Maternity Unit thoughts

[lynne duncan]

1. It's a pity in this day and age that the likes of bygone days pranks are not allowed. It would be nice to put Professor Calder in the back of an ambulance and transport him south to Inverness instead of allowing him to return by plane.
2. I know Thurso folk don't care much for dirty weekers and if the NHS get their way there will be an awful lot fewer of us about.
3. When the Perth Maternity unit was threatened with closure Ewen Macgregor's mum was involved in the campaign to keep it open who do we know thats famous and able to be contacted would help...

[trinkie]

1. Bygone Days Pranks were not allowed then either, so nothing has changed.
Why not ask Mr Calder if he would like to make the trip to Inverness
not forgetting a Blood Transfusion en route.

2. Thurso folk like the Wick folk fine - they just think they dont.
They will support you.

3. Famous Person ---- Do it yourself Lynne - YOU become that
Famous Person, you can do it.

4. First start a book of Horror Stories of such experiences from days
gone by. Get it published in National Papers and seen on Television.

GOOD LUCK.

[JAWS]

Sorry, but this isn't the time for a Thurso-v-Wick bickering contest distracting from a serious issue! There is nothing Raigmore would like more than to divide and conquer, it would play right into their hands.
I'm sure that Caithness General is needed just as much by the rest of Caithness as it is by Wickers.

No paediatrics department, then no maternity, no money to staff a free scanner, how long before all that is left is a 'super surgery' where all that can be done is to stick plasters on bruises and the odd stitch in small cuts?

Has any of the organisations involved with the hospital thought of inviting BBC Scotland here for their lunch-time programme on the 15th. I'm sure they would issue an invitation to Professor Calder or one of his entourage to take part in the programme. (Almost certainly bound to be refused - and how embarrasing that would be to them!)
I'm sure there will be enought MPs, MSPs, and local Councillors here to interest the BBC. Lets see if the Health board wish to snub them so publically!

After the problems they had over their plans for the hospitals at Lochaber and Fort William I'm sure the last thing they want is more bad national publicity of the same type.

It's time that the faceless ones in Inverness were dragged from behind cosy little offices into the full glare of the national spotlight. It's time the Health board were made to realise that some things are more important than to be left to bean-counters and that they are there to provide a decent service for the people of Caithness and that we are not just here so that they can be kept in their cosy, overpayed little sinecures.

[JAWS]

I thought one of the excuses for closing the Maternity at Wick was shortage of staff.

I've just been looking at the NHS site and checked the recruitment page
http://www.show.scot.nhs.uk/haht/vacancies/index.htm

Staff shortages at Wick Maternity? Then why are there no positions advertised??

[linzy222]

I was just reading in todays courier about Kerry MacKenzie who developed pre-eclampsia 3 weeks before she was due and had to have an emergency section!

I went through the same thing when i had my 1st daughter but that was 17 yrs ago and it was in the dunbar hospital, i had another 3 emergency sections after that all in caithness general and my last one was the worst, my sons heart rate (while he was still inside my stomach) went down to 11bpm and i reckon if they never got him out he would of died!! I'm upset just thinking about it!!

They can't shut down the maternity unit!

There is so many woman out there who need emergency sections!

I know how long it takes to get an helicopter up here from inverness coz my daughter has been flown down 3 times with an asthma attack and if they r busy then it takes even longer, i mind 1 time she was waiting for the helicopter and they were busy and they said it would be over an hour before they could LEAVE Inverness!!!

I think it is terrible what they r doing 1st there is no NHS dentist and now this, whats next?????

[Tristan]

I heard from a reliable source that the helicopter service cannot take a woman on board who is in labour, or who is in imminent danger of going into labour.

They can't take the risk.(?!!!)

So...how is the emergency back-up service supposed to work, if there is no way the woman is going to make it through the 2-4 hour drive to Inverness? Are we going to have emergency birthing procedures being provided by surgeons, who perhaps have not performed these procedures in the last 20 years or so?

Or do they expect midwives to learn how to perform an emergency c-section? Would you want to be a midwife up here under these circumstances...watch them leave in droves as well...leaving us with...what?

Scary thoughts indeed

[linzy222]

[quote="Tristan"]I heard from a reliable source that the helicopter service cannot take a woman on board who is in labour, or who is in imminent danger of going into labour.

They can't take the risk.(?!!!)

Oh well there u go!!

What happens in the winter when the snow gates r shut??

They will drive 2 the gates make u walk til the next set where an ambulance will b waiting to take u the rest of the way haha (no doubt they will)

I can c it in about 100 years there will b no-one living up here coz woman will b 2 scaried 2 have kids so there will b nobody left!!

[trinkie]

Last few days to write your letters girls.


PLEASE do all that you can to make sure that the best possible Maternity Care is
available in Caithness.

[trinkie]

Yes, I am on my high horse today.


WOMEN OF CAITHNESS DEMAND THE BEST ..
for yourselves and the babies.


KNOW YOUR WORTH.

[JAWS]

So another Obstetician has suddenly decided to leave Caithness General.
Did they fall, or were they nudged?
Perhaps they got got the "Gypsies Warning" about some future certainty which conveniently has not yet been made public. The timing is very convenient, very convenient indeed in view of Monday!

Besides, you ladies have to realise that you cause so much darned inefficiency.
First the nice medical people give you a date around which they arrange everything and then what do you ungrateful ladies do. You take things into your own hands and decide to go into child-birth too early, too late, with too many complications, or with any one of a number of other reasons which throw the proceedures into disarray. You really have no consideration for the economics of the system, all these problems have to be payed for.
This at the moment occurs at two hospitals. Now it would be, of course, far more convenient for the poor, stressed, overworked bean-counters if all this could be done in one place where they could make greater financial savings.

Meanwhile, all you care about is your health and that of your baby, how selfish and self-centred can you get.

Besides, expanding Maternity at Raigmore means more staff, more beds, better carpets and bigger offices to reflect the bean-counter's extra responsibilities.
People, please get your priorities right, you are there for the benefit of the Health Service Mandarins, not the other way round.

In five years time it will, no doubt, be pointed out that the birth rate in Caithness has fallen to almost zero, whilst that if Raigmore has increased proving that the decision to cut services in Caithness was right.

Anyway, whats a few lost babies and mothers between bean-counters, think of the money they will have saved!!!

P.S. Please don't shoot me, I'm only the poor old Devil's Advocate :evil

[JAWS]

OH YES, and I will be there on Monday giving you all the support I can!!!
Lets make them realise that patients are not just statistics, PEOPLE DO MATTER !!!

[Anonymous]

Where is our so called MP is he in hideding or has he got his head in the sand as one might say, and as fae our other so called SMP or what ever he is, I no he is still trying to get cheap Petrol, Lets face it they do not give a dam, they never do untill they want you to vote for them, by then they will have let thems down in Inverness shut our entire hospital let allowen one ward.
One more thing that puzzels me is why spend all that cash on a new A&E, Babies come first, without babies we would not be here, then we would not need a new A&E.
Come the powers that be, Get of your backsides see how long it takes you to get to Caithness on a good dry windless, snowless day, 2 Hours on a good day, thats 2hrs for that baby to LIVE OR DIE. WHAT GIVE YOU THE POWER OR THE RIGHT TO SAY IF THAT BABY LIVE OT DIES WHEN YOU HAVE SHUT OUR UNIT DOWN [evil]

[Anonymous]

I think we have had the wool pulled over are eyes good and proper,over the maternity unit in Caithness General, we have lissened to excuse after excuse from the parts in power, but none of tehm are telling us the truth about this unit.
The thing we have all over looked is the little matter of closing down Dounreay, after all thats why they spent all that cash on a new A & E unit, but if there is a big accident then where would they get all the needed beds from, as it stands now?. Thats right, i think you may by now have the answer [lol] .
Shut the baby unit down and reopen it as an A & E wrad with specil decontamination unit, because lets face babies and Dounreay do not mix very well. Just imagin you are just about to give birth to ones ofspring and suddenly a bloke walks in glowing green with Radiation, Now thats not quite the right way to start of ones life is it?.
But no one will come out and say thats why they want the unit shut down for, because they can not tell the truth, as they do not no what might happen when they start to shut down the hell they call "Dounreay".
So think about it, if you think long and hard it makes sence, and sending a prat from down the line is all a cover up.
Any how if he was here to make good recomendation, then why fly up?, why not drive from Ragemore to see how far it is, No they are just pulling the wool over are eye's.
Well some of us any how.
Merry Christmas & A Very Good New Year.
To one & all, where ever & who ever you are.
Cheers GEORGE. XXX :evil

[Caledonia]

Does anyone know the figures involved? What is the balance between what is 'sutainable' for the trust to provide, and what is required?

