Annual Representative Meeting 2004
Stories from the meeting
Tuesday 29 June
Copy supplied by the staff of BMA News
Prisoners 'missing out' on vital healthcare
Prisoners are not receiving the mental healthcare they vitally need, doctors have heard.
Buckinghamshire GP Gillian Beck told the ARM of how prisoners she treated were denied help because no-one was willing to take responsibility for commissioning or providing care.
She said this meant prisoners and doctors were vulnerable – prisoners because of their problems and GPs because they could get them blame if anything went wrong.
Dr Beck added: ‘Prison doctors are not psychiatrists. The current situation is untenable and must change.’
BMA civil services committee chairman Paddy Keavney said prisoners could be helped while in jail but the facilities were not available.
The ARM agreed that BMA council should urgently bring the problem to the attention of the appropriate authorities.
Public health medicine hit by break-up
Public health medicine continues to be ‘plagued by change’, doctors leaders have said.
BMA committee for public health medicine and community health chairman Peter Tiplady said public health doctors were doing a ‘tremendous job’ despite the break-up of the specialty by the changes to health authorities and primary care in England.
He told the ARM that well-staffed, well-resourced public health departments were deconstructed and distributed around something like five times as many primary care trusts as there were health authorities.
He warned that although there could be the opportunity to rebuild strong public health departments through the amalgamation of PCTs, ‘change is always difficult’.
He added: ‘It is likely that large numbers of doctors only recently appointed as directors of public health will be competing for one of the new posts’.
He said there were still staffing shortages in public health.
‘Doctors should not be criminalised for medical errors’
The widespread criminalisation of unfortunate mistakes is destroying the lives and careers of young doctors, it was claimed at the ARM.
Doctors said rather than just being the fault of individuals, mistakes were often symptomatic of system failures, and doctors should be supported and retrained rather than punished.
Manchester consultant pathologist Harekrishna Panigrahi said errors were inevitable and, sadly, some of these resulted in fatalities. He added that the blame culture of the NHS and society demanded a head on a block but the effects of this were catastrophic.
He said mistakes were ‘often the result of unfortunate errors made by hard-working and conscientious junior doctors working under tremendous pressure’ with a lack of support.
A website poll last week showed more than 80 per cent of doctors had seen colleagues make errors or had concerns about the care being provided. But just 15 per cent of incidents that could have led to death or disability were reported.
BMA civil and public services committee chairman Paddy Keavney said: ‘We are seeing unprecedented encouragement from the government and politicians fuelling patient demands and expectations of the NHS.’
He said the medical profession was increasingly excluded from the decision-making process; there was not enough time for training and professional development; and there were too few support staff.
London GP Kate Adams said doctors were concerned by the case of Feda Mulhem, sentenced to eight months in prison after pleading guilty to manslaughter. He supervised a doctor in injecting vincristine into the spine of Wayne Jowett, 18 when he was working at Queen’s Medical Centre, Nottingham.
Dr Adams said: ‘Prisons are a place for thieves, rapists and murderers. The increasing criminalisation of doctors serves no purpose.’
BMA must do more to help suspended doctors
Doctors have demanded that the BMA does more to address the needs of suspended doctors.
They said they were disappointed at the failure of the BMA council to implement fully a call at last year’s ARM to create a committee to make recommendations on the needs of suspended doctors and to create a peer support group.
Doctors called on the BMA council to set up a register of suspended doctors for each of the four UK countries, for groups to pool expertise within the UK countries and for the BMA to set up a network for suspended doctors.
Bedfordshire consultant child and adolescent psychiatrist Fathima Farook said she was concerned at the lack of progress. She said: ‘There has been a progressive increase in the number of suspensions. Doctors are made scapegoats to mask system irregularities and system failures.’
But BMA council chairman James Johnson said there had been action to help suspended doctors, including an agreement with the Department of Health on the handling of suspensions. He said the call for a committee to look at how the BMA could better support suspended doctors and for a peer support group had been referred to the BMA Doctors for Doctors Unit.
He also said a cross-craft working group had been set up, led by the BMA central consultants and specialists committee, that had been looking at these areas in detail. This is expected to report soon.
