DISCLAIMER: I am not an economist, and while I talk about union matters I’m not a member of any union.  Everything that I post here is true to the best of my knowledge at this moment.

When the unions asked the ambulance crews if we wanted to sign up to AfC “Agenda for Change”, we didn’t know the terms and conditions, nor what we would be paid.  The unions (at least Unison) suggested that we sign up to the new deal sight unseen.

The official deadline for the implementation of AfC was October 2004 – but it has taken so long for our pay to be worked out, we have only just started receiving it.

Our basic pay has gone down.

In the old scheme I was paid approx £22,500, with a bonus of £2,000 due to the high cost of living in London.  I wasn’t paid more for working nights or weekends.

Now, under AfC, I am paid £19,248 as basic pay.  I have money added for living in London.  The difference is that you receive a bonus on your pay depending on how many “unsocial hours” (nights and weekends) you work.  Due to the shift pattern I am on, my bonus is 25%.  Some people who don’t work nightshifts will have 0% bonus.

I take home more pay than I did under the old scheme (although in the long run I think I am going to be worse off because of the way the AfC ‘bandings’ work)

This month we have had our pay adjusted as we should have been paid this new rate from the deadline of October 2004.

However our ‘basic pay’ has been overpaid due to the difference between what we were paid (£22,500), and what we ‘should’ have been paid (£19248)

So that has been deducted from this months paypacket (around £3020 removed from each of us, some people for arcane reasons too complicated to go into have been deducted around £2,200).  Also deducted has been the £1,000 we were ‘advance paid’ last year.

Due to our ‘bonus’ for working unsocial hours which we haven’t been paid – I have an extra £5,137 in this months paypacket – which for me, personally makes this a good month.

My additions equal £5,137

My deductions = £4,020

My bonus for this AfC is therefore £1,117 which is added to my normal pay.  I come out on top (just).

But…

If you don’t work any unsocial hours – then you would miss out on that extra £5,137 in your packet, yet will have been deducted the £3,020 because of the reduction in our basic pay.  So I’ve heard of people taking home in total less than £800 this month.  (I’ve heard rumours of someone’s paypacket being £68.)

Also we have paid tax on the £3,020 we were ‘overpaid’ – will we be getting a tax rebate?

While our pay is ‘protected’ from being lower than it was before AfC, this doesn’t seem to count for deductions due to overpayment – although some people more legally minded than me are saying that such a ‘clawback‘ of money is against the terms and conditions of AfC.  Additionally it is believed that any reclaiming of ‘overpayment’ should be discussed with the staff four months in advance, and not sprung on us when we opened this months paypacket – it should also have been arranged so that any repayment doesn’t cause ‘undue financial hardship’.

The general thought is that the LAS accounting/management team has made a huge screw-up both legally and morally, and we are hoping that there will be a big U-turn over this pay coming soon.  Some staff are seeking advice from employment lawyers, which will make the next few days ‘interesting’ so say the least.

Morale at the moment is about as low as it can go – and this will doubtless affect our ORCON times, as who wants to come in and work overtime when you feel as if the LAS has shafted you.

The unions are remaining silent at the moment, and current belief is that they have sold us road staff down the river.

Personally, I’m fuming over decisions that have scuppered so many people on the road.

Comments are, as always, welcome especially if you think I have worked things out incorrectly – but trust me, everyone in the LAS affected by this has been working things out to be the same.

 

See – I told you I could do this without swearing.  Although there is a lot of swearing in messrooms across the capital at the moment.  I’ll update you when I know more.  Also – if my basic pay has gone down, this will affect any application I make in the future for a mortgage/loan – and I couldn’t afford a mortgage on my old pay…

An EMT killed their workmate when they ‘playfully’ shocked them with a defib.

“Joshua Philip Martin was in his fourth day on the job as a rescue-squad worker in Russell County when, in a playful mood, he decided to reach into the front seat of the ambulance and zap one of his co-workers with the defibrillator paddles. The rookie's mistake was fatal.”

A horrific story, and really beyond comment.

Via Warren Ellis.

Remember when I asked you to go vote for me for the Medgadget awards?  Well I won…twice, both best Medblog, and best Literary Medblog.  Nee Naw (also London Ambulance Service) won the Best Newcomer award.  A bit of a full sweep for us London ambulance people then.  You can read about it here.

So thanks for voting for me, it’s very much appreciated.

I’ve had a couple of people send me this.

 “Nursing staff from a Telford hospital have been accused of using an ambulance as a taxi after a night out.

 It was claimed some of the nursing staff got into an ambulance outside The Swan in Ironbridge on Sunday.

