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104-520: The same structure to junior doctor grades also applied previously in the National Health Service in the UK , and informal use of the term persists there. NCHD grades in order, from most junior to most senior: In Ireland, physicians typically spend one year as an intern, before becoming a Senior House Officer (SHO). Most doctors spend between 2–4 years working as an SHO. Advancing to registrar level

208-790: A "unified medical service" can be dated back to the Minority Report of the Royal Commission on the Poor Law in 1909. Somerville Hastings , President of the Socialist Medical Association , successfully proposed a resolution at the 1934 Labour Party Conference that the party should be committed to the establishment of a State Health Service. Following the 1942 Beveridge Report 's recommendation to create "comprehensive health and rehabilitation services for prevention and cure of disease", cross-party consensus emerged on introducing

312-482: A 1% pay increase. In 2005, the average starting earnings (salary plus bonuses) for a medical graduate was £32,086. In an inflationary environment, all wage-earners, including doctors, may find the buying power of their income becomes less; some describe this as a real-terms cut in pay of 15% between 2007 and 2014. In 2019, the British Medical Association came to an agreement with NHS England to settle for

416-539: A 3.4% increase in funding every year to 2024, which would allow it to receive an extra £20bn a year in real terms funding. [dead link] There is concern that a high proportion of this money will go to service NHS debts rather than for improved patient care. In June 2018, it was reported that there were calls for the government to write off the NHS debt. Saffron Cordery of NHS Providers said that hospitals needed help to do their work without being up in deficit, as two-thirds were in

520-481: A 4 January deadline for the talks to yield an acceptable outcome, or industrial action would be announced. An agreement was not reached by this deadline, and so the BMA announced that a strike would go ahead, blaming "the government's continued failure to address resident doctors’ concerns about the need for robust contractual safeguards on safe working, and proper recognition for those working unsocial hours". The first day of

624-508: A National Health Service of some description. Conservative MP and Health Minister, Henry Willink later advanced this notion of a National Health Service in 1944 with his consultative White Paper "A National Health Service" which was circulated in full and short versions to colleagues, as well as in newsreel. When Clement Attlee 's Labour Party won the 1945 election he appointed Aneurin Bevan as Health Minister . Bevan then embarked upon what

728-755: A beneficial or neutral impact in terms of measures of patient safety, clinical outcomes and postgraduate training. The reduction in number of hours worked by resident doctors is one of the factors leading to blurring distinctions between them and other clinical professions such as nurse practitioners who also perform complex tasks. An Organisation for Economic Co-operation and Development survey in December 2015 showed that 35.4% of NHS doctors, 34,000, were born abroad compared with 5% in Italy, 10.7% in Germany and 19.5% in France. The UK

832-569: A certain subspeciality where they would take up a specialist registrar post to train as a specialist in that particular field. To qualify for these, SHOs had to be in posts approved by a regional postgraduate dean , as well as passing postgraduate exams (such as the Membership of the Royal College of Physicians , MRCP). SHO jobs typically lasted four or six months in various departments and were often provided in one- or two-year rotations. In 2002,

936-488: A comprehensive range of health services , provided without charge for residents of the United Kingdom apart from dental treatment and optical care. In England , NHS patients have to pay prescription charges ; some, such as those aged over 60, or those on certain state benefits, are exempt. Taken together, the four services in 2015–16 employed around 1.6 million people with a combined budget of £136.7 billion. In 2024,

1040-686: A contract of 40 hours per week. Salaries are increased proportionally for any extra hours worked on average per week. Any hours outside "social" hours, namely 9pm and 7am, are supplemented by a 37% enhanced rate. Weekend duty is paid as a percentage bonus, up to 10% of the basic salary for working alternate (1 in 2) weekends. Other bonuses are also available for being non-resident on-call (being not physically on site, but available to answer calls or come in to hospital if necessary), for recruitment into academia and undersubscribed specialties, and for doctors living and working in London. In 2015, NHS Employers reported

1144-541: A doctor in training you’ll earn a basic salary, plus pay for any hours over 40 per week, a 37 per cent enhancement for working nights, a weekend allowance for any work at the weekend, an availability allowance if you are required to be available on-call, and other potential pay premia. In Foundation training, you will earn a basic salary of £32,398 to £37,303 (from 1 April 2023). If you’re a doctor starting your specialist training in 2023, your basic salary will be £43,923 to £63,152. The basic salaries outlined are defined for

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1248-553: A guaranteed 2% annual pay rise until 2023. In 2023, resident doctors in England initiated their longest-ever strike, protesting against pay disparities within the National Health Service (NHS). The strike, which began on 13 July 2023, continued for five days and led to the postponement of appointments and disruptions in healthcare services. While emergency care remained accessible, patients were advised to seek alternative options for minor health concerns. The ongoing dispute revolved around

