Annual Representative Meeting 2004
Stories from the meeting
Monday 28 June
Copy supplied by the staff of BMA News
Choice must be available to all, BMA council chairman warns politicians
Choice must not just mean choice for some ‘and the devil take the rest’, politicians have been warned by doctors leaders.
BMA council chairman James Johnson told the ARM that doctors had an important role to play in the government’s new choice agenda in protecting the interests of vulnerable, disadvantaged and chronically ill patients.
In his first speech to the representative body as council chairman, Mr Johnson declared that while choice is right in principle, doctors can, and should, ‘separate out the reality from the rhetoric’.
He said: ‘Choice, one can hardly fail to notice, is currently the only show in town.
‘Of course exercising choice has consequences. Exercising my choice may severely limit yours and the better-off, middle-class patient will work the system and reap the maximum benefit from it.’
Mr Johnson told doctors they could not sit in conference halls and decry choice because it would make them irrelevant and ignored. Instead, he urged them to work with patients to explore the boundaries of choice.
He described the policies by Labour and the Conservatives of improving choice and making more use of the independent sector as ‘a defining moment in the history of the NHS’.
He said: ‘Make no mistake about this, whether the next government is Labour or Tory, we face a fundamental shift in the balance between public and private provision. At present this is only a vision for England but the other nations of the British Isles cannot fail to be affected by the wind of change blowing through the English health service.’
Mr Johnson warned MPs of the challenges that needed to be overcome before choice became a reality for all, including the lack of spare capacity in the health service.
While welcoming the ‘serious progress’ made in increasing doctor numbers, he said the extra doctors would be mopped up by the effect of reduced hours, the European Working Time Directive, and the rising numbers of women and part-time doctors.
He said the NHS had a ‘shameful record of exploitation’ in relying on other countries – including ones that need doctors more than the UK does - to fill its manpower gaps.
He added: ‘Surely after over half a century of the NHS we should be producing enough doctors to look after our patients.’
Mr Johnson also criticised the government for its ‘dilatory and disgracefully complacent’ attitude towards smoking and sexual health.
He concluded that doctors must ‘ensure that the NHS moves with the times and that the BMA plays a major part in shaping its future’.
National identity cards backed by doctors
National identity cards have been backed by doctors on the grounds they would cut down on fraud.
London GP Kate Adams said she has had ‘direct experience’ of misuse of GP services by patients who are probably not eligible to receive NHS services.
Redbridge GP David Shubhaker said it was ‘vital’ for doctors to have patients’ health information available at the touch of a computer button.
However, support was far from unanimous as some doctors raised concerns about the £2bn cost to establish ID cards, civil liberties and the untested ‘biometric’ technology.
Perth consultant in general medicine Mark Garton said ID cards should be ‘vigorously opposed’. He said the cost to set up the cards would be better spent elsewhere in the NHS.
Dr Garton added he did not believe they could cut back on fraud or prevent acts of terrorism.
‘There is no technology produced by man that has not been subverted by accident or design,’ he said.
‘Hospitals need to be able to respond directly to patient enquiries’
Hospitals must be geared up to respond directly to patients’ continuing needs, doctors demanded.
They said hospitals should take responsibility for patient enquiries on: chasing up appointment delays and follow up, investigation results, the content of consultations with hospital clinicians, and immediate post-operative problems.
London GP Chaand Nagpaul said processes were needed for patients to contact hospitals directly. He said unnecessary trips to the GP wasted family doctors’ appointment slots. He said it was an even greater waste of time when the GP had not received results.
He added that following surgery, for example, patients needed access to advice and treatment from the clinical team with the appropriate expertise.
Lancashire GP David Wrigley said: ‘The clinician who requests intervention should be the one dealing with the results.’
He added that it was far too easy to refer patients back to GPs and called on hospitals to take responsibility rather than dumping work back onto family doctors.
Patient choice initiative unworkable, doctors say
The government’s ‘patient choice’ initiative is unworkable, does not deliver choice for patients and is a waste of NHS resources, doctors said.
They said lines of clinical accountability were unclear and the initiative should be piloted before national implementation was considered.
London GP Chaand Nagpaul said while there was a semblance of choice for some patients, for example those waiting for elective surgery, the reality was that millions of patients such as those with chronic conditions, had no real choice. He pointed out: ‘We naturally support giving patients true choice in the NHS.’
London consultant radiologist Jacky Davis said: ‘Patients want to see familiar doctors, want to get prompt treatment in their local hospital and want their hospitals to be clean and well equipped.’
She said the government’s agenda was a smokescreen for the introduction of multiple providers that signalled the break up of the NHS.
