Search the website

Central Consultants and Specialists Committee newsletter

April 2007

Modernising Medical Careers (MMC)
It would be hard to have missed the furore over the Medical Training Applications System (MTAS), which has made national news, caused anger and frustration many junior doctors and consultants alike and led to protest marches in London and Glasgow.

An MTAS review group was set up to find an urgent solution to the immediate problems. The BMA was represented on it by the Chairmen of the BMA Junior Doctors Committee (JDC) and the CCSC. The medical Royal Colleges and Department of Health were also represented. The review group has been making some progress towards finding acceptable solutions. However, its final proposals for round 1, and improvements for further rounds (which can be found on the MMC website: http://www.mmc.nhs.uk/pages/home were not acceptable to the JDC and thus to the medical profession as a whole. The BMA has therefore withdrawn from the group.

The CCSC has produced initial guidance to consultants on continued participation in MTAS, which can be found on the BMA website. This urges careful reflection before taking precipitate action, and advises consultants who are BMA members to contact askBMA to discuss their individual circumstances. It can be found here at www.bma.org.uk/consultants.

The CCSC will continue to represent the interests of consultants in this matter, seeking to ensure that members are protected against the consequences of appalling official planning

CATS/ICATS
As part of the second wave of the national procurement of services from the independent sector, the Department of Health has been supporting the provision of Clinical Assessment, Treatment and Support services in the North West of England. There are two proposals in the pipeline at different stages of development. The first, and more advanced, is in Cumbria and Lancashire where Netcare has been given preferred bidder status, and the second in Greater Manchester. The intention is to provide triage and diagnostic (and some treatment) services in a number of key specialties, notably orthopaedics, rheumatology, general surgery, ENT, Gynaecology and Urology.

Consultants and the CCSC have played a leading role in a BMA campaign against these schemes, which is based on concerns that they;

• reduce patient choice (as under the initial proposals GPs had no choice but to refer to CATS in the chosen specialties)
• undermine the professional relationship between doctors, and between doctors and their patients and
• have the potential to undermine the financial stability of traditional secondary services.

It is also unclear who would actually provide the proposed services. As part of the campaign the BMA has lobbied the PCTs in Cumbria and Lancashire and given evidence to the joint Overview and Scrutiny Committee of the local authorities affected. Jonathan Fielden, the Chairman of the Committee, along with GPC Chairman Hamish Meldrum and the Chairman of BMA Council, Jim Johnson toured the region speaking to local GPs, consultants and managers to hear first hand the concerns of colleagues.

The tour culminated in a successful meeting of doctors in Manchester at which the issues affecting them were discussed in depth. The campaign has already successfully achieved amendments to the proposals including the opportunity for local trusts to offer similar services.

The CCSC will continue to campaign to support local secondary care services and to ensure that local doctors get the help they need.

Referral management guidance
Following the procedural failings of the establishment of the CATS and ICATS services, the CCSC has produced with the BMA General Practitioners Committee (GPC) a set of guiding principles for a soundly evidence-based and clinically-led referral management system to help and guide consultants who get involved in work of this kind. This can be found on the BMA website at www.bma.org.uk/consultants and will soon be followed by longer background guidance and information on referral management.

The Regulation White Paper
The Government White Paper - Trust, assurance and safety: the regulation of health professionals in the 21st century was published in February and proposes adopting most of the recommendations in the Chief Medical Officers report Good doctors, safer patients.

These include proposals to:

• make regulators more independent, such as the appointment of council members, professional members no longer forming the majority of these councils and an independent adjudicator for doctors
• introduce revalidation, both at basic level to remain on the medical register (recertification) and at specialist level (relicensure)
• create GMC Affiliates at SHA level to deal with more cases locally and to ensure independent scrutiny of some elements revalidation
• change the standard of proof for fitness to practise cases from the criminal standard to the civil standard with a sliding scale
• move the adjudication function in fitness to practise cases to an independent body
• develop a more rehabilitative approach to regulation.

Some in the medical profession believe the proposals amount to the loss of professional self-regulation. Others feel that some of the changes are long over-due.

Many of these changes will require consultation and legislative changes, so there are opportunities for the BMA to influence the outcome. The CCSC has set up a group of members to deal with this challenging piece of work and this group will welcome your views.

The White Paper is on the Department of Health’s website: http://www.dh.gov.uk

You can send your views to jalderman@bma.org.uk. A CCSC briefing note and web forum on this topic will be available shortly on the consultant pages of the BMA website: www.bma.org.uk/consultants.

National Audit Office (NAO) report on the consultant contract in England
The National Audit Office will shortly publish its report on the consultant contract. It’s likely to criticise the Department of Health for underestimating consultant workload and therefore the cost of the deal.