If there is a figure, why doesn't someone raise it? Why not put the Town Hall project on hold? Why don't some of the local employers make a direct investment in their emplyees, if you can award multi million contracts to companies for decommisioning why not?

They are spending 25K on consultation on the Town Hall. My God, surely a 20K bonus tied into a consultant taking a three year contract would get one here, and how about Pentland Housing offering them a house to live in?

;)

[Bill Fernie]

I am not sure what the curent costs are but when I was a member of Highland Health Council a couple of years ago we were told that a consultant in a hospital cost in the region of £250,000. It will be much higher now and with the Working Time Directive cutting their hours signifcant extra costs are coming. But even on the old figures three consultants would be well over £750,000. Why so high? Well it is the other staff and infrastructure to support a consultant that pushes up the costs. Getting rid of three consultants might save over a million pounds a year. But no one will admit that thiere is any cost cutting exercise going on. Perhaps there is not ...........................yet.

An extra £20,000 over three years will not do it. There is a worldwide shortage we are told and as related in another post we as a country have not been training enough doctors.
It would be nice to think that extra money would quickly solve the problem but in this case it requires along term spend and what will we do in the six or seven years while the new doctors are training. People need to know when they start training that there willbe a career at the end of it all. There needs to be a significant commitment from government for the longer term and possibly some new ways of working . Can we rotate doctors round hospitals? Will they be willing to work in that situation. If not they will vote with their feet. Caithness General has lost two obsteriticians in a matter of weeks. Are they moving for normal reasons or are they leaving because they fear the worst?
I have yesterday received a reply to my letters to the First Minister and the Health Minister from the Deputy Health Minister Tom McCabe MSP. He states -

"Mothers' and babies safety must be paramount in considering appropriate arrangements for any maternity service. In exploring the current arrangements for any maternity service. In exploring the current arrangements, I understand that the professional team's assessment will cover all the factors likely to have an impact on safety, including non-clinical ones such as geography, weather and transport."
"It will also be for NHS Highland to consider any recommendations arsing from the assessment. If it considers that there is a need for any significant change to the current arrangements, the NHS Boardwill have to consult publicly on its proposals. We have consistently flagged up how important it is for Boards to involve all stakeholders - staff, members of the local community and their representatives included - in designing thier health services."

This throws the onus back on the Health Board and what worries me is that currently their are significant deficits in the Health Board's funding. They are at present sitting on a £6million deficit in thieir budget. The Health Board cannot borrow money like local authorities can to get out of a problem in a particular year. They require to delive a balanced budget annually. Anyone might reasonably ask how this is to be achieved in the face of dranmatically rising costs on shortening doctos hours in hospitals - junior doctors have already had their working week capped and the current pay agreements means significant rises for GP's and consultants. The increases in costs for th Helath Boards are huge.

I do not know the answers and I suspect nor do the Health Boards or the Scottish Executive and the MSP's who ultimately must decide no matter that the reviews like the maternity services review will go back to boards. There are no easy answers but I think it will be necessary for a political decision to be involved and not leave it to the cash strapped Health Boards to make a decision without access to the means to have a choice. Unless there is some way of directing more funds into health services then it seems likely that not only maternity services will face a bleak future but other rationalisations will be considered and the public will find they have to take on more campaigns like the current one in not just Caithness but all over rural areas of Scotland.

I would like to think that an extra £20,000 - a lot of money for the average worker would help. Or that a house being availabel would tip the balance in favour of an area like Caithness but unfortunately it will not and the funding required will shock most people if figures were made available.

The Helath Board will no dounbht come up with a solution but it may be that the solution is that the services are unsustainable in rural areas and if so then as the Deputy minister has said there will need to be a public consultation. We require to watch carefully what the consultation is actually about. There is often confusion in the language that people use -. for example I often hear people loosely talking about the "Closure of the Maternity Service in Caithness " but that is misleading when what they mean is "downgrading" - ie not a consultant led service.. simlarly when a public consultation comes along - if it does then everyone has to be clear about what is they are being consullted on.

Difficult decisions are coming no matter what the outcome of the current enquiry into matternity services -
How to maintain services and at what level in all of our rural hospitals. No one wants to give up what they already have. We have not been offered as yet any choices and the review when finalised will not tell us that we can have our maternity services if we close say two schools or stop another service. but unless there is some way of finding sginicant sums of money or and possibly even as well as some laterla thnking to find a new way of working in the NHS then policians will have to coome up with an answer.

The stauts quo is unlikely to be the end result. Even if the decision is to keep the services in Caithness - and I hope that is the outcome - there will still be a need to make changes to something as the lack of concultants in the required disciplines may not be easy to find. Hospitals like Caithness are in a very tricky situation and often require locum cover for a missing doctor - that is very expensive.

The Highlands and Islands are an attractive place to live but can a doctor find the career progression that they might be looking for. It would appear not in Caithness as the turn-over is high. But like any work group if the offers elsewhere are more atractive then they will move for all sorts of reasons. This might include housing - doctors can afford quite expensive houses in high cost areas which Caithness definitely is not. Services for them and their families may be a major consideration and unfortunately the results for Wick High school currently on the new web site launched by the Scottish Office a couple of days ago do not make good reading. These an many otherfactors may be inflencing decisions. But it is not just in Caithness or Fort William. All over the UK there is a shortage of consultants and although adverts may not appear in the newpapers ther are many gaps. Is this for financial reasons. It must be tempting to solve a budget problem by not filling posts. but here we are entering a complex debate and without a huge range of financial information and facts it is difficult to see a way to an answer.

For these reasons i think it needs not just review of materity but the whole NHS. We may yet have this. We surely cannot stagger from review after review and crisis after crisis every couple of years as we appear to be doing in Highland and elsewhere. The sytem is creaking and I am fraid that patching up will no longer work without significant decisions. The power to take them rests in Edinburgh. Let us hope they have the will to take it on or we will return here in another two years for the next helath servie crisis.

It might be interesting to hear from some of you in other countries on how your health services are dealing with getting consultants or othe rmedical staff at the moment. Do you hear of big staffing shorrtages. Is your helath service facing simlar threats. It would help us confirm that there is in fact a shortage worldwide as we are told. Or could adverts for doctors be placed int he press elsewhere with the hope of getting a repsonse. Do Australain, American , Canadian doctors wish to try the Highlands for a few years. Certainly plenty from the UK have gone overseas and the UK gets many doctors from India, Africa and so on. Knowing that the problem is worldwide will not help our situation but at least we will be more aware of the scale of the problem facing the NHS and Health Boards as well as the politicians.

Perhaps the answer will come over a number of years and pay for doctors go on rising until enough people are attraced into the profession. There must be n improving situation for doctors with reduced hours , increased pay and so on coming in now. but trainig new doctors will take years. Are we seeing a significant recruitment drive - I myself am not aware of one but then I am not looking at the medical press.

Plenty to think about and no doubt much more will be along before the current crisis - err........... review is finalised.

[A_Usher]

Hi there,
I want to add some views. I am Andrew Usher, Practice Manager of Dunbeath Surgery and husband to Dr Natasha Usher, Dunbeath GP Principal.

I have been reading with interest the views on the maternity issue and the old chestnut of how to get doctors to Caithness etc.

Firstly, we believe its imperative that the maternity unit remains open. Inverness is a long way with any complication during pregnancy and has the potential to cost lives.

Secondly, lets dispel the myth that Doctors get paid huge amounts of money, and can buy houses etc, etc. My wife gets paid a reasonably sum, but when you take into consideration she works 24 hours a day 7 days a week, minus time off for paid locums and cross cover her hourly rate isn't much more than £6 or £7 per hour. Not great for permanent on call and high responsibility. Urban counterparts do get paid more. There are reasons for this, too long to go into on this board.