‘Call centre booking systems confusing for patients’
Giving patients only a short time to ring call centres to confirm appointments is confusing, doctors agreed.
Doctors said they were concerned at the use of such booking systems and called on the BMA to campaign to change the practice.
Liverpool GP Rob Barnett said: ‘People have great difficulty in negotiating their way through call centres. I’m not opposed to innovative change but we have to make sure that change works.’
Cardiff GP Kay Saunders said a partial booking system in Wales was proving hard for her patients, especially non-English speakers, illiterate patients and those without a phone.
‘Out-of-hours services must not suffer under the transfer of responsibility to PCOs’
The UK governments must act to ensure out-of-hours services do not suffer when GPs hand over responsibility, doctors said.
They called for action to ensure primary care organisations worked with GPs to develop and implement schemes to take over out-of-hours services, and for adequate funding.
Doctors also said there must be no consequent adverse effect on A&E services and emphasis must be placed on educating the public on how to access appropriate services.
Birmingham GP Fay Wilson said many GPs were glad to stop subsidising the NHS and being responsible for providing the service. But she warned that many PCOs were not taking the issue seriously.
Some seemed to think they could rely on the ambulance service or on nurses, she said. Others thought they could rely on one GP for a whole area.
Dr Wilson said: ‘We call on the departments of health to safeguard patients’ rights to a decent and safe primary medical service out of hours.’
Hereford consultant ENT surgeon Ghassan Hanna said: ‘Unless something is done, some A&E departments will collapse under the pressure.’
‘NHS will lose out while private sector grows’
Independent treatment centres will gain at the expense of the NHS hospitals they are supposed to be assisting with capacity, doctors leaders have agreed.
Doctors at the ARM denounced the way continuity of care and clinical accountability was being ‘sacrificed for political expediency’ as the government increased the use of the independent sector to drive down waiting times.
They claimed public funding was being diverted to private profit and insisted that the government must concentrate on building up NHS capacity instead.
London GP Chaand Nagpaul said that under the government’s proposed ‘payment by results’ system where a tariff will be set for each procedure, ITCs would perversely gain at the expense of NHS hospitals because they would be cherry picking low risk, uncomplicated patients and leaving the NHS to deal with more expensive, complex patients for no extra money. He added that the centres would not be responsible for post-operative emergency complications, rehabilitation or follow-up – all this would be left to the NHS.
He added: ‘There is likely to be covert and overt political pressure on primary care organisations to preferentially commission care from these private sector units to justify their existence which, by definition, will result in a disinvestment in local NHS hospitals towards the private sector.
‘The public interest is best served by building up capacity in the NHS itself. The patients we see daily want to be treated in their local NHS hospital but want it to have more doctors and nurses, more beds and be looked after in an institution free from the vested interest of profit and commercial gain.’
London consultant general surgeon Anna Athow said ITCs were not even useful as a temporary measure.
She said the BMA should ‘stop pussy-footing around’ and oppose ITCs outright.
Staffordshire consultant ENT surgeon Priti De said doctors in his area were worried that surgeons who normally carried out routine operations would become deskilled as the work moved elsewhere. He added that junior doctors would not get the opportunity to manage patients during their training.
BMA council deputy chairman Sam Everington said there were ‘enormous concerns’ about ITCs, particularly cherry picking of patients and training opportunities.
Doctors agreed there should be no political pressure on PCOs to commission care from ITCs at the expense of the NHS and that capacity should be increased in NHS facilities.
Doubts were expressed about a move to compulsory insurance-funded care that was suggested by pressure group Doctors for Reform. Doctors agreed that such a move was a universal form of tax similar to direct taxation and would require more bureaucracy to collect.
Doctors call for government acknowledgement of NHS institutional racism
The government must acknowledge that the NHS is institutionally racist, doctors at the ARM said.
Leeds consultant psychiatrist Malikayil Alexander said he had to go through the process of taking his employer to an industrial tribunal because he was discriminated against. The case was decided in his favour.
He said many such cases were pending, adding that discrimination showed itself in a number of ways, including in the job selection process.
Dr Alexander said it had a demoralising impact on victims. ‘This practice of not selecting the right person for the right job has a bad effect on patient care. The government should stop the practice of racial discrimination. We should choose the right doctor for the right job by their merit, not by their colour.’
Bradford consultant urologist Tariq Shah said his wife – a consultant gynaecologist in West Yorkshire – had suffered discrimination and was suspended for almost two years. She is now back at work.
He said in this case the NHS had accepted liability but the case had left a serious stigma on her and left the whole family devastated. He said she had continued to suffer psychiatric problems.
