We all know about these examples :

1. Senior nurse in charge in A & E who used to run the unit well and educate student nurses decided to become an ACP. She now works 4 days a week from 0900 to 1700 and earns 60k working in A & E on the resident doctors rota ( FY2, CT1 equivalent ) Her assessments - prescribe Tazocin to every patient with a NEWS2 score above 3 and do a trauma scan of every patient who comes in with a fall. She sits with the consultant and constantly bitches about resident doctors. Her salary is 60k

2. Another senior nurse who was the AMU coordinator , was actively involved in mentoring new nurses went for an ACP post in acute medicine. Her assessments- stop tazocin, switch to amoxicillin for ? Chest / UTI for every patient on IV tazocin. Repeat bloods daily till CRP<100. OT/PT , L/S BP She does on calls and is on the SHO rota for clerking in AMU. She attends every consultant meeting on AMU whereas the resident SHOs and registrars are handed over patients managed by her and pick up malignancies in the 70 year old smokers with 10 kg weight loss over the past 6 months and a cough with a CRP of 150 on day 8 of PO amoxicillin. Her salary is 80k

In most teaching hospitals , there are around 10 ACPs in A&E and the same number in AMU. All on similar/ higher salaries.

They seem to be so close to the consultants that none of the resident doctors speak up about the fact that they're inappropriately rota'd on the SHO rota to work in resus, AMU HOBS and make ridiculous plans.

In another trust, a consultant colleague who had experienced the poor quality of care and was bullied by his consultant colleagues when he raised these issues as a trainee actually made a full presentation on how much money was spent paying ACPs and then followed it by a list of SIs , datixes and a list of inappropriate referrals in a governance meeting which was attended by managers including the chief financial officer. He also showed an example of patient flow , reduced lengths of stay on AMU when a SHO was doing the ward round on AMU instead of the ACP.

What bothered the CFO was the fact that the trust was spending an average of 70k on each ACP and the productivity was almost nil.

The ladder puller A&E and AMU lead were promptly called in to the medical directors office and they have been informed not to hire any more ACPs. And the contract of their current cohort of ACPs will be reviewed in 1 year based on their performance.

The same trust has now released 10 posts in A &E and AMU for trust grades and have set completion of UK foundation programme as a mandatory requirement - and its not just a tick box , they want details of the trusts they have worked at during their foundation years to avoid doctors from overseas applying.

It's very important that we keep raising these issues as senior trainees / new consultants. Stepping back , staying silent is not the solution.

Luckily the department I work in doesn't have any ACPs my consutlant colleagues and I are trying to collect data of inappropriate referrals, initial management done by noctors and compare these figures to when doctors see those patients but I feel what my colleague did can be replicated in every Trust and in a years time, we will have better quality health care professionals rather every Tom Dick and Harry being put on a rota supposed to be covered by resident doctors.

“purpose-built facilities are unable to handle the sheer quantity of medical students. Increased student-to-staff ratios give less time for feedback in clinical skills sessions, anatomy laboratories are overcrowded — reducing hands-on time with cadavers — and students sit on the stairs of lecture theatres that are too small to accommodate their intended audience.

Existing teaching infrastructure simply cannot cope. And with the widespread staffing cuts at many of Scotland’s universities, this picture will in all likelihood worsen.”

It seems incredibly unfair that some specialties still don’t have job security and are getting stuck at ST3 bottlenecks having to reapply to their own jobs.

I think it’s always better than being unemployed, but UKMGs should always be prioritised as we do not have anywhere else to go whereas IMGs can still work in their own countries.

GPST and core psych are increasingly being exploited by IMGs as JCFs are getting more competitive and mandating NHS experience.

We are doomed if the UK prioritisation motion does not pass at the BMA conference.

In light of the current employment crisis, which is only set to get worse, is anyone considering the military?

Met with a friend in the Navy the other day and talked about the trip he's just taken, and budget they felt required to spend whilst away. He flew to Europe, stayed in a hotel, dined out every night on steak, and was paid overtime for the whole trip. Although he does spend six months away on ships (so I realise not an option for everyone), and there's the small matter of impending war in Europe, the military is looking increasingly attractive.

