Stories from the meeting
Tuesday 1 July
Smith applauded for outstanding BMA service
Former BMA medical academic staff committee chairman Colin Smith received a standing ovation for his tireless work for the association over more than 25 years.
Dr Smith, who stepped down last month after 19 years as MASC chairman – making him the longest-serving chairman of any BMA craft – was personally thanked by outgoing council chairman Ian Bogle for his invaluable help and advice.
(Source: BMA News)
Tuition fee plan will deter poor students, ARM is warned
By Lisa Pritchard, BMA News
The prevalent elitism in medicine will not be tackled if government proposals for higher education are passed unopposed, medical students and academics have warned.
The Future of Higher Education white paper proposes to allow universities to charge students tuition fees of up to £3,000 per year and even more after 2009.
BMA medical students committee chairman Jennie Ciechan said the cost of a medical degree would be £15,000 ‘before a student even thinks about paying their living expenses, the cost of transport or buying any textbooks or equipment’.
Edinburgh University student Ben Carrick said fear of debt already put off many school-leavers who would be even more likely to choose shorter courses with well-paid jobs at the end if the proposals were introduced.
MSC joint deputy chairman Liz Kingston pointed out that the people who would be most deterred were the very people needed to ensure doctors were more representative of the communities they serve – those from lower socio-economic backgrounds.
Teaching and research should not be split, doctors warn
By Lisa Pritchard, BMA News
Controversial proposals to separate teaching and research within universities would spell ‘the end of medical education as we know it,’ doctors have warned.
The suggestions have been made in the government’s white paper The Future of Higher Education and by Sir Gareth Roberts’ report on reforming the research assessment exercise.
Former BMA medical academic staff committee chairman Colin Smith said to lose the valuable dual contribution of research and teaching in UK universities would be ‘a tragedy’.
BMA Welsh MASC chairman Iain Robbé said: ‘It is a policy marker from the BMA that we want to see universities continue to do research and teaching to promote good links to the evidence-based practice that helps us provide the best care for patients.’
(Source: BMA News)
‘VAT on fat’ call rejected
Doctors have rejected proposals for ‘VAT on fat’ as a way of tackling the UK’s obesity epidemic.
Liverpool GP Martin Breach suggested that a health tax should be introduced on saturated fats and other unhealthy food constituents such as sugar and the proceeds should be used to reduce the cost of healthy alternatives to ensure people from lower incomes were not unduly penalised.
But Kent consultant chemical pathologist Ian Bailey said it was ‘another nanny state proposal’.
(Source: BMA News)
SARS? DIY says NHS
Information about dealing with SARS was so inadequate Hampshire GPs were told to visit their local B&Q for protective clothing, doctors heard this week.
Hampshire GP John Dracass called for rapid and detailed plans of action relating to nuclear, biological and chemical war agents and public health emergencies such as epidemic infections to be communicated to the profession.
(Source: BMA News)
Hand washing target worth supporting, doctors agree
Simple cost-effective measures such as hand washing and the use of alcohol hand gel after patient contact to reduce the risk of infection transmission won doctors’ backing.
London consultant and honorary senior lecturer in occupational medicine Paul Grime said such a proposal should be supported because it was ‘a clinically based initiative, not a political target’.
(Source: BMA News)
GMC lay members transparency call
The BMA should clarify urgently the process by which GMC lay member vacancies are filled, doctors agreed. They said the election of medical members was transparent but on the issue of lay members, they called for information on where and by when advertisements are placed, by whom applicants are vetted, who they purport to represent and by whom they are appointed.
(Source: BMA News)
Study time vital, doctors agree
All NHS contracts in primary and secondary care should include specified and funded time for education and professional development, doctors said. GP negotiator Laurence Buckman said all doctors needed to keep their skills up-to-date and they needed the time and money to do so. Doctors also urged the BMA to seek to abolish the widespread disparity of allocation of study leave for senior hospital doctors between trusts and said annual allocation should be allowed to accumulate for three years.