Consultants in cities earn the same income however they have much more facility to earn external private income, hence increasing their income in some cases to double. The difference between an obstetric consultant here in Caithness is that they have no junior staff so have to take every call coming in and as their numbers are small have to be on call more for no extra pay. We are living in a social climate where doctors do not want onerous hours on call, want to be close to the city for diverse amenities and be close to family and friends, and have a solid and reliable infrastructure. Is that too much to ask?

Bill Fernie wrote: "When I was a member of Highland Health Council a couple of years ago we were told that a consultant in a hospital cost in the region of £250,000"

I would severely doubt this, as reported in this weeks BMJ the average consultant earns an average of between £54,340 (starting salary) and £70,150 (unless discretionary points). It may cost the NHS £250 000 to put into place an infrastructure for a consultant, due to nursing costs, secretarial costs, theatre costs etc , but they DO NOT earn £250 000.

Bill also wrote:
"This might include housing - doctors can afford quite expensive houses in high cost areas which Caithness definitely is not."

Again you are assuming doctors have surplus income. You would need to have a partner earning equal amount of money to own a house in the south of England. However lets not forget that a consultant or GP's partner may not find work here in the North, and therefore purchasing a house is just as financially difficult. Especially when people moving from the south with cash in hand are able to purchase easier. In our own case we have only of late found property to buy, and have had to rent, and move home on two occasions to stay in the area. So please, lets not make large assumptions that GP's and consultants are able to buy property at will due to large incomes.

Recruitment is the crux of the problem, we need more graduates. Graduates don’t come to remote and rural areas, why, well because they don’t get a real taste for the benefits of it. What is required is a form of undergraduate rotation, placing undergraduates in areas such as this to see the benefits of continuity of care, quality of living etc.

But be warned, the NHS is changing and in my opinion not for the better. The new contract is NOT and WILL NOT enhance the quality of remote and rural practices, in fact the Scottish Executive STILL DOES NOT have a solution for practices such as Dunbeath (known as inducement practices) and the financial package may force practices such as this into decisions which may spell the end for the practice. Worrying times ahead........

What I would like to see is that people be they the Scottish executive, msp, councillors etc, come and speak to local doctors and consultants and ask them what their situation is and how it can be supported or modified and NOT to make large assumptions based upon more assumptions that civil servants and urban doctors make which has little if any relevance to their remote and rural counterparts.

We are always keen to have a chat to interested parties......

Regards,

Andrew Usher

[Anonymous]

Mr Usher hit the nail on the head, but no one ever lissen, it was all done and dusted before that prat from Edinbrough came up last week on his wural wind tour of our hospital, Like is said before, if he had an open mind then ahy did he fly up here? in the first placse, why did he not come by road just to see what our new babies will have to put up with.
The road up is not abd at the moment but soon it will be a right mess when they strat widerning it ( :( "george your spelling is worst". Oh sorry :confused ), also they still have not got the bottle to come out with the truth of why they want to shut this unit down, its nout to do with doc's or cash in the hospital or staffing leavels. ITS all to do with Dounreay and if some thing goes bump, then no matter how many wards they shut and tehn reopen under a new name, we will all be glowing in the dark.
So come on the powers that be [u]TELL THE TRUTH IF YOU CAN FOR ONCE.[/uAs for rural doctors we would be in a right mess with out there deadication, the hours our Doc here in Dunbeath puts in a day, is more than them Prats down in Edinbourgh put in in one week.
She and her team are just pure magic, i for one hope we never loss her becuase of Cash.
:evil But its no good putting all this, some folks down in Inverness do not even no where Caithness is so how will a prat in an office now what its like to live here, work here, been born here. and just when you think you have won you go and die, then they want to take you and put you up the chimney becuase there is not grond left or no cash fae whole diggers, say the the prat in his new 3 pice sweet and his big fancy car.
We all got to wake up, or one day we will all DIE (in Ragemore)
All the best. George :evil

[Bill Fernie]

Re the £250,000 costs for a consultant. I did not say a consultant earned £250,000 - I said it cost £250,000. A couple of sentences on I asked the question and answered it to make the point. - Why so high? Well it is the other staff and infrastructure to support a consultant that pushes up the costs.
I think it is misleading to quote hourly rates based on 24 hours. What is the annual amount earned? Many people earn more if they work over time. The self-employed may work "All Hours" but no one ever looks at their hourly rate only whether they drive a Range rover or a second hand cortina.
Perhaps what is also required is a management review of how everyone in the Health Service spends their time. It is not that anyone doubts that everyone works hard but maybe it needs to be done differently. With all the changes coming most folk are going to have to get used to that.
It is certainly not in anyone's interest to have staff working endlessly on call leading to tired workers. No doubt the situation has been exacerbated over the years as the pace of change has speeded up - more paperwork, more reports etc and pressure to deal with more and at the same time we the public have become ever more demanding in our requirements and expectations.
I think what might give people the wrong idea are earnings from locum doctors who can apparently now earn a fortune. For example the locum covering the practices in Wick recently has scale charges that would indicate an excellent remuneration and they can be seen at http://www.coull.net/rates.html

Doctors Pay Scales in 2001 can be found at http://society.guardian.co.uk/NHSstaff/table/0,8082,620640,00.html

A bit more research brings the fact that Robbie Coull also runs a web site Locum 123 http://www.locum123.com/index.shtml
At the rate it appears to be expanding there will soon be no permanent GP's - they will all be locums earning a huge amount. Is this an exaggeration - Let us hope so or the NHS pay bill is going to go through the roof. Any solutions anyone?

[A_Usher]

Hi Bill,
I don't think its wrong to quote an hourly rate, especially when you work 24 hours a day. The fact of the matter is many people, district nurses, paramedics etc work on call, and receive very little remuneration at all for the service. However many do their own on call because they wish continuity of care, and to be available to the community. In fact 67 remote inducement practices are subsidised practices and aren't allowed to make external income, as this comes off the subsidisation and therefore unlike others there is no extra income to be made.

There is no doubt locums earn a lot of money, and what has to be remembered is that some practices have a set budget and locums who have exploited the short fallings in recruitment have caused practices enormous difficulties as a practice which is due set amount of weeks holiday may find due to increases that it simply cant afford to. What is also forgotten is that many GP's especially in our remote areas are in fact self employed, and merely a contracted service and therefore have the same problems as self employed individuals. However the general trials and tribulations of remote and rural practitioners is one often forgotten and we have a very worrying situation.

Management in principle is a good ideas, however part of the problem with the nhs is the number of managers, there are probably more managers that there are nhs beds. Things are going to change, no doubt about it, but my feeling is to the detriment of existing services. Lets take an example and look at the issue regarding out of hours. There is an ideological theory that one GP with some auxiliary staff will be able to be on call and cover the whole of Caithness for out of hours, using the two wick ambulances to ferry patients. Considering the demographics, is this a great idea? What if one patient at Berriedale has a Myocardial Infarction, and another at John O'Groats is attending a car accident, and then a pregnancy were to develop complications. What happens?

Not all change is good, and this is something that concerns me greatly. I would like to see the sway go away from how much a GP earns and to move towards what services do we have, what is going to be reduced, what the long term objectives are, and most importantly how does it affect the individual patient.

My concern is that those supposedly in the know regarding nhs care don’t seem to know what is required, nor have spoken to those on the ground that do the job. This is something that surely must change.

Regards,

Andrew Usher

Editited part:
Footnote.
Robbie Coull has undoubtedly pushed locums cost up in the last year, and my own opinion has been, and i have voiced this before that this is to the detriment of small practices. However Dr Coull will find himself in a very different position next year when the locum budget is cash limited, and inflated locum costs will not be acceptable.

