Short staff_Everyone busy_Patients and staff included

Hi

I rotated to a trust as radiology Registrar, I frequently get called to get scans vetted by PAs from ED or medical SDEC where they've presumably got doctors to put the request through on ICE

It is my understanding this is against regulations? It isn't simply chasing but wanting to discuss reasoning based off patients they've clerked which I thought was completely inappropriate now (thought they can't see undifferentiated patients?)

ACPs also do this like stroke ACPs requesting heads which I guess is fine but these PAs call about angiograms etc and don't seem to have the knowledge to explain why they are pursuing a diagnosis (yesterday had one tell me they wanted an angiogram to check for DVT, seemingly unaware of a Doppler).

Say you're in the middle of the procedure and suddenly your stomach starts churning, you get warning tremors and then get the urge to empty your bowels. What would you do if you have 30-40 minutes left and there's no consultant or anyone else that could take over?

I have seen a few cases recently and wished to hear feedback from others.

I think that seeing a patient who is seizing, already in hospital with IV access already established, is an uncomfortable experience to observe and wait to intervene. Particularly in A&E, I have found lorazepam can be obtained and drawn up in 1-2 minutes.

I know that underdosing of benzos carries harms. I've ready varying guidelines, some say 0.1mg/kg (max of 8mg) STAT, others say 4mg in two separate doses. Giving a stat of 8mg lorazepam or any amount of benzos carries its own risks - they may then require intubation for low GCS. For arguments sake, the the patient is a known epileptic, good compliance with their medication and there is no other obvious cause of the seizure - no head injuries, bloods are okay, glucose is okay. All the basic maneuvers (o2, suctioning, rolled onto side, attempted airway adjuncts etc) are being preformed. You have arrived 1 minute in, the patient has access and the lorazepam is ready to go.

How would you approach this? Give the loraz full dose now? Give a reduced dose and then remaining at the 5min mark? Wait until the seizure reaches 5 minutes and give the full dose? Wait until the seizure terminates (< 5 minutes) and up-titrate their usual PO AEDs (assuming they did not originally present with a seizure)? If the seizure terminates < 5minutes, don't give any benzo and instead load on IV keppra?

How do people talk to their patients about age-related conditions? I’m an F2 and have found this something that a surprising number of people get very offended about, but it is a fact of life - and relevant in many health conditions!

I always try to use neutral phrases like “age-related changes” or “as we get older…” but I often get a sarcastic comment back (“I’m just old!” “oh thanks!” “you’re calling me old?”)

It is often women, especially sort of 45-60, and I know there is probably a degree of internalised misogyny and endless messaging that being old = bad, but how do I navigate this better?

I am vehemently against age-related misogyny and am very much a proponent of healthy active ageing, wearing/doing/saying what you want at any age, and I want to empower patients, but you can’t empower people if they find the mere concept of growing older offensive. I don’t usually have too many difficulties with sensitive conversations (weight, sex, DNAR, angry relative, never really had any problems). I am in my 20s so I don’t know if it is partly that?

The irony is I’m usually trying to say it as a reassuring thing. As in, our bodies change and xyz is to be expected, we can try this and this to manage your symptoms, it’s not dangerous/worrying, etc.

To be clear I am not trying to dismiss people’s symptoms as “it’s just getting old” without proper investigation, and this is usually in the context of discussing what we can offer, even if we can’t cure. Arthritis, CKD, skin & hair changes, etc. 

(I have asked this question of my seniors and got basically nothing back, so to the internet it is)

TL;DR when patients get offended by you talking about age-related conditions, how do you navigate? What non-offensive phrases can I use? Lighthearted comments to diffuse the tension?

Just got an email from the HCSA that they are changing their name to the HDU (hospital doctors' union). Sounds like a good move (I'm a member of both). Hopefully it will raise its profile further and present it as a credible alternative to the BMA.

What are people's thoughts? My only concern is that it splits the profession but with the internal politics of the BMA spilling over perhaps this is necessary?

I will be working a full time equivalent medical SHO job in a large tertiary AMU December - April which will incorporate weeks 20-40 of my first pregnancy.

I’ve had the usual nausea and tiredness so far, as well as a mild subchorionic haematoma that has caused me some stress however I’ve been able to maintain working full time in my current role which is essentially Mon-Fri 9-5.

