Page 1


Board Members


Welcome from ITSEB Dr. Ali Demirbag MD


Message from H.E Ambassador ‚ evikš z


Message from Mr David Burrowes


Message from Mr Ahmet Demirok Consul General


ITSEB Programme for 14th March 2013


England/Britain Turkish Speaking Health Professionals Association (ITSEB) Ali Gul Ozbek


Dr. Alcakanat Case Sibel Gumus


Ankara Agreement and Free Movement of Doctors Aysegul Yesildaglar


Nobel Prize In Medicine


ITSEB on The Media


The New NHS Dr. Ali Demirbag MD


MOCEP & NHS PROJECT Sheila Yahya Levi


Being A Turkish Doctor in The UK, Year 1989 Dr. Erdinc Havutcu MD, MRCOG


Podiatrists in the UK Mr Murat Bozdag


The Sense of Humour from ITSEB


Board Members

Ali Gul Ozbek

Pharmacist Founder Member (Chair)

Dr Esra GUMUS BAYAZIT MD Anesthesiologist (Secretary)

Dr Ali Demirbag MD

Dr. Utkan C. Alacakanat MD

The Health Project Consultant Founder Member (Treasury)

Songul Guler Tas

Counsellors & Psychotherapist (Project Manager) 4

Dr. Mahmut Dogramaci MD

Consultant vitreoretinal Surgeon (Deputy Chair)

The Pediatrician (Deputy Treasury)

Dr Isa Ozburun MD General Practitioner

Eastbourne (Project Manager)

Welcome from ITSEB Medicine day, celebrated on March 14th every year in Turkey since 1827, is a day of celebration and reflection. Since the foundation of the Tıbhane-i Amire medical school on that historic day in 1827, and through the difficult years between 1912 and 1923, Turkey has produced many word-class healthcare professions. A large number of them now practice abroad. Medical practice has come a long way since 1827. Major advances in all aspects of healthcare continue to push the frontiers of medical knowledge forward. Healthcare systems in Turkey and the UK are undergoing change, as policy-makers seek to improve the return on healthcare budgets. In the UK, NHS reforms are underway, and it is hoped that new and more practical systems of service delivery will be introduced. In Turkey, the health insurance programme will bring highquality care to a large percentage of the population. Medical tourism in Turkey is also a growth opportunity. As specialist healthcare in the west becomes more expensive and difficult to reach, emerging countries such as Turkey stand to gain. The UK is now home to a growing number of Turkishspeaking doctors. Over the last two years, UK-based Turkish-speaking medical professionals have celebrated Medicine Day in the UK. This tradition is set

to continue. As more and more doctors and other professionals are now very well-settled in London and other major cities, perhaps the time is right to properly recognise this important date in March here in the UK. Turkish-speaking health professionals are also working in very difficult and sometimes hazardous situations, in other parts of the world. In crisis and other humanitarian support positions, they continue to demonstrate their professionalism and empathy, come what may. We dedicate this edition of the magazine to them as well as our great lecturers. As Turkish-speaking medical professionals in the UK, we celebrate this important date in the Turkish calendar. We celebrate the achievement of our colleagues working in various hospitals across the UK. We also note the challenges some professionals are facing in settling and practicing here. March 14th or July 5th are two dates we could choose to celebrate Medicine Day here in the UK. Whichever date we choose, letÕ s have a party to celebrate our achievements and reflect on the way forward! I wish all our colleagues every success for the future. Dr Ali Demirbag MD on be half of ITSEB


A Message from A Member of The Parliament from Enfield Southgate

A Message from H.E Ambassador ‚ evikš z

Dear Guests,

Dear doctors and health professionals,

I welcome the opportunity to host for the first time in Parliament Medicine Day. I also welcome ITSEB (Association of Turkish Speaking Health Professionals in the UK) and its aims to support medical development between Turkey and the UK.

The Medicine Day was first launched in Turkey 94 years ago, just like the “Children’s Day” of 23 April was born 93 years ago during the most difficult years of our history. This shows that even in the hardest times health and children are among people’s priorities. Today we are proud of the fact that both days are becoming more international as years are passing by.

ITSEB is a valued charity overcoming the language barrier for patients with their service provider; helping the Turkish Education Department to recognise UK graduate health professionals practising in Turkey; and financially supporting doctors and pharmacists in Turkey. I commend ITSEB for all their work which has been properly awarded the Charity of the Year 2012 award by the Centre for Turkey Studies. I hope todayÕ s event will not only celebrate the great contribution of Turkish healthcare professionals but also help pave the way to closer links between the UK and Turkey. With best wishes for a successful and enjoyable evening. David Burrowes MP

Since centuries, the doctors and health professionals are trying to help all human beings regardless of patient’s nationality, religion or race. When famous doctor and philosopher Ibni Sina (or by his Latinized name Avicenna), who is considered as the father of the modern medicine, introduced almost 450 treatments on a wide range of subjects a thousand years ago, he was able to travel without visa difficulties. Bearing that in mind, we all hope to see a visa-free regime for Turkish doctors and health personnel could be achieved in the immediate future in the UK. On this occasion, I would like to express my sincere belief that ITSEB’s activities will strengthen Turkish doctors’ position in the UK and congratulate all doctorsÕ and health personnelÕ s Ò Medicine DayÓ . † nal ‚ evikš z Ambassador


A Message from Consul General Ahmet Demirok

ITSEB Programme 14th March 2013 Medicine Day Part 1 Time: 17:00-18:50 Place : Portcullis House Event: Language of Medicine Seminar Speakers : Dr Ali Demirbag Mr David Burrowes MP Mr Ali Gul Ozbek Mr Sajid Javid MP (Economy Secreatary to the treasury)

