The Doctor, issue 46, August 2022

The magazine for BMA members

thedoctor

Issue 46

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August 2022

Battle weary GP scheme for veterans scarred by war Hearing each other Improving the dialogue between primary and secondary care Back to his roots Former BMA council chair Chaand Nagpaul’s next steps

Keeping up appearances The quiet revolution in how doctors are expected to look

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In this issue 3 At a glance Junior doctor’s deportation threat lifted after BMA pressure

4-7 Soldiering on Improving the care of military veterans

8-11 Hearing each other Progressing the often strained relationship between primary and secondary care

12-15 Making an impression The sweeping change in how doctors are expected to look

16-17 Two heads are better than one Why the BMA’s new co-CEOs feel a personal as well as professional commitment to members

18-22 From Thatcher to COVID Chaand Nagpaul looks back over a long career representing doctors and explains what motivates him

23 Your BMA Juniors can be treated badly during the changeover period – the BMA can help

24 On the ground A hospital trust seemed ignorant of the rights of a consultant they attempted to make redundant

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Welcome Phil Banfield, BMA council chair The medical profession and the NHS are at a crossroads, where it is no longer possible to ignore deficiencies in staffing driven by pay pressures across a whole career, from student debt to punitive pension taxation which inhibit doctors’ ability to give their best to patients in need.

These not only reflect intolerable stresses on a system that is underfunded, under-staffed and over-stretched beyond its limits, but are a sad reflection on poor culture, behaviour and discrimination all around us – at work and wider society.

In this month’s edition of The Doctor we look back on the career, achievements and legacy of Chaand Nagpaul, my predecessor as BMA council chair, and we also look forward to the future of the BMA in an interview with our new co-CEOs Neeta Major and Rachel Podolak.

Chaand served the BMA and our profession with distinction and dignity during his five-year period as council chair and will continue to be deeply involved with the BMA, NHS and his local community in north London.

In the feature he shares my view that this is a ‘watershed moment’ for an NHS, which simply cannot continue in the way it has been doing.

He wants the doctors of the future ‘to have a belief that they can be a part of a better future’. This is very much at the heart of my vision for the future of the BMA and our profession. Many of the issues Chaand started to tackle were previously in the ‘too difficult box’; for me, his legacy is that we will continue to deliver on his work.

This August edition includes features analysing the relationship between primary and secondary care – an area where greater understanding of the pressures each face is essential and how increased communication must be backed.

We also find out about a brilliant GP accreditation scheme which sees doctors working with veterans traumatised by their experiences to help them return to the front line. We hear from doctors who have tattoos about their experiences in the profession and the changing sense of what doctors ‘should’ look like.

Keep in touch with the BMA online at twitter.com/TheBMA

instagram.com/thebma

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AT A GLANCE

Home Office overturns junior’s deportation after BMA pressure

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doctor threatened with deportation owing to a visa dispute has spoken of his relief after the order to remove him was rescinded by the Home Office.

The UK-trained international doctor, who had faced being removed from the UK on 6 August because of fears he was planning on working in the NHS without an appropriate visa, was allowed to return home voluntarily as planned on 9 August.

The doctor, who wishes to remain anonymous, had previously been offered a job in the NHS and had been in the UK on a visitor visa to make personal arrangements such as organising accommodation, while awaiting his certificate of sponsorship – an electronic document required for the issuing of a skilled-worker visa.

After briefly leaving the UK to go on holiday with friends, he found himself being stopped by border security and having his phone and passport confiscated upon returning to the country on 2 August.

Following vocal online appeals for support by the doctor’s friends and intervention by the BMA, the decision to remove him from the UK was overturned by the Home Office.

The BMA is calling for his application to be expedited and for him not to face any further delays. Speaking to The Doctor, the junior doctor said, while he was treated respectfully during his detention at the airport, he had felt totally ‘blind-sided’ by an experience he described as ‘unexpected and bizarre’.

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He said his explanation he was making personal arrangements ahead of gaining the visa required for him to take up work fell on ‘deaf ears’.

He said: ‘They took it to mean that I was trying to start work without a visa. And after that initial impression was given to them, they never seemed to go off that.

‘It was a very unsettling and slightly surreal experience [and] the last thing I expected to happen. I’d got into the UK two weeks before and had a detailed but pleasant chat with one of the previous customs officials who was very understanding of the situation.’

After spending several hours being detained, the doctor was allowed to leave to go and stay with a relative, with border services retaining his passport.

He said the prospect of deportation was a huge worry as he believed it would count against him in future immigration applications.

‘I was extremely concerned because of this refusal of entry. It’s a huge mark that will definitely make future visa applications far more difficult and I was very concerned that this would impact my ability to work in the UK. ‘In the last 72 hours I was questioning whether it was worth it at all to go through and jump through hurdles to get back to work in the UK, but I do have a special fondness for the country itself having trained and worked here for close to a decade now.’

By Tim Tonkin thedoctor | August 2022

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ED MOSS

Alexander Kennedy MC (left) and Jonathan Leach

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ED MOSS

Soldiering on Military veterans often have very specific needs, which are easily missed. An accreditation scheme for GP practices seeks to boost awareness and offer reassurance to patients.