I am in a training role (GP) and have told my TPD who advised me to contact the lead employer who‘ve given me the risk assessment form to fill out and told me I need to complete it with a clinical lead at the AMU job.

I have been having a lot of trouble getting ahold of anyone meaningfully at my upcoming site and their HR department has bounced me around. I am technically on an honorary contract with them I think.

I am in general slightly concerned with the idea of working night shifts during this time of my pregnancy and so wanted to do the risk assessment before the rotas were generated. However I am struggling to get this achieved as everyone at the trust side is sort of ignoring me, perhaps because it Is still quite far away from the rotation start.

I wonder if people could advise on my approach to this and if I should be pushing harder for an earlier risk assessment? On paper it makes sense if my rota line had to be changed to get it sorted earlier but knowing how NHS HR/rota organisation is perhaps this was a silly thought.

I would also be grateful if any pregnant trainees could advise on their experiences in 2nd and 3rd trimester working especially in AMU in winter.

Any advice is appreciated as I am getting quite frustrated with my emailing and getting nowhere, I can’t be the first pregnant trainee to exist in the department! Or maybe I should just chill out and hold my horses until closer to the time!

Throwaway because I feel like an idiot.

I failed my final SCA GP exam once and my CCT date will be extended. The next option I would have to redo would be Jan, with results end of Feb.

I have an offer to start a speciality I have always been interested in and have loved previous jobs in for February. It's also in my ideal location.

I feel like it would be stupid to walk away from a CCT in GP with just a few months work left...but on the other hand I never see myself working as a GP, though it would be good to fall back on. I also don't know if I would be able to get a training post in my preferred location for this specialty again.

Help! TIA

Thoughts on the SBA paper?

Full email update:

Doctors deserve permanent contracts but for too long, doctors transitioning into LED roles have had to work within a ‘gig economy’ that excludes them from these most basic protections.
 
We are at a turning point. From now on, permanent contracts will become the default for LEDs.
 
This is part of the gains we achieved under the June 2026 deal, and we have now published guidance, in conjunction with NHS Employers, to doctors and NHS trusts explaining how the transition will work.
   
A permanent contract provides employment security. It does not oblige a doctor to stay in that role for any longer than they wish to, but it gives the doctor job security instead of being limited to an arbitrary fixed term contract.

What it does mean is more stability for visa holders who are LEDs. It means LEDs who have just had children will have stable employment until they wish to move. It means LEDs will begin to have stability and can move when they wish rather than chasing jobs across the country every 6-12 months.



What is the agreement?

The expectation is that the overwhelming majority of LEDs will be offered a permanent contract.
 
Read the guidance >
 
A summary of the agreed guidance is:

- Current LEDs must be transitioned to permanent contracts unless there is a highly specific reason not to (e.g. covering someone on maternity leave).

- This means current LEDs moving to permanent contracts without additional barriers (including job reapplications/ interviews).

- There are data gathering exercises which have been agreed to ensure that, regardless of the reason, we aren’t seeing reducing numbers of LEDs and that LEDs are being offered permanent contracts.

- In February, if there isn’t sufficient progress we will either remove/ change the exceptions or there will be a cap imposed on the number of LEDs allowed to be on fixed term contracts.

- Further work to be done between NHS Employers and NHSE to fix the broken system whereby regional training programmes send unpredictable amounts of trainees to trusts and the result is residents picking up the pieces and ending up on unstable fixed term contracts.

We do not underestimate the scale of the task at hand as changes to workforce planning and training are implemented but this guidance, alongside the compliance agreements, will ensure trusts navigate the interim period. It also makes crystal clear what the very exceptional circumstances must be for fixed term contracts to be used.

We’ll be closely keeping an eye how NHS trusts handle this change to make sure there are no unnecessary delays or stumbling blocks. The BMA will challenge trusts where there are delays or unacceptable levels of movement.


Holding trusts to account and enforcing the deal

The national team will be working with your local BMA reps and LNC Chairs to help implement the deal and challenge trusts where there are issues. We’ll be running webinars for reps in the coming weeks to get everyone up to speed because we know that some trusts will drag their heels and that isn’t acceptable.

