Why is there unemployment in the NHS considering what we hear?

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WGSMA@reddit

Because the Gov is committed to replacing Doctors and Nurses, who have globally in demand qualifications and can leverage that for more pay, with the “alphabeti-spaghetti” replacements like PA’s.

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When you say "in the past", how far back are you going? I qualified almost 15 years ago as a nurse. Some of my colleagues did not get jobs straight after qualifying. They ended up on the bank until they managed to get substantive posts.

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secretlondon@reddit

They won’t let us do bank until we’ve passed preceptorship. You can’t do preceptorship without a job. It means we have people doing HCA jobs with a PIN

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insertitherenow@reddit

The trust I work for has recruitment freeze on at the moment. All posts have to be deemed essential by a panel to filled. My team have lost several posts after people have left and the jobs just disappear if they aren’t considered essential.

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Any-Ticket8795@reddit

Also are there a lot more graduates

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insertitherenow@reddit

No. Numbers are down in some fields as they scrapped the bursary payments in 2017.

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secretlondon@reddit

We get the learning support fund which is a grant, on top of normal student funding

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waxfutures@reddit

Same. Currently only applies to admin (which is why my team has been stretched to breaking point for the past year and a half) but I wouldn't bet on it staying that way.

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Desperate-Drawer-572@reddit (OP)

Is this hcps or non hcps?

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Available_Hornet_715@reddit

Consultants as well.

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insertitherenow@reddit

Consultants not so much.

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insertitherenow@reddit

All posts. Clinical and non clinical.

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limedifficult@reddit

Same in mine. We usually took on all the student midwives who trained with us. We took on two on part time hours in the last batch of hiring. It’s absolutely hideous.

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insertitherenow@reddit

Yep. Student nurses on last placements often got jobs on the wards they finished on. Not anymore.

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secretlondon@reddit

My trust is not recruiting newly qualified nurses this year

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Hotheadz@reddit

Increased competition from overseas. You can get very skilled and experienced doctors with 10+ years or already consultants from another country doing the job of junior resident doctors and outperforming them at interviews. Egypt and India are the two most common at the moment.

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Ilikewhatyousay@reddit

This is nonsense. The issue is that trusts are freezing recruitment and not filling vacancies.

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ljh013@reddit

It isn’t nonsense. The BMA highlighted the exact problem themselves and that’s why the government has passed a law prioritising UK trained doctors.

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Hotheadz@reddit

I don’t think you understand how the resident doctor recruitment cycle works

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MrReadilyUnready@reddit

Not all NHS staff are doctors.

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jacobsnemesis@reddit

Are doctors in Egypt and India educated to the same standard?

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MrReadilyUnready@reddit

Yes and no. Doctors from India, Pakistan etc. are typically incredibly smart. It's hard as fuck to get into medical school in most developing countries, and they tend to score really well on our exams. However the concept of patient-centred care and bedside manner is incredibly poorly taught in developing nations, so you end up with smart doctors who patients don't like. You need a balance of both to be a good doctor - we really push bedside-manner in British medical schools and so we end up with more well-rounded doctors.

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jacobsnemesis@reddit

Thanks

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MrReadilyUnready@reddit

It's why the competition ratios for GP and psychiatry have been going fucking crazy over the past few years. There is no interview for those specialties, only an exam, therefore foreign doctors were getting those jobs over local doctors. Psych went from 1.5:1 in 2019 to 22:1 last year. Best bit? They don't actually want to be psychiatrists, they just use it to get a foot in the door and then try swapping to what they actually want.

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Hotheadz@reddit

I don’t know, but the doctors who come here from Egypt and India are educated to an excellent standard due to their experience. For example, a resident doctor may have been a doctor longer than their consultant.

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Nice_Back_9977@reddit

Yes. They generally perform very well when they work here.

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DingleDangleTA@reddit

1 issue is the NHS have brought in a lot of the workforce, around 20% which is the same as the national rate, I believe a lot came in during 2022 which may or may have not been Covid related. It's also increased by 25,000 in the last year if the figures are correct

Funding is obviously another issue.

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Ok-Plantain2948@reddit

The wages are shite.

I can earn close to 40k working from my boxroom 8-4, with all bank holidays and Christmas off and a cracking pension.

Why would I work for the NHS for less, for worse shifts, with a daily commute, no cost of living payrises, no respect for what I do from the general public?

Its a thankless job these days.

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LawabidingKhajiit@reddit

no respect for what I do from the general public?

But...we all clapped during COVID! Surely that's enough? You wouldn't want something as petty as money to get in the way of you looking after sick people?

