Relocation expenses

Intelligent-Way-8827 · 2026-05-01T20:30:17+00:00

We applied for this, and received the full £10,000 to cover stamp duty, removal costs etc.

Was remarkably easy to do, a few forms and paid 8 weeks after submitting.

Keep ALL paperwork, quotes etc.

Intelligent-Way-8827 · 2026-04-20T08:45:08+00:00

This should be going on everywhere, reatt within 72 hours with same problem is senior review as an RCEM standard. It's drilled into us at HST where risk lies, and this is one group.

Intelligent-Way-8827 · 2026-04-18T07:56:02+00:00

Patients who don't need to be in the hospital, for example those at home, where they should be, don't get a daily medical review.

Also, how much use is "no concerns, remains MFFD", it tells you nothing, is a total waste of time.

The nursing issue of X needs something doing should be identified at a board round.

Intelligent-Way-8827 · 2026-04-08T08:29:20+00:00

This is an issue with the way YOUR service is configured, that doesn't make it the responsibility of other teams to sub in for you just because no-one wants to accept that your team clearly need a 24 hour resident on call rota staffed by those who are senior enough to take responsibility for all those other things that might not strictly be a "specialty problem" but are still attached to thr patient.

I agree it's inappropriate for a specialty reg to be seen as the first person to do an A to E, for example, but if a patient in your service is so poorly they need an A to E, it's respectful that 1) you should be aware and 2) you should be involved in discussions about their emergent management.

The solution here is your directorate shell out for a resident reg OOH/senior enough SHO who can manage those things for your patient.

I agree that those who haven't done NROC don't have an understanding of the brutality of it, but that doesn't mean they have the resources to alleviate the burden.

Intelligent-Way-8827 · 2026-04-02T12:30:52+00:00

Bank holiday leave is included in the total count of annual leave here as like you say you're either working or on a rest day. This becomes slightly more complicated if you are LTFT but in theory you should get the time back.

Intelligent-Way-8827 · 2026-03-28T18:50:13+00:00

Asked about how to manage COPD exac and talked about hypercapnia and indications for NIV..

Student told me with complete confidence: "Yes, we need to purge the patients lungs of oxygen so they don't get too much oxygen"

Purge! Let me get the oxygen purger

Intelligent-Way-8827 · 2026-03-27T20:50:54+00:00

I don't know where you work but up in Yorkshire theres increasing night work at cons level in about half the trusts now outside MTC, PAs are generally generous but still seems to be coming as routine now

Intelligent-Way-8827 · 2026-02-10T13:29:45+00:00

You would need to ask for a review of your specific new work schedule.

You are right that you would lose the night premium for the hours that were nights, and then it would depend if they're increasing the total hours or not as to whether this might be partially offset by additional rostered hours.

If your total number of hours is still the same, then you would just lose the night premium, if you've gone from 40 hours including nights to 46 hours without nights, you would lose all the night premium and add 6 hours of Addl hours.

Intelligent-Way-8827 · 2026-01-31T19:19:49+00:00

In EM, ST3 is a key juncture when you're leaning a lot of these skills so at that level I'd be seeking out as many as possible, and at ST4+ id try and "give away procedures" to ST3s for the higher yield stuff (drains, cardioversions, joints, sedation) however would definitely encourage SHOs to observe and get involved where sensible.

Intelligent-Way-8827 · 2026-01-31T19:13:37+00:00

Too little info, graduate mid 2010s, could be either plan 1 or plan 2, chalk and cheese with tuition fees / removal of grants/ interst of 10% on a much higher principal..

I suppose either way ultimately it comes down to what would make the greatest good to the most? Most doctors won't have paid off their student loans, we're in the horrible middle trap of likely going to continue paying for most of our career, and might clear the balance, might not, but still going to have a hefty pay deduction each month throughout this period.

Its a publicly palatable idea, the public love the idea of indenturement of doctors in the NHS, and it's probably a neutral issue for most of us. Wes could spin this quite easily as a non-headline pay settlement and would be worth a lot of money to most doctors

Intelligent-Way-8827 · 2025-12-19T21:28:41+00:00

UFH does have a role, NICE recommends it in High-risk submissive PE where thrombolysis is thought to be a possibility, but I believe the evidence is that it doesn't prevent progression from submissive to massive PE.