BMA staff and associate specialists committee chairman Mohib Khan called for an investigation into the problem. He said that he himself had suffered discrimination and on one occasion when he asked for career advice, Mr Khan said he was asked why doctors like him let the system exploit them.
Representative body chairman George Rae, who is the outgoing BMA equal opportunities committee chairman, said: ‘It’s no longer acceptable for doctors to be denied the opportunity to fulfil their potential because of any form of racism.’ He highlighted work done by the BMA to illustrate the problem such as the publication of Career Barriers in Medicine: Doctors’ Experiences.
Doctors also said it was up to individuals to accept responsibility for their own behaviour and should not hide behind institutional failings.
Stop overseas recruitment, doctors say
Recruitment of consultants from overseas should stop and suitable staff and associate specialist doctors already in the UK given top-up training to achieve consultant status instead, doctors agreed.
Wirral associate specialist in anaesthetics Om Prakash Bansal said: ‘If you look at this from a cost point of view, the government is spending a lot of money on hiring consultants from overseas; would it not make sense to put some of that money towards top-up training for SAS doctors?’
In a narrow 97-95 vote, doctors backed his call.
London consultant histopathologist Anne Thorpe said although she was in favour of SAS doctors being given access to consultant posts, it would not be a good idea to stop overseas recruitment entirely.
Dr Thorpe said it was very difficult to find SAS doctors in some specialties and overseas recruitment was sometimes crucial to fill a post.
BMA chairman James Johnson said later it was ‘immoral’ for the NHS to be recruiting consultants from developing countries.
‘Tuition fees will endanger widening participation agenda’
The government’s decision to ignore medical student pleas for a tuition fees rethink will put its own widening participation agenda at risk, student leaders at the ARM said.
BMA medical students committee chairman Leigh Bissett said the people the £3,000-a-year university fee proposals would affect most were those who did not come from higher socio-economic groups – the very groups the government had given a commitment to help achieve university places.
He said: ‘These reforms will make a mockery of this alleged commitment.’
Doctors gave their overwhelming backing to the MSC’s fight for a better deal for medical students under the Higher Education Bill.
These include:
- Separate access agreements for medical schools – the current proposals require universities to agree access targets for encouraging students from non-traditional backgrounds into higher education. MSC wants separate ones for medical schools
- Expanding existing student support arrangements for medical students to ensure essential maintenance and course costs are met
- Ensuring medical students are not more in debt than those studying three-year courses.
Liverpool University final year medical student Liz Kingston said: ‘We have reached crisis point and without urgent action the situation will deteriorate rapidly.’
Sack trust managers not delivering on consultant contract, doctors urge
Trust managers not delivering fair implementation of the consultant contract should be sacked, consultants leader Paul Miller demanded this week.
In his speech to the representative body, Dr Miller criticised the way the consultant contract had been implemented in many areas. He condemned the government for allowing its own deadlines to be unmet twice.
He said: ‘I ask you to name me any other [government] target twice ordered by the minister where failure to deliver has been tolerated.’
Trusts were first supposed to have offered job plans to consultants by the end of January 2004. Not a single trust managed it. Very few managed to make the second deadline of April, set by Dr Miller and health minister John Hutton in a joint letter.
Dr Miller added: ‘Where trusts are not delivering fair implementation, it is now time for those responsible for that failure to be replaced by individuals who can succeed.’
Doctors at the ARM backed consultant calls for the government to offer strong support for the external duties consultants undertake outside their clinical role such as work for the BMA, GMC and medical royal colleges, or as examiners and assessors.
London consultant histopathologist Anne Thorpe said trusts should recognise external duties were a legitimate part of a consultant’s job.
Doctors say BMA should consider withdrawing from the Doctors and Dentists Review Body process
The BMA should consider withdrawing from the Doctors and Dentists Review Body process in the light of poor pay awards, doctors said.
Glasgow consultant psychiatrist Peter Bennie said the 2004 report was particularly unfair on consultants on the old contract, giving them only a 2.5 per cent award, below the government’s estimate for inflation for 2004/05.
He said: ‘We need to recognise that the great leaps forward in salaries over the years have come from new contracts.’ The DDRB, he added, had made a series of cautious awards tailor-made for government.
BMA junior doctors committee chairman Simon Eccles said the call would send a powerful warning shot. He said negotiations would soon start with the NHS Employers Organisation and doctors could take then take stock of the situation.
BMA council chairman James Johnson said NHS staff with review bodies had done infinitely better than those without over the years.
News in brief
Foundation trusts must show overall healthcare benefits
Proof of how foundation trusts have yielded overall healthcare benefits must be shown before granting extra freedoms to further trusts, doctors agreed.
