Report from the Chairman of Northern Ireland Council
Dr Brian Patterson
Wednesday 30 June 2004
In presenting my first report to the Representative Body in my capacity as Chairman of Northern Ireland Council I must pay tribute to my predecessor, Mr Maurice Dunlop, and publicly thank him for his hard work and commitment over the last five years.
My first year in the chair has been dominated by local consultant contract negotiations and new GMS contract implementation in Northern Ireland.
The former culminated in a decision by the profession in January to accept a new consultant contract, largely based on that agreed by the profession in England, for implementation on 1 April. Since then, the negotiators with the unstinting support and assistance of the BMA(NI) staff, have been engaged in an ongoing series of meetings with the DHSSPS to secure supporting guidance and terms and conditions of service as well as delivering joint job planning training, and to ensure that the contract is implemented in the spirit in which it was agreed. A contract for consultants employed by both Trusts and Queen’s University of Belfast is in the process of finalisation. Consultants are expected to be in a position to sign off their new job plans in September. It remains to be seen whether the potential threat to the service of a “10 PA only” contract in advance of a significant increase in the medical workforce, is recognised by management. Discussions are ongoing in respect of new disciplinary procedures, distinction awards and discretionary points.
NIGPC has had direct input to the regional decision-making mechanism vis-à-vis new GMS contract implementation in Northern Ireland. The LMCs have adopted a co-ordinated approach in their involvement across the four Health Boards which has included practice visits and ongoing advice to individual GPs. Some funding problems, however, remain to be resolved including the provision of enhanced services, out of hours’ provision and practice staff appointed after “the baseline year”. These important issues must be sorted to the profession’s satisfaction if the full benefits of this new contract are to be realised.
The second joint BMA(NI)/IMO Conference was hosted in November 2003 in Belfast. The Conference theme was to examine the health care systems of other countries with a view to looking at how the Republic of Ireland and Northern Ireland might be better informed in recommending a way forward for their respective healthcare systems. We see these all Ireland health conferences as a platform for the BMA and the IMO to jointly contribute to the health issues with which the North/South Ministerial Council will be concerned.
The Association in Northern Ireland will be taking a close look at the recommendations arising from ‘Learning the Lessons’, and local experience in the consultant contract negotiations, to ensure the profession is best placed to carry forward any future contract negotiations in a devolved setting.
I’ve already mentioned the urgent need to increase medical workforce numbers in the Province which has been acknowledged by the DHSSPS and there are plans to increase the number of medical graduates. NIMASC will be insisting that there must be a corresponding increase in the number of medical academics.
While the NI Assembly has been suspended, lobbying continues and interest in health issues among locally elected politicians is particularly high. Major parties are supporting the BMA’s views on top-up fees for medical students which is currently out for consultation in Northern Ireland. The application of the European Working Time Directive to junior doctors in August and the impact on the delivery of hospital services are also being flagged up with MLAs. BMA(NI) is working with the DHSSPS in this regard and joint guidance to the service has been issued in line with the rest of the UK. While acknowledging that compliance is a major challenge, health service employers must be urged to move as quickly as possible. The opportunity has been taken over past 6 months to disseminate information on the directive at a series of BMA junior doctor roadshows.
Unfortunately the current NI Health Minister has been unable to publicly commit to certain assurances about the development of Local Health and Social Care Groups, and GPs have not seen any merit in joining their management boards. Nevertheless, the profession’s representatives continue to work with Health Boards to ensure that the limited responsibility afforded LHSCGs, is deployed in the best interests of local communities.
Changes to the current structures will inevitably flow from the ongoing Review of Public Administration in Northern Ireland. We are mindful of BMA policy that should there be a reduction in the number of the Health Boards, but we emphasise that this should not result in a reduction in the public health function. There is little doubt that a population of 1.7 million is not best served by a Health Department, four Health Boards, four Health Councils, nineteen Trusts, six Agencies and fifteen LHSCGs.
As in the rest of the UK, appraisal, clinical governance and revalidation are all very much uppermost in our minds and the DHSSPS is now getting round to considering a model for linking these processes in Northern Ireland.
We have also been closely monitoring the Modernising Medical Careers initiatives and the new foundation programme in particular which is causing some angst. We will be considering what influence we can bring to bear in its roll-out in the Province to ensure our students are not disadvantaged. Further to the publication of ‘Choice and Opportunity’, SAS doctors in Northern Ireland look forward to a successful outcome to their new contract negotiations.
In the year ahead the Association will endeavour to progress the concept of initiating a ban from smoking in public places equivalent to the policy which has been successfully implemented in the Republic of Ireland. Similarly, the Association will press for timely access to care for patients throughout the Province. We recognise that delayed care is denied care and virtually guarantees less favourable outcomes.
As investment in Information Technology is increasing, the Association will be pressing for a structured implementation across all sectors of Health and Social Services to ensure that money is not squandered by inadequate planning as has been the experience previously.
In conclusion, I would like to stress the importance of recognition of the impact of responsibility for healthcare having been devolved to the respective administrations. I say this in terms of the governing structure of the Association and the need to be able to respond and deal with diverging health policy. I would propose that more work now needs to be done to assess the level of impact, with a view to ensuring the national offices are equipped to support the profession as devolved political administrations continue to develop. I would anticipate this will require increased resources for the BMA(NI) office.
Thanks to staff.
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