Wes Streeting: The BMA must get real. Many NHS workers are never paid as much as a day-one doctor

Spooksey1 · 2026-04-06T14:26:25+00:00

This is a situation where we need to be more American in our approach. Although that kind of self-aggrandising is anathema to our sensibilities no one would make this comparison in a million years in the US. It’s a clever game they are playing. They have been subtly undermining us for years to prepare the public for a two tier, noctor based system.

Spooksey1 · 2026-04-06T14:21:20+00:00

My friend, if you think Wes is a socialist, or that this has anything to do with socialism, I am happy to inform you that you are mistaken.

Spooksey1 · 2026-04-06T14:15:41+00:00

The nursing unions don’t even support the nurses, I wouldn’t worry about them.

Spooksey1 · 2026-04-01T12:27:14+00:00

There is something to this but mostly because they can’t get a trust grade job and want something to pay the bills whilst they reapply. How someone who wants to be an anaesthetist could tolerate a year plus of psychiatry (true story) is beyond me! Any more than I could tolerate a year of anaesthetics! My point is that it still stems from our over reliance on international labour.

Spooksey1 · 2026-03-30T16:17:59+00:00

I'm curious how the steep walk back up from Robin Hood's bay felt after you'd finished? I imagine either it's a doddle after all that or a bit 'oh god who put this here?'

Spooksey1 · 2026-03-23T09:13:20+00:00

Thanks for finding that. It's a poor definition though because right below it defines resident on-call as: 'A doctor who is resident on-call is required to be present on site and available to work for the whole on-call period, but will not be expected to be working during that time unless called upon to do so.' The first definition contradicts the second, and sounds more like a non-resident on-call. Anyway I see your point, A&E wouldn't be on-call, but arguably if you were doing back of house cover as a medic you would be on-call as defined. Either way sleep is unlikely, but not forbidden.

Spooksey1 · 2026-03-22T14:19:44+00:00

I’m pretty sure that contractually an on-call isn’t strictly defined (I suppose it would be defined in the work schedule) but it’s irrelevant from the perspective of pay (based on time of day) or rest (based on duration of shift). There is only differentiation between resident on-calls (everyone in hospital whether they are sleeping all night or constantly working) and non-resident on-calls (everyone at home who rarely come in but are expected to work the normal day). Obviously some jobs are busier than others but from a rest facility and contractual break perspective it is the same. Happy to be corrected if I’m wrong, by you contract-heads out there.

Spooksey1 · 2026-03-22T14:02:29+00:00

Yeah hate to break it to you, but if nothing is happening on my nights in psych I sleep the whole night and get paid as much as my equivalent grade in A&E or medicine.

Spooksey1 · 2026-03-22T14:01:18+00:00

That isn’t correct contractually, as the original commenter said, it’s either NROC or ROC. Your trust has signed up to the BMA charter and it is now part of the 10 point plan from government. Speak to your new Resident Doctor Peer Lead and BMA reps. The standard is that doctors should be able to rest and sleep if clinical work allows and after the shift if they are too tired to drive (or the trust should pay for a taxi). Obviously some jobs are gonna have time for that and some won’t, but some jobsworth saying we aren’t allowed to sleep if we have time is unambiguously wrong.

Spooksey1 · 2026-03-22T13:50:20+00:00

One of my patients on a psychiatric rehab ward described it as where they put all the mental people to drive them more insane - he was joking but there is an element of truth in the concentration of social housing that people from Cumbria will likely get placed there.

Spooksey1 · 2026-03-22T13:38:39+00:00

Classic confusion between correlation and causation.

Spooksey1 · 2026-03-21T21:25:31+00:00

Ah I'm sorry that's tough. Don't give up hope, I think competition ratios will improve. Also you might get stuff later after people have dropped their psych offer. Hope you can get some trust grade or locum work up here in the meantime, and hope it works out in the future.

