Animesh Singh
@DrAnimeshSingh
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Rheumatology & General Medicine | views my own
London
Joined February 2017
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Consultant 1 - leaves in Aug for pharma
Consultant 2 - leaves in Oct for pharma
Consultant 3 - leaves in Aug for Ireland
Consultant 4 - left in March for Dubai
Consultant 5 - left in Jan for ME
Consultant 6 - left in June for Canada
Just in rheumatology in 2023
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Do we have 4 x as many ICU nurses and doctors?
Hospitals in England now have four times as many ventilators compared to when the pandemic started.
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General Practice has delivered ~ 50million of the 66million COVID19 vaccines administered so far.
It is a phenomenal achievement
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10.5 hours into my acute medical consultant shift, haven’t come across a single patient who would have avoided admission with a GP appointment.
Cc:
@FraserNelson
@spectator
Lots of sick people who could be better served by more resourcing across health and social care however
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Consultant colleague in Ireland -earning 2 x nhs consultant wage
In Canada -earning 3 x nhs wage
In Dubai -earning 3 x nhs wage tax free
In Sydney-earning 3 x nhs wage
NHS consultant pay is no longer competitive. Need to see reverse of 35% cuts over 15 years
#ConsultantsStrike
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Another junior doctor quitting medicine and the NHS to pursue a non medical career. Seeing incredibly talented Drs leaving all too frequently now… pay, being treated like cannon fodder, inflexible rotas… staffing crisis is only going to get worse.
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My wife’s GP practice in Hammersmith & Fulham have vaccinated > 20,000 patients. They are vaccinating upto 500 patients/day and have done for > 40 days.
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& another rheumatology consultant leaving the NHS
One of the best of my cohort of consultants
Signing on the dotted line with a non NHS employer
75% uplift in pay for a shorter working week
‘The NHS has become toxic & I value my family & my mental health’ her departing words
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#NHS
STAFF ON THE FRONTLINE NEED TO BE VACCINATED ASAP
Those of us who are seeing sick and undifferentiated patients in A&E and on the wards need to be vaccinated as a priority.
@MattHancock
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Consultant colleague, leaving for non NHS UK employer - they hired someone to find her a new house, sort out all the utilities, find a new nursery for child, & a golden handshake that will buy her a new Tesla (although that comes w job already)
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Today a patient’s relative (also registered) attacked the practice manager at my wife’s GP practice.
Police called etc… & no serious physical injuries
But…
This is a direct result of the constant vitriol being thrown at GPs by the usual suspects.
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Thanks
Asked what unique skills they bring to the MDT & the question went unanswered.
My phone flooded with juniors and consultants thanking me for asking this question
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@Dienekes_
Join the club, lived here for 33 years, wife, father both GPs, all of us can be stripped of British citizenship & made stateless.
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0 out of 16 F2s I have spoken to are entering specialist training in the UK. 25% off to Auz/NZ, 25% have non-medical jobs & 50% are doing F3/locum
Not surprising given how they have been treated both by those in charge of ‘training’ (HEE, GMC, colleges) & those in charge of pay
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The IMT resident doctor diagnosed an overnight admission with HLH
So smart & impressive
Very much part of the reason why we need to support our trainees and promote excellence rather than diluting the medical workforce
#RCPEGM
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Just to be clear:
my bank will be closed,
my son’s school will be closed,
my son’s nursery will be closed
and hospitals will be running an emergency service only
Why single out GPs?
GPs allowed to close on day of Queen Elizabeth II's funeral
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We have fewer doctors (and nurses, hospital beds, scanners…) than any comparable OECD nation.
It’s no wonder that after a decade of underinvestment the NHS is struggling.
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Doing a rheumatology clinic in secondary care this morning - a mix of face to face & phone/video consults.
My GP wife is doing exactly the same at her surgery - mix of F2F & phone appointments.
Demand >> supply across the NHS. It’s not the fault of GPs or frontline staff.
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Now do it for consultants & junior doctors
MPs pay is lower this year than it was in 2010, in real terms.
Had MP salaries kept up with inflation, they would today be at £96,650. Instead they are £10,000 less than that.
Literally no one acknowledges this.
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Just anecdotes but the current
#JuniorDoctorsStrike
have pushed 4 FY2 Drs I’ve recently spoken to who had training numbers to take up alternative offers from Auz and NZ.