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LittleSadRufus@reddit

It's not just that. My friend's wife has qualified as a GP but can't find anywhere that will take her. They want her, and the NHS needs her, and she wants the job, they just don't have the budget to pay for her

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kelleehh@reddit

Can she not locum?

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stealthw0lf@reddit

Since the rise of non-doctors (paid for by ICBs and not practices), there’s very much less demand for locum GPs compared to pre-COVID. Additionally since the costs of running a practice have gone up but funding has gone up very little, there’s not much budget for spending on locum doctors.

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Isgortio@reddit

That's the ridiculous thing, there's money for locums (that cost more) but not for permanent staff.

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MrReadilyUnready@reddit

I'm sure she can, but locumming isn't a great way to live. If it's not a contract then there's no guaranteed income, no sick pay, no paid holidays etc. It's not the way you'd want to live, and certainly not the way it should be in a country where there is critical shortage of GP appointments.

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Desperate-Drawer-572@reddit (OP)

So shes out of work?

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xycm2012@reddit

You need places to put them. All well and good employing 100 nurses and 100 doctors, but you can’t pull hospitals and wards out of thin air.

Also, NHS money is tight. My department regularly goes through recruitment freezes, where staff will retire and their posts won’t get filled for a financial year. Given the complexity of our caseloads now the budget for said jobs will then often be combined to make a higher banded job. So we’ll lose 2x band 5 clinicians, not recruit for a year, then recruit 1x band 6 clinician. So one job disappears. More often than not that successful candidate is internal too, and their post isn’t filled for a year, so we’re then back to two jobs disappearing.

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BroodLord1962@reddit

Funding, so it is only going to get worse if doctors get the pay rise they want

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MrReadilyUnready@reddit

Every year the government spends more on covering strikes than it would cost to just give us full pay restoration.

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Desperate-Drawer-572@reddit (OP)

But does nhs not get record funding each yr?

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MrReadilyUnready@reddit

What do you define as "record" funding? NHS funding kinda just tracks inflation. The increases in funding are not in line with the rapidly increasing burden on the NHS. We have a growing population and an increasing percentage of old people, therefore there needs to be a sharp rise in real terms funding to make up for it.

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Ok_Young1709@reddit

They don't spend it very well though.

I'm with others, why would anyone want that job? It's awful hours, too many patients, not enough staff, stressful, full of bullying etc. oh please sign me up. 😂

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CrowApprehensive204@reddit

Not clinical but admin, they want ridiculous qualifications for a band 2 job, must be educated to degree level,,,for a temporary six month contract. Then when they leave because they've got a better position elsewhere, they have to have an exit interview where they have to justify themselves. Also, the training is atrocious, do a bit online at home then come in and sit bored to tears because you haven't got a smart card or access to any systems you need.

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ughhhghghh@reddit

You don't have to attend an exit interview, nor do you have to "justify yourself".

I've been in the NHS for 20 years. Worked my way up from band 1 to band 7.

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CrowApprehensive204@reddit

Good for you. I've been there longer. Been up the bands and back down. And no, you don't "have to" attend an exit interview but you are expected to in your last week.

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ughhhghghh@reddit

I've never been asked to attend one. I've move role 5 times in the last 7 years and never been "expected to". Not that there's anything wrong with an exit interview. It was more your comment about justifying yourself.

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lavayuki@reddit

For GPs there’s no finding to hire new GPs and also lack of space.

Practices have a budget and aren’t getting the funding from the NHS to hire new GPs. Also some practices are small and don’t have rooms to put more doctors in, any form of extension or getting a bigger premises again costs money.

So it’s all basically lack of funding from the NHS. No money means no doctors

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freckledotter@reddit

My sister works in oncology as a nurse and they offered them all redundancy as part of making cuts to the budget. Y'know, totally unessential members of staff.

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Skylon77@reddit

They are needed bit the monwy isn't thete to employ them.

Rhe NHS qastes .assive amounts of money. In my Trust we have a Director of Art, a director of sustainabiloyy and, belirve it or not, a Director of Winter.

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roslid@reddit

Money, there's insufficient funding and hospitals are saving on staff. Our ratio used to be 6 patients to 1 nurse and 1 health care support worker. Now it's anything between 8 to 14 patients to 1 nurse and 1 hcsw. I left last month, it's impossible to maintain decent quality of care.

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Nice_Back_9977@reddit

I left the wards in 2016 for that reason, was supposed to be 1:8, decided I was done after a shift caring for 22 people.