Ben Ireland reports

‘I

was having nightmares and I couldn’t walk down the street or step on grass,’ says Alexander Kennedy MC, a military veteran who witnessed his fellow soldiers – close friends – killed by improvised explosive devices in Afghanistan.

It is perhaps no surprise to doctors that Mr Kennedy has been diagnosed with PTSD (posttraumatic stress disorder) since those incidents in Helmand Province, but the stigma around mental illness continues to prevent many veterans seeking support.

That, and Russia’s war in Ukraine retriggering trauma, is why the RCGP (Royal College of General Practitioners) and NHS England are encouraging more practices to become ‘veteran-friendly accredited’, in an initiative strongly supported by the BMA. Mr Kennedy is thought to be the youngest person to receive the Military Cross, one of Britain’s highest military decorations, since the Second World War. He received it in recognition of his efforts to aid his injured platoon commander while under fire during a battle in 2009.

For him, knowing the clinician treating him understands his situation is important.

He joined the Army’s Mercian Regiment at 16 in 2007 and was deployed to Afghanistan having just turned 18, the youngest age soldiers can be deployed to the front line.

His first tour was ‘a great experience’, he says, ‘but I was unaware how much it had hit me until a couple of years later’.

Promoted to lance corporal, Mr Kennedy was sent on a course that covered bomb combat to prepare for his next tour.

‘At that time there were a lot of amputees, or

people killed that way,’ he tells The Doctor.

‘After that, it hit me pretty hard. My mum sensed something wasn’t right. I took myself out of the field and came home.’

Change in behaviour Mr Kennedy says the Army’s macho nature means seeking help is stigmatised. At first, he remained undiagnosed and turned to alcohol, which he says ‘amplified’ the trauma.

‘Within the military it’s known we drink an awful lot,’ he says. ‘It’s work hard play hard.

I know people who have criminal records because they were spiralling.’

Although Mr Kennedy was seen by a military doctor in Afghanistan, it was only when he returned that a senior officer ‘noticed a change’ in his behaviour when he was preparing for his next tour.

‘They told me to stop drinking,’ he recalls.

‘But my parents knew it was more than that.’

His parents knew their local GP, Jonathan Leach, was ex-military so urged him to pay him a visit.

They may not have known Dr Leach is also NHS England’s associate medical director for armed forces and veterans’ health and set up the accreditation for GPs along with Brigadier (retd) Robin Simpson, a former Army GP and professor of military primary healthcare and veterans’ health.

Mr Kennedy remembers his first appointment with Dr Leach: ‘He just looked at me and said, “You need help”. He understood.

He has a lot of experience with trauma and has seen what can happen. Ultimately, Dr Leach saved my life.’

Mr Kennedy was referred to a specialist thedoctor | August 2022

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ED MOSS

LEACH: ‘This is a group of individuals with very specific needs’

‘I had lots of space and time but people were there if I needed anything’

veterans’ unit for eight weeks.

‘Things happened very quickly,’ he recalls.

‘There were a lot of other specialists, like psychologists, involved.’

Mr Kennedy, who remains on sick leave from the Army, says PTSD is ‘a subject that makes you very vulnerable’.

‘You have PTSD because you survived,’ he says. ‘Your colleagues didn’t. I needed to speak to somebody who understands that [because] you are exposing very personal things. PTSD for someone who has been in a car crash is different. Veterans have seen their friends getting blown up. We’re not special, but it’s different.’

The need for understanding ‘Each GP practice is likely to see a military veteran every day’

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Mr Kennedy was alongside other veterans with PTSD. ‘A lot of it was a blur,’ he says. ‘But it was reassuring to be in an environment with other people being treated for the same thing. I had lots of space and time but people were there if I needed anything. My mum and dad had an emergency number.

‘I could open up. I spoke to just one individual [clinician], which helped. I didn’t want to constantly relive the trauma. It was fast, but not too quick for me to be able to deal with it. I had gone months not knowing what to do, the next minute I was on track. We like structure in the military.’

Mr Kennedy says he is lucky to have a supportive family but notes ‘not everyone has that’, which is one of the reasons he wants

more GP practices to become accredited through the RCGP. He believes it will give more veterans the reassurance to seek help from someone who understands the unique pressures of serving in the military.

So far, 1,500 GP practices have the accreditation, which has helped refer more than 20,000 veterans.

For Dr Leach, who spent 25 years in the Army and served in Iraq, Yugoslavia and Northern Ireland, spotting PTSD among veterans is ‘a lot easier, because I get it’.

‘I have a particular advantage because I served,’ he says. But he wants to see an accredited clinician in every hospital and primary care setting to help advise where referrals can go via Op Courage: The Veterans Mental Health and Wellbeing Service and the Veterans Trauma Network.

‘The concept is very straightforward,’ explains Dr Leach. ‘When someone registers, we ask if they have a military background, and code it. There is a clinical lead for the practice.

It doesn’t need to be a doctor. It’s a similar concept to a safeguarding lead.’

Accreditation affects the culture of the whole service ‘from the receptionists through to referral’, he adds. ‘Wider understanding is really important. This is a group of individuals with very specific needs.