We are losing doctors from the NHS faster than ever.
Blame
@RishiSunak
@Jeremy_Hunt
&
@SteveBarclay
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A zoology degree has no relevance to the practice of medicine
Please stop describing PA studies as ‘a 2 year intensive course in medicine’
PAs who have subsequently actually studied MBBS say it’s very different
@medicalmodelbri
@parthaskar
Maybe not. But you cannot deny their value to multidisciplinary practice. The PAs are educated. Have a first degree in a science plus a two year intensive course in medicine. Show some respect!
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Hi Allison, as a medical consultant in London whose been on call this week admitting patients, your numbers are wildly incorrect.
@JamesWard73
@LucyGoBag
James, you have no idea what you’re talking about.
70% of London Covid inpatients are not in hospital for Covid.
They test positive after admission for other ailments.
Only one third of “Covid patients” are being treated for Covid.
Get better data!
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Disappointing letter in The Times today. No other university graduate has a period of bonded labour for tax payer subsidised degrees. & part time GP is a full time job. Carrot approach usually works better than a stick.
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A subset of
#MedTwitter
love to criticise my friend
@doctor_oxford
but I wonder if they have ever been able to hold the Govt to account as brilliantly as she did tonight on
@bbcquestiontime
#bbcqt
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A lot of criticism regarding GP access but it needs to be directed at the Govt & not frontline GPs. There simply aren’t enough doctors or practice staff available to meet current demand. We were promised 5000 extra GPs by previous SoS but never materialised.
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Dear
@bbclaurak
this nonsense should have been challenged by you.
The PM says consultants and SAS doctors have settled their pay disputes. This is incorrect.
We’ve put the Government’s offer to our members and they’ll now decide. We’re deeply disappointed the Government hasn’t made a credible offer we can also put to junior doctors.
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Another substantive NHS consultant Rheumatologist quitting and moving abroad.
That’s 6 in North Thames that I can count in the last few years who have either moved abroad or moved into pharma.
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Yeah when I go into the City on Xmas day or at 4am, it is absolutely filled with lawyers and bankers working away
@DrAnimeshSingh
Higher working hours in medicine? The hours in law and banking are far higher then in med
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Childcare costs for junior doctors are significantly higher than other groups due to shift work and nights/long days. We had a nanny but required my wife’s entire post tax income.
When we have children, I tell you what his salary will probably be the only reason why I can afford to return to work with the expensive childcare costs.
Not everyone has a partner to help. Or not every couple can.
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@doctor_oxford
I lived away from my wife and kids for 3 months & spent Xmas alone as worried about bringing Covid home from medical/Covid take.
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And…
Another consultant rheumatologist leaving London to permanently work in the Middle East.
2 to pharma, 2 to Middle East, 1 to Canada, 1 to Ireland, 1 left NHS early for pure private.
And that’s just the last 6 months & colleagues that I know.
& another rheumatology consultant leaving the NHS
One of the best of my cohort of consultants
Signing on the dotted line with a non NHS employer
75% uplift in pay for a shorter working week
‘The NHS has become toxic & I value my family & my mental health’ her departing words
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The amount of 2ndry care dumping that my wife in general practice has to deal with is unbelievable.
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Post CCT upper GI surgeon.Where is he going -Geneva for his consultant post
Post CCT respiratory physician.Where is he now?Australia & loving life
Both would have made excellent consultants in the NHS but opportunities are so much better in other healthcare systems & industries
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M B B S via G-E-M
Can we create a course to lift PAs to a medical degree standard. Need educationalists to fix this. They broke it.
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Aren’t staff already able to do WLI / bank work?
They don’t because:
- rate of pay is poor
- extra £ would trigger punitive taxation (loss of childcare/PA etc)
- they want to spend time with family
- they are burnt out from covid & day job
NHS staff already work weekends.
Labour will pay staff overtime for extra shifts at evenings and weekends to cut waiting lists.
It’s already working in a handful of hospitals. We need it to happen across the nation.
It will cost £1.1 billion, paid direct into staff’s pockets.
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Not going to work.
Any offer from
@SteveBarclay
&
@RishiSunak
needs to be credible and reverse the decade long pay cuts junior doctors have put up with while their working conditions have also deteriorated.
#JuniorDoctorsStrike
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@MarcusRashford
You are allowed to be successful & do more than your fair share for causes you believe in.