PANEl OPENINg Mrs Sheila Levi MOCEP NHS PROJECT Project Manager- NHS

Dr Denny Grant MOCEP NHS PROJECT Project lead- NHS

Q&A Aysegul Yesildaglar Doctors rights to work in the Uk

Prof Dr Alihan Gural Acibadem Univers覺ty Hospital Istanbul The National Health Service-NHS of the United Kingdom (UK) is one of the most comprehensive national health schemes in the world. The NHS hosts a diverse international staff, which in turn is a natural reflection of a multicultural British society. As reports by UK government institutions confirm, today there is almost 400 thousand strong Turkish community in the UK. ITSEB in this regard plays a vital role in representing the professional interests of Turkish health sector experts who are increasingly playing an important part in the NHS. ITSEB serves as a platform for relevant parties to congregate and exchange information on how to improve the standards of service provided by Turkish health experts to patients throughout the UK. ITSEB has come a long way in representing the legal rights of Turkish health sector experts in the UK. I am confident that their voice will be heard by respective UK institutions and Turkish health sector experts will soon start contributing with full potential to the NHS system. I take this opportunity to wish ITSEB further success in their future endeavours. Ahmet Demirok Consul General


Assoc Prof. Dr Ender Gedik Inonu University Malatya Transplantation and Intensive Care Assoc Prof. Dr H. Ilksen Toprak Inonu University Malatya Transplantation and Anesthesia

Q&A Part 2 Time: 19:30-20:00 Place House of Commons Dining Room A 19:30 Reception 20:00 Dinner 20:10 Welcome speech by Mr David Burrowes 20:20 Music - Opera 21:00 Guest Speeches & Host speches Dr Ali Demirbag Mr Ahmet Demirok - Consul General Mr Orcun Basaran - Counsellor Mr Ali Gul Ozbek Dr Alihan Gural Dr Ender Gedik Dr Ilksen Toprak Dr Mahmut Dogramaci Dr Esra Bayazit Dr Isa Ozburun Dr Utkan Alacakanat 21:40 Dessert, Coffee and Music - Opera 22:00 Thank to our guest present memory of the day


England/Britain Turkish Speaking Health Professionals Association (ITSEB) Our association is a non-political institution which believes in the universality of science and medicine without discrimination of culture, religion, language, race or sex. Our aims are • to inform the Turkish speaking community in England, in order to raise awareAli Gul Ozbek ness for a better understanding and effective use, of the health system. We Pharmacist aim to work closely with civil society organisations and the NHS to conduct Founder Member (Chair) seminars on commonly acquired illnesses and carry out public health checks when necessary. • to bring together the health workers for whom Turkish is the common language and conduct events and meetings, where they can talk of their problems if they have any, of challenges they have encountered or encounter, and take part in exchange of information. • with our members from all professional backgrounds, to voluntarily provide services and help on equivalence of diplomas and work conditions. • The association will function as a bridge between health and education ministries of England and Turkey to aid in the process of adaptation of health workers. • to keep close contact with health professions institutions of Turkey, such as Turkish Medical Association, Turkish Pharmacists’ Association and the Board of Medical Specialties, in order to conduct exchange of information with regards to equivalence of diplomas and solution of professional problems. Since its inception, ITSEB, in line with the above aims, has carried out numerous great works and has been highly successful in almost every field. If we were to briefly summarise these: • ITSEB was founded on 27 February 2011. • On 28 February 2011, in order to gain legal status for the association, a meeting with Mr Deniz Oguzkanli took place. • On 14 March 2011, ITSEB attended the Medicine Day in France. • On 25 March 2011, the first management committee meeting took place and regulations were discussed. • On 27 March 2011, the second general members meeting (when did the first one take place?) took place, and the regulations were approved. • On 31 March 2011, Turkish Prime Minister Recep Tayyip Erdogan was consulted and a dossier about ITSEB was given to him. • On 5 April 2011, a letter from ITSEB, regarding the cuts to interpreters within NHS, given to Deputy Prime Minister Nick Clegg and meetings with Liberal Democrat MPs took place. In response to the association’s letter to the Deputy Prime Minister, the Minister of Health responded positively to our requests and thus planned cuts to interpreters within the NHS did not take place. Furthermore, the letter from the Minister of Health to the association also detailed that there would be no cuts to interpreters for patients who need them and that this was a legal right. • On 10 April 2011, the second management committee meeting took place. • On 15 April 2011, a meeting with Turkish Ambassador Mr Unal Cevikoz, and the dossier about ITSEB was presented. • On 1 May 2011, the third management committee meeting took place. • On 6 May 2011, a meeting with Turkish Consul General Mr Ahmet Demirok took place. • On 10 May 2011, a meeting with the management committee of Cem Evi took place and on 11 June


2011, a community meeting was held, in which social and psychological problems of the community were discussed. • On 8 November 2011, we rushed to the aid of the earthquake victims in the city of Van, Turkey. We provided health checks and medication to approximately 1000 victims each day. • Following the Van earthquake, various civil society organisations in England carried out health checks Chairman of ITSEB Mr Ali Gul Ozbek and ITSEB Management and public health screenings. Committee Member Dr Utkan Alacakanat met with TurkeyÕ s Minister • Following this, the Board of Mediof Heath Prof. Dr. Recep Akdag. cal Specialties in Turkey was contacted, and a dossier containing more than 400 pages of information was submitted, in order for medical specialties carried out in England to be accepted in Turkey. In order to chase up the process of the dossier, the association went to Ankara on 3 occasions. Chairman of ITSEB, Mr Ali Gul Ozbek had to go to Ankara on one occasion, and our valuable management committee member Dr Ali Demirbag had to go to Ankara on two occasions for the same reason. • The association gained the product of its work in May 2012. In Turkey, medical specialties carried out in three countries, namely Germany, USA and Hungary, were accepted as being equivalent. However, thanks to the efforts of ITSEB, England was accepted as the fourth country to this list. Later on, the association submitted many applications of GMC registrations for doctors carrying Turkish passports, who graduated from medical schools in Turkey. ITSEB wishes to thank our dear Ambassador and Consul General for their continuous support with regards to this issue. In line with this aim, and to gain support from Turkey’s Ministry for European Union (Avrupa Birligi Bakanligi), the association visited Ankara and gave a presentation to the Ministry of Europe (Avrupa Bakanligi) and obtained a promise of continuous help for the work carried out by us on this issue. Furthermore, we also conducted meetings with local members of parliament with regards to this issue. Finally, at the 11th congress of Turkish Pharmacists’ Association, a presentation was given on behalf of ITSEB, representing England, during a panel named Pharmacy in Europe. ITSEB was awarded a Certificate of Appreciation for this presentation.