1352-514: A hospital/trust as opposed to a Deanery, where a physician is employed at a level after full registration with the GMC and before entering higher specialty training. These posts are typically referred to as "Trust SHO", "Junior Clinical Fellow" or other such terms. In the United States, physicians in training are also sometimes referred to as "senior house officers" in their later years of residency , but

1456-542: A lot of coverage in the media. The Welsh and UK governments announced a partnership on 23 September 2024 to reduce NHS waiting lists in England and Wales during the Labour Party Conference in Liverpool. This collaboration aimed to share best practices and tackle common challenges. Previously, Eluned Morgan rejected a Conservative proposal for treating Welsh patients in England. The Welsh Conservatives welcomed

1560-472: A medical degree could in 2015 expect to pay £40,000 on university tuition fees alone. Student loans are available to meet these costs, with repayment starting as soon as individuals begin working as a resident doctor. University tuition in Scotland is free for students ordinarily resident in Scotland, and grants and loans are available to help with living costs. Changes to working patterns of doctors meant there

1664-422: A nationwide basis, with doctors in London given an additional payment (£2,162 as of 2013) known as London weighting to compensate for increased cost of living. Since 2007, resident doctors have been receiving below inflation salary rises. The independent Review Body on Doctors' and Dentists' Remuneration (DDRB) takes evidence from a range of sources and makes recommendations around pay; in 2015, they recommended

1768-527: A number of "push" and "pull" factors, including seeking a better work-life balance and wanting to take advantage of other opportunities abroad. Most doctors who complete foundation training do eventually return to specialty training in the UK within three years. In 2005, postgraduate medical training was significantly changed in the Modernising Medical Careers programme. A two-year Foundation Programme

1872-479: A pension which will be based on the average of a member's pensionable earnings throughout their whole career, with a revaluation of active members benefits in line with the Consumer price index plus 1.5 per cent per annum. The 1995/2008 scheme is closed to new entrants. Since 2012, NHS Employers and the BMA had been in negotiation towards a new contract for resident doctors. These talks ran into serious problems when

1976-621: A resident doctor starts when they qualify as a medical practitioner following graduation with a Bachelor of Medicine, Bachelor of Surgery degree and start the UK Foundation Programme . It culminates in a post as a consultant , a general practitioner (GP), or becoming a SAS Doctor, such as a specialty doctor or Specialist post. The term resident doctor currently incorporates the grades of Foundation doctor , Core Trainee (in some specialties, such as surgery, medicine, and psychiatry), and Specialty registrar . Before 2007, it included

2080-509: A shift towards "Postgraduate Doctors" instead. In December 2023, then Health Secretary Victoria Atkins faced criticism for using the term "doctors in training" as an alternative to "junior doctor" in a TV interview on BBC Breakfast . This was followed by a spokesperson for the Department of Health & Social Care stating they respected the profession's decision to move away from the term "junior doctor". In September 2024, as part of

2184-449: A specialty doctor you’ll earn a basic salary of £52,530 to £82,400. If you are a specialist grade doctor you'll earn a basic salary of £83,945 to £92,275. Consultants As a consultant from 1 April 2023, you'll earn a basic salary of £93,666 to £126,281 per year, depending on the length of your service. You may apply for local Clinical Excellence Awards and national Clinical Impact Awards (previously known as Clinical Excellence Awards). This

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2288-490: A weekend. A research paper published in 2012 looked retrospectively at data from 2009; the study observed an increase in 30-day mortality for people admitted to hospital on Saturday and Sunday, compared to mid-week days. The risk of dying in a hospital on Saturday or Sunday was actually less than on a weekday. The data in the study did not enable the authors to describe the cause of this so-called weekend effect . Subsequently, there has been considerable speculation around whether

2392-406: Is a competitive process which takes into account work that you do over and above delivering your basic job requirements. In addition, if you take on extra responsibilities, for example in management or education, you may expect to be paid more. Consultants can also supplement their salary by working in private practice if they wish. The opportunities available will depend on their specialty areas and

2496-599: Is dependent on experience and aptitude within a specialty; in most cases, becoming a registrar depends primarily on having successfully passed postgraduate examinations such as MRCP/MRCS, although this is not a strict requirement. Most doctors work at registrar level for 1–3 years before being accepted onto a training programme in a particular subspecialty (e.g. Cardiology ), after which time, they are known as SpRs (Specialist Registrars). SpR programmes typically last for between 3–6 years. On completion of an SpR programme, doctors are eligible to apply for consultant positions, although

2600-409: Is dependent on the contract of employment of the resident doctor, which is for agreement locally. The Junior Doctors Terms and Conditions of Service continue to provide that if a doctor is contractually required to live in hospital accommodation no charges should be made for the accommodation provided." The NHS Careers web site states: Specialty doctors and specialist payscale If you’re working as

2704-461: Is often locally referred to as "the NHS". The original three systems were established in 1948 (NHS Wales /GIG Cymru was founded in 1969) as part of major social reforms following the Second World War . The founding principles were that services should be comprehensive, universal and free at the point of delivery—a health service based on clinical need, not ability to pay. Each service provides