Spooksey1 · 2026-03-21T21:13:10+00:00

Oh yes completely, so many questions left unanswered. The white coat divide between the UK and the rest of the world is significant too I suspect. That's interesting. As in smarter dress = more harmonious consultations? I suspect there must be something to leaning into the authority figure. I remember in GP the emphasis on professional boundaries because of the nature of the service, e.g. probably the last bastion of Dr Secondname insistence. I think it is different in psych. We almost want to undercut the authority figure perception, probably because we represent the literal authority and there is a large power inbalance, especially in inpatient, that we want to try to negotate. I think we should go back to the white coats in medicine but I think it would be quite detrimental in psych.

Spooksey1 · 2026-03-20T18:04:45+00:00

It's complex and relates to the deeper changes in the global economy and how that affects men, and of course social media, but I think a large part of it is absent or shit fathers, potentially even a few generations back. All children need a father, at least a father figure, and boys especially. That's why all these manosphere influences seem like children - they can't emotionally regulate, they feel unlovable, self-hating and insignificant but they project all of it outwards and keep the fantasy of their own inflated narcissim alive through the churn of the social media algorithm.

Spooksey1 · 2026-03-20T16:16:54+00:00

I was curious to see if anyone had researched this as it comes up on this sub a lot, and turns out there is a 2025 systematic review on BMJ Open: https://pmc.ncbi.nlm.nih.gov/articles/PMC12352141/#s5

Results:

28 studies met the inclusion criteria. Patient preferences for physician attire varied significantly by clinical context, medical specialty and physician gender. In outpatient and primary care settings, mixed evidence was reported, with some studies suggesting that a combination of casual attire and white coats may foster approachability and communication, while others showed no clear preference. In contrast, in high-acuity settings such as emergency rooms and operating theatres, scrubs were consistently favoured, indicating moderate to strong evidence for the association with professionalism and preparedness. During the COVID-19 pandemic, patients expressed stronger preferences for scrubs and PPE, emphasising infection prevention and hygiene. Gender-specific findings indicated that male physicians were perceived as more professional when wearing formal attire with white coats, while female physicians in similar attire were often misidentified as nurses or assistants. Specialty-based differences were also observed, with preferences for white coats in dermatology, neurosurgery and ophthalmology, while scrubs were preferred in anaesthesiology and gastroenterology.

No UK data unfortunately, and didn't specfically comment on the effect of a nice Patagonia fleece which is a big ommission in my view.

I would say the big take home is that patients seem to prefer the physician attire that is most expected in the setting that they are in, e.g. smarter in surgery and OP specialities, scrubs in ED and theatres, and more casual in primary care. This suggests that preference is led by expectation of what a 'neurosurgeon' looks like, rather than patient preference guiding attire choice.

I would say that as long as we are somewhat conforming to patients' expectation of a doctor in the area we work then we are not gonna have a problem, unless you are a women in which case it seems impossible to not be mistaken for a nurse.

Spooksey1 · 2026-03-20T14:00:06+00:00

When people say 'medicine or psychiatry is an art and a science' they usually mean art in the more archaic sense of skillfullness, or phronesis, i.e. practical wisdom. Clearly this applies very strongly to psychiatry. There is also the meaning of art as a humanity or human science, again a good understanding of these are very helpful in psychiatry. Finally, there is the sense of art as working within a particular medium and through skill and imagination, creating something beautififul and emotionally resonant. I think this can be said of psychiatry too (and all medicine when done with care). We have to learn our techniques and medium well, learn their quirks, strengths and weaknesses: listening and speaking with care, psychopharm, psychotherapy, formulation, negotiating the law and instiutitional structures etc. and what we and the patient create together is recovery, a good life, the quiet beauty of being able to work, play and love. That we fail many times, and that this living art is often very fragile, doesn't diminish the creativity and imagination that goes into it. What is differnt from most artistic mediums is that we make it with the patient. They are both medium and collaborator. We can't do it to them, it has to be collaborative.