During the London visit of TurkeyÕ s Minister of Heath Prof. Dr. Recep Akdag, our Management Committee member Dr Utkan Alacakanat had a one and a half hour meeting with the minister on behalf of ITSEB. 10

At the same time, members of our association were carrying out conferences regarding public health here at Cem Evi , Aziziye and Suleymaniye mosques. Ali Gul Ozbek - Pharmacist Chair

Dr. Alacakanat Case ITSEB is currently supporting an important case which is due to go ahead at the High Court in relation to the General Medical Council’s (GMC) policy of registering Turkish doctors to practise in the UK. The case concerns a Turkish doctor who has applied to the GMC requesting to be treated as an exempt person as per the European Community Association Agreement with Turkey which has been in force since 1973. Dr Alacakanat is a Turkish doctor who arrived in the UK in 2008 and applied to the UK Border Agency (UKBA) to set up in self-employment, providing services to disabled children. The UKBA subSibel Gumus sequently informed him that he is free to operate as a self-employed person in the UK ‘in any capacity’ subject to registration by the relevant body pursuant to HC 509 and 510-the immigration rules in place on 1 January 1973. Dr Alacakanat sought and was refused the relevant registration by the GMC to practise as a doctor in the UK. Dr Alacakant claims that as a national of Turkey seeking to remain in the UK as a self-employed person he can rely on Article 41(1) of the Protocol to the Association Agreement between the EEC and Turkey. By virtue of the UK’s membership of the EEC on 1 January 1973, it became bound by the terms of the Agreement. Article 41(1) provides: “The Contracting Parties shall refrain from introducing between themselves any new restrictions on the freedom of establishment and the freedom to provide services”. The Court of Justice in C-37/98 Savas v Secretary of State for the Home Department held that Article 41(a) has direct effect. Dr Alacakant seeks to rely on this article as it is argued by his legal representatives, namely Sibel Gumus of Morgan Has Solicitors and Mr John Walsh that he ought to be entitled to rely on this article. The effect is that the UK-like other Member States of the EU-cannot impose greater restrictions on the freedom of the Claimant to pursue self-employment in the UK than were in place on 1 January 1973. Dr Alacakant’s legal representatives Miss Gumus and Mr Walsh submit that since 1973 by way of the Medical Act 1983 and subsequent amendments and other regulations, his freedom to practise as a self-employed doctor is now much more restricted than it would have been on 1 January 1973. These new restrictions are contrary to EC law and Article 41(1) in particular. It is further stated that the GMC have a duty under sections 3(2) and 19(2) The Medical Act to treat relevant applicants for registration as if they were nationals of an EEA State. Dr Alacakanat enjoys an enforceable right under EU law and so should be treated as if he were a citizen of an EEA State for the purpose of registration. The current GMC regulations in force are discriminatory against doctors whom are non EEA nationals. An applicant who is either an EEA national or is the family member of an EEA national is treated as an exempt person for the purposes of GMC registration. It is noted that this does raise the question of the adequacy of the system in place whereby a Turkish doctor (or any other non EEA national doctor) who is married to an EEA national is treated more favourably than a doctor who is not. One cannot help but ask in these circumstances, the relevance of a doctor’s nationality in assessing their medical skills and capabilities. It is self evident that a doctor will not gain any professional benefits or skills by forming matrimonial ties with an EEA national other than the technical benefit of being treated as exempt person when registering with the GMC. Morgan Has Solicitors 06 March 2013


Ankara Association Agreement Between Turkey and The European Union and Judgements of The European Court of Justice on Turkish Citizens with A View to Their Impact on Medical Doctors Who Wish to Work in The Uk Ankara Agreement and Free Movement of Workers In the long running history of TurkeyÕ s accession process to the European Union (EU), the Ankara Agreement of 1963 which lays down the principles of the association between the partners, the Additional Protocol of 1973 setting out the conditions and timeframe for the implementation of this Agreement and the successive Association Council Decisions of 2/76, 1/80 and 3/80 for gradually securing employment and social security rights for Turkish nationals in the Member States until the accession of Turkey have led to very important legal gains with regards to free movement of our nationals in EU Member States. By courtesy of the legal texts mentioned above, nationals of Turkey are in a more privileged position, sometimes referred to as quasi-status, when compared to other third country nationals. As it is well known, there are 4 basic freedoms of movement in EU countries being the free movement of goods, capital, services and people. Despite the provisions of the Additional Protocol which envisage that the free movement of Turkish workers will be realized in gradual stages between 1986-1996, and by no later than 1996, Turkey-EU relations have not progressed as expected due to political reasons (the deadlock in relations following the 1980 coup etc.). As a result, the EU Council unilaterally suspended the free movement of people in 1986, the very year when it was supposed to start. Increasing problems of Turkish workers in the Member States arising from the implementation of the Immigration Legislation of these countries and the search for possibilities to provide solutions to these problems within the framework of Turkey-EU Association Law have paved the way to the European Court of Justice (ECJ) for Turkish nationals since 1996. It was clarified by the use of a ‘test case’ (Meryem Demirel) which was sent to the Court from Germany, that the Ankara Agreement would be observed as being an integral part of EU Law, and that the cases of Turkish nationals could be sent to the ECJ for interpretation of the Turkey-EU Association Law. Turkey, due to the highly unique development of her EU membership process as described above, is the one and the only country that can have the cases of her citizens referred to the ECJ from the national courts of Member States although she is not yet a member of the EU. Thus it should be noted that even if the EU membership of our country does not ever take place due to political reasons, the expansions of rights by law will constantly continue. Judgements of the EJC and their Impact on Our Citizens Since 1996, approximately 50 judgements concluded by the ECJ on Turkish cases have provided very high gains in terms of employment and residence rights (free movement of people) for our citizens in the Member States. The favourable interpretation provided by the ECJ , which has always played a leading role in developing the free movement of people, has taken the rights to a much further extent than anticipated within the context of the Ankara Agreement, the Additional Protocol and the Association Council Decisions. By means of these judgements the following have been clarified; • Turkish citizens legally residing in the Member States can prolong their work permits with the same employer after having legally worked for him for 1 year; after 3 years of legal employment with the same employer they can prolong their work permits to work with any employer in the same sector and after 4 years of legal work,