2808-545: Is regardless of whether they derive a salary or wage from the organisation, or receive any type of funding or assistance from the organisation for the purposes of working overseas. This is in recognition of the fact that most missionaries would be unable to afford private health care and those working in developing countries should not effectively be penalised for their contribution to development and other work. Those who are not ordinarily resident (including British citizens who may have paid National Insurance contributions in

2912-517: The BMA , called for a strike, the first since the 1970s. The strike vote started on 5 November. In November 2015, the BMA balloted over 37,700 of their members in response to Hunt's contract proposals; 76% of eligible doctors voted, with 99.6% of doctors voting for action short of strike and 98% voting for all out strike. In November 2015, Hunt said he would offer a basic pay increase of 11% but still remove compensation for longer hours. On 19 November 2015,

3016-581: The Department of Health announced reforms in the training of newly qualified doctors under the banner of " Modernising Medical Careers ", merging the PRHO year and the first year of SHO training into a "foundation programme" (FY1 and FY2). This programme was formally introduced in August 2005. In August 2002, Professor Sir Liam Donaldson , the then Chief Medical Officer , published a report titled "Unfinished Business", which focused on reforming SHO training. The SHO grade

3120-479: The European Health Insurance Card . Those from other countries with which the UK has reciprocal arrangements also qualify for free treatment. Since 6 April 2015, non-EEA nationals who are subject to immigration control must have the immigration status of indefinite leave to remain at the time of treatment and be properly settled, to be considered ordinarily resident. People not ordinarily resident in

3224-530: The General Medical Council , because of concerns from trainees. 20 of these were analysed by the Health Service Journal in 2020. Bolton NHS Foundation Trust and Barking, Havering and Redbridge University Hospitals NHS Trust featured prominently. Reports included consultants leaving resident doctors with insufficient support, bullying, reluctance to report concerns and IT problems. It has

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3328-575: The Institute for Fiscal Studies had stated a 5% real-terms increase was needed for real change. Paul Johnson of the IFS said the 3.4% was greater than recent increases, but less than the long-term average. In July 2016, health experts said the money would "help stem further decline in the health service, but it's simply not enough to address the fundamental challenges facing the NHS, or fund essential improvements to services that are flagging." In November 2018, it

3432-482: The Office for Budget Responsibility said that "the rising trend in health and social care spending and pensions will be adding something like another £75 billion spending over the next five years, £150 billion, potentially over the next decade" as if treatments are available to keep people alive longer, then people will want them. In July 2022, The Telegraph reported that the think tank Civitas found that health spending

3536-410: The strike , a move which the BMA has condemned. In September 2015, Hunt proposed new contracts for resident doctors which would scrap overtime rates for work between 7am and 10pm on every day except Sunday while increasing their basic pay in a move that Hunt said would be cost neutral, a claim the BMA say NHS Employers have been unable to support with robust data. In response, the doctor's union,

3640-470: The 'Centre for Health Economics' at the University of York found that between 2004/05 and 2016/17 the productivity of the NHS has increased nearly two and a half times as quickly as the larger economy. Between 2010 and 2017, there was a cap of 1% on pay rises for staff continuing in the same role. Unions representing doctors, dentists, nurses and other health professionals have called on the government to end

3744-513: The EEA coming to the UK for a temporary stay of more than six months are required to pay an immigration health surcharge at the time of visa application, and will then be entitled to NHS treatment on the same basis as a resident. This includes overseas students with a visa to study at a recognised institution for six months or more, but not visitors on a tourist visa. In 2016 the surcharge was £200 per year, with exemptions and reductions in some cases. This

3848-595: The EU holding a valid European Health Insurance Card and persons from certain other countries with which the UK has reciprocal arrangements concerning health care can get emergency treatment without charge. The NHS is free at the point of use, for general practitioner (GP) and emergency treatment not including admission to hospital, to non-residents. People with the right to medical care in European Economic Area (EEA) nations are also entitled to free treatment by using

3952-448: The GP's health and that of their patients at risk. The Royal College of Physicians surveyed doctors across the UK, with two-thirds maintaining patient safety had deteriorated during the year to 2018: 80% feared they would be unable to provide safe patient care in the coming year while 84% felt that increased pressure on the NHS was demoralising the workforce. In June 2018, at a time when the NHS

4056-577: The NHS England published the NHS Long Term Plan . The Guardian reported that data for 2020 suggests a change, and that the doctors' trade union and professional association , the BMA , say this was largely due to raised spending during the pandemic and the effect of Covid on the whole economy, since the GDP of the UK dropped more than that of all other G7 nations. The BMA also said in December 2022 that