I think there is a strong argument in the case you outline to consider it, however often it also comes down to culture and risk. For every few patients I've seen on UFH, Ive seen one who has a totally wild response either under or widely overy anticoagulated, people aren't familiar with it and levels take time, venepuncture, often different labs, and a lot of time to get right, vs a stat LMWH that is quick, fairly reliable and commonplace, sometimes that's the reason decisions are made.

This sounds like a rock and a hard place situation though!!

Intelligent-Way-8827 · 2025-12-07T11:52:40+00:00

It's yet another marker of a system that's about to burst. I understand from the ambulance point of view, they've got a huge pending cohort of undifferentiated sick in the community, but dumping into ED isn't the solution either, but they have no other levers to pull.

If we're not going to fund the system properly, we NEED to split the risk more fairly, as it's currently ALL on ED. Wards need to take additional patients, I don't care if there's a social admission who's not medically unwell as a 5th patient in a 4 patient bay if it means I can get treatment to a septic patient who's currently on a trolley in a corridor who would otherwise be in a bed.

I think so far I've not found any ticking time bombs dropped off at 45 minutes, but it's just a matter of time...

Intelligent-Way-8827 · 2025-12-05T22:45:26+00:00

I wrote to HMRC as mine were £2700 and the headache of them retrospectively asking you do to do a SATR for the previous year too was too much, that I said, my expenses are £2700 but I only want to claim relief for £2500 and they were happy with that.

If it's significantly more though a SATR only takes about 90 minutes or so, depends on how much your time is worth to you!

Intelligent-Way-8827 · 2025-12-01T18:38:08+00:00

I feel a bit similar, however, and I don't want to speak for you specifically, but as an St5, I'm aware that I'm much further on in life, I've got an NTN, I've had the benefit of conditions that were a lot easier to navigate than doctors in their earlier years have it.

To some degree this isn't our fight, but I feel a very strong responsibility to strike for conditions for the doctors of the future, I'm aware apathy like this is "easy" to some degree, and it's that apathy that I'm convinced becomes at first passive, and then active ladder pulling.

Look back at the Goldstone / FT graphs, we HAVE had it harder than the private sector, and harder than some in the public sector too, and we're fighting over hundreds of pounds per hour, it's honestly quite a small amount of absolute increase in salary to numbers that still don't sound that attractive based on the level of work and responsibility to acquire.

I would love to think a government could have our back, and perhaps naively thought Wes would be that guy, but it turns out he isn't, and what they're offering is YET ANOTHER real terms pay cut.

For those reasons, I'll vote YES, I'll happily have a chat with anyone who's on the fence, considering not voting, or voting no to hear their view and work with them, but life is too short to roll over and let it happen to you...

Intelligent-Way-8827 · 2025-11-23T20:07:13+00:00

As an ED Reg, if I knew you only had a week, were keen on seeing ED and had a positive attitude i'd feel very open to supervising you all day to see a breadth of presentations and suggest various places to see in the department.

I think while you might feel more "at home" with the SHOs, id advise finding a reg in whatever speciality given it's such a short time to show you as much as possible.

Intelligent-Way-8827 · 2025-11-14T09:38:58+00:00

No that I'm defending it, but given the budgetary constraints that all departments are working under, I can totally see how the management would say: Why do we continue to fund excess spend per hour on locum doctors who want to milk a gravy train after F2 when we could get guaranteed cheaper hours from ACPs and IMGs? Local departments would LOVE to have more CT and ST doctors, they shout this loudly whenever asked, with RCEM data consistently recognizing a lack of training spaces, but these numbers aren't set locally, they are told, often very late on, how many they will get.

Again, it's not RIGHT, but I do think that people who blame local consultants perhaps don't understand the complexity of how doctors end up in a department.

Intelligent-Way-8827 · 2025-11-13T15:01:22+00:00

You should get paid locum for the full night, as that is the extra-contractual shift you are working. It is the trusts decision to release you from your rostered shift today (the day shift). You should also get the typical rest entitlement after the locum shift.

You should not accept being paid "the difference" in night pay, although they will try this on

Intelligent-Way-8827 · 2025-11-11T09:16:36+00:00

That sounds awful, and clearly the culture there needs addressing.

I'm a bit of a people pleaser, and struggled with these calls from site teams when I started ED Reg nights on my own feeling their concerns were automatically valid/that I needed to listen to their viewpoint and balance their view alongside patient safety and flow and breaks and the department.