[Bill Fernie]

The cuts of earlier years are certainly coming home to roost now. The fact that locums can earn significant sums is like any other business due to supply and demand. As country we appear to have fallen down on the training of enough new doctors and other staff in health services. And this despite the huge fall in the number of beds n hospitals over the past few years.
The shortage of Dentists, GP's and Nurses - the frontline seen by patients is exacerbated by the shortages at least in rural areas of the Professions Allied to Medicine (PAMS) Caithness specifically seems to have had endless problems in recruitment for speech therapists, and other posts. In addition there has been permanent list of vacancies at Social Work Services including Children's Services. The general lack of people in many posts has to have a knock on to other professionals trying to fill gaps and working without the support that might be expected in other areas.

Public services seem to have been on a continual run-down for some years despite the increases in spending that we are told has gone on. It apparently is not enough - to attract staff with the correct qualifications, to retains staff or to adequately train replacements.

Other services are also under pressure from new regulations and lack of money. I would cite the recent decision by highlands and Islands Fire Brigade to suspend the attendance of non=mobile Auxiliary units to Road Traffic Accidents. As in other places a set of regulations is being applied that may work well in the urban situation but hits a rural area hard unless significantly more resources are applied. The Integrated Risk Management planning process is being used to stop local crews attending Road Traffic Accidents. the Auxiliary fire crew at Lybster will no longer be allowed to attend Road Traffic Accidents in the area. Although only a few accidents happen per year in the area the local Lybster crew could be the first at the scene of a road traffic accident and give emergency first aid as well as effect a rescue from a crashed vehicle.
whilst the risk assessment has identified problems in respect of safety of personnel, lack of equipment and not enough training the net result of applying this risk assessment is to withdraw this possibly life saving service manned by local volunteers.
The immediate withdrawal of the service seems like hasty decision and the service will no doubt have to be covered by crews from Wick or Dunbeath adding to the time taken for the arrival of assistance.
I cite this as yet another example of how many services seem to be under great pressure and it seems like a knee jerk reaction to Risk Assessment without to date any mention of how the noted lack of training or other requirements will be addressed.
At least in the health service we are getting reviews over a longer period.
But I wonder if anyone in Edinburgh is taking account of how the sum of these many decisions and lack of staffing in our public services is impacting on the ground.
For example in the case of a rural GP. Will the rural GP turn up at road traffic accident now have to wait longer for any assistance - ie a fire crew from further away to help remove people from a crashed vehicle.
How frustrating is it for a GP to refer a patient to a service to find there is a long waiting list due to lack of people in other departments. Does this lead to a lack of satisfaction with the job and perhaps deter others from applying for posts.
In many cases we appear to have reports on all sorts of areas and disciplines with very high expectations and standards and then not the money to ensure they are actually delivered. I think this is partly why many changes are coming.
We are in this country very good at applying regulations but as many of these are emanating from the European Parliament it would be interesting to see if other countries are applying the regulation as fast and as assiduously as we appear to be in this country.
Does France have a lack of GP's in rural areas? Are they short of Social Workers? Are the Germans or Italians telling their rural auxiliary fire brigades not to attend accidents due to Integrated Risk Management. Does this make sense?
Lots of questions here and I do not think anyone has the whole answer.

[Anonymous]

All talk of working 24hrs and pay rates got me thinking....

hmm, I almost work 24hrs, so my hourly rate works out about £1.18. If it were £6 or 7 an hour, I could then afford all the caffine I require to keep me awake 24hrs a day, 365 days a year, and the aftercare I would need for sleep deprivation.

There is no such thing as "working 24hrs a day", being on call is very different indeed. Fair enough your free time is not completely free, but until you are called you are not actually working.

From someone who is not going to be earning 50-70k for quite a long time yet, I find it offensive that people getting paid these huge salaries are willing to complain about it. Is life earning that kind of money so tough that you think everyone is having a better time than you and therefore you have grounds for complaint?

Lets ask everyone, hands up all those of you living in caithness that make over say £45,000? hmmm, not many hands there. [para]

Personally, I dont see why there should be such a huge financial package for any job that doesnt have you up to your neck in it. I'm lucky if I visit the nice, warm, ambient doctors surgery for any medical attention 1 or 2 times a year (at a push), but the guys who empty my bins, I see promptly, once a week. Anyone who thinks that the guys on the refuse truck have a cushy job, should go out to Seater, stand at the edge of the landfil and take in the sights, sounds and smells that these guys have to work with every day. I'd happily see them get paid 50-70k a year.

I'm sorry if this viewpoint doesnt fit with the good doctor's own, but you have to see things from this side of the bank balance to appreciate how crass arguing over those sums of money can seem.

A house in the south of England.... if I ever have a million quid, the last thing I would spend it on is some crappy 2 bedroomed semi in the south of England :roll:

My solution, is simple, if we need better public services, then we need to pay for them. Our current government, and pretty much all of the previous, have been chipping away at out tax bills year by year, giving us the perception that we have more money in our pockets. At the same time, services we used to get on the NHS have moved back into the private sector and have become much more expensive to the user of the service. (see dentists and opticians as an example). So the government wins another election as we're all paying less tax, but they've cut back on another service and so we have to pay more for it, leaving you with less money in your pocket than before the tax cut. For whatever your view of the SNP they got it bang on when they told us that if we wanted better services we would have to pay for them. Less tax = less services. If we allow these things to go unchecked and keep being fooled by the party that's going to cut tax then we're stuffed and only the rich doctors will be able to afford to pay themselves for medical attention. So 10p on the lower tax rates and the reintroduction of super-tax (about 95% should do it) and it'll be rosy for all of us :cool:

[A_Usher]

Niall,
You wrote:
"There is no such thing as "working 24hrs a day", being on call is very different indeed. Fair enough your free time is not completely free, but until you are called you are not actually working."

Evenings, may be paper work, and there is a fair bit of that, and whilst in their spare time they may not be 'working' as you put it and merely 'confined' to the practice area when they are called it can be anything from attending a road traffic accident to a broken leg. And with practice areas covering huge mileages, it only takes two or three calls a night, to have a busy night. In some cases you could be with a patient for over an hour waiting on an ambulance. Sleep is often very deprived. You cant phone in sick, so if you are out all night then you are on all day. There is more to it than I think you understand. And there is a huge responsibility level. Rural practitioners are often confined to their practice area, cant go to the shops, bank, etc, relying on spouses or partners to do daily living chores.

You also wrote:
"From someone who is not going to be earning 50-70k for quite a long time yet, I find it offensive that people getting paid these huge salaries are willing to complain about it. Is life earning that kind of money so tough that you think everyone is having a better time than you and therefore you have grounds for complaint?"

Personally I am happy as things stand, we came here to provide patient continuity, and my wife is more than happy to work her own on call but we are not talking about us, we are talking about doctors in general and it appears a lot of the public think they are overpaid without any realisation of what is involved, yet complain when services are reduced.

Lets take the new graduate, perhaps studying in the south of England who has completed med school who now has debts of over £20 000. Starts house officer jobs, where by, contrary to what you believe Niall they DO work 24 hours in many cases, especially inner city casualty jobs. Junior and Senior house officer jobs do not pay particularly well, you have accommodation etc, keeping in mind that the individual already has over 20 k of debt. You are going to need a relatively good job to be able to afford to pay your debts back, before you even get involved with life, and mortgages etc.

I am self employed for the majority, and I am only a part time practice manager, and I don’t get paid for my on call, and by that I mean when my wife attends an incident and is out of mobile coverage I then need to take over the phone and triaging if need be. I don’t make over 50 K, far from it, but I don’t work single handed, and have a huge responsibility level, and I actually admire those single handed practitioners who provide a world class service in a very unique way, as those practitioners are often multi skilled individuals and often act as doctor, nurse and paramedic when there are no auxiliary staff at hand. They attend all major incidents, and the majority of single handed practitioners do the job for the love of it, not the money. In fact it would probably be more beneficial for them to leave the single handed practices, and become locums. AND this is why so many single handed practices are without GP's and struggle to recruit. So you may find it offensive that a single handed GP gets around 52 000 for what they do, but in my view, as a patient living in a remote area, I am more than happy they commit to this lifestyle.

You also wrote:

"Personally, I dont see why there should be such a huge financial package for any job that doesnt have you up to your neck in it. I'm lucky if I visit the nice, warm, ambient doctors surgery for any medical attention 1 or 2 times a year (at a push), but the guys who empty my bins, I see promptly, once a week."