4160-400: The NHS experienced "historical underfunding and under-resourcing" during the ten years before COVID. The King's Fund maintains The investment in services started in 2021 was badly needed, but despite it restoring key services and performance standards will require years. Shortages of workers and growing staff numbers experiencing burnout and thinking of leaving the NHS may stop progress. If

4264-446: The NHS has among the lowest numbers of doctors, nurses and hospital beds per capita in the western world. In May 2018, it was said that nurses within the NHS said that patient care was compromised by the shortage of nurses and the lack of experienced nurses with the necessary qualifications. In June 2018 it was reported that the NHS performed below average in preventing deaths from cancer, strokes and heart disease. In September 2018 it

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4368-727: The NHS. The NHS is the largest employer in Europe, with one in every 25 adults in England working for the NHS. As of February 2023, NHS England employed 1.4 million staff. Nursing staff accounted for the largest cohort at more than 330,000 employees, followed by clinical support staff at 290,000, scientific and technical staff at 163,000 and doctors at 133,000. In June 2018, the Royal College of Physicians calculated that medical training places need to be increased from 7,500 to 15,000 by 2030 to take account of part-time working among other factors. At that time there were 47,800 consultants working in

4472-551: The Royal College of General Practitioners for doctors specialising in family medicine . Doctors typically may be resident doctors for 8–20 years, and this may be extended by doing research towards a higher degree, for example towards a Doctor of Philosophy or Doctor of Medicine degree. In England there are around 71,000 resident doctors. There had been controversy about the historical term "junior doctor", with many organisations and individuals voicing concern that it created misconceptions about their work and does not do justice to

4576-818: The Secretary of State for Health, Jeremy Hunt , appeared willing to impose items from the Conservative 2015 election manifesto upon resident doctors in England. On 12 January 2016, resident doctors in England took part in the first general strike across the NHS, the first such industrial action in 40 years. Emergency care was still provided. There have been claims that the Medical Director of NHS England , Professor Sir Bruce Keogh , has used performance target levels to justify and encourage NHS Trusts to declare an emergency situation, forcing resident doctors to work despite

4680-442: The UK are in general not entitled to free hospital treatment, with some exceptions such as refugees . People not ordinarily resident may be subject to an interview to establish their eligibility, which must be resolved before non-emergency treatment can commence. Patients who do not qualify for free treatment are asked to pay in advance or to sign a written undertaking to pay, except for emergency treatment. People from outside

4784-464: The UK can use the NHS without being asked to pay the full cost of the service, though NHS dentistry and optometry do have standard charges in each of the four national health services in the UK. In addition, most patients in England have to pay charges for prescriptions though some patients are exempted. Aneurin Bevan , in considering the provision of NHS services to overseas visitors wrote, in 1952, that it would be "unwise as well as mean to withhold

4888-452: The UK had increased by more than any country despite the significant drop in national income due to the COVID pandemic. The Labour Government elected in 2024 stated that their policy was that the "NHS is broken". They announced an immediate stocktake of current pressures and the reasons for them led by Labour peer Lord Ara Darzi. This was to be followed by development of a new "10 year plan" for

4992-456: The UK of which 15,700 were physicians. About 20% of consultants work less than full-time. Brexit , in 2020, was predicted to affect medical practitioners from EU countries who worked in the NHS, accounting for more than 1-in-10 doctors at the time. A 2017 survey suggested 60% of these doctors were considering leaving, with a record 17,197 EU staff leaving the NHS in 2016. The figures led to calls to reassure European workers over their future in

5096-487: The UK. A study by the Centre for Progressive Policy called for NHS trusts to become "exemplar employers" by improving social mobility and pay especially for those "trusts in poorer places where they can play a particularly large role in determining the economic wellbeing of the local population." They found the NHS to be " a middle ranking employer in comparison to other large organisations and falls short on social mobility and

5200-432: The availability of consultants was a factor. The authors of the paper have also openly criticised the conclusions drawn by the government and popular media on the paper, saying that to draw such conclusions as to associated decreased weekend staffing levels to increased mortality at 30 days post-admission would be "rash and misleading". Health Education England produces reports on NHS trusts under “enhanced monitoring” by

5304-628: The average starting salary of resident doctors was the third-highest of all graduate starting salaries, after dentistry and chemical engineering. In 2016, it was reported that after 10 years of employment, medicine graduates had the highest salary of all degrees. Research conducted in December 2014 showed that across a range of other jobs, almost a third of graduate programmes at Britain's best known and leading employers paid starting salaries of more than £35,000; however, 83% of these leading employers reported that they were recruiting for jobs in London where salaries are higher, whereas NHS salaries are set on

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5408-542: The cap on health service pay, claiming the cap is damaging the health service and damaging patient care. In 2017, the pay rise was likely to be below the level of inflation and to mean a real-terms pay cut. In 2017, the House of Commons Library research predicted that that real-terms NHS funding per head was to fall in 2018–19, and stay the same for two years afterwards. In January 2018, The Guardian reported that GPs faced excessive workloads throughout Britain and that this put