(Source: BMA News)
Flexible training crisis worsens NHS doctor shortage
By Lisa Pritchard, BMA News
Flexible training is in crisis because of the government’s refusal to fund it properly – despite its vital role in meeting NHS Plan targets, doctors agreed.
Southampton GP Alex Freeman said it was ridiculous that doctors were ‘ready, willing and able to be trained’ but were being left with the choice of training full time or not training at all.
She added: ‘Doctors are sitting in a queue, waiting for funding to be trained at a time of doctor shortages. There needs to be a comprehensive review of the funding to ensure enough money goes into the system.’
Would-be flexible trainee Simon Minkoff, who has a chronic illness, said North Thames Deanery told him he was a suitable candidate for flexible training. He added: ‘But in the next breath the flexible training dean told me while I was eligible there was no funding. So I am now in limbo. This inadequate system must change.’
Belfast senior house officer in anaesthesia Brian Foster condemned the way some employers coerce flexible trainees into increasing their session because of the financial difficulties.
Yorkshire GP registrar Rosario Vega-Munoz said flexible training was one way the government could increase the number of fully trained doctors on the ground.
Support call for suspended doctors
By John Weaver, BMA News
Doctors say they deplore the increasing misuse of suspension and the damage it causes.
They called for a committee to be created to make recommendations on the issue and for the creation of a peer support group to tackle existing inadequate support.
Cardiff associate specialist in clinical genetics and GP locum Jane Fenton-May said: ‘We should look at this issue more seriously and make sure there is a mechanism for giving these doctors support. Suspension ruins lives, not just those of doctors but of their families.’
She said sometimes doctors were found not to have done anything wrong and were not told what they were being suspended for.
She added that lives were at risk unless action was taken, adding that doctors had committed suicide.
Racist doctors should be struck off, ARM agrees
Racist doctors should face charges of serious professional misconduct to tackle endemic discrimination in the NHS, doctors agreed.
Cambridge University medical student Francis Sansbury said the BMA report Racism in the medical profession: the experience of UK graduates had discovered racism was ‘manifest in access to training and careers and norms of acceptable behaviour’.
He said if a case of racism was proven, ‘the profession would have the option of removing the racists within itself’.
Medical schools should also incorporate anti-racism education as part of their core curriculum, doctors agreed.
University of East Anglia medical student Leigh Bissett said doctors should be dealing with racism at a ‘preventative and professional’ level. He said although medical school curricula were ‘already jam-packed’, space had to be found for anti-racism education.
BMA Welsh medical academic staff committee chairman Iain Robbé said the attitudes medical students and doctors should have were covered in the GMC’s Tomorrow’s Doctors.
(Source: BMA News)
Consultants and SAS picking up juniors work as EWTD deadline looms, ARM hears
By Lisa Pritchard, BMA News
The clinical and administrative burden on doctors other than juniors is already escalating ahead of next year’s European Working Time Directive deadline, doctors heard.
More medical work must be done in less time and the extra workload is largely being transferred to consultants and staff and associate specialist doctors, even though they are also supposed to be working European-limited hours.
Doctors at this week’s annual representative meeting supported the work being done on the EWTD by the BMA junior doctors committee and called for adequate resources to absorb the additional workload.
They also stressed the importance of not delaying the EWTD’s implementation.
Belfast consultant anaesthetist Steve Austin said: ‘This is health and safety legislation. Everyone else in work has this protection.
‘A safe doctor means safe patients. Working long hours without controls is not safe.’
Doctors pledge support for consultants in bid for new contract
By Mike Foster, BMA News
Doctors have united in support of consultants in their bid for a new contract, saying they will support seniors in requesting whatever action necessary should talks with the government fail.
As negotiators prepared for a meeting with health secretary John Reid, doctors at the BMA annual representative meeting in Torquay also said they regretted the impasse in delivering a new contract and recognised consultants’ anger at the delay.
Consultants said they were buoyed by conciliatory statements by Mr Reid, but warned that it was vital the government changed its ‘control freak’ tendencies and showed a willingness to renegotiate.
