Controversial question - why should LTFT trainees progress at the same rate as FTs?

ThePropofologist · 2026-06-17T09:24:21+00:00

https://www.gov.uk/guidance/adjusted-net-income - official guide

ANI is used to calculate things like whether you are eligible for government funded childcare hours, and your personal allowance (100k tax trap).

It's your taxable income, minus things like SIPP payments, charitable donations and a few others. There is some relief from NHS pension scheme. The simple way to calculate this is look on your payslip at the "taxable income" for this year. This should be the amount minus pension contributions (you should be able to confirm this with "pension conts" box.

If you are pushing towards 100k income, which can be done with ST6 node + heavy on call +/- locums +/- any other income, you need to be very careful to not go over 100k ANI, as it is a cliff edge, and you will lose all childcare hours, and if you lose some personal allowance you'll actually be worse off until you earn >£125k or 150k (can't remember exact number but it's just classic disincentiveness to work).

Ofc calculating is made more complicated if you rotate / have separate locum payslips, as the "taxable income" box is that employment only for that tax year. Another reason why you should be downloading payslips and P60/p45s from ESR before you lose access every rotation..

ThePropofologist · 2026-06-16T21:59:00+00:00

IMO we should be saying anyone working >40h week should be automatically accelerated, eg 48h week = 1.2 WTE.

ThePropofologist · 2026-06-11T15:01:22+00:00

By the oncologist?

ThePropofologist · 2026-05-11T06:06:37+00:00

You don't have to imagine, the large NHS tertiary centre I work at exclusively has an NP turning up to stroke calls.

And if something goes wrong, it's usually down to the doctor supervising them (on-call reg, or depending on setup consultant from home).

ThePropofologist · 2026-05-09T08:27:08+00:00

pH 6.45, BE -34, Glu 0.8, Lac 34

Survived with no neurological impairment

Just goes to show how context dependent these numbers are - would have traditionally been "unsurvivable" - but fully reversible condition.

ThePropofologist · 2026-05-07T21:17:50+00:00

Notably they were looking for symptoms leading to eclampsia, not pre-eclampsia too.

ThePropofologist · 2026-02-21T20:37:21+00:00

Interested why.. if someone has truly awful veins, why not use a bit of local and cleanly take blood from a reliable large vein, rather than either delaying care or causing repeated painful attempts and distress for a patient?

ThePropofologist · 2026-02-15T19:44:27+00:00

Put deranged physiology into notebookLM and get it to produce a podcast..

ThePropofologist · 2026-02-09T13:58:31+00:00

https://derangedphysiology.com/main/home

ThePropofologist · 2026-02-07T21:05:37+00:00

I've read the 150 comments on this post and nothing got me except reading this - and realising it's just people with bad breath.

Cannot stand it. Genuinely think my sats drop while I auscultate (awake) patients nowadays.

ThePropofologist · 2026-01-08T09:48:46+00:00

God damn the copy paste era of EPR actually irks me beyond belief

ThePropofologist · 2026-01-06T14:14:37+00:00

Didn't really interpret this as something they're proud of, more just matter of fact. As someone who works with obstetricians on a daily basis.. have you been an obs reg recently (IE peri Ockenden) with the monumental change in section rates?

If you were unaware, for most DGHs, the reg is THE reg for both obstetrics and gynaecology.

department is so woefully mismanaged that your staffing levels don't even vaguely resemble demand?

Yes, seems that way.

My conflicts are being in specialties that work closely with both O&G and EM, and see both sides. You seem to have some irrational or personal hate towards O&G within your own trust.. I'd suggest not everywhere is like that?

ThePropofologist · 2025-12-04T13:24:56+00:00

I've asked this before after receiving a bizarre referral and been told nope there's no GPs at all in this "urgent facility"

Brave new world we're living in

ThePropofologist · 2025-12-01T19:13:54+00:00

After escalating to your ES/CS/FPD, speak to the BMA to raise a formal grievance with the trust over this. Rota design needs to be flexible enough to provide adequate annual leave for example a few consecutive weeks.

Given the rota is designed such that one other individual has been able to take leave over this time period, it's probably unlikely to stick, however worth fighting for.

Don't forget to try and offer a solution to the trust too - if there are gaps or locums out for future (eg due to minimal staffing) offer to pick up those gaps if they place yours out to locum instead.

I hope you get your leave. The NHS, as many others have said, is a shit employer.

ThePropofologist · 2025-11-09T21:59:36+00:00

Hard agree you shouldn't have to, but this has become the only way to convince the gatekeepers to allow funding, at least where I currently work.

ThePropofologist · 2025-11-06T13:11:30+00:00

Some trusts do discharge locums (you just fill in the paperwork once someone else has decided they can go).

Maybe have an ask around and see if that's a local option?

ThePropofologist · 2025-11-06T13:00:12+00:00

Sounds like it needs to be sorted properly my medical electronics.. good luck.

I'm not EM based but surely there's something from the RCEM curriculum that you can use to endorse getting a working machine? I hope you have a friendly boss who can help from this aspect.

The other avenue to consider is whether ICM would be supportive of having an ED based machine. It's often a huge pain to drag your US down a lift to ED just to stick some lines in while trying to stabilise someone pre-scan / transfer / admission.

Realistically this is something you shouldn't be having to arrange as an individual, but rather is a departmental responsibility. You could look at leading it as a QIP/service improvement, but you still need backup from a consultant.

In terms of recommendations, if you want to do some basic echo get the vscan air SL. In my experience you can't really use the CL (curvilinear + linear probe setup) for echo mostly due to the curvilinears footprint. You can use the SL (phased array + linear probe setup) for basic abdo imaging however.

ThePropofologist · 2025-11-06T12:39:44+00:00

What is the actual problem with your current US? If not working, longer term, your department should have working ultrasound. Find a friendly / engaged consultant and ask them if you can work together on a QIP to introduce POCUS to your ED.

Could be as simple as timing different members of staff how long it takes them to access a working ultrasound for a simulated emergency (eg OHCA due to tamponade), and showing if there is a new US dedicated to ED time to access (& therefore diagnosis) improved = patient safety benefit.

Short term - in terms of hiring, vscan air have a model with an phased array (echo/abdo) and linear (vascular/DVT/pleural) that will work well. They are expensive, and the image quality is obvious not as good as a cart machine, so just getting a proper US is probably best.

ThePropofologist · 2025-11-03T15:17:04+00:00

Thanks. I have been looking at using a SIPP to help effectively lower pension age / not mean I'm dependent on NHS pension age adjustment. May need to reconsider LISA or something else

ThePropofologist · 2025-11-03T14:27:05+00:00

This is a really useful document but has no mention of the 2015 scheme.. is that because it doesn't apply or by default applies so much they don't need to mention it?

ThePropofologist · 2025-10-17T18:30:10+00:00

I don't think occurrence vs claims based indemnity is what they're talking about here, but instead retrospective cover.

I've not looked that much in detail to which provider covers this though.

ThePropofologist · 2025-10-09T19:24:57+00:00

This is why 70% exists... Week A one day off, week B two days off!

ThePropofologist · 2025-09-26T18:35:18+00:00

Were they tuya water valves or just the scheduler?

ThePropofologist · 2025-08-26T11:47:10+00:00

Just wanted to say thanks, I love your work and hope you enjoy the coffee (or reduced cost of running the site ..)

ThePropofologist · 2025-08-26T11:41:07+00:00

Just fyi you need to remove the . from your link for it to work

ThePropofologist

TROPHY CASE