‘Rather than bouncing in and out of services, you can refer patients to the right place at the right time. It helps in terms of getting people better, but also – given where we are in general

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WEIR: Service is likely to help veteran and service families

LODGE: Able to expedite patients through the NHS system

practice – identifying trauma earlier helps take some pressure off the service.’

Early intervention The aim is to refer patients ‘before things escalate’ and a two-week schedule is the target. ‘In the same way as cancer, treating it earlier leads to better outcomes,’ says Dr Leach, who notes: ‘Every individual is going to have slightly different traumas but it’s the same combined reason.’

Having knowledge of PTSD from a military perspective has also helped Dr Leach identify it in civilian cases, including one patient who had been in a car crash a year earlier and a woman who had been sexually assaulted by her father when she was a teenager.

‘These examples have nothing to do with the military but me and colleagues are much more attuned to the signs,’ Dr Leach says.

‘The more clinicians who have this understanding, the better.’

Jackie Lodge, a GP at Kirkbymoorside in North Yorkshire, became veteran accredited after seeing an email from the RCGP last August. Her practice already knew of 31 veterans among its 6,000 patients but has since identified more.

‘It can be as easy as a simple question,’ says Dr Lodge, who has learnt some patients are veterans from conversations in consultations.

She also praises her reception and nursing teams for helping to ask or including the option on forms.

‘One veteran saw a poster about the bma.org.uk/thedoctor

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accreditation and told me all about his military service,’ she says. ‘He said if he hadn’t seen it, he wouldn’t have said anything.’

Fast-track option Dr Lodge says she learnt more about Op Courage referral options through the training and how she is able to fast track veterans with injuries sustained in active service.

One of her patients, injured serving in Northern Ireland, had hip pain and was on the waiting list for a musculoskeletal clinic that can take up to a year. ‘I was able to quote the Armed Forces Covenant to expediate him through the NHS system,’ she says. ‘Two weeks later he had been seen, was comfortable and pain free.

I couldn’t believe it.’

The scheme is evaluated by the University of Chester, which found 84 per cent of accredited practices now feel they have a better understanding of veterans’ needs.

And it has been ‘wholeheartedly’ welcomed

by Colonel Mark Weir, chair of the BMA armed forces committee, who says: ‘Such a service is likely to prove supportive to both service and veteran families, some of whom may face similar challenges.’

Dr Lodge says the accreditation appealed as it is free and not time intensive. ‘Each GP practice is likely to see a military veteran every day,’ she says. ‘It’s so easy and can really help our patients.’

For more information, visit https://bit.ly/3zXw6Vx

‘The more clinicians who have this understanding, the better’

‘In the same way as cancer, treating it earlier leads to better outcomes’

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The relationship between doctors in primary and secondary care has been put under pressure by legislative barriers, poor IT, and being forced to compete for meagre budgets. Tim Tonkin talks to doctors working to bridge the divide, and hears why it has never been more important to do so

Hearing each other

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SIMON BOLTON

HUSSAIN: Advice and Guidance system needs to ‘mature’

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n the NHS, the interface between doctors in primary care and those in secondary care has long been a fulcrum, one that determines how effectively and efficiently the wider health service delivers care and meets patient need.

Yet despite its central importance to the day-to-day critical functions of the NHS, the link between primary and secondary care is a complex and evolving relationship, and one that remains beset by a wide variety of structural and cultural challenges.

Many of these challenges and organisational barriers such as patchy communication, a lack of interoperable IT and a mutual misunderstanding among doctors as to the roles and capabilities of their sector counterparts, are longstanding but have undoubtedly been thrown into sharp relief by the pandemic.

Indeed, in addition to the unprecedented demand posed

by COVID-19 on all parts of the health service, the past two years have seen sections of the Government and media appear to attempt to stoke division and suspicion between those working in general practice and those in hospital settings.

Efforts towards improving the functioning of the interface through encouraging greater communication, collaborative working and understanding, were already under way prior to the pandemic, but with an elective care backlog of 6.5 million, finding solutions has become more vital than ever.

Managing referrals London GP Farzana Hussain understands only too well the extent to which the whole health service is under pressure and under-staffed and the imperative this creates for resources and referrals to

be used carefully.

Based in the borough of Newham, Dr Hussain’s practice is part of the NorthEast London integrated care system where, like in many other parts of England, the Advice and Guidance triage service is being used to help manage referrals from primary to secondary care.

Introduced as part of NHS England’s elective care recovery programme, Advice and Guidance aims to give doctors in general practice access to digital support from specialists in secondary care.

She says that while she can see the potential in the new system, she feels it is too broad in its scope and does not provide a shared primary and secondary care IT record where hospitals can see all the primary care records.

‘I think the Advice and Guidance system needs a lot more maturity,’ she says.

‘I think it’s a very good idea.

But I don’t think we should be mandating it for 12 specialties.

‘If I as the GP, or any of my primary care colleagues, think our patient requires secondary care, we cannot get them referred to a clinic where a consultant or a secondary care team member will see them or phone them; it has to be us emailing to the electronic record system.

‘Some of my issues with that are they don’t have the patient in front of them [and] they can’t look at our EMIS records that

‘The past two years have seen sections of the Government and media appear to attempt to stoke division and suspicion’

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we use in general practice. The only information they have is what we are putting in [and] without the whole GP patient record [that] has a huge clinical risk about it.