Fair treatment for SAS doctors is 'urgent', ARM agrees
Frustration among staff and associate specialist doctors at the lack of recognition and reward for their work has led doctors to issue a united plea for urgent action.
Doctors condemned the UK health departments’ delay in negotiating a new contract for SAS doctors and called for a future pay deal to be back-dated to April 2004.
They also spoke out against the bullying of SAS doctors by managers and consultants and called on the BMA to conduct a UK survey to determine the extent of the problem.
BMA staff and associate specialists committee chairman Mohib Khan presented a video Untold Stories, which highlighted the plight of three highly skilled SAS doctors.
One of these, Halifax associate specialist in trauma and orthopaedic surgery Subhash Halder has received international acclaim for inventing ‘specialist nails’ that have revolutionised the treatment of neck and arm fractures, but was ‘demoralised’ that he could not have patients referred to him directly by GPs.
Mr Khan also highlighted the £40,000 pay gap between an associate specialist who is an expert laproscopic surgeon and a consultant colleague doing similar work.
He said: ‘Not only is our group disadvantaged in terms of career progression, recognition and financial reward, many of us are also subjected to bullying and harassment at work.’
Doctor expressed strong support for their SAS colleagues.
Yorkshire anaesthesia and pain management consultant Ian Wilson said: ‘Entering the SAS grade should be a positive choice. So much of the existing NHS relies on them.’
Sick notes a 'huge and unnecessary burden' for doctors
Doctors have called for changes to sickness certification because it falsely medicalises absence from work.
They said it potentially breached doctor-patient confidentiality, was a huge and unnecessary burden on doctors’ time and gave rise to inaccurate data about the causes of absenteeism.
Doctors called for the Department for Work and Pensions to look at more effective systems of recording and managing sickness absence.
BMA occupational health committee chairwoman Susan Robson said: ‘The present system serves no one well. We’re asking for BMA support in proposing to the department they move to full self certification with a system of random audit as with the present tax system.’
Call for new conflict of interest rules
BMA reports should include declarations of possible conflicts of interest in future, the ARM agreed.
The calls for such a move were backed following controversy over a board of science and education report Genetically modified foods and health: a second interim statement, published in March 2004.
Shortly after the report’s publication, board chairman Professor Sir David Carter was accused in the media of being a support of pro-GM lobby group Sense about Science.
He assured the ARM he had talked to the group only once, on behalf, and with the full knowledge, of the BMA.
The representative body decided that to ensure the BMA was seen to be fair and impartial, board members and the authors of board reports should declare their interests.
Doctors opt for the status quo in BMA structure
Doctors have rejected root and branch reform of the BMA’s decision-making structures, saying the options for change were ‘seriously flawed’.
Each of three options presented to the representative body would have retained an annual conference, using different-sized boards to implement policy, but doctors voted to keep the status quo.
And in a separate ballot on the preferred model for the BMA’s local cross-craft structure, they called for the retention of divisions.
BMA governance committee chairman John Canning urged doctors to vote for change. He said: ‘The association’s reputation is at risk. We need to change and we need to make a decision. There is no option to continue with the status quo.’
But GP negotiator Laurence Buckman said: ‘I don’t think any of the three models are fit for purpose. They are anti-democratic, don’t enable the membership to communicate with the board, whatever that is. I was hoping for an opportunity to take what we had and clean it up thoroughly but what I have got here is something that offers me three options that I don’t like.’
Northern Ireland GP Ian Banks said: ‘The answer is to make this body representative. You don’t do that by scrapping it or removing any power it possibly has.’ He said what annoyed doctors was the perception of an old boy network in the inner circle.
Northampton consultant paediatrician Keith Brent said the process had been a ‘complete shambles’.
Truro consultant radiologist John Hyslop said the important issue was to connect with grassroots doctors. He said the failure to invest in divisions was the root cause of the debate.
Essex GP Hector Spiteri said: ‘Policy making must rest in the biggest possible body of representatives that we can afford to have.’
But Birmingham GP Fay Wilson said the BMA had to change. ‘The status quo may suit you and me but it doesn’t suit the members out there. People out there do not see this as a representative organisation. They feel disenfranchised. If we carry on like this we will die.’
Dr Canning said: ‘Members will not continue with membership if we don’t provide the services they want.’ He added that 150 divisions were virtually or totally inactive.’