Wrexham associate specialist in acute medicine Farookh Jishi said an independent evaluation of the first wave of ten foundation trusts was needed to determine their potential impact on neighbouring non-foundation trusts.
Dr Jishi said issues such as whether doctors and nurses are ‘poached’ from non-foundation hospitals need to be ‘carefully studied and analysed’.
Students call for mentoring scheme
The BMA will set up a mentoring scheme for medical students by junior doctors following calls at the ARM. BMA medical students committee joint deputy chairman Karen Hebert said university pastoral care services were inadequate for medical students, and juniors were best placed to offer the right kind of support.
Emergency planning in the NHS inadequate
Emergency planning in the NHS is inadequate and urgent action is needed to prepare for a terrorist attack, doctors agreed.
Bury GP Kumar Kotegaonkar said funds for emergency planning have not been ring-fenced and there are no back-up plans for treating chronic care patients in the event of a biological, chemical or nuclear incident.
Retired doctors angry at GMC proposed charge for revalidation
Retired doctors are angry that the GMC plans to charge them for a revalidation method that is being developed especially for them.
BMA retired members forum chairman Michael Vickers said GMC president Professor Sir Graeme Catto had promised a ‘third way’ for retired doctors to retain their licence to practise other than appraisal/clinical governance or an independent route for doctors not in a managed environment.
But he told the ARM that the GMC proposed to charge retired doctors for the extra time and cost involved.
Access to health records
It is essential for any doctor asked to prepare a report on a patient for a third party to have access to all the relevant health records with the patient’s consent, doctors said. They said there was a need for suitable training and payment should be appropriate and timely.
Emergency worker protection
Doctors welcomed proposed legislation in the Scottish Parliament to increase penalties for obstructing emergency workers, including doctors, nurses and paramedics, when attending emergency situations. They called for the government to consider similar legislation for the rest of the UK.
Handle clinical competence investigations sensitively, doctors urge
Investigations of a doctor’s clinical competence must be handled with sensitivity and use appropriate criteria, doctors agreed.
Leicester GP Vijoy Kumar Singh made an impassioned plea for greater consistency in the process after a colleague committed suicide following an investigation into his referral rate.
Retired Hertfordshire GP Donald Richardson said the way in which matters were handled varied enormously and some doctors found themselves facing ‘full blown adversarial committees’.
NICE guidelines and NSFs not to be treated as exclusive arbiters of good practice
Guidelines from the National Institute for Clinical Excellence and national service frameworks must not be treated as exclusive arbiters of good practice, doctors agreed.
Doctors said they supported evidence-based practice but Kent retired family planning doctor Phyllida Lawes said: ‘Let common sense prevail. Let patient welfare be the prime focus of doctors’ concerns.’
Doctors call for BMA to carry its own headcount
The BMA has been asked to determine the accurate number of whole-time equivalent doctors in England following a dispute with the Department of Health over head counting. GPCGP registrars subcommittee chairman Tom Earnshaw said he is counted as two doctors under the current system. Dr Earnshaw said: ‘We should not bow to the fudging of figures to meet government targets.’
Fund rural GPs properly, doctors say
The government must provide enough funding to enable doctors in rural areas to deliver adequate and appropriate health services, a Cumbria doctor told the ARM.
Locum GP and staff grade doctor in community paediatrics Martin Harris said doctors delivering healthcare over huge geographic areas did not get any extra funding compared with those treating the same number of patients in much smaller catchment areas.
‘Stigmatisation of mental health must be rooted out’
Recommendations to root out the stigmatisation of patients and staff with mental health problems must be acted upon by senior members of the profession, doctors have agreed.
The ARM welcomed proposals arising from The Report of an Independent Inquiry Into the Care and Treatment of Dr Daksha Emson and her Daughter Freya, published in November 2003.
Crash calls
Doctors have called for the use of standardised crash call number 2222 to be fully implemented immediately and called on the BMA to press for this to happen by the end of 2004. BMA junior doctors committee chairman Simon Eccles called for the government to act.
24-hour childcare for health workers
On-site round-the-clock childcare facilities should be provided in NHS trusts for doctors and other healthcare professionals working shifts, doctors agreed.
The demand for 24-hour childcare facilities received unanimous support as doctors face changes to working patterns sparked by the European Working Time Directive.
Wilks is new RB chairman
BMA medical ethics committee chairman Michael Wilks was elected unopposed as the new representative body chairman.
He takes over the three-year role from Tyne and Wear GP George Rae. Glasgow consultant psychiatrist Peter Bennie was elected deputy.