5512-493: The commissioning of hospital services for the community 2) salaried GPs who are employees of independent contractor practices or directly employed by primary care organisations. From 1 April 2023, the pay range for salaried GPs is £68,975 to £104,085. Resident doctors may pay into the NHS Pension Scheme , which from April 2015 has been a Career Average Revalued Earnings (CARE) scheme. The 2015 scheme involves paying towards

5616-618: The demand for a 35% pay increase to address below-inflation salary increments over the past 15 years. The impact on patient care, NHS costs, and waiting list reduction was a matter of significant concern. Doctors pay professional annual fees to maintain registration with the General Medical Council and medical indemnity cover. Resident doctors also incur costs associated with training courses, preparing for and sitting exams and college membership; training can be associated with £420-£3,000 of professional fees annually, depending on stage of training and level of income. English students embarking on

5720-592: The department is making 4,000 training positions available for GPs every year, which help create an extra 50 million appointments annually. In 2023, a report revealed that NHS staff had faced over 20,000 sexual misconduct from patients from 2017 to 2022 across 212 NHS Trusts. Some of the claims included rape, sexual harassment, stalking, and sexualised remarks at staff from patients. In the report, female staff members were told by hospitals to continue caring for patients even after there were issues regarding abuse or harassment without further safeguards in place. Other parts of

5824-507: The first of many controversies over changes to the NHS throughout its history. From its earliest days, the cultural history of the NHS has shown its place in British society reflected and debated in film, TV, cartoons and literature. The NHS had a prominent slot during the 2012 London Summer Olympics opening ceremony directed by Danny Boyle , being described as "the institution which more than any other unites our nation". Everyone living in

5928-656: The free service from the visitor to Britain. How do we distinguish a visitor from anybody else? Are British citizens to carry means of identification everywhere to prove that they are not visitors? For if the sheep are to be separated from the goats both must be classified. What began as an attempt to keep the Health Service for ourselves would end by being a nuisance to everybody." The provision of free treatment to non-UK-residents, formerly interpreted liberally, has been increasingly restricted, with new overseas visitor hospital charging regulations introduced in 2015. Citizens of

6032-413: The government and BMA, Hunt withdrew his threat to impose a new contract without agreement, and the strike action that had been planned for December was suspended. The first day of strike action was called off hours before it was due to start (too late to avoid some disruption), with later days suspended. On 24 December 2015, Dr Johann Malawana , leader of the BMA's junior doctors committee (JDC), gave

6136-663: The government, the NHS and the British Medical Association (BMA) agreed a package of measures on working hours, pay and conditions which was called the New Deal for Junior Doctors . The Doctors' duty hours, which were felt to be excessive, were reduced to a maximum average of 56 hours actual work and 72 hours on call duty per week, although the change was not enforced until 1 December 2000. The European Working Time Directive (EWTD) sets out minimum health and safety requirements for

6240-530: The grades of Pre-registration house officer , Senior house officer and Specialist registrar . During this time, resident doctors will do postgraduate examinations to become members of a Medical royal college relevant to the specialty in which they are training, for example Membership of the Royal College of Physicians for doctors specialising in Internal medicine , Membership of the Royal College of Surgeons for doctors specialising in surgery or Membership of

6344-559: The majority opt to undertake 1–2 years of fellowship training – often abroad – prior to appointment at consultant level. Since the introduction of Modernising Medical Careers (MMC), grades in the UK differ from those in the Republic of Ireland. Before MMC, physicians applied for SHO posts after completing their mandatory pre-registration house officer (PRHO) year after qualifying from medical school . They would typically work as an SHO for 2–3 years, or occasionally longer, before going on to

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6448-696: The needs of everyone, that it be free at the point of delivery, and that it be based on clinical need, not ability to pay. Three years after the founding of the NHS, Bevan resigned from the Labour government in opposition to the introduction of charges for the provision of dentures, dentists, and glasses ; resigning in support was fellow minister and future Prime Minister Harold Wilson . The following year, Winston Churchill 's Conservative government introduced prescription fees. However, Wilson's government abolished them in 1965; they were later re-introduced but with exemptions for those on low income. These charges were

6552-451: The new funding is to be efficiently used the NHS will need a comprehensive and fully funded workforce strategy to ensure future supply of staff. In March 2022, Rishi Sunak doubled the annual efficiency target for the NHS in England. The 2.2 per cent target would deliver annual savings of saving of £4.75 billion. At the same time the additional Covid funding is being removed in 2022–23. At the same time Sir Charles Bean , recently leader of

6656-583: The new partnership as overdue, while Plaid Cymru criticized it as insufficient for addressing deeper issues within the Welsh NHS. There was a concern that a disorderly Brexit might have compromised patients' access to vital medicines. In February 2018, many medical organisations planned for a worst-case Brexit scenario because "time is running out" for a transition deal to follow the UK's formal exit that occurred in March 2019. Pharmaceutical organisations working with