The ambulance service has found a crew did provide unauthorised transport to staff but said it was not in operation and returning to base at the time.”

To be honest this tends to happen a bit.  You tell the nurse “hop in the back, we’ll give you a lift – if we get a call you’ll have to hop out again”.  It helps keep relations good between the hospitals and ourselves, and it doesn’t hurt anyone.  It definitely doesn’t remove an ambulance from service.

In fact it can do good – a crew I know was giving a nurse a life to the train station after her shift finished, they then got a call to a cardiac arrest and the nurse was able to help out.  As long as the crew weren’t refusing calls, then I can’t see the harm in it.  In London I’d imagine that our Control would love it – as it would mean we are out ‘roaming’ rather than sitting on station, something Control management are eager for us to do.

And if I’m going to spend all shift taxiing drunks around, I don’t see why we can’t sometimes help out the poor buggers who work their fingers to the bone looking after those same drunks.

I wonder if the person that complained is the sort of person who expects an ambulance to turn up seconds after they’ve cut their finger?

So… What is the new and expanded role of the ambulance service?  It’s actually one of the better ideas, but why it can’t be done by the hospitals mystifies me.  I’ll let the memo tell you.  (PRF= Patient Report Form)

Routine screening for early diagnosis of diabetes

There are over two million people in the UK who have been diagnosed as diabetic. Because of modern diet, lifestyle and the way populations are changing diabetes has become one of the UK’s fastest growing diseases – the number of diabetics is likely to double over the next five years (it is already estimated that there are about one million undiagnosed diabetics in the UK).

The majority of people with diabetes have Type 2 diabetes, which usually occurs in people over the age of 40. The older a person is, the greater their risk of developing Type 2 diabetes. Due to a complex range of factors including genetics, cultural and lifestyle differences, people from a black or minority ethnic group are at increased risk over the age of 25 and are four to five times more likely to develop Type 2 diabetes than people from white ethnic groups.

The longer diagnosis is delayed, the more chance there is that people with diabetes will go on to develop serious and life-threatening complications – kidney failure, blindness, lower limb amputation and increased risk of coronary artery disease and stroke are all potential results from undiagnosed, and therefore untreated, diabetes. Once diagnosed, diabetes is a manageable condition, and diabetics who manage their condition are better able to lead full, healthy lives.

In view of the above facts, the Department of Health’s National Service Framework for Diabetes sets out a vision for ‘fewer people developing [Type 2] diabetes.’ Part of the approach for realising this vision includes increasing the number of people who are screened for diabetes, particularly those who are more at risk.

To contribute towards this goal, whilst continuing to test the blood-glucose of patients who are known diabetics, EMTs, paramedics and ECPs should routinely test the blood-glucose levels of all patients who are:

1. • 40 years of age or over
2. • 25 to 40 years of age with one or more of the following pre-disposing factors:

1. o from a black or minority ethnic group
2. o a history of diabetes in close family (mother, father, brothers and sisters)
3. o overweight (BMI of 25-30 kg/m2 or above) with a sedentary lifestyle
4. o ischaemic heart disease, cerebro-vascular disease, other circulatory problems or hypertension

Where blood-glucose testing would not normally form part of their assessment and treatment, the patient’s consent should be sought before the test is carried out, explaining why the test is being done.

If a patient declines to consent to the test this should be recorded on the PRF. The results of the test should be recorded in the usual way on the PRF.

If the blood glucose reading is outside normal limits (above 5.6 mmol/l or below 3.0 mmol/l) in a non-diabetic patient, this information should also be passed to the receiving staff upon handover at the receiving hospital unit.

If the patient isn’t conveyed, the pink copy of the PRF should be left with them, and they should be advised to see their GP to discuss the test results. Generally, the hospital or GP will diagnose diabetes when two separate blood tests reveal blood glucose levels above 7.8 mmol/l before eating or above 10.0 mmol/l after eating.

The screening for diabetes should not take priority over assessment and treatment pertinent to the patient’s presenting condition, nor should it contribute to unnecessarily extended times on scene.

So, during our roaming around we are to check the blood sugar of pretty much all out patients to screen for diabetes.  Got a twisted ankle?  Get a free trip to hospital with added diabetes check.

It’s not a bad idea to be honest, if we can detect diabetes earlier, then we can better treat it.  But, I’m betting that we aren’t getting any extra money for this new role…  Also, given the make up of Newhams population, I’m going to be checking the blood sugar of pretty much everyone over the age of 25 I go to.  I wonder if this is why we currently have a shortage of the blood sampling needles?

As for the person who suggested that we are about to be asked to work twelve hours without a break – we already are expected to do this, we get £7.10 paid to us because we don’t get any breaks.