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The new BMA consultant contract has pay starting at £100K and going to £132K after 14 years of being a consultant (& likely ~ 24-30 years as a Dr).
Meanwhile in City legal services…. 🙄
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My wife’s ‘half day’ of general practice started at 08:45 & ended at 16:45 including a 10min lunch break.
Primary care is busier than ever. Govt gets incredible value out of GP partners.
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So a registrar in Auz gets ~ £7K after tax per month.
This is far higher than a UK consultant on the highest point of the salary scale.
#JuniorDoctorsStrike
So here’s a payslip from when I worked in 🇦🇺 recently as a registrar (full-time, public). Note this was my FORTNIGHTLY pay. This govt has no idea what good value for money we are in the NHS. This is what our skills are worth elsewhere
#PayRestorationNow
#JuniorDoctorsStrike
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& as I come to the end of my 12.5 hour shift on call - which as usual was excellent - I am yet to see the mythical beast - the patient who waited hours for a bed, whose admission could’ve been avoided by a GP appointment.
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Patients can’t see GPs
GPs can’t find work
Make it make sense
@VictoriaAtkins
It’s really worrying. I’m in a phase of moving to a new area and needing to find work and so the current situation is markedly apparent to me. There is little work to no work advertised in Manchester even for salaried GPs, from my own research and also from hearing tales of
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Staff at Trust A have full access to
#CovidVaccine
,Trust B there is limited access & no access at Trust C
Yet we are all looking after the same types of patient & taking personal risk
Why is there no parity in vaccine access across the
#nhs
for frontline staff?
@MattHancock
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Removal of stitches is not part of standard GMS2 GP contract.
It is for whoever put in the stitches to organise the removal & not just dump more unfunded work onto general practice.
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@alastairmiller3
What was your debt when leaving university? Was it zero?
How much rent did you pay as a house officer? Was it zero?
What was the ratio between your salary and the first house you bought?
As someone who is semi-retired,how does your pension on 95 scheme compare 2 2015 scheme
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This is excellent news for Australia, NZ and Canada
exc
@theipaper
Jeremy Hunt is poised to fund thousands more medical school places under long-awaited NHS workforce plan.
NHS had hoped it would coincide with Budget but now likely to be later this month.
Story:
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And yet, if someone graduates from a Russell Group university & goes to work in the City or in law, a £45K starting salary w no experience would be very common
@ClaaareKirwan
Despite a gross lack of experience… which counts the most… as you may well know, irrespective of sector.
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.
@NickTriggle
your BBC article is incorrect. Junior doctors are not asking for full pay restoration in one go.
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Rheumatology clinic - mix of Face to face and phone appointments.
Just like my wife’s GP clinic.
@sajidjavid
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Yep
Wages down by 35% since I signed up
Glad you agree that is unfair & needs to be reversed
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If you don’t pay junior doctors or consultants properly, you won’t have any front line services left.
🔴 Bowing to striking doctors’ calls for a bigger pay rise could result in cuts to frontline services, a senior minister has warned
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Dear FRCP colleagues
The vote is out
Please vote FOR motions 1-5
#RCPEGM
You will be voting for high quality patient care & supporting our trainees who are the next gen of consultants & GPs
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Think a big part of why > 18mil people have had (Atleast) 1 dose of vaccine is the brilliance of UK primary care.
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NHS salary is not remotely competitive for either consultants or junior doctors.
Top end talent is heavily being poached by industry who recognise their skills & are willing to pay the market rate
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Just a reminder that waiting lists have gone up relentlessly during the last 13 years of a Conservative Govt. They were 7 million and rising before and strike action
Nearly 900,000 appointments have been cancelled due to strike action.
I fear the BMA’s hard-line stance and threat of indefinite action means this number will only keep rising. (2/4)
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And another consultant colleague - gone. Despite having done basic and higher medical training in the UK, is moving back to Delhi, somewhere he hasn’t lived for 20+ years. Describes working in the NHS as ‘toxic’ & will get better QoL and pay in India.
So…
Two more consultant rheumatologists leaving the NHS to work in global pharma roles.
Unless T&C and pay for both junior doctors and consultants is rapidly fixed, the NHS will continue to lose its best & brightest staff.
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Hang on. Which other taxpayer subsidised degree has mandatory indentured labour?