6760-467: The number of GPs has fallen by 1,622. Some family doctors have 2,500 patients each, forcing patients to attend A&E instead. Certain regions have fewer than 50 GPs per 100,000 people, while other regions have more than 70, presenting a challenge to the NHS's founding principle of equal treatment. A growing number of family doctors are reporting unsustainable workloads, and many have chosen to work part-time. A Health and Social Care spokesperson said that

6864-527: The official historian of the NHS, Charles Webster , called an "audacious campaign" to take charge of the form the NHS finally took. Bevan's National Health Service was proposed in Westminster legislation for England and Wales from 1946 and Scotland from 1947, and the Northern Ireland Parliament 's Public Health Services Act 1947. NHS Wales was split from NHS (England) in 1969 when control

6968-437: The organisation of working time. The EWTD required the average working week to fall to 48 hours or less by 2009. The shortening of resident doctors' working hours had implications for how training programmes are organised, especially for specialties such as surgery, where there was a tradition of maximising the hours of experience. Most studies that have looked at a reduction of resident doctors working hours have found either

7072-420: The past) are liable to charges for services. There are some other categories of people who are exempt from the residence requirements such as specific government workers and those in the armed forces stationed overseas. In 2016, the systems were 98.8% funded from general taxation and National Insurance contributions, plus small amounts from patient charges for some services. As of 2016, about 10% of GDP

7176-530: The patients. In wards which had not closed staff sometimes worked under stress due to staff shortages. It was also predicted then, that Brexit was likely to aggravate those problems. In November 2019, it was reported that due to the shortage of nurses the NHS was then relying on less qualified staff like healthcare assistants and nursing associates. For the period between 2010 and 2018 the Health Foundation funded research by Birmingham University said there

7280-425: The personal relationship between doctor and patient. Conservative MPs voted in favour of their amendment to Bevan's Bill to maintain local control and ownership of hospitals and against Bevan's plan for national ownership of all hospitals. The Labour government defeated Conservative amendments and went ahead with the NHS as it remains today; a single large national organisation (with devolved equivalents) which forced

7384-516: The power to withdraw trainees from trusts but this was only used once since the start of 2019. National Health Service The National Health Service ( NHS ) is the umbrella term for the publicly funded healthcare systems of the United Kingdom , comprising the NHS in England, NHS Scotland and NHS Wales . Health and Social Care in Northern Ireland was created separately and

7488-448: The real Living Wage", and ranked trusts using a 'good employer index'. Ambulance trusts were ranked worst. On 6 June 2022, The Guardian said that a survey of more than 20,000 frontline staff by the nursing trade union and professional body, the Royal College of Nursing , found that only a quarter of shifts had the planned number of registered nurses on duty. The NHS is facing a shortage of general practitioners . From 2015 to 2022,

7592-419: The remaining 20% split between buildings, equipment, training costs, medical equipment, catering and cleaning. Nearly 80% of the total budget is distributed by local trusts in line with the particular health priorities in their areas. When the NHS was launched in 1948 it had a budget of £437 million (equivalent to £20.07 billion in 2023). In 2016–2017, the budget was £122.5 billion. In 1955/56 health spending

7696-437: The report showed that staff were pressured into not reporting grievances. In June 2023, the delayed NHS Long term Workforce Plan was announced, set up to train more doctors and nurses and create new roles within the health service. In 2024, multiple NHS hospitals started mandating radiographers to ask all male patients aged 12 to 55 if they were pregnant. This policy was instated as part of an 'inclusivity' drive and received

7800-479: The result of the BMA strike ballot was announced, with more than 99% in favour of industrial action short of a strike, and 98% voting for full strike action. Hunt said the strike was "very disappointing", but declined the appeal for arbitration. He was criticized for failing to answer MP's questions about the strike, with his deputy claiming he was too busy preparing for the strike. Hunt eventually agreed to discussions overseen by Acas . After five days of talks between

7904-476: The settling of a long-running pay dispute, it was announced that the term "junior doctor" would be changed to "resident doctor" within the NHS from Wednesday 18th September 2024 onwards. In Europe and the US, there has been some reduction of the working hours of doctors who are in postgraduate training, in line with recommendations and legislation aimed at improving patient safety and doctors’ working conditions. In 1991,

8008-486: The skills and experience acquired by these doctors, many of whom have been working for several years. The British Medical Association (BMA) voted to discontinue the term “junior doctor” from all forms of communication at their 2023 Annual Representative Meeting (ARM). The motion was presented to the BMA Representative Body by Dr Sai Pillarisetti, a Foundation Year Doctor. After a debate and vote of members, it

8112-693: The strike went ahead on 12 January. Resident doctors again withdrew their labour for routine care on 10 February 2016, leading to the cancellation of around 3,000 elective operations. In a case involving University Hospitals of Derby and Burton NHS Foundation Trust in July 2019, the Court of Appeal decided that the trust had breached the 2002 contract for resident doctors because their hours and rest periods had been underestimated by commercial software over some years. The case will affect other NHS employers and substantial arrears will be due. The period in August where there