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Thpfkt@reddit

Even 1:8 is unsafe. I had 1:8 as standard on the ward but when I moved to A&E sometimes I'd be 1:12 (ambulatory a&e) and even 1:50 (minors). I can't remember the exact numbers in the study but during my training I think it was any amount over 1:4 increases the patients mortality risk by a certain % for each extra patient even with ward work. We need mandatory legally protected ratios - but the RCN won't do shit about it.

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Nice_Back_9977@reddit

1:4 is perfect for ward level patients, its enough to give them all the attention and care they need and deserve without losing your mind or finishing your shift two hours late.

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Thpfkt@reddit

Agreed, 1:4 would feel manageable. Especially when we get plenty of higher acuity patients on the ward now with the lack of HDU/ITU beds on the regular. Plus the lack of specialised beds for MH, dementia etc where extra supervision and intervention is sorely needed.

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Serious-Top9613@reddit

I’ve never worked in the NHS, but saw a TikTok video of all things that really put things in perspective. A graduate had their job offer rescinded in the NHS because of funding issues, the same day they’d began a lease on a property in a city they’d just moved to.

They knew nobody there, were tied into a legal binding document, and had no job.

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ResplendentBear@reddit

There's a big fight going on with the government and junior doctors (or whatever they're called these days). Part of that includes new posts.

I would try and explain it more but the *interesting* view of moderation on this sub means it would probably be classed as political and deleted, so what's the point.

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MrReadilyUnready@reddit

Resident doctors. "Junior" doctors makes people think we're medical students, not actual doctors.

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ResplendentBear@reddit

But that is what you used to be called. And I acknowledged I was using the out of date term.

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MrReadilyUnready@reddit

I'm aware. I'm just informing you of the correct term as you appear to not know it. We chose to change it for a reason.

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Careless_Soup_109@reddit

To what extent did the BMA get played by the government re the name change from Junior Doctors?

Being a 'resident doctor' doesn't get you the public sympathy during strikes, I'd imagine?

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MrReadilyUnready@reddit

I don't really understand your point. It was something the BMA members wanted. "Junior doctor" is term that was weaponised to make us seem like we were unskilled and therefore undeserving of what we're asking for.

Somebody who has been in training for 9 years is still considered a resident doctor in loads of specialties.

Also most of us are no longer bothered by public opinions. The British public have a huge issue with crabs in a bucket mentality. Train driver strikes prove that disruption matters more than public sentiment.

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Expensive_Peace8153@reddit

Because the government's incompetent and broke. The disorganisation means they find the money to train new people but then decide they can't afford to hire them when they graduate. So basically UK taxpayer money goes into training doctors and nurses that countries like Australia reap the benefits from instead of us.

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MrReadilyUnready@reddit

When we left the EU we lost a law that meant that British + EU doctors were prioritised for training posts in the NHS. This opened the floodgates for doctors from every other country to apply here on equal footing to our own doctors. We went from about 19k people competing for 16k training posts, to 30k last year.

Last month the government implemented the UK Grad prioritisation bill which means foreign doctors cannot be offered a training post until all brits applying for that position have had their say.

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Desperate-Drawer-572@reddit (OP)

But is that bill having much of an impact?

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MrReadilyUnready@reddit

It's already had some impact as training offers for this cycle came out after the bill was implemented. This meant British doctors with lower scores than foreign doctors were prioritised. Unfortunately interviews happened before the implementation, but from the next cycle it'll apply to recieving interviews too.

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Ok_Adhesiveness_8637@reddit

Its been a month, give it a chance.

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Key_Plum_99a@reddit

Unlike private industry, where you can choose to invest and employ more people to make more sales income, the NHS income is fixed so they can’t just choose to employ more people.

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nikokazini@reddit

Vacancies skew towards experienced staff, not recent grads

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BobBobBobBobBobDave@reddit

Basically, there isn't a lot of synchronisation of the number of people trained for roles versus the number of roles. For doctors training in a lot of specialities, as one example, there are not enough places at the next stage of training for people who pass the current stage. So you might have 20 doctors in an NHS Trust completing a stage of, for example, Anaesthetic training, but then there are actually only 7 jobs for next stage.

So what do the other 13 people do?

They can hang around probably and wait for a training place later, but then what about the people below who want their role?

Add in that a lot of qualified staff from overseas are also going for roles and it is a bit of a mess.

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blahblahblah1234_@reddit

For resident doctors, there are not enough training posts ie the government doesn’t want to create jobs because that means they have to spend money. Trusts therefore have to make their own internal non training posts to hire doctors locally or abroad. And obviously there is rarely career progression that way.

Nurses are hired via the trust unlike doctors. So the reason would be trusts don’t have enough money to hire nurses.

So now you have a large population who struggle to get seen because of the refusal of creating jobs. The end.

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