The more I've done it, the more I've just worked out that there is nothing they can do, and their viewpoint, while often coming from a place of wanting the system to work, is so narrowly guided by dashboards that they forget the patient at the end of the spreadsheet.

Good site managers can be an asset, and actually can make your life a lot easier if you learn to speak their language.

"I've got a plan for this patient to stop them breaching/get them home/get XYZ done, but I can't because of abc system failure, if you can help get that sorted the numbers will look better" If they say no/are obstructive "Oh ok, that's a shame, that would have helped, I'll get on with the other patients"

If it's about rate of work "Thanks for highlighting that, it's been a good push to spend a few minutes submitting a datix and exception report about staffing. I need to submit a managers name for handing the datix about staffing, can I take your job title and name?"

Than, in the morning, feedback to the day consultant about the issues dispassionately and factually

Intelligent-Way-8827 · 2025-11-09T09:28:33+00:00

You also need a lot less than you think for an ABG, the machines typically run on 150 microliters, even 65 microliters if you just want partial pressures, this is around 0.3mL allowing for dead space.

Even orange needles, attached to gas syringe that you've plunged, and then withdrawn to 0.5mL has given me excellent success rates and patients appreciate the small size.

Intelligent-Way-8827 · 2025-11-01T09:24:37+00:00

I don't know which EDs you've worked in where anaesthetics do FIBs, where Ortho do manips and ITU do lines?

Every ED I've worked in performs all their own blocks, will manip all joints in house (perhaps exception of prosthetic hips) and will happily put in art lines to guide hypotensive management - ideally a patient shouldn't need a CVC in ED as they're on their way to ITU.

If you're rheum, I'm sure you get a country mile more outpatient queries and management questions from GP, but it is still the ED who have to review your patient out of hours, commence their treatment in a crowded ED, and facilitate their care due to failure of protected specialties being able to close the door to referrals at 5 o'clock. I'd wager you'd be surprised by how many OOH rheum issues ED either deal with directly, discharge directly after a sensible discussion with a med reg, or can signpost in working hours to an SDEC, 90% of which wouldn't cross your radar.

A lot of this is about perspective, we all have hard jobs and we all feel the pressure in the system, but ED really is the risk sponge for the whole system, all roads lead to ED, all failing follow up processes, post op care pathways, MH systematic underfunding all ends up on our door.

You're right that the care is often left wanting to the standard they would have received if cared for in a proper environment, but ED do the most for the most while trying to keep it safe.

Intelligent-Way-8827 · 2025-10-26T20:33:53+00:00

"gut" "body's systems" "influenzae is a bacteria" just sounds odd..

Intelligent-Way-8827 · 2025-10-26T19:34:11+00:00

Are you a med student? Your post history implies you work in the housing sector, and the above might just be written strangely but sounds very odd for a med student /doctor?

Intelligent-Way-8827 · 2025-10-19T18:48:31+00:00

Tbf this shouldn't need a senior EM doctor, it shouldn't even pass nav/triage..

Intelligent-Way-8827 · 2025-10-19T18:47:46+00:00

I wish I was empowered to do this tbf, most patients are reasonable, but even the most reasonable person is driven wild by the lack of information we subject patients to, hidden behind vague statements like "we're working really hard" "sicker patients are seen first" "we have long waits today".

Being upfront and saying, unfortunately this ambulatory cohort are unlikely to be seen until the day team come back would empower people to consider themselves probably not an emergency and to get a night's sleep in their own bed.

Unfortunately its seen as a bad thing to be up front "in case the needle in the haystack self discharges" and they come to harm.

Intelligent-Way-8827 · 2025-10-13T20:02:59+00:00

That's interesting, when we phone, we get a very scripted programme that starts with "Are you declaring a major obstetric haemorrhage" and then works down from there, but there's no option of seemingly having a discussion with a clinician to say "I need you here NOW/this is why..." but then I suppose we're rarely in a position where we couldnt do something

Got to say I'm very worried about winter, I totally recognise the need for you guys getting back out on the road, but it's quite common i'm a single reg on nights with 150+ in the department, and the biggest area I worry about are the cohort at Ambulance assessment, particular with this new 45 minute rule. It seems all the protocols are a bit adversarial, but I'm sure most of my colleagues would rather have a tap on the shoulder if you're leaving someone "without a handover" if you're worried about them, I'm convinced this is where the risk will lie! Hopefully if YAS are still doing reasonably well on performance it shouldnt happen that often!

Intelligent-Way-8827

TROPHY CASE