‘I’m not against the system, I just think that it needs to have a full patient record.’

Dr Hussain adds that, while the backlog and staffing crisis across the whole of the health service are at the root of much of the pressure on the interface, misconceptions about the capabilities and ways of working in each care sector also have the capacity to create barriers.

Based on her own practice’s experience, she says bringing GPs and hospital doctors together through multidisciplinary work is an excellent way to build mutual understanding and collaborative working and promote patient care.

‘I do think that one of the solutions here is to have proper multidisciplinary team working, whether that’s virtual, or whether it is face to face,’ she says.

‘For about six or seven years now in Newham, once every two months we have a meeting with our consultant endocrinologists. [These meetings] started off with discussing cases so that we could reduce referrals, but the knowledge that we’ve got from that relationship works really well.

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‘I think we need to be talking to human beings, the consultants or registrars on the other side, and we need to be getting to know them. A primary care network is a great site to do that [as] consultants aren’t going to have time to talk to 46 practices in Newham, but you can do that with nine primary care networks.’

Building connections Forging bonds between general practice and hospitals through greater cross-working is something paediatric consultant Christian Harkensee is a firm believer in.

Based in Gateshead, Dr Harkensee is closely involved in a programme that provides fellowship posts to GPs from the local area to work in a secondary-care setting.

In doing so, these doctors are able to gain experience in a particular clinical specialty and then take these skills back to primary care following completion of their fellowship.

Dr Harkensee says the initiative is not only effective in countering the ‘siloed thinking’ he believes has traditionally acted as a barrier between primary and secondary care but helps to foster a greater understanding and closer relationship between community and hospital services.

‘[A GP] gaining that experience and expertise, but then also having a leadership in primary care towards their peers and colleagues by training and teaching others [helps] build these connections and expand these connections with secondary care,’ he says.

‘I think these kind of posts should be converted into a more formal programme to which people can apply. They probably should cover most, if not all, specialties [and] become something regular rather than something exceptional and we should have similar posts, for example for secondary-care doctors who want to do the same thing in primary care.’

A consultant in the NHS for almost 12 years, Dr Harkensee says he had seen the spiralling level of demand on primary and secondary care, and how this had strained the referrals process between the two sectors.

‘I think the structural issues with the NHS, in particular the underfunding and understaffing of large parts of it, are what increases these tensions,’ he says.

‘It sometimes feels a little bit like [emergency] departments or specialist clinics function a bit like an overflow of what general practice cannot see.

This is not the GPs’ fault; this is just the underfunding and understaffing of the system [and] the pandemic has just exacerbated that.’

United despite pressures Despite the success of initiatives such as his trust’s fellowship programme, Dr Harkensee believes improving interworking between care sectors requires systemic change, such as introducing a shared curriculum at medical

HARKENSEE: Spiralling demand has strained referrals process

‘We need to be talking to the human beings on the other side’

‘The structural issues with the NHS are what increases these tensions’

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school level to foster greater mutual understanding.

Fundamentally, however, change and improvement can only be possible and sustainable through addressing the NHS staffing crisis and through greater resourcing and investment in the health service at a national level.

‘We can’t catch up at the local level what has not been fixed at the centre,’ he says.

‘That really has to come from the top. We can improve it a little bit and it’s important to do that and to change mindsets, but at the same time we need to advocate at a higher level, to say that what we’re doing here without the resources is not sustainable.’

The BMA is working with NHS England to address concerns around Advice and Guidance, in particular to clarify issues around incomplete access to medical information and the implications this has for medico-legal responsibility.

BMA consultants committee member Simon Walsh and his GPs committee counterpart Richard Van Mellaerts have been involved in the association’s negotiations on Advice and Guidance and work concerning the interface.

They say that, while there were many areas ripe for improved integration and interworking between the two sectors of care, GPs and hospital doctors still share the values of ensuring good care and patient experiences.

They add that, despite the huge pressures facing the health service, doctors in primary and secondary care would remain united in their aims and resist attempts to deride and divide the medical profession, such as the attacks on GPs promoted by politicians and sections

of the press at the height of the pandemic. They say: ‘The understanding between clinicians of the challenges we and our counterparts face in the understaffed and underfunded health service, shows there is a strong unity of purpose among members of the medical profession.

‘The past few years have been tough for doctors, and the resultant backlog of elective care is a challenge and one that can only be addressed by a united profession. To that end, we are determined to explore increased ways of working, but we also know that greater integration can only be achieved by addressing the deeper malaise in the NHS. ‘Simply saying primary care needs to do more or secondary needs to do more is not the solution. The solution is a comprehensive workforce strategy that is realistic and addresses the healthcare needs of the population, rather than being constrained by political ambitions.’

VAN MELLAERTS: GPs and hospital doctors have shared values

WALSH: Doctors remain united in face of attempts at division

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CHARLIE BIRCHMORE

RACKLEY: Positive reaction from patients

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A quiet revolution has swept away many of the conventions on how doctors should look. Jennifer Trueland speaks to those whose appearance may have raised (unpierced) eyebrows a generation ago, and asks how patients and colleagues respond

W

hen Professor Sir Gregor Smith, Scotland’s chief medical officer, was photographed having his COVID injection last April, he revealed some impressive tattoos.