they can work in any sector and for any employer; • Family members may also obtain work permits under certain specified conditions; • The extension of working permits also necessitates the extension of residence permits, • The children of Turkish citizens who legally reside in the Member States can benefit from the same educational facilities as the citizens of those countries where they reside; • Our citizens may only be deported from the countries where they reside on the grounds of posing a threat for public security, public order or public health, instead of arbitrary reasons, • Turkish citizens who are legally residing in EU countries may benefit from social security facilities on equal footing as the citizens of the country in which they reside. New Rights Obtained by EJC Judgments in Cases Sent From England and their Impact on Turkish Doctors The judgement in the case of Abdulnasir Savas (2000), sent to the Court from the UK, has brought forward a very important opening with regards to the right for establishment setting one’s own business or the right for free movement of services. Savas Judgment clarified that no new restrictions can be brought forward to Turkish citizens’ rights to establish and provide services after the date when the Additional Protocol came into effect in a Member State. The Additional Protocol went into force in 1973 in the UK meaning that more restrictive measures introduced into the national legislation of the UK from this date on, in terms of Turkish nationals would be in violation of EU Law (standstill clause). Following this judgment, England has implemented the use of a new visa named “Ankara Agreement Work Visa” (ECAA2) for Turkish citizens who wish to obtain residence permit to work in the self-employed capacity by establishing their own business. There are currently no obstacles for getting an ECAA2 visa for Turkish nationals in un-skilled professions. However, we have a problem other than that of visa with respect to certain professional occupations (doctors, lawyers etc.) since it is illegal to work without being registered with an occupational board of a professional occupation even if one has a visa. For example, even if Home Office allows an ECAA2 visa to a medical doctor who opens his own clinic, this person cannot legally perform his profession without registration with the General Medical Council (GMC) of the UK, which, instead of providing a smooth registration for Turkish doctors applies the same rules employed for other 3rd country nationals. We are of the opinion that in line with the interpretation of the ECJ, 1973 rules of registration should be applied to our doctors, which were very easy and straightforward. We believe that doctors who are Turkish nationals should be able to register with GMC on the basis of their visa and qualifications in line with Association Law and the Judgements of European Court of Justice. It is important that we should pursue our hard earned rights by all relevant stakeholders collaborating to this end. It is pleasing to see ITSEB as one of the Non-Governmental Organisations (NGO’s) working hard in this direction. An application of a doctor who is a Turkish national for registration on the basis of Turkey-EU Association and supported by ITSEB has been a matter for a judicial review and is now awaiting some legal interpretation. Whatever the consequence of this case might be, we believe that it will be a win-win situation for our doctors. If the decision is favourable it will be an elimination of an obstacle for Turkish doctors who would like to work in the UK. If not, we shall see how far we can extend our rights stemming from the Association Law between Turkey and EU. Mrs Aysegul Yesildaglar Aysegul Yesildaglar worked as an Attache of Labour and Social Security in several EU countries and as the Head of EU Coordination Department at the Turkish Ministry of Labour and Social Security. She currently works as a consultant and is also one of the three members from the UK of the Advisory Board for Turks Abroad recently set up by the Office of the Prime Minister, TURKEY 14

Nobel Prize in Medicine 1972-2012 2012: Sir John B. Gurdon, Shinya Yamanaka “for the discovery that mature cells can be reprogrammed to become pluripotent”

2011: Bruce A. Beutler, Jules A. Hoffmann, Ralph M. Steinman Bruce A. Beutler and Jules A.