@BMA_JuniorDocs
So we funded your very expensive training & you’re off 🤔
Time to bring in a mandatory 10 year stint in the NHS I think.
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Truly
What is this generalist nonsense?
To be a generalist is the hardest job in medicine.
You are the ultimate risk assessor.
And generalism doesn’t come from a 2 year PA degree I’m afraid.
Another PA who thinks prescribing is an inevitable consequence of regulation and that they have "all the necessary training" to work in any specialty.
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When general practice fails , the whole NHS will fail.
And at the moment general practice is being failed by
@sajidjavid
&
@BorisJohnson
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My wife’s ‘part-time’ GP hours are more than most people’s full time hours.
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@Jeremy_Hunt
@LondonMarathon
@RSCharity
You literally hold the pursestrings for being able to fund NHS cancer care to what patients in Western Europe routinely get.
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Doctors should have GMC, indemnity and courses & exams (& costs associated) paid by their employer.
The difference between the NHS & private employers is stark.
Consultant colleagues in Auz get AUD$20K study budget. In the NHS we get £400-800.
I thought it might be interesting to compare the position for Drs with that of lawyers, the majority of whom work in the private sector. I have used my experience, but it may differ for others.
1. Exam fees: now around £1800 + VAT. The firm I trained with paid. Free.
🧵
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@SAH_Rowan
@MPritchardUK
1. Why is it not okay to work part time? What’s wrong with having a life outside of work and managing other commitments. 2. My wife is a part time GP. Her part time hours are more than most full time jobs.
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Now do it for A level students entering university with 4 A*s and also account for higher working hours in medicine
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A year 1 ICU consultant in NZ earns £60K more than a year 1 ICU consultant in the UK.
Not including the ~ £10K of study leave budget (compared to £4-800) in the UK.
Add all this together and the total salary of a first year ICU specialist under all the T&Cs above is NZ$$283,959 or GBP148,339.
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@ShaunLintern
A PA is a specialist & my largely autonomous ST7 medical spr who runs the hospital overnight is still a ‘junior’…
🤦🏽♂️
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My wife’s ‘1/2 day morning’ in GP on Friday finished at 5pm. Her ‘part time’ hours are more than most full time jobs.
@DrShanHussain
I'm sorry I respect GPs and the work you do but seriously you don't know youre born. Most GPS I know work part time because they get paid so much they don't need to work full time hours plus you have autonomy. Work in a call centre then tell me about brutal
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PS
The pay from her new employer is a 100% uplift from NHS 11 PA consultant pay.
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@jonsopel
Completely agree. There is a real disconnect between what the public think our junior doctors are paid and what they actually receive. Especially when you contrast with other anglophone nations + much higher costs associated w training, bigger student loan & moving every year.
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Issuing med3s (sick notes) for patients requiring to be off work for > 7days has been 2ndry care contractual responsibility since atleast 2016. If your department doesn’t have med3s & sees patients who work, speak to your managers & get some. Not fair or appropriate to dump on GP
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Our rheum SpRs learn from rheum CNS
I know diabetes SpRs learn from diabetes CNS
I learn weekly from biologics pharmacist
But supervision & mentoring …
Should be led & delivered by senior doctors
But what they really mean is non-doctors educating, supervising, training and mentoring doctors.
I am absolutely not averse to other members of the MDT being involved in post-grad teaching and training. Groovy! Should be more of it.
But supervising and mentoring??
5/
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@Doc_IonaCollins
Legend. & great to see white coats back in action. Always think removal of white coats was more about de-professionalising of doctors rather than anything to do with infection control.
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Oh
And another one going going gone…
This time to pharma
£40K higher starting salary than nhs consultant, car parking(!), flex working and being treated as a valued employee
Another substantive NHS consultant Rheumatologist quitting and moving abroad.
That’s 6 in North Thames that I can count in the last few years who have either moved abroad or moved into pharma.
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No don’t think so. Very different academic standard for getting into medical school v PA training.
@drpoco
Basically as the same level as a third year med student... which is their level of training
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The attack on general practice by the Govt,MPs & the right wing press is just malignant.Rather than tackling the problem -funding,resourcing,workload,pension rules-this sustained attack will result in the collapse of practices in some areas & the local NHS
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@BBCHughPym
Bma remain open to negotiating and have written repeatedly to the PM and SoS for health.