The intricate designs were, he explained, ‘very personal’ and depicted Asclepius, the god of medicine, and Apollo, god of (among other things) healing, disease, music and light.

Sir Gregor isn’t alone – many doctors embrace tattoos and, in doing so, shatter stereotypes of what a medical professional is expected to look like.

‘I’m a doctor with tattoos, piercings and coloured hair, currently blue,’ says Emily Rackley, a specialty trainee 4 in old-age psychiatry in Gloucestershire.

‘I have two tattoos, one on my leg, which is an elephant with flowers round it, and one on my arm – a sunflower and a honeybee. Patients will only occasionally see the very bottom of the elephant in summer, but they can always see the one on my forearm because I’ve got my sleeve rolled up.’

She has never had a negative response from patients, she says – quite the opposite. ‘Because I work with older adults, I get quite a lot of people saying they wished they could have had something like that when they were younger.

And sometimes, when people have been confused or quite delirious, they’ve tried

to touch the bee on my arm which is quite sweet. It’s the same with the coloured hair – it really gets people talking, and saying they wish they were brave enough to do that.’

She has only once had a colleague – a senior nurse – say that he thought her hair (then purple) looked ‘unprofessional’.

‘He’s someone I’ve got a good relationship with, so we were able to have a conversation, and I didn’t really take it as criticism.

‘When I was applying for advanced training, I did think about [my appearance] and I made sure I had orange hair at that point, because although it’s still a bit mad, it’s slightly less mad for an interview.’

Once, when working in orthopaedics as a foundation doctor, a surgeon commented that she should remove her nose ring. ‘I just sort of nodded and smiled and left it in.’

She stands out less in psychiatry, she says, because a lot of her colleagues, particularly nurses, also have brightly coloured hair and tattoos. But it’s still less common in the acute hospital, where she does shifts in the emergency department.

‘Not everybody wants to have tattoos and coloured hair, and that’s absolutely fine – but if doctors want to have tattoos, then they should be allowed to, without fear of it affecting your career, because it doesn’t affect your ability to be a doctor.’

‘When people have been confused or quite delirious, they’ve tried to touch the bee on my arm’

‘When applying for advanced training...

I made sure I had orange hair at that point, because although it’s still a bit mad, it’s slightly less mad for an interview’

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LAWS: Patients have more progressive views than some realise

No offence

‘At the time, Edinburgh was very conservative, and as a woman, some of the wards wouldn’t even let you in if you were wearing trousers’

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In theory, there’s nothing to stop doctors having tattoos or blue hair at work. Although it’s forbidden in some religions, NHS dress codes usually specify that visible tattoos shouldn’t be ‘offensive’. Such research as there’s been on the topic suggests that having body art such as tattoos or piercings makes no difference to whether patients perceive them as professional, trustworthy, caring or competent or not.

But it wasn’t always seen that way. When Kate Dawson was a medical student in Edinburgh in the 1980s, she wanted to have a tattoo – but, as a woman, it wasn’t straightforward.

‘I was doing a stint in A&E and saw a woman with the most beautiful peacock tattoo on her arm. I decided I wanted to try that. I couldn’t find anyone in Edinburgh who tattooed women, so I had to go to Glasgow. But [the artist] didn’t have a design for a peacock so I ended up with a butterfly.’

She chose to have the tattoo on her upper outer thigh so she could show it off if she was swimming or clubbing – but also so that she could cover it up at work.

‘At the time, Edinburgh was very conservative, and as a woman, some of the wards wouldn’t even let you in if you were wearing trousers.

So, I thought a tattoo was possibly going to be a step too far.

‘I’d already been called to the dean’s office for having an outrageous hairstyle – I had a Mohican – but that was in the pre-clinical years and I had to promise I’d shave it off before I reached the next

bit of my degree. My take on it was that I might as well have it before it gets to the point where I have to start conforming to people’s ideas – or my own idea – of what a doctor should look like.’

Dr Dawson, who is now a GP on the island of Benbecula in the Outer Hebrides – and a grandmother – has found having a tattoo has helped confound expectations of what a doctor should be like. She also sounds quite envious of the array of options now open to people who want tattoos – she would have no problem to find someone to do a peacock now. But she remains fond of her ink, although she says it’s not as shiny and pristine as once it was. ‘It really only comes out now when I’m swimming, but I think most of my adult patients know I have a tattoo. I think some of the younger nursing staff think it’s quite cool that I’ve got one. I don’t think I’d get another one – I got it done to adorn my body when it was worth adorning. Now it’s just part of me.’

Barbed comments Scott Redmond is in his second year of a graduate medical degree at the University of Dundee – and has many tattoos, including a full sleeve on one arm. He had his first tattoo when he was 18. ‘The ones that I got initially were mostly coverable – I’ve got a big anatomical heart on my chest, for example (which is in slightly the wrong position, which is something I found out literally on my first day at medical school).’

His full sleeve is primarily modern art, featuring works by artists including Van Gogh, Dalí, Warhol and Klimt. ‘They’re all artists who had some form

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of mental illness throughout their lives, and I loved the idea of finding beauty in that. They were able to create these beautiful things that have touched so many people.