BMA junior doctors committee chairman Simon Eccles said it was important to have the flexibility to make policy more than once a year.
Doctors also called on the BMA organisation committee to coordinate a wholesale review of the articles and the byelaws of the BMA and bring recommendations to next year’s ARM.
Doctors decided the BMA remuneration committee should start looking at a scale of remuneration for medico-politicians undertaking council, board or craft committee duties for the association. However, the ARM rejected calls that the committee should not approve remuneration of individuals for loss of earnings, including private practice earnings.
Medical degree not required for BMA secretary post
Doctors rejected a call that future BMA secretaries should be medically qualified and that the title should remain the same.
GP negotiator Hamish Meldrum said it was important to have the best person for the BMA. He added: ‘What we want is a chief executive’. But Fife GP David Sinclair said the title ‘secretary’ best fitted the role.
BMA council chairman James Johnson said the selection process for successor to Jeremy Strachan was well underway.
'Extinction' threat for academics
Many clinical specialties in academic medicine are under threat of extinction and female academics are failing to progress, academic leaders warned this week.
BMA medical academic staff committee chairman Michael Rees told the ARM of a meeting he recently attended with a group of predominantly female, high-flying senior academics in critical specialties such as paediatrics and obstetrics.
He said the academics were failing to progress in their careers and all were being branded as failures despite excellent international track records.
He added: ‘Their jobs are under threat because their departments have set impossibly high standards and are reinforcing negative messages about their progress.
‘The threat of redundancy in medical academic life is very real. This should be unheard of in a sane system where we are desperately short of doctors let alone medical academics.’
The ARM backed academics’ calls for academic activity to be promoted in the NHS.
Doctors set out wishlist to boost flexible training
Doctors have called on the BMA junior doctors committee to renegotiate the deal for flexible trainees to keep doctors in the profession.
They set out a wishlist of measures to boost flexible training. They called for more access to flexible training so 20 per cent of all trainees could train part time and called for salaries to be equitable with full-time colleagues.
BMA junior doctors committee joint deputy chairwoman Jo Hilborne said flexible training, essential to keep doctors in the NHS, was in crisis.
She added that the lack of funding from deaneries and trusts had caused huge problems in access to flexible training. For example, she said women on maternity leave were being told they could not return to anything less than full-time training.
She said more women were choosing to study medicine and fewer were prepared to delay having a family until they completed their postgraduate training.
News in brief
Equipment shortages hit forces doctors in Iraq
Doctors have returned from the Iraq war with ‘shocking’ stories of equipment shortages, the ARM heard this week.
After hearing of leg amputations because of a lack of vascular kits and doctors told to give their flak jackets to infantry soldiers, despite having to accompany those soldiers to the front line, doctors agreed the BMA should lobby the Ministry of Defence to ensure all military medical personnel are adequately equipped and supplied in future.
BMA to look at new and emerging health threats
New and emerging infectious health hazards are to be investigated by the BMA.
BMA medical education board chairman Peter Dangerfield said the growth of international ‘mass transit’ had led to the spread of serious diseases around the world.
The board of science is to look into the issue. Doctors also agreed the board would look into the implications of genetic screening for patients, the exercise and nutrition needs of young children and the implications of the increasing availability of over-the-counter drugs.
Paid leave demand for reservist doctors
Territorial Army doctors should be entitled to two weeks’ paid annual leave to fulfil their training commitments, the ARM agreed.
BMA armed forces committee deputy chairman Martin Daly said some trusts were already offering this, but the association should lobby the Department of Health to ensure it happened nationwide.
Free BMA membership for first-year students
Medical students are to benefit from a new membership package.
Under a pilot scheme for those who start their courses this autumn, membership will be free in the first year, £24 in the second year and £30 in the third year. Students must sign a BMA subscription direct debit mandate.
Legal action call against unfair suspension trusts
The BMA should consider legal action against trusts who suspend doctors unfairly, the ARM said this week.
The Association should also assist such doctors in re-employment once they are cleared by disciplinary procedures.
London GP Anthonipillai Nicholas-Pillai said the way disciplinary processes were applied at the moment was ‘barbaric and inhuman’.