12 February 2011

Working for nothing

Yesterday afternoon Dr Grumble settled down to do some work with one of his scientific colleagues. She mentioned to Dr Grumble that she is being worked very hard. She is. She even gets called about problems in the night. She does not get paid for this. She does not get paid for all the overtime she works. It's always been like that in the NHS. That's why the new consultant contract cost the trusts more not less. Managers from outside did not realise that there is a long tradition in the NHS of doing what is required rather than working set hours for money. With the new contract, for the first time, there was pressure to pay consultants for what they did. Now, with the cuts, there is unseen pressure to go back to the old ways. The hours staff are being paid are being cut back. The work that needs to be done remains the same.

Honorary physicians and surgeons have a long history.

Of course people cannot necessarily go on like this. The Grumble hospital is in an area of very expensive housing. The influence of bankers and other industries more lucrative than healthcare has seen to that. The consequence is that not only do the staff in the Grumble hospital work hard they also have to travel long distances to work and this is both exhausting and expensive.

At the end of the afternoon Dr Grumble went to his office to upload his letters to his typist in India. Grumble's letters are typed by the cheapest transcribers in the world. That's NHS efficiency. Quality secretaries are difficult to recruit to the Grumble hospital. Lawyers and bankers pay more than the NHS. Fortunately some secretaries like to work for the NHS. They like the idea that they are contributing to the care of patients.

Just as Grumble was about to leave work the phone rang. It was a consultant colleague, a lady called Dr Werkard. Dr Grumble is not sure he has ever met her. It is like that in the Grumble hospital. In the old days consultants knew all their colleagues. Now, in hospitals the size of the Grumble hospital, they know very few. There are various reasons for this. Quite a lot revolves around meals. We used to have a thing called the lunch hour. These days, in common with the rest of society, lunchtime sustenance has become a hurried sandwich while catching up with the emails. Colleagues our masters would have chatted to over a leisurely lunch are now just names on a circulation list. It is not the same. And it is not conducive to good medicine. Meeting your colleagues over lunch is a good way of finding out who they are and what they do. That's good for patient care. These days it would be called networking. Our masters called it lunch.

Dr Werkard seemed really pleased to hear Dr Grumble's voice. Human contact is important to us all. We have shared the care of several patients. Our patients know both Dr Werkard and Dr Grumble but we have never met each other. There is something wrong with that. Dr Werkard told Dr Grumble that she had been very pleased with the assessments her patients were being given. This, of course, is a wonderful compliment to Dr Grumble. He was very pleased. You actually see things like this in the records from time to time when a consultant will thank a GP for a helpful details in a letter. It is a way of saying that you think your colleague is a good doctor and has done a good job. It is about the only praise you will ever get. But with the bouquets come brickbats. Only this week Grumble has received a letter of complaint from a GP. Complaints from GPs are unusual and usually revolve around poor communication. Quite often they show scant understanding of the difficulties we are working under. Reading between the lines you can detect an underlying anger. Without the anger, they wouldn't have bothered. To be fair, they are angry for their patients.

Dr Grumble wondered why he had never once met Dr Werkard and she told him that mostly she works at the Western Hospital but she spends three days a week at Grumble Hospital. Maths is not Grumble's strongest point but there seemed something wrong with this. Dr Werkard explained that she only works part time. She is only paid for one day at Grumble Hospital but she works three. Two days a week she works for nothing. That's the NHS for you. Perhaps her husband is a banker. Dr Grumble didn't ask.

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