‘I’ve had issues with my own mental health – I suffer from anorexia – and I’ve always liked that idea of being able to use this thing that will always be with me in some way to create something bigger and kind of beautiful in spite of itself. So that connection really stuck with me.’

At the bottom of his sleeve, he has a Romani chakra. ‘I come from a Romani Traveller family.

That’s something that’s always been important to me, so I have it proudly on show. As a community we’ve quite often had to kind of hide ourselves from various things, so I like the idea of reclaiming it. It’s very powerful.’

Although he now has ambitions to go into cardiac surgery, he chose the heart design simply for aesthetic reasons. ‘As pretentious as it sounds, I’ve always thought the heart is the most beautiful piece of art in nature. It’s so simple and elegant.’

He laughs: ‘To be honest, if I’d known I was going to go into medicine, I wouldn’t have got it because it feels a bit cringey now.’

He has had mixed responses to his tattoos since starting medical school, he says, but it’s been mostly positive. ‘The vast majority of people seem to really like them – people have said it makes them feel more comfortable and they see me maybe as someone a bit more human as a medical professional. I was vaccinating people during the pandemic and having the tattoos was a bit of an ice-breaker.’

Having said that, one person did ask if they were being vaccinated by a health professional or a bike gang member while others asked if he thought he looked ‘professional’.

This has occasionally happened at university too. ‘I had an [objective structured clinical examination] recently where, as I left the station, the doctor who was the examiner made what I felt was a pretty barbed comment along the lines of “tattoos – people will certainly remember you”.

They weren’t saying it in a nice way.’

Although he says that – purely as a matter of personal taste – he wouldn’t have a tattoo on his face, he believes his body art doesn’t and shouldn’t affect his ability to be a doctor.

‘I think perceptions are changing, and as long as it’s not anything you’d be embarrassed to walk down the street with on your arm, you shouldn’t be embarrassed to have it whilst working as a medical professional. At the end of the day, we’re bma.org.uk/thedoctor

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just regular people – I’ve always disliked the societal view of the doctor as something above and beyond. So, anything that can humanise us as much as possible is a really positive thing.’

‘Frightening old ladies’ Arianne Laws, a consultant rheumatologist in Paisley, had always known she wanted a tattoo – but didn’t know what design she wanted. When she saw the work of a Dundee tattoo artist, she recognised the style she wanted.

‘It was just a pretty picture, essentially,’ says Dr Laws. ‘I wanted something with brightly coloured hair. Then the second one I got was just before the pandemic. I’d seen [the artist’s] work and I liked the mermaids she did, so I thought I’d like a mermaid holding my cats, Gilbert and George.’

She is planning to travel to Ormskirk for another tattoo soon, again on her leg.

‘My dad died earlier this year, so I’m getting a tattoo for him – it’s a lighthouse from near where I come from, surrounded by botanical images, although I’ve yet to decide on what flowers and things like that.’

Patients can only see them (they are on the fronts of her thighs) when she is bending down next to them, but they have been overwhelmingly positive. That’s not always been the case with other doctors, however.

‘I was doing a clinical leadership fellowship and we’d been talking about what a doctor should look like. One of the guys said he thought that we should look conservative because otherwise we might be “frightening to little old ladies” – that we should look like their image of what a doctor should look like.

‘I said that I felt little old ladies were more progressive than he thought, and that people just wanted to be looked after well, as opposed to being worried about what you look like. And also, that if he thought it was inappropriate for a doctor to have tattoos, he should have a word with Gregor Smith.’

For more stories, including the tattoo inspired by a Commonwealth gold medal, search for ‘Making an impression’ at bma.org.uk/news

REDMOND: Perceptions are changing

‘One person asked if they were being vaccinated by a bike gang member’

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JOINT FORCES: Rachel Podolak and Neeta Major

Two heads are better than one The BMA’s new co-CEOs feel a personal as well as a professional commitment to the members they serve. Neil Hallows reports

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eeta Major’s late father was a doctor who came to the UK from India in the 1960s. She says the BMA helped him to feel that he belonged.

‘This organisation was there for my dad to help him through some challenging times.

He would love to know I was here.’

Rachel Podolak came for a part-time job, became interested in the politics, and worked in a wide range of areas such as marketing, the branch-of-practice committees and the international department, before a spell elsewhere and returning as national director of BMA Cymru Wales.

‘If you come here, it is very hard not to become totally passionate and committed to the broader cause,’ she says.

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Bases covered The two new co-chief executive officers of the BMA have a strong personal affinity for the members they serve.

Ms Major and Ms Podolak were appointed in May, replacing Tom Grinyer. They are the first people ever to share the job, and have also kept their previous roles (Ms Major’s being group chief finance officer and Ms Podolak as national director BMA Cymru Wales) with some backfilling from colleagues.

They say the role splits fairly easily – with Ms Major doing the corporate side and Ms Podolak the political. And it has an obvious advantage.

‘I’ve been on boards for several years before joining the BMA and board positions can be

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quite lonely,’ says Ms Major. ‘The wonderful thing about doing this kind of job share is that you can really brainstorm, because having two minds in the room is always better than having one.’

So, what are their priorities? Putting it simply, they are about ensuring the BMA can meet members’ needs. Take, for example, the policy, decided at the association’s recent annual representative meeting, to restore pay to 2008 real-terms value in five years.