Well you obviously don’t know much about remote and rural general practitioners, who are often up to their neck in it, who are as I mentioned previously first to attend emergencies, provide and facilitate medical back up, who go out what ever the weather is to emergencies at all hours of the day. Who have extremely high responsibility levels, and for the majority of them go on day to day without complaining. And lets not forget those auxiliary staff such as district nurses, paramedics etc, who are on call covering large areas on lower pay scales. I would be curious to know how you would value a skilled medic financially Niall?

Niall also wrote:
"I'm sorry if this viewpoint doesnt fit with the good doctor's own, but you have to see things from this side of the bank balance to appreciate how crass arguing over those sums of money can seem."

I am not arguing per say over money, I am stating the worrying fact that changes may mean small remote practices close, with deteriorated services, which could jeopardise lives. I am assuming you live in a town, and not remote and rural, and hence in the dead of night would not be having to travel 30 or 40 miles whilst unwell to see a doctor. Nor have a branch surgery, where by a rotated doctor comes to the village two or three times a week. Money whilst important for many is our least concern. RETAINING services and providing a solid and reliable infrastructure is the imperative part.

Caithness needs medical services, and long-term solutions need to be found. But when the public only hear misinformation from the media about how doctors are better off etc, they fail to understand that is the majority, and there is a minority that will be worse off, and I don’t mean salaries per say, I mean in the terms of maintaining a remote medical surgery and its services. For example with the new financial figures many are concerned about having enough money to afford a receptionist, secretary, etc, and will this mean redundancies for some staff? I hear politicians cry this and that, but don’t see any of them coming to speak to approximately 67 small, remote and rural practices that are potentially going to loose out with the new contract, who will have to make changes which may be for the worst and who are struggling hard to provide continuity of care to their patients.

Some of us Niall worry more about how patients will be affected when the new contracts come into play, than how much our pockets will be affected.

Regards,

Andrew Usher
www.andrewusher.com

[Anonymous]

All talk of working 24hrs and pay rates got me thinking....

hmm, I almost work 24hrs, so my hourly rate works out about £1.18. If it were £6 or 7 an hour, I could then afford all the caffine I require to keep me awake 24hrs a day, 365 days a year, and the aftercare I would need for sleep deprivation.

There is no such thing as "working 24hrs a day", being on call is very different indeed. Fair enough your free time is not completely free, but until you are called you are not actually working.

From someone who is not going to be earning 50-70k for quite a long time yet, I find it offensive that people getting paid these huge salaries are willing to complain about it. Is life earning that kind of money so tough that you think everyone is having a better time than you and therefore you have grounds for complaint?

Lets ask everyone, hands up all those of you living in caithness that make over say £45,000? hmmm, not many hands there. [para]

Personally, I dont see why there should be such a huge financial package for any job that doesnt have you up to your neck in it. I'm lucky if I visit the nice, warm, ambient doctors surgery for any medical attention 1 or 2 times a year (at a push), but the guys who empty my bins, I see promptly, once a week. Anyone who thinks that the guys on the refuse truck have a cushy job, should go out to Seater, stand at the edge of the landfil and take in the sights, sounds and smells that these guys have to work with every day. I'd happily see them get paid 50-70k a year.

I'm sorry if this viewpoint doesnt fit with the good doctor's own, but you have to see things from this side of the bank balance to appreciate how crass arguing over those sums of money can seem.

A house in the south of England.... if I ever have a million quid, the last thing I would spend it on is some crappy 2 bedroomed semi in the south of England :roll:

My solution, is simple, if we need better public services, then we need to pay for them. Our current government, and pretty much all of the previous, have been chipping away at out tax bills year by year, giving us the perception that we have more money in our pockets. At the same time, services we used to get on the NHS have moved back into the private sector and have become much more expensive to the user of the service. (see dentists and opticians as an example). So the government wins another election as we're all paying less tax, but they've cut back on another service and so we have to pay more for it, leaving you with less money in your pocket than before the tax cut. For whatever your view of the SNP they got it bang on when they told us that if we wanted better services we would have to pay for them. Less tax = less services. If we allow these things to go unchecked and keep being fooled by the party that's going to cut tax then we're stuffed and only the rich doctors will be able to afford to pay themselves for medical attention. So 10p on the lower tax rates and the reintroduction of super-tax (about 95% should do it) and it'll be rosy for all of us :cool:

Poor old Nail he don't even get the minimome wage of £4.80p. But what he gets is the fact he can sit there and rule over his little world, so if you are only getting a few pennies then why do it?, after all most good webmaster are making a good penny or two. Striange that you make so little, Now tell why you had to bring England into it, do i see some raceiem comming in, just like when you went to your Yell awrd you came out with it then but soon after you tolly removed it.
I no you will ban me now for telling the truth.
So before i go, Pray tell me where we who are on long tearm sick, were are we going to get the money you want us to pay for the better services from, Try going out in to the real world boy, do not be blinded by what the goverment tell you, there are millions of folk out there how can not aford your Torry ideas.
As fae rural doc's They are worth every penny they make.
Now fae some one like ye self sat there in his warm office on £1.60 an hour, it only takes the doc 5 mins to get to you they can walk it if it snow badly.
So darlings with brain, Tell me how long would it take my doc to get to me if i lived at Ousdale?, on a good day, how long if there was no rural doc? and they had to come from wick.
Now here is some facts for you to think of I am a dieabetic, if i take the coma i have to have an Insurlin injection with in 20 mins or i am DEAD yes thats right DEAD, So to clever men tell how much is my life worth £1.60p per hour or £7.00 an hour.
You lot are playing games with folks lifes and most of the time you are only doing this for your own gain.
So when is it going to stop? When we are all DEAD. :evil

[Anonymous]

Well put georg...

Obviously I get paid over minimum wage, the point was to illustrate how ridiculous it was to try and say that a doctor only earns 6 or 7 pounds an hour, so by the same calculation ((annual salary/365)/24=hourly wage), I get paid £1.18ish per hour. These high paid web masters jobs you talk of, in wick are they? or are you another one that wants me to leave the county to get better work? Haven't we lost enough young folks already? (honest I'm still young :) )

England... again, you've missed my point. How can you compare the south of england to here? especially when talking about house prices? Racism? eh? are we reading the same post?

Yell.com, well where did that come from? Yes I did post something derogatory about London, ABOUT LONDON!!!!!, I said it was a dirty smelly hole, or words to that effect, and it is. But when I read about our award in the London papers that morning, I thought I would remove it to save offending anyone who might have visited the site after reading the paper. Was that a bad thing to do?

Long term sick.... Well george, if you are on the sick m8, you need us to pay more taxes don't you, otherwise yes, you might lose your benefits, or the country might not have enough money at its disposal to pay for your local medical services. If you're on the sick, exactly how much tax do you pay? As far as I can see, probably not much at the moment, so a 10% increase on nothing is nothing yes? so whats your problem with a tax increase, it can only be a path to better services for YOU.

Tory, please, thats the funniest thing I've ever heard, I can't even think of a reply, its just so funny.

Yes, I agree, rural docs are worth every penny, and a little increase in taxes might allow us to afford more such luxuries for those of you living in even-more-rural-than-wick Ousdale. I don't see what your problem with that is? My problem is with people trying to make out they get paid less than they do or that their job is more difficult or important than many others in our community.

And then you have medical problems, well georg, that is a problem now isn't it, it sounds to me that if you're so close to death then perhaps you should look at moving closer to medical services until you've got your diabetes back under control. Otherwise, surely you're taking the same risks everyone else does in a rural area, you bank on the fact that you wont "take the coma" or be ill in another way. i wont bore you with my own condition. But yes I am glad that if I make it to the phone and call for help, someone is likely to be here in as you say, about 5 minutes. Thats exactly the reason I stay in the town, I like to have these amenities nearby and not just the medical facilities.

What are these games we are playing? I have no power to change things, I don't control anything that would affect your life goeg, so from all this lack of control what do I stand to gain?

Yes georg you told the truth, but only the side that you saw, as usual, if you think thats worth a ban, why not just ban yourself goerg, personally I'm not that bothered either way. Its not like you've just cut me to the bone or anything :roll:

AND I still think that the solution to all our problems is an increase in taxation to provide the money for the services we (and georg) obviously need in rural and even-more-rural-than-wick areas.