Hoffmann “for their discoveries concerning the activation of innate immunity” and the other half to Ralph M. Steinman “for his discovery of the dendritic cell and its role in adaptive immunity”. 2010: Robert G. Edwards, “for the development of in vitro fertilization.” 2009: Elizabeth H. Blackburn, Carol W. Greider, Jack W. Szostak, “for the discovery of how chromosomes are protected by telomeres and the enzyme telomerase.” 2008: Harald zur Hausen, “for his discovery of human papilloma viruses causing cervical cancer” and Françoise Barré-Sinoussi and Luc Montagnier, “for their discovery of human immunodeficiency virus.” 2007: Mario R. Capecchi, Sir Martin J. Evans, Oliver Smithies, “for their discoveries of principles for introducing specific gene modifications in mice by the use of embryonic stem cells.” 2006: Andrew Z. Fire, Craig C. Mello, “for their discovery of RNA interference - gene silencing by double-stranded RNA.” 2005: Barry J. Marshall, J. Robin Warren, “for their discovery of the bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease.Ó 2004: Richard Axel, Linda B. Buck, “for their discoveries of odorant receptors and the organization of the olfactory system.” 2003: Paul C. Lauterbur, Sir Peter Mansfield, “for their discoveries concerning magnetic resonance imaging.” 2002: Sydney Brenner, H. Robert Horvitz, John E. Sulston, “for their discoveries concerning ‘genetic regulation of organ development and programmed cell death.” 2001: Leland H. Hartwell, Tim Hunt, Sir Paul M. Nurse, “for their discoveries of key regulators of the cell cycle.” 2000: Arvid Carlsson, Paul Greengard, Eric R. Kandel, “for their discoveries concerning signal transduction in the nervous system.” 1999: Günter Blobel, “for the discovery that proteins have intrinsic signals that govern their transport and localization in the cell.” 1998: Robert F. Furchgott, Louis J. Ignarro, Ferid Murad, “for their discoveries concerning nitric oxide as a signaling molecule in the cardiovascular system.” 1997: Stanley B. Prusiner, “for his discovery of Prions - a new biological principle of infection.” 1996: Peter C. Doherty, Rolf M. Zinkernagel, “for their discoveries concerning the specificity of the cell mediated immune defense.” 1995: Edward B. Lewis, Christiane Nüsslein-Volhard, Eric F. Wieschaus, “for their discoveries concerning the genetic control of early embryonic development.” 1994: Alfred G. Gilman, Martin Rodbell, “for their discovery of G-proteins and the role of these proteins in signal transduction in cells.” 1993: Richard J. Roberts, Phillip A. Sharp, “for their discoveries of split genes.” 1992: Edmond H. Fischer, Edwin G. Krebs, “for their discoveries concerning reversible protein phosphorylation as a biological regulatory mechanism.” 1991: Erwin Neher, Bert Sakmann, “for their discoveries concerning the function of single ion channels in cells.” 1990: Joseph E. Murray, E. Donnall Thomas, “for their discoveries concerning organ and cell transplantation in the treatment of human disease.” 1989: J. Michael Bishop, Harold E. Varmus, “for their discovery of the cellular origin of retroviral oncogenes.” 1988: Sir James W. Black, Gertrude B. Elion, George H. Hitchings, “for their discoveries of important principles for drug treatment.” 1987: Susumu Tonegawa, “for his discovery of the genetic principle for generation of antibody diversity.” 1986: Stanley Cohen, Rita Levi-Montalcini, “for their discoveries of growth factors.” 1985: Michael S. Brown, Joseph L. Goldstein, “for their discoveries concerning the regulation of cholesterol metabolism.” 1984: Niels K. Jerne, Georges J.F. Köhler, César Milstein, “for theories concerning the specificity in development and control of the immune system and the discovery of the principle for production of monoclonal antibodies.” 1983: Barbara McClintock, “for her discovery of mobile genetic elements.” 1982: Sune K. Bergström, Bengt I. Samuelsson, John R. Vane, “for their discoveries concerning prostaglandins and related biologically active substances.Ó 1981: Roger W. Sperry, “for his discoveries concerning the functional specialization of the cerebral hemispheres” and David H. Hubel and Torsten N. Wiesel, “for their discoveries concerning information processing in the visual system.” 1980: Baruj Benacerraf, Jean Dausset, George D. Snell, “for their discoveries concerning genetically determined structures on the cell surface that regulate immunological reactions.” 1979: Allan M. Cormack, Godfrey N. Hounsfield, “for the development of computer assisted tomography.” 1978: Werner Arber, Daniel Nathans, Hamilton O. Smith, “for the discovery of restriction enzymes and their application to problems of molecular genetics.” 1977: Roger Guillemin and Andrew V. Schally, “for their discoveries concerning the peptide hormone production of the brain” and Rosalyn Yalow, “for the development of radioimmunoassays of peptide hormones.” 1976: Baruch S. Blumberg, D. Carleton Gajdusek, “for their discoveries concerning new mechanisms for the origin and dissemination of infectious diseases.Ó 1975: David Baltimore, Renato Dulbecco, Howard Martin Temin, “for their discoveries concerning the interaction between tumour viruses and the genetic material of the cell.” 1974: Albert Claude, Christian de Duve, George E. Palade, “for their discoveries concerning the structural and functional organization of the cell.Ó 1973: Karl von Frisch, Konrad Lorenz, Nikolaas Tinbergen, “for their discoveries concerning organization and elicitation of individual and social behaviour patterns.Ó 1972: Gerald M. Edelman, Rodney R. Porter, “for their discoveries concerning the chemical structure of antibodies





The New NHS

Changes, Challenges & Opportunities The NHS is set to undergo transformational changes. The new GP-led clinical commissioning groups (CCGs) will no doubt transform the way the NHS delivers its services. With the Care Quality Commission keeping a careful regulatory eye on service delivery, and Monitor focusing on standards, governance and finance, the potential for excellent patient care looks bright. Or does it? How do you transform what has been suggested as the third-largest public employer in the world, after the US Department of Defense and the China’s Peoples Liberation Army? How do you manage an organisation which has been branded ‘too big to manage?’ NHS numbers make interesting reading. Over one million patients are seen at an NHS facility every thirtysix hours across the UK. 50 percent more operations were conducted by NHS specialists in 2009/10 than in 2000/01. Over the same period, average waiting times fell sharply. For instance, for coronary artery bypass grafts, from 180 to 45 days, and for hip replacements from 162 to 65 days. A&E departments across the UK delivered services to 21 million patients in 2010/11. Outpatient appointments saw an increase of 3.8 million in 2010/11, over the previous year. NHS net expenditure increased from £49 billion in 2001/2002 to £104 billion. Planned expenditure for 2012/13 is set at £108 billion. Per capita expenditure in England has also increased, from £1,287 in 2003/4 to £1,979 in 2010/11. These are impressive numbers, by any standards. The concept of ‘free-of-charge at the point of use’ continues to drive NHS philosophy. Available to all, regardless of wealth, the NHS is a true national institution that must be safeguarded and celebrated. On the other side of the coin, the numbers need careful attention. The UK population is projected to rise from an estimated 62 million in 2010 to 71 million by 2030. By 2013, an estimated 16 million Britons will be aged over 65. There will be 4 million diabetes sufferers in 2025, up from 2.8 million in 2010. Obesity will continue to be a national issue. All these figures are against a backdrop of life expectancy figures of 78.2 years for men and 82.3 for women. As a national strategy, public health education, and prevention seem to be the key ways forward for the NHS. How will NHS reform address these stark and pressing issues? How can NHS managers get more for their pound, whilst delivering more quality per pound spent? There is no doubt that medical practice has changed significantly over the last fifty years. The UK has led the world in many areas of medical science, technology, research and practice. With major discoveries and improvements in blood testing, CT, MRI and X-ray, immunology and nuclear medicine, the future for medical practice and integrated patient care looks positive. Evidence-based practice, patient-empowerment, integrated approaches to service delivery, and social-economic pressures on budgets, all come together to present new dimensions to inform NHS reform.