BMA central consultants and specialists committee chairman Paul Miller said: ‘We are the modernisers, the reformers of patient services. We are described as militants, threatening industrial action. We are not.
‘We are the defenders of the doctor-patient relationship. We are the independent professional view of the NHS. We are the advocates of patients.
‘So strongly do we hold these values that we have left £133m of pay unclaimed because we believe some aspects of the framework threatened those values.’
Showing a willingness to work constructively with the government, Dr Miller said: ‘It is easy to find grounds for disagreement, and we have the stomach for the fight if necessary. It is much harder to find agreements. But we stand ready to do the hard thing, to put the conflict behind us, to achieve a new contract which will be good for patients and good for consultants.’
CCSC joint deputy chairman Nizam Mamode said he took heart from Mr Reid’s conciliatory comments on BBC1’s Breakfast with Frost last week.
Mr Mamode said: ‘He used words like ‘‘I will see if I can tweak things’’. Such comments, whilst they may seem minor to many of you, we believe represent a significant change in approach. We must go to that meeting with a very clear, very appropriate message from the BMA.’
West Yorkshire consultant anaesthetist Ian Wilson warned that unless the Department of Health changes its ‘Stalinist, centralist, control-freak agenda’ the government would ‘see the mettle of which we are made’.
Governance committee should be replaced, ARM agrees
The BMA governance consultation process was brought to a halt this week when doctors decided the committee currently charged with the task should be replaced.
Doctors at the ARM agreed the governance review was essential but said the process so far had lacked transparency, credibility and accountability.
BMA junior doctors committee chairman Paul Thorpe told the meeting: ‘It is very difficult to get people to change their minds. The [Representative Body] will see its role in setting policy disappear. Change does not mean that you should remove the teeth of the RB completely.
Doctors also agreed that cross-craft BMA divisions should be retained at the end of the governance shake-up – despite claims that many were no longer active.
Staffordshire consultant anaesthetist Stephen Millar said: ‘This is not the time to bury them, this is the time to resuscitate them.’
But doctors acknowledged the divisions mainly ran on the goodwill of individual members. Divisional honorary secretaries could be given an ‘appropriate honorarium’.
(Source: BMA News)
Doctors willing to take the heat over public smoking ban
By Lisa Pritchard, BMA News
Doctors have demanded the UK’s governments follow the lead of the Republic of Ireland and ban smoking in public places.
Former BMA council chairman Sir Alexander Macara, who campaigned for the recent European tobacco advertising ban, said he could see doctors at this week’s annual representative meeting were puzzled as to why the government had not done anything so far – three years after it agreed steps should be taken to reduce smoking in public places.
He told the government if it was worried about being accused of taking unpopular measures and creating a nanny state, ministers could say doctors were insisting on this move and so the government would be ‘let off the hook’.
University of Wales College of Medicine reader in public health Norman Vetter called on new Welsh secretary Peter Hain to ensure a smooth passage of legislation demanded by the Welsh Assembly to ban smoking in public places in Wales.
Training should not suffer in bid to increase doctor numbers, doctors warn
By John Weaver, BMA News
‘Generalist’ consultants require at least as much training as ‘specialist’ consultants and should be recognised as being of equal standing, doctors at the ARM agreed.
They said training must only be shortened in specialties where there was evidence it was excessive and that putting poorly trained doctors in ‘generalist consultant’ posts was potentially dangerous for patients.
And expressing fears of ‘dumbing down’, doctors said that, with regard to the Postgraduate Medical Education and Training Board, the training time for juniors should not be shortened merely to achieve the government target of an increase in consultant numbers.
Stockton-on-Tees obs and gynae specialist registrar Fiona Kew said the government had made repeated statements about having different types of consultant – generalists, specialists and those who wished to teach or manage.
She said these moves were in order to meet government-devised targets on consultant numbers, adding that the international recruitment campaign had failed and new medical students would not be qualified consultants for another ten years. She also said some of the medical royal colleges had perpetuated the problem with their approach.