[rich]

I think most people would be prepared to pay higher taxes to get better medical services. But is it really necessary? What proportion of your taxes goes to the health services; what is the priority that health for rural popululations has in the government agenda?

COuld it be that UK fiscal priorities are weighed towards the armed forces, debacles like the Millenial Dome, and trhe creation of more and more Quangos to get Westminster off the hook for providing any services at all to taxpayers?

Add to that the truly frightening incompetence of the new Scottish assembly and the future is looking dire. How many maternity units could have been provided for by the money poured into that bottomless swamp at Holyrood? Why does the Scottish assembly require this Taj Mahal?

In the wake of the economic anarchy introduced by the Thatcher government and carried on by New Labour one can only fear for Britain's "underdeveloped" regions.
Maybe the problem of distribution of health services would be made easier if people just left Caithness, abandoned it. It is clearly not an economic proposition.

[Anonymous]

I am sorry Neil or nail or nial or have you want to spell it ( George is spelt george not georg) You are quite right let the rich folk pay more tax, i think 2p on every pound extra would do the trick. I stll don't qiute get the thing about down south but it will come one day soon.
But this is getting us no where, we should be fighting to save the ward in the hospital not each other. Why not try and find out the truth of why they want to shut it in the first place, I no we must not start a panic about Dounreay?, why not also find out why all of a sudden they do not close down the one in Thurso but do it up in stead :evil .
As fae wick being rural, well thats a joke in its self [lol] .
I am not at death door thank god, i just used it for an instence ( or what ever it is ), its ok for bloke who can use fancy words to put a cross what you are trying to say. But i serpose "oh weel don't go down that one george".
So to the porrest web master in the land, I hope to have a good Christmas before its taxed out of sight, But i hope even more so, that you have a better new year and that you make some good cash, or even better still, get a grant from C.A.S.E. [lol] .
All the best Nial.
Thank you.
Sir George of Dunbeath :evil [ [evil] [lol]

[A_Usher]

Niall wrote:
"Obviously I get paid over minimum wage, the point was to illustrate how ridiculous it was to try and say that a doctor only earns 6 or 7 pounds an hour, so by the same calculation ((annual salary/365)/24=hourly wage), I get paid £1.18ish per hour."

The fact is that an inducement doctor is contracted to work 24 hours a day minus locum or other arrangement, and THEREFORE the annual payment broken down provides the hourly rate? This is FACT, so if you are disagreeing give me some facts! I can't figure out what you are implying, why is this ridiculous? Are you implying this is not this case? If so please enlighten me.

Niall also wrote:
"Otherwise, surely you're taking the same risks everyone else does in a rural area, you bank on the fact that you wont "take the coma" or be ill in another way. i wont bore you with my own condition. But yes I am glad that if I make it to the phone and call for help, someone is likely to be here in as you say, about 5 minutes. Thats exactly the reason I stay in the town, I like to have these amenities nearby and not just the medical facilities."

I would advise that people do not take risks, if they are feeling unwell that they contact the doctor. I would severely hope that Niall's statement is incorrect and people are not risking their lives.

What is worth considering is that for many it isn’t easy to move away, they may have financial commitment or family commitment, or housing elsewhere may be difficult to obtain. Are you saying that just because people live in a rural area they are to expect poorer services than you receive in a town? If so, then I find that appalling, everyone should be entitled to proper health care. What happens to the older generations within the community if medical services are reduced. What happens in 40 years for now Niall when you are in your seventies, and Caithness has seen a change, no general hospital, reduced services. Its fine for people in health to make assumptions, but what about those who require it now, and in the future. What about terminally ill patients, patients house bound?

Unfortunately this seems to be the view of many of those in administrative roles, that if you live in a rural area, then that is you choice and therefore you have to expect a reduced service. Something I find appalling, and something I hope the majority of people also find appalling. Niall is correct we are losing the younger generations, but when services such as maternity are lost, along with smaller medical practices, how much encouragement is there for young families to settle when the appropriate services are not in place. We should also remember that those in North West Sutherland are also served by Wick and their travelling is greater.

Regards,

Andrew Usher

[MrGreen]

Hi there,
Im new to the board, so be easy on me.

Been reading this post with interest, and i am very concerned about a few things.

Firstly, Mr Usher, i agree we need services, and rural docs are a must. Pay, i am not sure about as i dont know much about it, but it does sound like Niall is calling you a liar, which i dont think is fair. He is also giving a very parochial view (Niall) which doesnt seem very fair, and seems to have a chip on his shoulder on the money matter.

However what worries me most, is the fact that yell.com winner can post such a thing about london, in such a prejudiced manner. I bet you wouldnt say no to a londoners cash for advertising on your site. I have to say for a list owner to post as he is, is very, very unprofessional.

Back to Mr U, i think what he says is worrying and we should be uniting to keep services open rather than posting stupid libellous post, such as Niall is.

Regards,

Coll Green

[Anonymous]

:evil Oh dear Nail they are having ago at you, but hay guy's he an'it that bad, he tries to put over the other side of life god bless him, and he does a good job fae so little money (£1.60p an hour ) or there abouts.
Don't get things rong, i am not sticking up fae him, he is a big boy now he can do that on his own, what i am saying, "how the heck does this all stop the prats from Edinbourgh shuting a much needed ward in OUR HOSPITAL.
None of it. Do some thing right the lot of you ASK THEM WHY, ASK THEM FOR THE TRUTH.
Where are our MP's and SMP's and the euro twit ( He is off digging fae cheap petrol ), We should be fighting for what we need and now not later, as later will be to late.
Mr Usher is right to, our rural doc's need looking after as they look after us 24 / 7. But not at any cost as in the end no one will pay. I have an idea, Why not let rural Doc's take on privet pations so to make extra cash, and not as it stands now. I belive that if they do it now, then they will los the money they get from the NHS.
I am shore Mr Usher will put me right on this matter.
Its the same as putting up tax's in some ways.
Any way its coming up to Christmas eve and most of the world will not be giving a dam about out like this. Now is a time for love, peace and goodwill to one and all.
A Merry Christmas 2 you all. Where ever you are. :o)

[Anonymous]

Well George, its been a while since someone had a go.

As you say George, the poorest, na, probably not the poorest. But hey I get paid a salary, like the doctors do, on my contract, it says SALARY, not hourly wage. In every job, where I've been a salaried employee, I've never had an hourly rate, only an annual one. For that annual salary I was expected to carry out whatever work was required, putting in whatever hours it took to get it done. No such thing as overtime for salaried workers?

My beef with this whole thread is not the quality of medical care we receive, or the work that has to be done to provide it, its the way that mr usher has tried to make out that his wife only earns a minimal wage for her efforts. I object to his tabloid-taktiks and relience on innumeracy when trying to make his point.

I do not believe for one second, that anyone, doctor or no, works 24hrs a day every day all year. After a few short weeks, she would herself be in need of medical care. Also, I dont believe that on her contract it says "Hourly Wage: £7" as if it did, she would want to retain her 24hr a day work schedule. Reason, well when the working-time-directive comes into play, by her rates, she'll only make about £14-15k a year when reduced to working a 40 hour week.

I don't believe that the situation that mr usher and his wife find themselves in was a great surprise to them. Surely they knew about this even before dr usher went to medical school. Doctors get such good renumeration because of the unsocial aspects of their job, as far as I know, this arrangement goes back a long time.

My chip, has come from people who obviously earn a great deal more than I trying to make out that its not a lot of money when obviously it is. If its not enough, then do what the rest of us do, get another job. Sure, you could say the same about me, but I'm not griping about the money I make, I like my job, all and any of the 24hrs in a day that I work. But if I did want more money from the same job, I'd ask. But I would not expect any sympathy from someone who was unemployed. To them I'm sure my salary would seem pretty good and for me to complain to them how little money I get for my "hard hard week" would probably earn me a slap. So for Mr Usher not to recognise that this feeling might be present when he says that earning about 5 times my salary is some kind of pittence shows a great lack of empathy for the situations of others. I know plently people in the county who dont even earn as much as I do and know they would find his comments just as distasteful.