The govt and DHSC are refusing to negotiate. They haven’t spoken to the BMA in > 100 days
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@SteveBarclay
‘When are you cutting down your hours’ - a very common question among my peer group of relatively new NHS consultants due to punitive AA taxation.
@Jeremy_Hunt
recognised it when chair of HSC although hasn’t moved to fix the problem now he holds the pursestrings.
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@SteveBarclay
Give it up Steve.
Sit down and negotiate with the BMA who are the voice of doctors in the UK.
Move to restore pay for juniors and consultants to 2008 equivalent levels & improve their T&Cs. Scrap the bottlenecks in training. Provide basics like food, parking & rest facilities.
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@DrEilidhMaria
CEO doesn’t know what they are talking about.
Fully support our (junior) doctors in taking strike action and push for FPR.
And yes, they have a multitude of very valid grievances - pay, training, bottlenecks, scope-creep etc that all need addressing.
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Looking up and down my
@TfL
overland train. Less than 25% mask wearing , no enforcement (ever seen). Even those wearing masks have them as chin supports. Good luck London because this winter will be grim with Covid.
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You literally created this problem when SoS for health.
My last die in the ditch attempt to get the government to see the need to train more doctors and nurses
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Another consultant leaving the NHS.
Just like
@ClinOncDoc
& many others I have seen.
No surprise. International demand for HCPs & other nations willing to pay a fair salary to talented Drs & offer better working conditions.
@VictoriaAtkins
11. Personally I'm done. I'm worn out with emergency work, which uses up so much time it compromises my ability to deliver a decent speciality outpatient service.
So I am leaving the NHS. I have taken a job outside the UK where I will be only be doing my speciality. With regret
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Speaking to a MSK radiology consultant yesterday, 50% of radiologists in his department have left.
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@ameliagentleman
I would dispute this statement. Implies that doctors were involved in deciding re: overseas status which is not something I have ever seen.
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Sorry but this is fundamentally wrong.
The patients in A&E waiting > 12 hours for admission are sick complicated multimorbid patients - I look after them day in day out on the medical take.
Their problems are not manageable through a 10min GP appointment.
….lack of in-person GP appointments are fuelling a crisis in A&E….
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Would beg to differ
Given the current bottlenecks in training
& the much bigger bang for your buck you get with doctors v advanced practitioners.
With current resources, doctors alone cannot meet the needs of service demand and complexity placed on us.
This results in worse outcomes, rising waiting lists, dissatisfaction, moral injury, and burnout.
It cannot continue.
4/
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Which shows
The biggest bang for your buck will always come from consultants & GPs.
It means prioritising our resident Drs in training & expansion of artificial bottlenecks in both SpR & consultant posts.
@Burnt2020
Any serious bleeds involving an unstable patient is consultant led and done in theatre, where we receive valuable support from you guys.
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So…
Two more consultant rheumatologists leaving the NHS to work in global pharma roles.
Unless T&C and pay for both junior doctors and consultants is rapidly fixed, the NHS will continue to lose its best & brightest staff.
Oh
And another one going going gone…
This time to pharma
£40K higher starting salary than nhs consultant, car parking(!), flex working and being treated as a valued employee
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@dr_nigel_lane
@TheBMA
Nigel , I think it is sensible to listen to legitimate concerns from the next gen of consultants & GPs about lack of training , pay and progression rather than just dismissing. Bma motions reflect this.
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& yet membership is at record levels & the mandate for strike action is stronger than ever. Bma is representing the views of shop floor doctors.
Perhaps it’s time for the Govt to negotiate with the BMA?
As I said yesterday, the BMA is destroying the reputation of all doctors. Doctors need to leave it before it sinks them all.
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Always blows me away when we have near-death HLH patients coming back to clinic a few weeks later looking & feeling back to normal.
Has been a steep learning curve over last 4 years but really think we have transformed care & survival for these patients.
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@iDrSunny
@BenMearns
@sashnhs
@RCPhysicians
See you at the EGM Ben.
Medicine is brilliant.
Unless you are the F1 on the ward left doing TTOs & cannulas while the PA who was sold as assisting you is in theatre assisting & paid more than you despite you doing nights & being more qualified.
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The fallout from
#COVID19
is being seen on the medical take everyday: lots of advanced/ delayed cancer, lots of mental health & self harm problems... I don’t see how ‘normal service’ can resume when we have such a backlog of work with such poor resourcing + burnt out staff.
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