While some commentators argue that the NHS was slow to notice changes in lifestyle, demographics, social attitudes and patient preferences, others believe that the service is world-class, fit for purpose, and remains the envy of the world. No matter which position commentators take, one point is clear: the NHS will benefit from a more entrepreneurial approach to long-term reform. This entrepreneurial approach will embrace new ideas, increased private sector participation, highimpact, targeted interventions, and an overall focus on sustainable, quality delivery. The ‘brave new NHS’ will also take a total, integrated approach to deliver care, based on local patient needs and social dynamics. A new strategy for inviting and integrating foreign-qualified and experienced health-care professionals will also need to be developed and implemented. Certain GP-related issues such as lowstandard practice premises will need to be addressed. Closing down practices which do not meet basic standards will raise the overall quality of service delivery across the UK. GP practices are independent entities, providing services to the Department of Health. As self-employed operators, limited companies or partnerships, their incomes depend on their patient list size, the Quality & Outcome Framework (QOF), various additional services, and generally, PCT-paid surgery freeholds. The investment in premises provide a relatively good income, in addition to the other income streams. GP contracts generally do not provide incentives for them to improve their practices and provide more services in-house. These contracts also make it very difficult for new GP practices with better facilities to be set up to compete with existing practices. As GP practices will now have to be registered with the CQC from April 2013, it will be interesting to see how regulators engage with them regarding their premises. The contribution of foreign professionals in the NHS is well-documented. 92,500 (36%) of the 252,400 or so doctors practising in the UK are from overseas, making up a significant proportion of the NHS frontline delivery team. The language barrier some doctors experience is being addressed by intensive training and qualification standards. Whilst the quality and credentials of these professionals must meet the highest standards, it is equally important to improve on the reception, support and general integration approach received by these highly-motivated doctors and nurses. A reform strategy will surely address these critical staffing issues for the long-term sustainability of excellent patient care. Big challenges call for bold actions. The scale and complexity of the NHS challenge is evident. Successive governments have implemented policies designed to tackle pressing healthcare problems. Perhaps the time for a root-and-branch approach has come. One such action is the one-stop ‘total service delivery’ approach. Driven by defined local need and socio-demographic markets, bringing together the key elements of primary, secondary and tertiary health care will provide the quality of care patients demand today. It will give NHS managers more value per pound. It will also give patients better care. It will tackle local socio-economic challenges, whilst putting local practitioners in full control of frontline delivery. This integrated strategy will free valuable NHS resources to address burning issues which will not go away - an aging population, obesity, and lifestyle choices.


This integrated approach is not a new idea. Shifting some of the secondary care services to GP practices will make life easier for patients and cost effective for NHS. Michael Porter and Elisabeth Teisberg have argued that high-quality care should be less costly, as a result of ‘the right kind of competition on results”. Improvements in efficiency and quality should follow, drawing on findings from their own research. The new, entrepreneurial NHS will surely make big strides in quality delivery and efficiency savings through the shifted approach. Private sector operators, social entrepreneurs and institutional investors will be attracted by the ‘win-win-win’ outcome, where the NHS, practitioners and most importantly, patients, all benefit over the long term. Bringing together primary healthcare resources and some secondary healthcare capabilities in one package makes good sense for all stakeholders. The reform will not be flawless. Teething challenges will need to be overcome. Patients will need to be educated on their new choices. Practitioners will need to embrace change and engage more closely with each other. Regulators and managers will need to adopt a flexible approach, whilst maintaining ‘law and order’ across the system. As a long-term, sustainable and cost-efficient model, the GP service + shifted secondary care model needs to be at the centre of any reform agenda. It presents a unique opportunity for all stakeholders to engage at the point of delivery. GPs have a lead role to play in GP-led CCG reform agenda. As key delivery agents, their expertise and long-term sustainability is crucial to the success of this integrated approach to patient care. It will improve the way they do business, provide more flexibility for them, and make them the key players they need to be in any efficient, world-class healthcare system. It will also improve their business models, and ensure the long-term viability of their practices. With investment coming in from private and institutional sources, new opportunities will emerge for GPs to build their businesses over the long-term. Although it has been suggested that the ‘conflict of interest’ issues have been addressed, we wait to see how this works in practice. The new NHS will look after over 70 million potential service users over the coming years, with a growing percentage of pensioners. This reformed NHS will tackle obesity challenges on a major scale, across all ages. On the other hand, it will also transform itself into an army of highly-skilled professionals, delivering complex, mission-critical services across a logistics system comparable to the US and Chinese defence organisations. Making bold decisions and efficiently combining its resources can only be a good thing for patient care at primary, secondary and tertiary levels. The red tape will always be in the background to regulate the system. In our brave new NHS, red tape will have one more player to embrace, the social investor and entrepreneur. Dr. Ali Demirbag MD Project Director of LSC

1948: Park Hospital on the day the NHS was born 24

Psychosocial Enrichment Program for Turkish Speaking Parents and Their Children living in North London This study is the first and most comprehensive Randomized Controlled Trial on migrants coming from impoverished and mostly rural parts of Turkey to London. Turkish speaking people are one of the largest migrant groups living in Europe. Approximately 80.000 Turkish speaking people are said to be living Enfield. Our study aims to evaluate whether young Turkish speaking children living in London would benefit from a program devoted to educating their mothers in how to engage better with them. These children who live in greater London are believed to be at risk primarily because of their background and their current home environment. Most of their educational needs are found to be greater than those of other ethnic populations (Yule, Berger, Rutter, & Yule, 1975; Stubbs, 1981; Sonyel, 1990). Sonyel discovered that this group constitutes 35% of the allocation in special schools. According to the Swan report (1985), Turkish ethnic minorities are particularly disadvantaged in social and economic terms, and this extra deprivation was the result of racial prejudice and discriminaSheila Yahya Levi tion bearing directly on children within the educational system, as Chartered Clinical Psychologist & well as outside. Sonyel claims that these children cannot benefit Child & Adolescent Psychotherapist from the British education system owing to the low expectations of adults around them. Kagitcibasi (2009) adds the fact that many of the child-rearing patterns of Turkish families value conformity, observation and imitation rather than “reflection-enhancing parenting�. As a result, these parents also fail their children in developing a sharp analytical focus that the Western post-industrial world demands. They suffer a multitude of traumas: not only were they not given an opportunity to develop their minds in interpersonal experiences (Schore, 1994; Fonagy, 2002; Tronick, 2007) (which consequently puts their global development behind their age group), but they were also further traumatised by being deprived from literacy nurturing activities at their homes. Moreover, the parents experience culture clashes in their everyday lives in the UK, having been dislocated from mostly rural Turkey to urban neighbourhoods in the UK. A reorganisation of their identity is required (Akhtar, 1995), which in turn may have a negative effect on their parenting skills. As schools are often migrant children’s first contact with Western culture, this is where their significant adaptation difficulties begin to manifest themselves. For many, the school experience is not a good one, and the school is therefore perceived as an alienating environment (Enneli, Moddod and Bradley, 2005). They and their parents require an adult education and child development program that encourages effective parenting. The Mother-Child-Education-Program (MOCEP) together with the Cognitive Enrichment Program (CEP) is suggested here for this purpose. The aim of these Programs is to foster strong relations between