Ms Podolak has experience of BMA pay negotiations with the UK and Welsh governments, and while she won’t be personally at the table for these talks, she and Ms Major see themselves as having a great deal of influence and responsibility in helping the initiative succeed.

Member engagement The starting point, says Ms Podolak, is to recognise that ‘if you’re arguing for a legitimate ask, you feel strength’. The next is to ensure the expertise of the elected members and the staff is brought effectively together. As she puts it, ‘we need to harness the unity behind that ask, and the strength of the organisation as a whole’.

She says, if there is going to be industrial action, members need to be engaged, and involved in the common cause. And, of course, the rest of the organisation still needs to function, helping members individually and campaigning for change. She says the chief executives’ priorities are to set an effective overall strategy and maintain a positive, inclusive culture.

The campaign for fair pay unites the profession, but it is not easy to generalise about everything that a typical doctor or medical student needs – mainly because there is no such thing as a typical one.

Members’ needs change, and the BMA seeks to meet them at every stage. To Ms Major, this is a particular selling point of the organisation, and a great source of attraction for members and staff alike.

She says: ‘What is compelling about joining is this is a unique association that offers to look after you from student to retirement.

It can offer you support at every point of your career journey.’ She gives a few examples – bma.org.uk/thedoctor

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employment representation, the collective negotiation of contracts, rota checking, the library, wellbeing services.

The latter has seen a substantial increase in use during the pandemic. Ms Podolak is proud the BMA provides them, and that they consistently get good feedback from members, but she also wants the BMA to work for a health service that makes them less necessary. One that has the investment, that gets the basics right in areas such as rotas, that recruits enough staff, that plans its workforce properly, that tackles soaring student debt.

‘What we really want is that people don’t get to the stage of needing our wellbeing services but unfortunately they do, and hence we provide them.’

Experience matters Another priority will be to make progress in implementing the changes that make the BMA a more inclusive and representative organisation. Ms Major says, since the Romney report into sexism in 2019, there have been a lot of positive developments, such as a speak-up guardian and the network of elected women.

There has been an independent review which ‘said you’re about half way – you’ve got another 20 per cent that are in progress, but you’ve got a way to go’.

The co-CEOs are determined to work their way through the recommendations, but just as important in improving the numbers side of representation on committees is monitoring the experiences that members have.

‘We don’t want it just to be a tick-box exercise,’ says Ms Major.

What’s undeniable is that the two are setting an example by their own working arrangements. Ms Podolak says: ‘The biggest surprise is how quickly we have had enquiries from members, asking how do you job share, we’re thinking about standing, is that a possibility for elected members?’

The answer is a resounding yes.

As Ms Podolak says: ‘We said when we applied for this role, we were keen to show that the BMA had really modernised, and was open to the best people for the roles, regardless of background.’

‘The wonderful thing about doing this kind of job share is that you can really brainstorm’

‘If you come here, it is very hard not to become totally passionate and committed to the broader cause’

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MATTHEW SAYWELL

From Thatcher to Covid Anger at the erosion of NHS values and experience of discrimination are what led Chaand Nagpaul to an ‘accidental’ career representing doctors. As he steps down after five years as BMA council chair, he tells Neil Hallows about leading the profession during the first years of the pandemic, his efforts to tackle the scourge of inequalities, and his work towards building a better NHS

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ome people find politics. For others, politics open hostility to foreigners at the time, with racist signs finds them. in windows making it abundantly clear to anyone from It was 1992, and Chaand Nagpaul was hiding an ethnic minority that a particular job or flat was not his nerves as best he could. Recently qualified as a GP, available to them. He heard phrases such as ‘Pakihe had no previous BMA experience, but there he was, bashing’, reflecting the reality of racial assaults. about to deliver a speech to hundreds of doctors at a He and his sister were the only non-white students BMA annual representative meeting at primary school in Finchley, north for the first time. He remembers the London. ‘I felt exceptionally alone faces in the audience, ‘unfamiliar, and misunderstood,’ he says.

‘I simply wanted politically savvy, opinionated’.

Secondary school was a little to shout from the What had brought him there more diverse, and had high rooftops about what was his anger at the Conservative standards. ‘I realised at a young Government’s 1990 health reforms, age that to succeed in a society in I felt were such which had introduced a purchaserwhich your colour disadvantages damaging reforms’ provider split and a competitive you, the one thing I could do was internal market in the NHS. to work hard to excel academically.

