pay. Most of you work 48 hours on average already, every extra overtime hour attracts penalty rates. This means that its much cheaper to hire locums than to have rota gaps. Market pressure will either bankrupt everything or create incentives to train and roster more doctors. Of course, a creeking NHS by 2020 would be a disaster for the Tories, and they are falling apart at the seams already…

Rough calculation on pay:

Lots of you are saying that you’ll be forced to work a full rota with Out of Hours for only basic + 7%. That is wrong.

To make thing easier, I shall be using the current basic pay as your base. (also I got a D in GCSE maths, so verify the adding up yourself)

  • Weekend night shift will be: 37% (night shift uplift) + 11% (basic wage bump) + 6-7.5% (working 1 in 5 to 1 in 2 allowance) Total: base + 54 – 55.5% (and possibly another 8% for oncall) so maybe 63.5% tops
  • Normal Night shift: 37% (night shift uplift) + 11% (basic wage bump), so Base + 47%
  • Non resident on call: 8% (were fucking your home live rate), 11% (basic pay bump) plus pay for any work done (pay for all work done kids. Night shifts, weekends and over 48hours all attract an uplift) so anywhere between base + 19%, to base + 125% (assuming hours breech on a weekend, at night)

Also, those of you at ST4 or above will have your basic pay bumped to 48K immediately. (yes, you’ll only get cost of living rises each year, but you’ll earn more money in the long run.)

To put that in perspective, an ST4 will now receive an extra £10k a year, before “banding” weighting and overtime.

What to do now?

Lets be frank, you are not going to get a better offer. Assuming you actually bother to use the automated time sheet system (which as I read it is a part of the conditions) and make sure your rota coordinator engages with the CASS e-rostering system not only will you get adequate sleep, pay and rest. But you’ll be able to choose your holidays!

Contrary to popular belief rostering doctors is more than just making a pretty excel spread sheet. Its an n-dimensional game of tetris, something Proff Glass (and her team) is very good at. Software exists to make your rota bearable, I’ve seen it. With some collaboration (hinted at in the ACAS settlement) it should be with us by next year

What not to do now.

Well unless something fishy turns up in the full details, if you vote no, I’m going to go round and personally shit on your face. Why? because what else are you gonna do? If you play the system correctly, you’ll be able to make it so unbearably expensive, trusts will be forced to hire and train more staff.