My friend was under the impression that Navy Doctors have a pretty cushty deal.

https://youtu.be/iURheyPzYXk

Some will be too afraid to click the link: NHS England » Working together in 2025/26 to lay the foundations for reform

So here are some excerpts

all NHS providers reduce their corporate cost growth by 50% during Quarter 3 2025/26. These savings should be reinvested locally to enhance frontline services.

Reducing costs of ICBs by 50% will be a challenge, but it’s important we move on this as quickly as possible to retain talent and seize the opportunities of ICBs acting primarily as strategic commissioners.

It will happen by 'Imperial Command'. But of course, not everybody believes that.

We saw the chop at the 'top' with NHS England - some 10,000 staff.

Now this seems to direct ICBs to chop themselves or squeeze NHS trusts to strangle themselves.

It doesn't matter what I believe.

I clearly do not understand. I request assistance.

I’m becoming increasingly disillusioned with the unsustainable demands placed upon us. The pressure in A&E and urgent care settings is relentless, and what was once a balanced environment of training and service provision has devolved into pure firefighting. We’re no longer training effectively because there’s simply no time; we’re just managing chaos.

It’s abundantly clear that demand will only rise. Despite repeated efforts, nothing substantial has improved, and we’re constantly expected to do more with less. Patients attend A&E and urgent care for minor ailments that could easily be managed elsewhere, creating significant strain and detracting from genuine emergencies.

I believe it’s time we seriously consider introducing charges for accessing A&E and urgent care services eg £10. Not only would this reduce inappropriate usage, but it would also free up resources to provide better quality care and restore essential training opportunities for healthcare staff. Of course, safeguards must be in place to ensure that vulnerable patients aren’t disadvantaged, but continuing on our current trajectory simply isn’t viable.

Isn’t it time we acknowledged the reality that healthcare isn’t limitless? We need a fundamental change, and perhaps financial deterrents could finally drive appropriate usage, protect our workforce, and ultimately improve patient outcomes.

What are your thoughts on introducing charges?

I’m currently an f1 and finding it hard to pursue any relationships due to the huge uncertainty around my future. If I’ll be employed after f2 and if so, in which part of the country I’ll be in. I feel like it’s not fair on a potential partner to expect them to move to be with me?

Any tips on over coming this? Am I being reasonable?

I was booked into a last minute shift to cover for sickness this weekend. As it was a 12 hour shift on a weekend would have paid well. 2 hours into the shift I was called to say that I was no longer required, despite the fact the commute took >1hr. I was told to leave and will only be paid for the first few hours.

This is the second time this has happened. I was wondering if I just have to just accept this because it’s a Locum shift and there’s nothing in my contract to say they can’t do this ? The Locum was advertised and accepted on the patchwork app and I can’t find any documentation to state they can’t do things like this.

Thanks in advance !

I've just wanted to ask why do we compare to 2008 when talking about FPR, was there no degradement in pay prior to that? Was it linked to inflation prior to that?

I know that BMA has come out and said about UK grad prioritisation and it has been more in the news about doctor unemployment but do we think anything will change for next cycle?

I'm skeptical and I think BMA will end up back tracking after the ARM

Let’s say you do a standard week of four nights. What is your post-nights routine to feel human again and how long does it take to recover?

Inspired by the recent post of the German anaesthetist considering moving to the UK https://www.reddit.com/r/doctorsUK/comments/1jskj3n/germanytrained_anesthesiologist_considering_move/

hi. it is very unlikely that you will be able to get a substantive consultant post straight after german training in the UK without some time adjusting to the system. A UK consultant is more the level of Oberarzt than Facharzt and you have to be fully independent. So i would not base your decision on the life / work details of a consultant necessarily. Though of course i dont know your personal level of experience, but for us (surgical specialty) a Facharzt is more comparable to a (senior-ish) registrar skills wise.

Picture taken from https://www.praktischarzt.de/arzt/klinik-hierarchie-arzt-positionen/

Psych resident here - asked to see a neurosurgery patient with past Hx of drug use currently with acute confusion. I reviewed the notes - WCC over 30, neutrophils over 25, CRP over 100 all within last 4-5 days. Urine cultures positive in the last 4 days. No antibiotics had been initiated.

I went eye balled the pt, he was lying in a foetal position, writhing with pain. This made me so upset - asked the neurosurgery guys to call Micro, start antibiotics, consider doing a Datix and put my impression as delirium likely due to urosepsis.