Later I’ll tell you about another role that we seem to have taken upon ourselves.

This weeks Grand Rounds are up at Clinical cases.  As always, some good stuff.

The honour of hosting the first Grand Rounds of 2006 has fallen to me.  Well…. actually the evil minds behind it got me drunk first.  When I said ‘yes’ I thought I was agreeing to another round of drinks.
Grand Rounds consists of mainly medical bloggers sending the links of their best post of the week to some poor sucker who has to collate them all and post them on their own blog.  It’s a great way to be introduced to some of the excellent blogs out there.  Unfortunately in this case you are going to be directed to much more interesting people than me – so please promise to come back here when you are finished…
Reading through these posts has meant I'm adding yet more blogs to my already overflowing Bloglines subscription.

Next weeks sucker host of Grand Rounds will be Clinical Cases Blog

In no particular order (and please note, some descriptions may be slightly tongue in cheek) I present this week's Grand Rounds...

Dr Charles has hallucinations while treating a patient!

Sumer asks “It can be tough being married to a doctor, but if they are a radiologist, is it tougher?”

Red State Moron comments on how difficult it must be to announce the birth of a child with a disability.

Orac has a very personal post touching on how hard it is to be medically trained, and to have a family member critically ill.

GeekNurse talks us through an unusual x-ray (and yes, I jumped to the obvious conclusion as well).

HealthConcerns has one of those interesting thoughts that comes to you at three in the morning. Her thought could also apply to medical Blogs.

Was there really a malpractice crisis?  Medpundit disagrees with the local media.

Doc around the clock plays guitar and sings then points to an article on physician musicians.

Medical Connectivity Consulting reports on GE Healthcare staking a claim on wireless networks in hospitals.

KidneyNotes expresses concern about recent news that bowel cleansing preps may cause kidney damage.  (And provides further references).

Anonymous rating of doctors, is it a good thing?  MSSP Nexus blog investigates.

Joan H. over at Oasis of Sanity tells us about the peculiar body image issues that female cancer patients should deal with, but often don’t.

Jim Hu notes an interesting idea that Proton Pump Inhibitors may aid Clostridium Difficile.

In a very scary report, Clinical Cases notes that for Doctors, speed can kill.

The Daily Rhino presents a clinical case that every medical professional must have thought about at one time or another. Vroom, vroom!

I read Medviews’ post, but being in the land of milk, honey and socialised medicine I have no idea what they are talking about.  I think it’s something about Doctors and pay.

Fixin’ Healthcare looks back on 46 years of medicine, and points out a possible future path.

The UK has just started allowing patients a choice of hospitals, Insureblog points out a problem with this ‘consumer driven healthcare’ in America.

Genetics Health points out that there are plenty of jobs in clinical genetics.

Healthcare.wurk.net meanwhile tells us about a simple way of getting the message across – comics.

Health Business Blog comments on ideas to prevent runaway spending on biotech.

This ain’t livin’ has a funny post that makes me glad that I have ‘man bits’ for my own personal undercarriage.

The pleasures of the internet include seeing how other countries deal with healthcare.  Mexico Medical Student tells us (in four posts) about Mexican community medicine (you can read the other posts easily as they are linked in his sidebar).

Diabetes Mine has good news for type 1 diabetics, it seems that all the hard work of controlling your blood sugar is well worth the effort.  She also reports on a potential new way of measuring blood sugar.

NHSBlogDoc (who seems to be turning into my nemesis, although for that to work he’ll need more flying attack robots with death-rays), well…he has a crap in his office, and it’s still there.

Dr Tony examines some testimony from a doctor who has…erm…strange views of medical practice.

Steve, over at The Eyes of an EMT, writes about the thing all us ambulance people dread – the complicated ‘late job’.

nbm at DSPS – the sleep disorder, has got me as a new regular reader – because this post rings very true to my sleep patterns.

UPDATE: You know, there are always a few people who leave it to the last minute.  Some people also forget that due to timezones and other arcane things I’m a couple of hours into their future.

So here are some late Grand Rounds submissions.

The Medical Blog Network has had a site redesign.

From Manila in the Philippines we have a detailed post on fireworks injuries.

GruntDoc has a scary report on how to spread measles to as many people as possible.

DB’s Medical Rants shows us the importance of clinical judgement.

Herbicide as cancer cure?  Interested-Participant thinks not (and so do all right-minded people).

Some stories on how to make a Christmas in hospital as special as possible from Hospital Impact.

Biotech Weblog reports on a phase one study on using stem cells for child brain injury.

Remember, next week Grand Rounds will be hosted by Clinical Cases Blog