the mother and the child within the educational cycle and assist not only the children at school, but also the whole family’s integration into the British society. MOCEP consists of 25 weekly group sessions, each session lasting 2 hours. The sessions are semi-structured and followed by CEPs where mothers are trained in small groups about the ways of helping children gain study skills. The three main elements of the Program are: to foster cognitive development of the child; to sensitize mothers on the overall development of the child; and to educate mothers on reproductive health and family planning. Evidence collected in Turkey regarding the MOCEP is convincing that parents can be taught both new skills and additional knowledge related to child rearing, specifically “reflective parenting skills”, and can be helped with their child’s particular developmental issues (Kagitcibasi, 2009; Bekman, 2000) longitudinally (Kagitcibasi, et. al., 2009). The challenge here is to see whether the positive results obtained there can be repeated with the Turkish speaking groups in London. This study is of value, as it claims to be an economic program to achieve preventative work in terms of protecting children and mothers from future academic as well as mental health related problems. It can also empower isolated migrant mothers within their community to become better parents in supporting their children’s adaptive development. In order to raise funds for this valuable project five ladies (Ayla Toprak Zengin, Sibel Ucur, Ozlem Edige, Nursel Gundes, Seda Samji) organized a charity dinner on 25th of February at Edmonton Prince and Princess Hall where Ilhan Sesen, Kursat Basar, Aysen, Yasar and Felicity Kaya performed for free to support our project. £19.000 profit gained after the event. The money is donated to the charity account “MOCEP-CEP London” charitable funds established within Barnet, Enfield, Haringey NHS Mental Health Trust to be spent only for the expenses of the project. REFERENCES • Akhtar, S. “A third individuation: immigration, identity, and the psychoanalytic process”. Journal of American Psychoanalytic Association, 1995, 43: 1051-1084. • Bekman, S. (2000). A Fair Chance: An Evaluation of the Mother-Child Education Program. Istanbul: Mother-Child Education Foundation. • Bottari, A, Hillman, S. & Levi, S. (2012). “The impact of natural disaster trauma on children’s actual and ideal self and object representations in Kinetic Family Drawings”. Unpublished MSc thesis, London: Anna Freud Centre. • Burns, R.C. (1982). Self-Growth in Families. New York: Brunner/Mazel. • Enneli, P., Moddod, T., and Bradley, H. “Young Turks and Kurds: a set of ‘invisible’ disadvantaged groups”. (Feb 2005). Bristol University Research Project. • Erikson, E. (1956). The problem of ego identity. In Identity and the Life Cycle. New York: International Universities Press, 1959, 101-164. • Fonagy, P. (2002). Affect Regulation, Mentalization, and the Development of the Self. New York: Other Press. • Goodman, R. (1997). “The strengths and difficulties questionnaire: A research note”. Journal of Child Psychology and Psychiatry, 38, 581-586. • Hodges, J., Steele, M., Hillman, S., & Henderson, K. (2003) “Mental representations and defences in severely maltreated children: a story stem battery and rating system for clinical assessment and research applications”. In R.N., Emde, D.P., Wolf, & D. Oppenheim (Eds.), Revealing the Inner Worlds of Young Children: The MacArthur Story Stem Battery and Parent-Child Narratives. Oxford: Oxford University Press. Kağıtçıbaşı,Ç., Sunar, D. and., Bekman, S. Long-term effects of early intervention: Turkish low-income mothers and children. Applied Developmental Psychology .2001, 22, 333-361. • Kagitcibasi, C. (2009). Family, Self, and Human Development Across Cultures: Theory and Applications. London: Psychology Press. • Kagitcibasi, C.; Sunar, D.; Bekman, S.; Baydar, N.; Ornektar, Z. “Continuing effects of early intervention in adult life: The Turkish early enrichment project 22 years later”. Journal of Applied Developmental Psychology, 2009, doi:10.1016/j.appdev.2009.05.003. • Mattner, D. (2006). ADS die Biologisierung abweichenden Verhaltens. In: M. Lauzinger-Bohleber, Y. Brandl & G. Huther, (Eds.), ADHS – Fruhpravention statt Medikalisierung. Theorie, Forchung, Kontroversen (pp.51-69). Gottingen: Vandenhoeck & Ruprecht. • Schore, A. N. (1994). Affect Regulation and the origin of the self: The neurobiology of emotional development. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc. Sonyel,S. (1990). “Educational difficulties of Turkish children living in England”. Report. • Stubbs, W. Inner London Education Authority (ILEA)’s Research Findings: British Literacy, RS 776/81, Feb 1981, p. 5-9 & Educational Research Feb 1981, p.83-95. Tronick, E. (2007). The Neurobehavioral and Social-Emotional Development of Infants and Children. London: W.W. Norton & Company. • Yule, W., Berger, M., Rutter, M., & Yule, B. “Children of West Indian immigrants – II. Intellectual performance and reading attainment”. Journal of Child Psychology and Psychiatry, Vol. 16, 1975, pp. 1-17.


Being A Turkish Doctor in the UK, Year 1989 I graduated from Aegean University Medical Faculty, Izmir, Turkey in 1989, and the same year made my way to the UK for a better postgraduate training. However, as a Turkish Cypriot, I am eternally grateful for the education I received in Turkey. There are a few reasons for me choosing Britain for my postgraduate training. Firstly, UK is one of the leading countries in medicine. Secondly, the fact that there has been the never ending political uncertainty in my home country Cyprus, and thirdly, Cyprus’s historical allegiance to the UK. My first point of contact was General Medical Council. Any doctor who is to practice in the UK, needed to be registered with this organisation. In order to be registered, an overseas doctor needed to qualify for an examination called PLAB (Professional and Linguistic Assessment Board) test. Certain Turkish university graduates were allowed to take this exam. Luckily, Aegean university was considered to be one of the old universities with good reputation. However, a doctor friend of mine Ahmet, could not qualify as he was a graduate from Uludag University which was considered to be a new university at the time. For him, USA was his destination, despite being married to an English girl.