Miss Kew said: ‘If you can call a trolley a bed, you can certainly call a registrar a consultant.’
County Down consultant anaesthetist Peter Maguire said: ‘I work in a small district hospital as a generalist. I need much more training than a specialist in a smaller area. How anyone can say we can get away with a shortened CCST [certificate of completion of specialist training] to become a generalist is living in cloud cuckoo land.’
London senior house officer in renal medicine Ahmed Elsharkawy said: ‘Our patients deserve fully trained consultants that can give them full, independent and clinically sound judgements.’
Speaking on the PMETB, Surrey consultant radiologist Tiz North said: ‘We have to get the length and quality of training right. We should refuse to be bullied by a government whose only interest in reducing training time is to achieve a government target.
‘We want an increase in consultant numbers, not by artificial inflation but by education, education, education.’
Joint Consultants Committee chairman James Johnson said consultants could be produced in their early 30s but Department of Health proposals to produce ‘so-called fully trained doctors’ in their late 20s risked the dumbing down of specialist training..
Doctors also said training should be based on competencies and trainees should not be charged for CCSTs.
Doctors call for fairer job interviews
All interviews for medical appointments should be objectively structured and externally audited, doctors have said.
But they rejected a call to abandon the system of references for job applications on the grounds it could be biased because there was not yet an adequate replacement for it.
(Source: BMA News)
Doctors 'on our doorstep' could help solve recruitment crisis, ARM agrees
The government should stop looking abroad for doctors to plug NHS staffing gaps and focus on those ‘on its own doorstep’, doctors have said.
London GP Terry John said there are thousands of overseas doctors in the UK ‘willing, waiting and wanting to work in the NHS’.
Yet because of the hurdles they have to cross and complex rules relating to postgraduate training their skills were going to waste.
Dr John particularly criticised immigration processes which meant doctors had to hand in their passports when applying to extend work permits or switch from non-permit status – sometimes for up to 12 months at a time. They were left trapped in the UK, unable to travel abroad for conferences, holidays or to deal with family issues in their native countries. If a doctor did have to demand the return of their passport, they were immediately returned to the bottom of the queue.
London GP registrar Kate Adams said the NHS could not function without overseas doctors who make up 26 per cent of the medical workforce.
She added: ‘There is a real political will at the moment to improve things from the Department of Health and the GMC’.
(Source: BMA News)
'Overseas doctors lose out in professional exams', ARM hears
Postgraduate professional exams are unintentionally discriminatory and medical royal colleges should include more assessors from broader ethnic backgrounds in their courts of examiners, doctors said. Nottinghamshire senior house officer in general surgery Khalid Siddiqui said: ‘Year after year the success rate of overseas doctors does not reflect their professional capabilities.’ He said such a move would mean a more level playing field.
(Source: BMA News)
Call for all trainees to spend time in general practice
All postgraduate specialist training must include a period in general practice, it was agreed. Somerset GP Berge Balian said it would give a greater understanding of GPs’ working environments and the pressures they faced. Hampshire GP Julian Neal said it would give hospital doctors an understanding of the holistic nature of general practice.
(Source: BMA News)
Sick doctors need more support, doctors agree
Action to prevent sick doctors feeling compelled to go to work, risking their own health and that of their patients, is urgently needed, doctors have said.
GP registrars subcommittee chairman David Wrigley told this week’s annual representative meeting he had heard of instances where employers called doctors at home after just a day or two’s sick leave demanding to know when they might be returning.
He urged all doctors to register with a GP from whom they could receive impartial advice and sick notes if necessary.
He said: ‘We have a duty to our patients and when we are unwell we should take time out so patient care does not suffer.
The NHS must understand this. This would ensure we have healthier doctors and also healthier patients.’
Bedfordshire and Hertfordshire Local Medical Committee chief executive Judy Gilley said she was horrified when a candidate for providing a GP occupational health service said his ambition would be to prevent GPs taking sick leave and get those who were off back to work.
She added: ‘I am always trying to do the reverse.’
(Source: BMA News)