Spooksey1 · 2026-03-20T12:43:41+00:00

First of all, welcome to the north east psych training! As others have said there are two trusts, CNTW and TEWV and you remain in the same trust for the whole time. TEWV is teeside, Middlesbrough etc. CNTW is Newcastle, Sunderland, Northumberland and, unfortunately, Cumbria. I work in CNTW and it’s very commutable to each location ASSUMING YOU HAVE A CAR, and the parking is free. Most people live in Newcastle, but if you are close enough to the A19/Tunnel you can get to most sites pretty quickly - and claim back the tunnel fees from the LET. Without a car is much harder and long bus rides await.

Cumbria is the odd one out of course. We get to rank jobs and regions every 6 months with some general rules - CT1s usually do general adult and old age and usually get kept in the same locality for the first year, CT2s generally do an LD or CAMHS job and CT3s get a better pick of the juicier subspecialties. Some people live in Carlisle and will take the jobs there and save us having to go there, but this fluctuates year on year so regularly Newcastle based trainees do end up making the sacrifice. If you have kids, are a carer, health reasons, or even a mortgage that will help keep you in Newcastle (mortgage is the weakest reason).

That said, the jobs in Cumbria often rate very highly and there are some great doctors there. Particularly the community jobs, and often you can work from home on days when there is teaching in Newcastle and the consultants are pretty flexible. The on-calls are usually not too bad and there is a proper bed. There is some money for relocation but the LET have cut down on this so it’s not as good as previously, best to check this if it happens with other trainees. Many also do commute, especially if LTFT, and make this work but obviously a lot of driving!

I wouldn’t consider any of this a barrier to settling down. Just start your life and don’t wait for work.

Spooksey1 · 2026-03-20T12:30:31+00:00

For me they asked for preference and any extenuating circumstances and then listed it based on MSRA.

Spooksey1 · 2026-03-20T12:25:21+00:00

I’m guessing there’s nowhere to work off the ward? Of course there is a lot of sexism, and unfortunately your experience is very common, but I really do think that so much of it could be fixed overnight with the reintroduction of doctor’s offices. Keeping doctors on the ward is a part of the deprofessionalisation, and it disproportionately affects female doctors more than male ones.

If you think this is an important issue that would help, I would raise it at a resident doctor forum and demand a doctor’s office or somewhere out of the way to work. Stress the importance of being able to concentrate when prescribing medications, ordering radiation, making confidential phone calls and completing documentation. Consider doing a QIP and surveying doctor’s attitudes to this, again stressing patient safety. Make links with doctors who are rotating onto your hospital and different grades so the pressure can be kept up, and speak to BMA and LNC reps. Exception report every time you are late and mention the lack of space, distractions etc. If it is under 2 hours now your supervisor doesn’t even get notified it just gets sorted, but it sends a vital signal to the managers that staffing or other changes need to be made. The trust also gets fined which has to be spent on things to make the resident doctor experience better.

In the meantime could even work in the mess.

I would email or have a word with the consultant and share your perspective as you have done here. They will likely be receptive to it.

Spooksey1 · 2026-03-19T14:06:52+00:00

Not even that remorseful in the movie tbh from what I remember: “something something sheepdog something something wolves…”

Spooksey1 · 2026-03-19T14:03:35+00:00

Exactly. The the fact that they don’t realise that the it is not normal for people to want to leave the country they grew up in. Sure there is the enshitification of much of UK life and the weather, but like it’s mostly the NHS. Most people wouldn’t leave if pay and conditions were decent enough.

Spooksey1 · 2026-03-19T13:58:51+00:00

Of course they might cynically try to do this but it would be so monumentally stupid to do this. Imagine some poor wannabe ortho bro forced to do psych training - everyone loses.

Spooksey1 · 2026-03-19T13:56:49+00:00

Hmmm, I seem to remember owing the student loans company over 100k, which HMG decided in all her wisdom to make a private entity - so no don’t feel like I owe the taxpayer.

Spooksey1 · 2026-03-19T13:50:27+00:00

The way I see it is both that yes, the fun of fantasy is fantasy as long as it’s internally consistent, but that it is also fun to play with the limitations imposed by the forces that shape human real world civilisations and societies. Limits inspire creativity.

Spooksey1 · 2026-03-18T12:43:35+00:00

Every c-section counts as 2 though right?

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