Dr Erdinc Havutcu MD, MRCOG

The PLAB test was a difficult test with a pass rate of about 10%, made up of 8 different modules which had to be passed at the same sitting. It was also an expensive test costing around £400 to take. I had to compete with other overseas doctors mainly Pakistani and Indian who had had a similar medical curriculum in Englsih as in British medical faculties. Our curriculum and training in Turkey which was in Turkish had more in common with USA than the UK medical faculties. I later found out that British doctors were being trained in more practical side of medicine than theoretical. Hence, I had a big task in hand that I had to adapt my medical knowledge not only to English, but also be more practical and patient oriented. In 1989, there were a lot of Turkish people, mainly Cypriots concentrated in North London, but not many Turkish doctors in this country. There was no other Turkish doctors in my position either. As one does, I felt the need of a Turkish doctor mentor, somebody who would be a guidance for me. I asked Dr Tahsin Bilginer’s advice. However, he is much older than me, and at his time he did not have to take the PLAB test to practice in this country. I thought “How lucky!”. I started to improve my English. I also had to finance myself, as at the age of 24, it is not as easy to be dependent on one’s parents, although my dearest father was more than willing to support me all along. I found a job at a fast food restaurant which gave me the opportunity to earn some money, and have some contact with people to improve my English. However, in order to be able to talk and treat a British patient, one had to have a good command of not only spoken colloquial English, but also medical English. I should be able to break a bad news when necessary, or be able to prepare a patient for an intimate examination in a sensitive way. Luckily, there was a college called Southwark College in Waterloo specifically giving a medical English course to overseas doctors. Mrs Joy Parkinson who had written the book called Ò Manual of English for Overseas Doctor” also taught there. She was of great help in my education too. The rest was day and night hard work in revising the medical books in English. When I took the test, and failed in two of the eight modules marginally, had to take it all the modules for the second time. Fortunately, my second attempt was of a success, and that day, I remember very well, was one of my happiest days in my life! That had enabled me to be able to look for a training medical job in this country. Getting the very first job was always going to be difficult, as I had had no working experience in this country.


Podiatrists in the UK I am a specialist Podiatrist currently working in the NHS and undertaking MSc in Podiatric Surgery. Podiatrists are healthcare professionals who diagnose and treat deformities of the feet and lower limb. They treat patients from all age groups from infant to elderly. Podiatrists also provide professional advice on footcare, footwear and the prevention of foot problems. They play a significant role in prevention and treatment of patients with high risk of amputation, for example diabetic patients. In order to practice in the UK, Podiatrists need to be registered with the Health Professions Council (HPC). Registered practitioners are required to complete and pass a full time honours degree (BSc Hons) in podiatry/podiatric medicine.Podiatrists work as part of a multidisciplinary team to provide better care for their patients. The team may include; GPs, vascular surgeons, rheumatologists, nurses, dietitians, and physiotherapists. They are also responsible for the supervision of podiatry assistants in provision of footcare and treatment. Podiatrist may undertake postgraduate courses to specialise in podiatric surgery, minor surgery, sports medicine, biomechanics, and diabetes/wound care. • Podiatric Surgery simply involves the surgical treatment of the foot. Usually carried out under local anaesthetic by podiatric surgeons.

Mr Murat Bozdag Specialist Podiatrist

• General podiatrists can carry out minor surgeries such as nail and soft tissue surgery. Also, they can administer local anaesthetics. • Sports podiatrists deal with treating injuries related to playing sports or physical activities. This may include injuries to joints, muscles, tendons and ligaments. • Biomechanics deals with the movement of bones and muscles and its role in standing, walking, running and posture. Biomechanics specialists treat postural pains and injuries, for example flat feet. Diabetes and wound care involves prevention, diagnosis and treatment of ulceration and amputations. Some of the common foot problems: Ageing feet, Athletes foot, Blisters, Bunions/toe deformities, Callus, Chilblains, Corns, Diabetes, Gout, Heel pain, In growing Toenails, Osteoarthritis, Rheumatoid Arthritis, Sweaty Feet, Verrucae.


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M: 07816405838 • Tel: 0208 886 1119 Mr.S.Gul, BSc, Master Practitioner, MBABCP NLP-Psikoterapi, Hipnozterapi

Doctor Doctor I think I’m god?

Doctor Doctor

How did that start? In the beginning there was darkness...

I canÕ t stop stealing things Take these pills for a week; if that doesnÕ t work I’ll have a color TV!

Can I have second opinion? Of course, come back tomorrow!

What can I do? I think I’m a pair of curtains? Pull yourself together man!

My irregular heartbeat is really frightening me. DonÕ t worry - weÕ ll soon put a stop to it!

Every time I drink a cup of coffee I get this stabbing pain in my eye! I suggest you take the spoon out!

r Doctor Docto What can I do? Everyone thinks I’m a liar? I find that very hard to believe!

I think I’m a bridge? What’s come over you? Oh, two cars, a large truck and a coach.

Doctor Doctor

Doctor Doctor

Doctor Doctor

Doctor Doctor

ctor o D tor . me Doc p l e le h sib ase nvi i e l P I’m se! ink ea l P I th xt Ne

n? poo tir! s ts ea l lik on’ e d e If nd till a s l l i St

r Doctor Docto You’ve got to help me I just can’t stop my hands shaking! Do you drink a lot? Not really - I spill most of it!

r Doctor Docto My daughter has just swallowed my pen what shall I do? Use a pencil!

r Doctor Docto

r Doctor Docto I think I’m a bell? Take these and if it doesnÕ t help give me a ring!

I’ve got insomnia Just sit on the edge of the bed. You’ll soon drop off!

Doctor, Doctor I think I’ve broken my neck? Don’t worry - keep your chin up!

r Doctor Docto I think I’m a cat? How long has this been going on? Oh, since I was a kitten I guess!

Doctor, Doctor I’ve just swallowed my mouth organ Well look on the bright side, at least you werenÕ t playing a grand piano!

Prepared by Sibel Ozburun:-) 34

Good Old Days

Prepared by M. Kemal Beyazit:-)


the iris  

Medical Journal United Kingdom Editor Dr Ali Demirbag