8216-523: The term is more variable in its American than its European usage. Specializing post-graduate clinical students are still referred to as Senior House Officers in many other countries around the world, most of which were British colonies and adopted the British education system like Uganda. Junior doctor Within the National Health Service , resident doctors (previously known as junior doctors ) are qualified medical practitioners working whilst engaged in postgraduate training. The period of being

8320-431: The time they wish to spend on this outside of their NHS contracted hours. General practitioners There are two contractual options for GPs. They can be: 1) independent contractors who are in charge of running their own practices as business either alone or in partnerships. They have autonomy in how services are delivered according to their contract with NHS England. In England, these GPs have increasing responsibility for

8424-468: The total annual earnings for foundation doctors in England averaged just over £36,000. While the basic starting salary for doctors in specialty training was £30,002, NHS Employers were reporting that average earnings in this group of doctors was nearly £53,000. In 2013, graduates who had studied medicine or dentistry were the most likely to be employed and had the highest average gross annual pay when compared to graduates who studied other subjects. In 2015,

8528-590: The total health sector workforce across the United Kingdom was 1,499,368 making it the seventh largest employer and second largest non-military public organisation in the world. When purchasing consumables such as medications, the four healthcare services have significant market power that influences the global price, typically keeping prices lower. A small number of products are procured jointly through contracts shared between services. Several other countries directly rely on Britain's assessments for their own decisions on state-financed drug reimbursements. Calls for

8632-431: The transfer of ownership of hospitals from local authorities and charities to the new NHS. Bevan's principle of ownership with no private sector involvement has since been diluted, with later Labour governments implementing large scale financing arrangements with private builders in private finance initiatives and joint ventures. At its launch by Bevan on 5 July 1948 it had at its heart three core principles: That it meet

8736-413: The year to 2018. It was also said that some expressed doubt over whether May could carry out this proposed increase in funding. The next day, Health Secretary Jeremy Hunt backed the extra £20bn annual increase in NHS funding and responded to criticism by stating that taxation would be used to carry out the funding and that details would be revealed at the next budget. In June 2018 it was reported that

8840-450: Was 11.2% of the public services budget. In 2015/16 it was 29.7%. This equates to an average rise in spending over the full 60-year period of about 4% a year once inflation has been taken into account. Under the Blair government spending levels increased by around 6% a year on average. Between 2010 and 2017 spending growth was constrained to just over 1% a year. A 2019 report said that a study by

8944-575: Was a large changeover of hospital staff has sometimes been dubbed the "killing season" (due to a perception that there is an associated rise in the number of patient deaths). In 2009, research looking at emergency admissions to hospitals in England established that a small but statistically significant increase in patient mortality occurred during August. The limited data was collected retrospectively over an 8-year period, comparing two week-long blocks (one week prior to commencement, one week post commencement). The methodology meant that drawing firm conclusions

9048-402: Was abolished and renamed specialty registrar . This change took place in 2007. Amongst the many changes, many doctors who had completed their Foundation Training were now appointed into a "run-through" training programme that incorporated the previous SHO and specialist registrar grades. The job title changed from "SHO" to "ST1/ST2" (specialist trainee year 1 & year 2). Part of this decision

9152-417: Was born out of the ideal that healthcare should be available to all, regardless of wealth. Although being freely accessible regardless of wealth maintained Henry Willink 's principle of free healthcare for all, Conservative MPs were in favour of maintaining local administration of the NHS through existing arrangements with local authorities fearing that an NHS which owned hospitals on a national scale would lose

9256-576: Was costing about £10,000 per household in the UK. This, they said, reflected the third highest share of GDP of any nation in Europe. This was said to show that the UK "has one of the most costly health systems – and some of the worst outcomes". The findings were made before the government increased health spending significantly, with a 1.25% increase in National Insurance , in April 2022. Civitas said this showed evidence "runaway" spending as health spending in

9360-473: Was increased to £400 in 2018. The discounted rate for students and those on the Youth Mobility Scheme will increase from £150 to £300. From 15 January 2007, anyone who is working outside the UK as a missionary for an organisation with its principal place of business in the UK is fully exempt from NHS charges for services that would normally be provided free of charge to those resident in the UK. This

9464-543: Was insufficient and falling NHS capital spending that put patient care and put staff productivity at risk. The Health Foundation said that £3.5 billion more a year would be required to get capital spending to the OECD average. Spending limits were effecting service efficiency, and patient care. Shortages of equipment and equipment failures had an impact as did relying on ageing diagnostic equipment. In 2018, British Prime Minister Theresa May announced that NHS in England would receive

