Chapter 17. Working in the UK
THE NEW POST
Preparation
Shadowing
Most hospitals run ‘shadowing’ schemes for incoming pre-registration doctors. These may now also include aspects of what was covered previously during the hospital ‘induction programme’. If your hospital does not run such a programme, ask if you can visit the ward informally and speak to the team working there. Introduce yourself to the current junior doctors and nursing staff and ask:
• when are the ward rounds and what are you expected to do?
• is there a phlebotomist, what hours do they work and where should requests be left?
• where can you find needles, venous cannulae and blood culture bottles?
• where are forms kept: drug and fluid prescription sheets, consent forms, death certificates and any forms used to refer to other departments?
• how can ECGs, radiographs and emergency procedures, e.g. endoscopy or theatre, be arranged out of hours?
• what are the pharmacy opening hours; when should discharge prescriptions be completed; how can you contact a pharmacist during and out of hours; where is the hospital drug formulary kept; are there any specific drug nomograms or policies?
• what should be put on any ward notice boards or charts that show patient details, e.g. is any system or colour used to code different types of patient, and who is expected to update the details?
• do any of the consultants have any specific ‘do’s and don’ts’, e.g. specific drugs or tests they prefer to be used?
• when you are on-call, who takes the calls from GPs and, if it is you, is there anyone or any place you are expected to notify about incoming admissions?
• where are rotas kept and how do you know which member of senior staff to contact for help during the day and out of hours and how is this done routinely?
• are there any rules around how or when certain staff are contacted out of hours?
• how do you contact or refer to other departments?
• where can you get something to eat (especially out of hours)?
• when and for how long can you take breaks and are you supposed to tell someone when you go for one?
• where is the library and when/where are any departmental teaching, audit and X-ray meetings held?
Professional organizations
Register with a Medical Defence Organization (e.g. MDU, MPS, MDDUS). The BMA can be useful for advice regarding rotas and working regulations.
Outside work
If you are moving into a new area, sort out your accommodation early and do not rely on hospital accommodation, as many hospitals no longer provide this. Register with a local GP and a dentist. Plan your route to work to avoid being late on your first day and check what transport is available for the end of later shifts.
Rota
Check if your rota is available and if you are scheduled to work out of hours in the first few days. If you are planning any leave, contact the rota coordinator ahead and, ideally before you book it, to see whether this is possible (see ‘Leave’, p. 461).
First day
Turning up
• be on time: remember that you need to park the car, find the ward, get your belongings organized and may even want a cup of coffee before really starting work
• bring a stethoscope, pens, a note-pad, (money to buy) your lunch, qualification documents, GMC certificate and any professionally related health certificates, e.g. hepatitis status
• wear something appropriate and smart avoiding exposed mid-rifts, excessive jewellery, jeans or tops bearing obvious logos; women should also avoid short skirts, low-cut tops and high heels.
Induction
The ‘hospital induction programme’ can run over the first couple of days. Some hospitals may already have covered much of this during ‘shadowing’.
Check that you have passwords for the relevant hospital systems. Check how your pager works and note any guidance given on using the labs (including blood transfusion), radiology and pharmacy departments. Make yourself aware of the fire procedures.
Someone from your department should introduce you to the staff with whom you will be working, departmental policies and procedures and your educational supervisor. You may be expected to attend Occupational Health for a check-up and/or verification of any vaccination certificates.
On the wards
Take the time to introduce yourself to the nursing staff, pharmacists, physiotherapists. Listen to their advice and be courteous. Your reputation in your hospital matters and news of it quickly spreads from ward to ward. Adopting an ‘I’m the doctor and I’m in charge’ attitude never helps and will only upset experienced staff, regardless of whether you think you are correct (and you will probably, in fact, be wrong). The more you get a reputation for being pleasant, readily contactable, prompt and helpful in your responses, conscientious, sensible and concerned about your patients, the more other staff will go out of their way to help you with the tasks you have to do.
Colleagues
Get to know your colleagues early: you will all be subject to the same pressures and can be of enormous support to each other. Try to find time to have coffee or lunch breaks together and, if possible, organize an early night out so that everyone can get to know each other.
FINANCE
Money coming in
Payslips and expenses
Your net salary will be paid to you after all necessary deductions have been made from your gross salary by your employer, e.g. tax, pension contributions, NI, student loan repayments, charges for accommodation or telephone. It is your responsibility to check that the calculations are correct. It is worth noting:
• at the start of your employment you may be on an emergency tax code and what you are receiving net may need to be adjusted later
• deaneries and trusts often have time limits within which expenses can be claimed and maximum rates for mileage between two specific points or for accommodation as part of meetings; check the policy, make sure you claim what you can, but do not assume everything you claim will be paid
• if you are part-time, the slip will often show what the WTE (whole time equivalent) salary is for your grade and the average hours you are contracted to do on which your pay is calculated
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