The CCSC will defend both the contract and its involvement in the negotiations in 2001-03, where it presented a far more realistic view of how much consultants were doing. It will stress the ways in which effective job planning can benefit consultants, employers and patients.

Sadly, although it was the Department of Health’s refusal to credit the high workload of consultants that resulted in the contract exceeding cost estimates, the report will inevitably be spun as an attack on consultant salaries. We need to defend consultants by explaining to the public why consultants are worth every penny spent on them.

We will work with NHS Employers to further develop job planning and improve the link between objective setting and improvements to service delivery. This does not mean that consultants will have to work more for the same or less money but it does mean NHS managers accepting that consultants, when empowered to drive change, can innovate in a way that will develop the whole service, and ultimately, enhance and save lives.

The report will be available in April on the NAO’s website www.nao.org.uk.

2007 DDRB award
Most of you will already be aware of the £1000 flat rate increase for consultants. The Government demanded a low increase to suppress inflation and contain NHS costs, and despite a robust counter argument the review body accepted the Government’s case.

However the Government’s staging of the reward merely adds to the insult. Consultants are not the cause of the debt crisis affecting many parts of the NHS, where the blame more properly lies with changes to accounting rules and financial mismanagement. Consultants continue to work hard to shore up a first class service for patients against a backdrop of falling morale and endless managerial and financial crises but have been repaid with an effective pay cut.

The Government should give serious consideration to how they think that will impact on the motivation of the NHS’ clinical leaders. Consultants will not continue to tolerate such treatment indefinitely.

We will be surveying a representative sample of consultants about their workload, job plans and objectives in the near future. It is important that the Department of Health understands how much the NHS relies upon the goodwill and forward thinking of consultants and how these valuable qualities will be affected by such a low pay rise.

Read more on pay scales.

The full text of the report is available on the Office of Manpower Economics website here: http://www.ome.uk.com/downloads/Cm%207025.pdf

External Duties
In March, the CCSC published new guidance (which is on the BMA website) for consultants who carry out external duties in the NHS. We have repeatedly been given assurances as to how vital this work is perceived to be by the Department of Health. Yet some consultants who carry out this vital work for the wider NHS still experience difficulties in getting this work properly acknowledged in their job plans. The guidance explains how to illustrate the benefits of your external duty PAs both to the NHS as a whole and to your trust. It is also intended to show how to fit external duties into a job plan.

Clinical Excellence Awards
Last year, the Department of Health asked the BMA and NHS Employers to write a report on the operation of the first two years of the Clinical Excellence Award Scheme. After some delays caused by Ministerial changes, the Department of Health finally considered the report and asked the ACCEA to address the recommendations made by the BMA and NHS Employers. Although the report acknowledges that both consultants and employers consider the scheme to be an improvement on the discretionary points and distinction awards schemes, it is critical of the ACCEA for not demonstrating sufficient accountability or procedural clarity in the way it works. Specifically, it identifies a number of key problems:

• The timetable for the process is badly planned and restrictive
• The online application process is unwieldy
• The reporting and monitoring of the scheme has been poor
• There is a lack of clarity over funding and budgetary matters
• There are significant, but unexplained variations in the number of awards granted, particularly by specialty and region
• The appeals mechanism, particularly at local level, is unclear and insufficiently resourced
• There is widespread confusion regarding matters of eligibility and investment

CCSC representatives are attending quarterly meetings with ACCEA to discuss how it is taking the recommendations forward and believes that this review will improve the scheme considerably.

Conflict of interests
Increasing numbers of consultants in England are providing services to the NHS via their own companies or private providers of healthcare. Some trusts have questioned whether this work constitutes a conflict of interest with their main NHS employer. The CCSC has obtained expert legal advice and will shortly be publishing guidance for members on the BMA website.

Seminar for local consultant representatives
Local knowledge and activity is the key to achieving success. On 2 May, the CCSC will host a seminar for local consultant representatives to discuss the implications of NHS change and how we need to adapt both as individuals and as representatives. This date is now fully booked but it is likely that similar events will take place in the future.

The BMA is continually reviewing the range of services it provides in a changing NHS. A group has been set up to develop new guidance and services to members who may wish to operate in the area between traditional NHS and private practices. The first in a series of pieces of guidance should be be available in May.

Consultants Conference 2007
The Consultants Conference 2007 will be held on 6 June at the Conference Centre, Church House, Westminster. A dinner will be held on the night of the conference at One Great George Street (Institute of Civil Engineers). The deadline for receipt of motions is noon on 10 April. RCSCs should send motions to Sophie Brannan at sbrannan@bma.org.uk.

System transformation: the role of medical leadership

This conference for medical managers will be held on Tuesday 15 May 2007, BMA House, London

Read more on the conference