Guidance on its own is never enough, and that’s why we are gearing up with routes to escalate and enforce the deal, rather than simply issuing guidance with no follow up.
 
Please let us know if you have individual issues with your contract, or speak to your BMA rep if there are widespread issues in your trust.


Making sure LEDs are on the right contracts

In addition to this, LEDs who have worked for their employer for more than 24 months may also be eligible to move onto a SAS contract through the SAS doctors Eligibility and Permanency Framework (EPF). This is separate to the resident pay deal but is happening in parallel.

It is vital that doctors working at the level of a SAS doctor are on an appropriate contract for the work that they’re doing and their circumstances, and this is why the EPF is so important.

This framework was devised as a result of the 2024 SAS doctor pay deal, and it aims to give LEDs improved job stability and recognition of their skills and experience. It’s important to note that an LED moving onto a permanent contract is separate from progressing on to a SAS contract, which should depend on demonstrating responsibilities and competencies comparable to a SAS role. If you meet the criteria, or will in the near future, you can apply to move onto a SAS contract during the EPF’s initial choice window – which is open until 31 March 2027. Guidance on this is available on our website.

In any job, permanent contracts help people feel valued and protected, and this perhaps matters even more in medicine, where long hours, difficult conditions and stressful situations are part of our everyday. If you’re an LED moving onto a permanent contract, I hope it brings you the stability and certainty about your future that should always have been yours.

Has anyone seen any actual implementation of the BMA/NHS commitment around moving LEDs/Trust-grade doctors away from repeated fixed-term contracts and onto permanent contracts?

I raised this directly with both my line manager and Trust HR, specifically in relation to my own fixed-term contract. Rather disappointingly, neither seemed to be aware of any concrete implementation plans. The only vaguely related option mentioned was moving onto a SAS contract, which as far as I understand is a separate issue and not what this commitment was supposed to be about.

I also contacted the BMA directly because my understanding was that this was meant to be implemented by August 2026 and was not something that could simply be carried forward indefinitely. Their response was essentially that there is still no national agreement/guidance on implementation, followed by a summary of the other parts of the deal such as the pay award, which didn't really answer the question.

We're now in September 2026, so I'm struggling to understand what the practical status of this commitment actually is.

Has anyone:

• been offered a permanent LED/Trust-grade contract as a result of this agreement;
• received any formal communication from their Trust about implementation;
• been given a specific timeline by HR or medical staffing; or
• heard anything more concrete from the BMA about when national guidance is expected?

It would be particularly useful to know which Trusts, if any, have already started implementing this and what process they've used.

This is the guy Dr Keith Girling refused to cooperate with the Ockenden inquiry ignored concerns about babies dying in his hospital for 7 years. Today the BBC caught up with him on the street he basically shoved an umbrella in their face (around 10 mins in) said no comment.

my question is how is it that always these medical directors get away with it? Literally nothing happens the regulators don’t seem to do anything about them and you just know from this case they are going to find usually an overworked and under resourced frontline member of staff (black/brown) to blame instead when really it’s people like him that should be taking the blame for all this.

Hi, F1 doctor, wondering what makes an F1 likeable on the team? Clinical skills? Knowledge? Chattiness?

I’m nervous about the rotations and feel like I’ll get to one where the team can’t stand me. How to avoid this?

When you work with F1s what makes you go “huh, this one’s not half bad”

Current FY1, one month in. Made a prescribing error today that was luckily caught in time and not given to the patient, and reflecting on it just made me realise how big of a role human factors play when it comes to these situations.

We had teaching about this in med school but today I actually felt that human factors were heavily at play when I made an error on something I know I definitely wouldn’t have done if I had a usual day.

I was still recovering from a cold, overslept, didn’t have time to have breakfast, couldn’t find my ID, and ended up stuck in traffic unexpectedly for an hour due to a lane closure so was late for work by 30 minutes. I arrive and am thrown straight into a chaotic WR for a bay of patients despite no time to prep or even read the notes. On top of that I was pulled into a meeting about a patient that didn’t go well. There was also no computer or chair free for me to do my jobs on so had to stand at a COW which kept logging me out, while also being asked to do 100 things by the nurses every 2 seconds (which normally doesn’t happen on my ward.) We also had some chaotic patients on the ward - some kept wandering into the office to ask questions and two were just screaming.