Obviously, in my ideal world, Dr Usher would only be working a 40 hour week, probably on a rotating shift system along with the 2 other GPs in her practice AND she would still be paid the same money. For this I would expect another chunk of time to be "on call", mabee another 40 hours of that, but with the other 2 GPs in her practice, "on call" would only be to really bad emergencys. At no point have I said that Dr Usher does not do a great deal of work and put in long hours but I do object to her husband trying to convince us that she is the only one. I'm sure her tale expects sympathy from those who do only work 40 hrs a week. But I'm also sure there are those in the county, who wish (like me sometimes) that we had a 25 or 26hr day so they could keep up with what what needs to be done.

I dont see that the maternity unit is much different, here we have a wonderful facility, that due to its geographical location, is not used 24rs day by constant streams of women having babies every 45 seconds, or whatever daft status a maternity unit has to maintain these days. So it comes down to a money calculation again. I totally agree that the service is an absolute must in a rural area like ours but I can also see that when you are given a limited budget to maintain all of these differing medical services we have, it can all get a bit tight. Thats why I think the solution is to increase tax, at least until such time as we all have the services that we need and every part of the country is covered by 24hr a day HAPPY medical staff. It seems that over the last 20 years we have moved away from actually having just that, to now having to over-justify why we might need even the slightest form of medical care. This is because the govenments have been chipping away at income tax, their greatest method of getting cash out of us and tried to dilute it with other no-so-far-reaching taxes. Whats the point of de-centralised government, when they are also trying to centralise everything else? Will the power thats handed out by de-centralisation actually have anything left to control?

To create an efficient service, I can only see that we give it whatever it needs, if its more money, then lets get it more money, if its more staff, then lets get em trained and in there. As George said how much is a life worth, to a car manufacturer, perhaps not that much, but to our government, it should be priceless.

Really though, we should be looking to our elected representatives in parliament to get this fixed, if they can't then they're really not up for the job we gave them are they? Its not like we haven't mumped to them often enough about it. :roll:

[A_Usher]

Hello again,
I am going to probably make this my last post on the subject.

Niall wrote:
"No such thing as overtime for salaried workers?"

I disagree, this statement of yours is incorrect. You may not have received overtime whilst on a salary, but I have often, for companies such as Microsoft, Scottish Telecom, Scottish Power, BT etc, and I am sure many other employees UK wide have also. As far as I am aware in employment law at time of acceptance of position your contract be it hourly rate or salaried would have outline a job description laying out the hours to be worked. It may however have stipulated that your hours may involve a shift pattern or a variance, and you may be expected to fulfil other roles. So, I hasten to disagree with you, and think if you have worked all those hours whilst salaried, you have been working for no pay when you should have.

Niall also wrote:
"My beef with this whole thread is not the quality of medical care we receive, or the work that has to be done to provide it, its the way that mr usher has tried to make out that his wife only earns a minimal wage for her efforts. I object to his tabloid-taktiks and relience on innumeracy when trying to make his point."

I never said she was unhappy, in fact if you had cared to read properly you would have seen I had posted that we were happy with the present situation. I am merely as stated above highlighting perceptions. And I do not think I am resorting to tabloid tactics, far from it, I am being honest as to the present situation in order to encourage debate. I have not provided misinformation, and have presented the facts as they stand, you merely choose not to believe them, which you are wholeheartedly allowed to do.

Nial wrote:
" I do not believe for one second, that anyone, doctor or no, works 24hrs a day every day all year. After a few short weeks, she would herself be in need of medical care. Also, I dont believe that on her contract it says "Hourly Wage: £7" as if it did, she would want to retain her 24hr a day work schedule. Reason, well when the working-time-directive comes into play, by her rates, she'll only make about £14-15k a year when reduced to working a 40 hour week. "

Again, as you seem to be missing this, despite me posting it several times, 67 inducement practices, many single handed with no partners work 24/7 except locums cover or having an associate. Many do not have an associate ,and locums when being used in areas such as Wick or elsewhere find it difficult to recruit them and therefore may work many weeks single handed without any time off. So YES they do work 24/7 on call. If you don’t believe me, why not come down and visit the practice for a chat, and we will show you a day-to-day running of it. As for the working time directive then this is going to represent huge problems for the nhs as many GP's at present are not working in line with them, and when it comes into play this will mean doctors having the option of not doing their own out of hours, which means the primary care trust resolving the issues of care out of hours. Whether this will be for the better is debatable.

Niall wrote:
"I don't believe that the situation that mr usher and his wife find themselves in was a great surprise to them. Surely they knew about this even before dr usher went to medical school. Doctors get such good renumeration because of the unsocial aspects of their job, as far as I know, this arrangement goes back a long time"

Yes my wife was well aware of the situation as a medical student and when she came to work here. In fact us coming here was primarily due to her being an associate doctor between Lybster and Dunbeath providing cover to allow the two previous doctors time off, as they where working 24/7. My point, which you have failed to see Niall, is the difficulty in getting consultants to work first on call in Wick as they may not have to do this elsewhere.

You also wrote:
My chip, has come from people who obviously earn a great deal more than I trying to make out that its not a lot of money when obviously it is. If its not enough, then do what the rest of us do, get another job. Sure, you could say the same about me, but I'm not griping about the money I make, I like my job, all and any of the 24hrs in a day that I work. But if I did want more money from the same job, I'd ask. But I would not expect any sympathy from someone who was unemployed. To them I'm sure my salary would seem pretty good and for me to complain to them how little money I get for my "hard hard week" would probably earn me a slap. So for Mr Usher not to recognise that this feeling might be present when he says that earning about 5 times my salary is some kind of pittence shows a great lack of empathy for the situations of others. I know plently people in the county who dont even earn as much as I do and know they would find his comments just as distasteful.

I can appreciate why you find the topic distasteful, like some would find your comment about London, but the fact remains as I am highlighting the present situation, and lets AGAIN consider the fact that a med student in order to become a GP eventually will place themselves with OVER 20 000 pounds worth of debt, before housing etc, so how do we encourage more graduates as at the moment we have a huge shortfall. And please present factually Niall, I never said your wage was a pittance, nor did I say I thought my wife was not getting paid enough. Honour me the courtesy of factual information as I am doing here, rather than your emotive inaccurate posting. If you are going to mention me and what I say please get it right.

Now I did a computing science/psychology degree, and have my own companies, one of them being web design and IT consultancy. I didn’t incur over 20 000 pounds of debt, nor need to train for such a long time, and my earnings are I feel proportionate to my education and subsequent training. I work out of hours, covering my wife and providing technical support. I appreciate and respect that we need med students, that they have to pay fees and loans and it is relatively highly skilled job, and dependant on their final position, be it consultant or GP their salary is reflected on responsibility and professional qualifications. This is my opinion.

Niall wrote:
"Obviously, in my ideal world, Dr Usher would only be working a 40 hour week, probably on a rotating shift system along with the 2 other GPs in her practice AND she would still be paid the same money. For this I would expect another chunk of time to be "on call", mabee another 40 hours of that, but with the other 2 GPs in her practice, "on call" would only be to really bad emergencys. At no point have I said that Dr Usher does not do a great deal of work and put in long hours but I do object to her husband trying to convince us that she is the only one."

It appears to me that you have paid absolutely no attention to what I have written; at no point did I say my wife was the only one, in fact only really mentioning her in my first post, and briefly in another. What I have been talking about, to which you seem to paying little attention to is that in general, the plights of remote and rural doctors, the lack of graduates and how things may change. You are indeed the one who has pursued the financial fact, and again in such away that does not factually represent inducement practitioners, so for one last time, Niall, as you are obviously not reading it, it is this:

Inducement practitioners were set up as essential practices to provide medical service to remote and rural areas. This means that for the single handed GP, excluding locums to cover time off, or cross cover that the practitioner will work on call 24/7. FACT.

I had hoped we could have stirred a debate rather than an emotive personalised view, and looked at what the future holds and what we can do about it. However it appears not, however if anyone has queries let me know.

A happy festive period to all,

Regards,
Andrew Usher
www.andrewusher.com

[Anonymous]

First off, my, erm, statement was a question, you may notice the question mark at the end.

