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Friday, 5 June 2009

Junior doctor worries are a worry for us all

I think we are all aware that there a significant number of junior doctor vacancies in Wales. BMA Cymru Wales has been working with the Deanery in Wales to try and improve this situation and attract junior doctors to come and live and work here.

The effect of vacancies will be exacerbated in August with the introduction of the European Working Time Directive. The adverse consequences of unfilled junior doctor posts and its impact on the ability to deliver patient care cannot be overestimated.

I didn’t, however, appreciate just how bad the effects are being felt NOW, until I met with some junior doctors in South Wales, and heard some worrying concerns about many aspects of their training and development. They highlighted a range of issues, only some of which I’ll outline here:

A&E on-call rota

I was told of instances where F1 and F2 doctors are merely acting as clerking machines, which isn’t allowing for teaching on post take ward rounds. Rotas are also being used as a fast-track, in order to maintain the four hour A&E targets set by but this doesn’t provide opportunities for juniors to learn.

Rota gaps and lack of cover on wards
I also heard of how F1 doctors are being left without senior support on wards, for days at a time. Rota gaps are so widespread within the majority of specialities, there isn’t any advertising in advance for any known gaps and I was told that whilst medical rotas appear to be compliant on paper, that doesn’t actually translate into reality.

Locum cover

The meeting highlighted how there’s no real effort made when it comes to finding locums, instead juniors are being called back from annual leave to cover, with locum rates here being apparently half those in England; this is no way improve morale or make Wales the premium destination for junior doctors, especially when it is undertaken in a climate of bullying and intimidation.

Nurse Practitioner intimidation

Anecdotal evidence was also relayed to me about how Nurse Practitioners are prescribing medications and fluids and then demanding that doctors sign for them, even though the Nurse Practitioners are meant apparently to be independent prescribers. Junior doctors also felt that some working arrangements left them restricted and limited in their exposure to the range of clinical experience necessary for their training, especially when managing problematic patients.

I could go on, but I think this highlights the sort of issues facing junior doctors in Welsh hospitals. BMA Cymru Wales is so concerned about all of this, it is considering an initiative led by Welsh Council and the Welsh Junior Doctors Committee to take these matters up with the relevant employers.

Unless urgent action is taken to address these matters, our ability to attract the best to Wales will be thwarted. And that would be a shame as the direction of travel of the WAG and the Health Minister, Edwina Hart, to get back to the core values of the health service is something the BMA welcomes. It is a system that doctors should be queuing up to be a part of. Let's all get on the case of the problems, have more ambitious aspirations and ensure the patients of Wales receive the high standard of services they deserve.

Expect to hear more about this over the coming weeks, this blog post won’t be the end of the matter!

If you have concerns as a doctor working in Wales, or a patient receiving care here, over any of the issues highlighted in this post, then please tell BMA Cymru Wales about them! You can do so just by leaving your comments on this blog post, anonymously.

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