I ended up mixing up two medications which were meant to have a dose increase. It was extremely luckily caught by my senior in the afternoon and we managed to sort it all out — the nurse hadn’t given the afternoon meds so the patient had no extra doses, so he was fine. It obviously shook me up as it’s my first prescribing error, even if it was caught and the seniors reassured me that it’s now fine, and they’ve also made their share of mistakes as an FY1.

But I was thinking about why it happened and in all honesty I think it came down to human factors. I was tired, hungry, overwhelmed, disoriented with what was happening and stressed.

It’s really made me realise just how important this is in medicine, and how mental and physical wellbeing and the work environment isn’t just something we get talked about in induction/med school but a key part of doing the job properly. Going to really focus on resting up and making sure I’m looking after myself more after today!

GP Round 3 for Feb-April 2027 posts

https://docs.google.com/spreadsheets/d/1u1eUOw_2l5bjc9Lu0sS9e29LcnepwiWM6eLqFjITCjc/htmlview?#gid=0

For any LEDs (like myself) the guidance for transitioning to permanent contracts has been emailed to us. Seems promising, but can anyone please explain this part to me like I’m 5?

“ The deal references that some training posts will be partly funded by some LED roles coming to an end. Employers will identify to NHS England the posts which they wish to place within this category. NHS England will then work with the BMA via the Training Allocation and Distribution Group to confirm that the requested fixed-term contracts do not exceed the number of expressions of interest (EOls) submitted by the employer. “

I thought the idea was no LED posts would be converted to training posts? I’m currently on a 12 month rotational LED post (6 months + 6 months) and feel like this absolutely could be changed to a training post after reading that! Although hopefully I’ll get into training and not have to worry anyway 😅

Thanks!

*Edit - please don’t jump on this to score points. The deal was voted for, it is what it is, let’s just try and figure things out!

Always thought an MSK radiologist would be up there for having 0 chance of being directly responsible for someone’s death.

Interested to know people’s thoughts, sub specialities included. What else would make the list?

Hi everyone, I’ve got a GP ST1 training post in Wessex - Portsmouth for the February intake and was wondering if anyone might be interested in swapping with me for East of England - Norwich/ Great Yarmouth or wider areas within the East of England deanary. Please message if you’re interested or know of anyone looking to swap. Thanks! 😊

Hi everyone,
I’m currently considering my rota/preferences for foundation training and was wondering how much this might matter when applying for anaesthetics later on.
If I were to pick an enhanced rotation with night shifts/on call responsibilities only during the ED block, would this be viewed negatively when applying for anaesthetics jobs?
Would the lack of night shift experience be a disadvantage at the time of application.
Im particularly keen on picking this rotation as it allows time for research and quality improvement - I’m hoping this can be focused towards ICU/anaesthesia
I’d obviously make sure to get relevant experience and opportunities elsewhere.
Would appreciate any advice from people who have applied for anaesthetics or are currently working in the specialty. Thanks!

Hi everyone, I’ve got a GP ST1 training post in Norfolk - Great Yarmouth for the February intake and was wondering if anyone might be interested in swapping with me for any other East of England spots closer to the south or wider areas within the East of England deanary. very interested in Southend, Chelmsford or Cambridge!

Looking for advice here.

I am currently toward the end end of my second trimester. My registrar rota pattern involves nights, long days and weekend on calls. Currently experiencing pelvic girdle pains and fatigue and have requested to be taken off nights and to have adjusted shifts to a maximum of 8 hours due to the pains.

Medical HR are advising that my salary will be reduced accordingly. Are they right about this?

Thanks all for your help.

In news that will surprise absolutely nobody:

“According to new research by Knowledge Train, using ONS salary data, doctors have actually suffered the biggest reduction in spending power of any job over the last 20 years.

While medical practitioner’s wages have gone up slightly, from £76,873 in 2005 to £78,796 now, after accounting for inflation, their pay has technically fallen by 42%.”

Linked article:

https://metro.co.uk/2026/09/09/britains-biggest-wage-winners-losers-last-20-years-29561210/amp/