QUESTION : when does your wife sleep?

QUESTION: are medical students the only students to incur this level of debt whilst at university?

QUESTION: is the issue of student fees and debt not for another thread as it effects more than just medical students?

QUESTION: where did I say that your wife was not happy?

QUESTION: what's the difference in effect when you say "£6 per hour 24 hrs a day, 365 days a year" or "£52,560 per year"?

QUESTION: why mention pay at all?

QUESTION (for MrGreen): "libellous post", where?

[A_Usher]

Niall:
Started by writing:
"First off, my, erm, statement was a question, you may notice the question mark at the end. " which was in regard to the following in a previous post.

"For that annual salary I was expected to carry out whatever work was required, putting in whatever hours it took to get it done. No such thing as overtime for salaried workers?

Applogies, however i replied an opinion to your implication, or as you would put it, erm question....

You then wrote:
"QUESTION : when does your wife sleep?"

At night, assuming its not disturbed and thing don’t go bump in the night! You got to watch out for those vampire bats you know :)

You also wrote:
"QUESTION: are medical students the only students to incur this level of debt whilst at university?"

No, never said they where, but something of interest for you is that medicine is a longer course and incurs more financial cost. I would imagine veterinary and dentistry are also at the higher end of costs. I am a big believer that everyone has the right to an education, and student fees etc concern me greatly.

You also wrote:
QUESTION: is the issue of student fees and debt not for another thread as it effects more than just medical students?

Yes, so why don’t you start a thread, I would be more than happy to contribute.

Also written:
"QUESTION: where did I say that your wife was not happy?"
You implied she was looking for sympathy.

You wrote:
QUESTION: what's the difference in effect when you say "£6 per hour 24 hrs a day, 365 days a year" or "£52,560 per year"?

None,never said it was, I said that if you are contracted to work 24/7 single handed, and you where to put an hourly rate on it, it would be £6 or £7. I also explained to you, that unlike others who get shift allowance, etc, the inducement practitioners are contracted to work 24/7. Your point is that no one permanently works, 24 hours, i.e. physically, which in the case of inducement is probably correct, however as I stated if you where to be called out 4 times in an evening, this could in effect be 5 or 6 hours, effectively making It a 24 hour day.

You wrote:
"QUESTION: why mention pay at all?"
Well its seems to entertain you and you seem to like to mention it, so why do you?I mentioned it at the start in reply to a comment made by bill, which was "This might include housing - doctors can afford quite expensive houses in high cost areas which Caithness definitely is not." But if you had properly read my post you would have seen that.
Seeing as you missed it, I posted this,

"Secondly, lets dispel the myth that Doctors get paid huge amounts of money, and can buy houses etc, etc. My wife gets paid a reasonably sum, but when you take into consideration she works 24 hours a day 7 days a week, minus time off for paid locums and cross cover her hourly rate isn't much more than £6 or £7 per hour. Not great for permanent on call and high responsibility. Urban counterparts do get paid more. There are reasons for this, too long to go into on this board."

Hopefully we will see some answers to your questions by you.

Regards to all,
Andrew Usher
www.andrewusher.com

[Anonymous]

Well it seems that we're just going to go round and round on this one.

On one side, we agree, on the other, we also agree, but arguing over the intentions of each other's post is getting us nowhere.

To end my part in this particular bit of the thread, I was a bit put out at what I percieved to be the cheapening of something I consider to be a very large salary. That aside, I agree with Mr Usher on topics concerning the coverage of medical care in rural areas. And I have to have a wee chuckle at all those who felt their only way to contribute to this thread was to have a wee dig at me.

So, I think we should make this issue and other related issues the fault of our representatives in parliament, make it known to them that if we dont get some kind of satisfaction then it'll be their neck on the block. If they can't help us then what use are they to us, lets get some new ones at the next election. I still think that we will never get out of the bit with things like this until we realise that we need to be paying in more money to the national coffers so there is more money to spend on our essential services. On a government level, you get nothing for nothing. Fair enough there may be better ways to spend the money they already have, but how many governments do we have to go through to get to someone that can balance the books and keep everyone happy at the same time. The longer it takes, the worse our situation gets and the more sacrifices we'll have to make to get back to even where we are now. why wait until things are so bad that the ONLY way to retrive things is to raise taxes by some huge amount, when at the moment, as has been said, a couple of pence on the pound would make a massive difference.

[Anonymous]

I am a pationent at Dunbeath so what i am about to say put me in mortal danger, But what the heck as all this got to do with the prats down in Edinbrough clossing our baby unit down. MONEY and thats all you two think about in the end, Money, You are well sad the both of you. Ok so i get struck off ye doc's list so what, wake lad you are both lossing the plot Its a baby unit not flipping World War 3.
Money is the root of all evil, Nail must think we are all daft to think he just sit there fae fun doing this great web sit. As fae you Mr Usher you and your good lady wife the would not be here if you where not getting a good wege.
I would Mr usher just like to ask one thing if i can, it has puzzeled me some time now, if you need some much cash then why move here in the first place?, Why not stay in the big city where you could do privet med and make millions of £££££££££££££'s.
Even you nail would make a good wege in the big city with your web skills.
( Now george you will be looking fae a new doc now as he will have you struk off fae asking why "oh well thats life) Hay Nial is there any good doc's in wick.
A Merry Christmas Boy's

[A_Usher]

Hello,
Very well put Niall.
All this Mr Usher makes me feel very old....... :)
im only 31..... (i know, an old git to some.)

So to Niall and all at caithness.org, a very merry festive period.....

Regards,

Andrew

P.S.
George, all I have to say to you is merry Christmas and happy new year when it arrives.

[Fifi]

Gents,

We are all on the same side here! Your posts have been very interesting and, in some cases enlightning, but maybe you could put your considerable knowledge to better effect by forming a committee to formulate some alternative solutions to this problem in time for any potential public consulatation. It would be quite impressive if the people of Caithness and North Sutherland were able to present a united front and some feasible ideas.

As Niall rightly said we need to be sure of our subject matter here - the question is about downgrading, not closure, so that brings a slightly different focus to the campaign.

From my personal point of view - I would like to know what would actually happen to other consultant-led services e.g. gynae clinics in the area. At the moment (well, up until 2 more consultants left) the waiting time was not unreasonable. However, the waiting time for an appointment at Raigmore is currently upwards of 6 months for a consultant! Would all women be added to this list and expected to haul themselves down to Inverness, or would we get a consultant on 'rotation' and be subject to a once a month (or less) service?

Our services seem to be slipping away by stealthy means - the ultrasound scanner at Thurso went 'out of commission' some months ago, already forcing patients through to Wick and making a 1/2 hour appointment into a 2 hour one. As another issue we maybe need to flag up all areas where our services are inadequate and all of this info needs to go to the Scottish Parliament. By the way, I think our MPs really are behind this issue and we should be supporting and communicating with them instead of flinging cheap insults at them.

[frank ward]

There is a Public Meeting in Wick at 2pm on the afternoon of Saturday 7th February, in Wick Assembly Rooms

The theme is 'Maternity Unit - which way forward?'

The meeting is organised by the Scottish Socialist Party and is an open forum.

The main speakers are JAMIE STONE MSP and CAROLYN LECKIE MSP

Invitations have also been sent to the League of Friends and the Trades Council.

The meeting has been timed at 2pm to allow full participation by those not able to attend midweek meetings.

In view of the weather forcing cancellation of the initial Action Group meeting last week, this is an ideal opportunity for such a group to be launched.

Jamie Stone (LibDems) is already known to many in the area as the local MSP. Carolyn Leckie is one of 6 socialist MSPs elected in May. A midwife, she is the SSP's spokeswoman on Health. As chair of her UNISON branch she saw union membership double and led a successful strike against the multinational Sodexho, winning substantial wage increases for hundreds of low-paid workers.

That such people of widely different political opinions are ready to share a platform on this issue is an indication of the strength of feeling.

I appeal to everyone to attend the meeting, hear suggestions and ideas for action, participate in the discussion.

Thank You

Frank Ward
SSP Caithness & Sutherland Branch
(01862 811233)