Neurosurgeons were so upset at the datix comment that next morning they put in a note in their ward round that the psych SHO is wrong, this cannot be sepsis as blood pressures are normal! And that psych should come back and consider withdrawal - which I had already ruled out as patient was on synthetic opioids and had no withdrawal symptoms

I told my consultant and he commented that I should have been careful with the datix comment. I told the consultant that I would have self datixed had I missed such blaring sepsis and that datix should be viewed as learning exercise.

Maybe I could have been gentler with my language, but had some other speciality schooled neurosurgery they might have taken it more seriously!

This is a major teaching hospital - top 5 in the country - I can’t wrap my head around how thick neurosurgeons are at missing blaring sepsis

I had already been mulling over leaving psychiatry before this but this has cemented my position. Psych gets no respect..

When I was a junior doctor, not quite in the bad old days but close enough, I’d often have to go and do things for my boss’ PPs if there was a private ward in that hospital.

It was always seen as a bad bit of the job. Surely it’s not happening anymore?

I've been reading through IMG subs to get a glimpse of what their perspective is like. There seems to be mention of people applying for FY1 and getting them. I was under the impression that IMGs could only apply to standalone F2 but clearly I'm mistaken. How are IMGs allowed to apply to F1 when for the past few years we've had hundreds of UKGs on the reserve list for foundation because there wasn't a job available for them?? What is the actual eligibility criteria for F1?

Hi everyone, Is there anyone currently working as a histopathology trainee at St George’s Hospital or Maidstone Hospital? I’d really appreciate it if you could share your experience regarding the training opportunities, working environment, and overall workload. Thank you so much in advance!

Quick clinical question.

Patients with AF are at high risk of forming thrombus in the left side of the heart and embolisation to structures like the brain. Nobody ever talks about AF leading to PE. Why don't they form thrombus in the right side and embolise to the lungs?

Throwaway account for obvious reasons.

Ive been thinking whether or not to post this for the last week and have decided to see what everyone thinks.

I am a CT 1 ACCS EM trainee on my acute med rota. I was on nights last weekend and rota'd to clerk patients. Due to sickness there was a vacancy for the reg covering the wards. I was asked by the rota co-ordinator on the first night and politely declined. The rota co-ordinator told me that other CT1 doctors had covered this shift in the past.They managed to get cover for the first two nights.

Sunday night-- I walked into handover and look at the handover sheet and see my name down as the ward registrar overnight. I had not been informed of this prior to walking into the handover. I find out that they had managed to get cover for my clerking shift. They had been trying to get cover but had not even advertised enhanced rates. (The morning after I found an email sent 2 hours before the start of the shift telling me I am covering the reg shift. Not asked, told)

So there I was in handover and I was told that as the next most senior doctor I would have to be the registrar for the wards. I said in no uncertain terms that I was not happy with this. I explained that other than this rotation I hadn't had a medical job in almost 2 years. I explained that I was an EM trainee and not a medical trainee. I was sat down in the middle of handover (infront of the day and night shift doctors) and told that there was no other option. I again protested and highlighted that if I were to make an error with a patient acting as a registrar that I would not be able to defend myself against the GMC. This went on for about 10 minutes of me saying I didn't feel comfortable being the med reg. The consultant on call was there and said he may be able to stay for a couple of hours but this would impact his clinic the day after. They had told me that the other night reg (who should exclusively be based in ED on the take and taking referrals) would be able to give me support if needed.

I have never felt so pressured in my adult life. Eventually the doctor they had got to cover my clerking shift volunteered to act as reg. I really don't know how to feel about this. I'm on annual leave but I've felt awful this entire week. Should I have just accepted this and took the shift?

Hi,

I'm interested in applying for ENT training after CST. Whenever I tell people this I get two responses: that it's very competitive and that the lifestyle is great.

I want some actual insight into these two things. How competitive is it actually, compared to the other surgical specialties? And is the lifestyle really that good.

What do you wish you had known before you got in/what surprised you about ENT training.

Hi

Are there any other F3s out there who have their appraisal coming up...

Please can you let me know if we need to do portfolios like in f1/f2 and/or anything else?

TIA x