9568-602: Was introduced for newly qualified doctors, the number of years of postgraduate training changed in some specialties, and doctors needed to decide which specialty to follow sooner after graduation. There were later initiatives to engage resident doctors in NHS leadership; resident doctors are seen as essential to the drives to achieve efficiency savings in the NHS since 2010. 1 year total time in training: 4 years total time in training: 5 years total time in training: minimum 7 — 9 years total time in training: 8 — 10 years* The NHS Careers web site stated in 2023: As

9672-537: Was no longer a requirement for first year resident doctors to be resident, and from 2008 free accommodation was no longer provided by employers. The British Medical Association said that this amounted to a £4,800 annual pay cut for those who might have previously lived at the hospital rather than independently, but the numbers of doctors involved was not clear. Ann Keen , Labour Parliamentary Under-Secretary for Health Services, stated, "The provision of free accommodation for foundation year 1 doctors who are on call at night,

9776-423: Was passed in full and made BMA policy. References to junior doctors in BMA policies and communications are due to change to 'resident doctors' from September 2024. An independent report for Health Education England (HEE) authored by Prof Scarlett McNally found more than 75% of those surveyed found the term "junior doctor" inappropriate, and almost half thought "trainee" should be avoided. The report recommended

9880-678: Was passed to the Secretary of State for Wales . According to one history of the NHS, "In some respects the war had made things easier. In anticipation of massive air raid casualties, the Emergency Medical Service had brought the country's municipal and voluntary hospitals into one umbrella organisation, showing that a national hospital service was possible." Webster wrote in 2002 that "the Luftwaffe achieved in months what had defeated politicians and planners for at least two decades." The NHS

9984-551: Was reported that Cancer Research UK maintained that more NHS cancer personnel were needed to enable the UK to catch up The NHS in England was expanding early diagnosis services with the goal of increasing the proportion of cancers diagnosed early (at stages 1 and 2) from 53% to 75% in the decade to 2028. In September 2018, it was reported that the NHS was the first health service in Europe to negotiate coverage for novel CAR-T cancer therapy, with agreement reached within 10 days of its European marketing authorisation. On 7 January 2019,

10088-507: Was reported that death rates from breast cancer were falling faster in Britain than in any other of the six largest countries in Europe, and were estimated then to have improved beyond the European average. In October 2018, according to Breast Cancer Care , 72% of NHS trusts across the UK did not provide dedicated specialist nurses for patients with incurable breast cancer." In September 2019 it

10192-479: Was reported that staff shortages at histology departments were delaying diagnosis and start of treatment for cancer patients. In England and Scotland cancer wards and children's wards have to close because the hospital cannot attract sufficient qualified doctors and nurses to run the wards safely. In November 2018 it was reported that cancer patients and child patients were having to travel very long distances to get treatment and their relatives had to travel far to visit

10296-475: Was short of doctors, foreign doctors were forced to leave the UK due to visa restrictions. A study reported in November 2018 found that a fifth of doctors had faced bullying from seniors in the previous year due to pressure at work. In May 2018 it was reported that the NHS was under-resourced compared to health provisions in other developed nations. A King's Fund study of OECD data from 21 nations, revealed that

10400-432: Was spent on health and was the most spent in the public sector. In 2019, the UK spent roughly 10.2% of GDP on healthcare compared to 11.7% in Germany and 11.1% in France. The money to pay for the NHS comes directly from taxation. The 2008/09 budget roughly equated to a contribution of £1,980 per person in the UK. Some 60% of the NHS budget is used to pay staff. A further 20% pays for pharmaceuticals and other supplies, with

10504-590: Was subsequently reversed in a number of specialties, with competitive entry into the registrar grade ("uncoupled training"), and in these specialties the SHO level posts are referred to as "CT1/CT2" (core trainee year 1 & year 2) and in some "CT3". Some hospitals use the term senior house officer in an unofficial capacity for physicians in FY2 and CT1/2 year, who often have similar working patterns in duty shift rotas. The term still applies to non training posts, those organised by

10608-643: Was the second highest exporter of doctors, second only to Germany, with 17,000 British doctors working in other OECD countries. These figures are for all doctors in the NHS, not just resident doctors. According to the Career Destination Report published by the UK Foundation Programme Office in 2019, an increasing number of UK resident doctors are seeking to take up work abroad. A report by the General Medical Council described

10712-494: Was thought that inflation may erode the real value of this funding increase. As part of the 2018 funding increase the UK Government asked the NHS in England to produce a 10-year plan as to how this funding would be used. In September 2019, it was reported that cancer survival rates in the UK had been rising fast but probably still lagged behind the best results internationally, mainly because of late diagnosis. In March 2019 it

10816-405: Was unwise with correlation not implying causation. In the month when resident doctors start working, when other factors are adjusted for, patients had a 6% increase in mortality. For patients admitted as an emergency who were not requiring surgery or suffering from cancer, the mortality rate increased by 7.86%. Other concerns have been raised regarding mortality following admission to hospital at

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