He felt betrayed – that the very That would give me a secure NHS values that drew him to become a doctor were future career.’ He was rewarded with offers from four being destroyed – and he wanted the BMA to challenge London medical schools, of which Bart’s was the the Government head on. His speech went down one he accepted. well, very well. He was completely unprepared for the ensuing standing ovation, the hordes of representatives ‘Foreign-sounding name’ coming up to thank him, and the media coverage The reality that prejudice had not disappeared that followed. from British society hit him hard when, despite an This marked the beginning of his career in the BMA, impeccable CV, he received nine consecutive rejections becoming a regular speaker at ARMs, elected to the without interview when applying for GP training BMA GPs committee in 1996, after which he progressed schemes in 1986. He sought advice from his trainer in national representative roles in the association. who felt the rejections probably related to his foreign‘When I look back, my career in the BMA was very sounding name – a disturbing phenomenon also unearthed in celebrated research by Sam Everington much by accident rather than by design. I simply and Aneez Esmail several years later. wanted to shout from the rooftops about what I felt For his 10th application, Dr Nagpaul presented were such damaging reforms striking at the heart of the himself in person at Charing Cross Hospital, knocked NHS’s founding principles.’ on the door of the postgraduate tutor, handed him Dr Nagpaul has a conviction for equality driven by his CV to put a face to his name, described his passion his own profound, visceral response to experiencing to become a GP, and urged to be considered for an discrimination at an early age. interview. He was thereafter shortlisted and offered Born in Kenya to parents of Indian origin, his family one of two places out of 180 applicants. He recalls moved to the UK in the late 1960s when he was seven researching studiously for the interview, knowing more years old, as part of the exodus of Asians from East about the green paper reforms for general practice at Africa. He recalls feeling shocked and fearful at the 18

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MATTHEW SAYWELL

NAGPAUL: A conviction for equality from an early age

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PRESCIENT: A young Chaand Nagpaul plays doctors with his sister Seema, who is also now a GP

the time than the senior GPs on the interviewing panel.

Here is another feature of Dr Nagpaul, noted by those who have worked with him throughout the decades at the BMA – he does his homework, and is in command of his brief. ‘Winging it’ may be good enough for certain prime ministers, but it’s not for him. His ARM speeches were invariably fluent, urgent and precisely timed.

‘I used to cut out articles throughout the year. This was before the internet and I’d go to the local library to research my speeches, because I knew what I was saying had to have substance,’ he says.

He chose to become a GP during his general practice attachment in an inner-city London practice as a medical student. ‘I was overawed as I watched my GP tutor manage the entire spectrum of medical conditions and pathology, with dexterity and sensitivity.

I also saw how patients deeply trusted their GPs, confiding in them with information they wouldn’t even share with their loved ones. From that moment I knew I wanted to be a GP.’ Dr Nagpaul became a partner in a group practice in Stanmore, north London, in 1989, the day after completing his GP training. He has worked at the same practice since for 33 years, serving a large multi-ethnic community and he is passionate about the continuity of care he has been able to offer. He has overseen the He also led the Quality First workload management expansion of his practice to three times its original size, initiative for GPs, to address inappropriate workload into a modern bespoke multi-professional medical afflicting GP practices, which included negotiating centre. changes to the hospital contract in England to end GPs His conviction that GPs should be re-referring patients for missed properly supported and resourced outpatient appointments, or underpinned his election in 2007 chasing secondary care-generated ‘I saw how patients as the first non-white member of test results. deeply trusted their GPs, the GPC executive team. When he confiding in them with Breaking the glass ceiling was thereafter elected as the first In 2017 he was elected as the ethnic minority GPC chair in 2013, information they wouldn’t association’s first ethnic minority he inherited a contract imposed share with loved ones’ council chair in its 190-year history. by the-then health secretary He couldn’t help but look back Jeremy Hunt, with punitive and at his first years in the BMA with unachievable demands such as a predominantly white hierarchy. Not in his wildest some 100 per cent target achievements. dreams could he have imagined ever becoming ‘Relationships had broken down. I wrote to Jeremy chair of its council. He felt that by breaking this glass Hunt asking for a meeting. My emphasis was on patient ceiling he also was repaying the hopes and trust that care, and I graphically explained how his imposed many ethnic-minority doctors had invested in him, contract would actually harm patients, threaten trust while demonstrating the BMA had come a long way in between doctor and patient and in turn be damaging becoming a more diverse organisation. for government itself. It appears he listened, such that Dr Nagpaul has always believed in thought leadership the majority of his imposed contract was reversed and as council chair led one of the BMA’s most within six months,’ he says. ambitious projects, Caring, supportive, collaborative, He also negotiated proper sickness and maternity underpinned by a comprehensive survey of 8,000 leave reimbursement for all practice GPs, addressing doctors’ experiences, together with feedback from practices being exposed to extortionate costs of cover. grassroots members in roadshows he attended across ‘I was putting right a wrong that had discriminated the country. against practices with sick and pregnant doctors.’

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Published in 2019, the report defines a vision of Tackling inequalities a health service driven by a culture of learning and On every big call he was there, often well before support, with equity of opportunity and reward, an the Government. He saw through ministers’ claims adequate workforce and collaboration between primary at the outset that there was sufficient personal and secondary care. protective equipment, speaking up for the thousands He presented his proposals in roundtable talks at BMA of doctors being put in harm’s way. At the Health House attended by senior figures including the-then Select Committee in March 2020 he challenged the health secretary Matt Hancock and NHS England chief Government’s infection-control policies, which fell executive Simon Stevens. The findings have been quoted below World Health Organization standards, and which in publications of NHS England and the GMC, and have were subsequently revised by Public Health England. He influenced policymakers from various stakeholders. gave evidence to the National Audit Office about failings Dr Nagpaul has publicly called for root-and-branch in Test and Trace, with private companies soaking reform of GMC processes believing up billions of pounds, to deliver them to be disproportionate, an inferior service, after years of flawed and unjust, with racial cuts to public health. And while ‘I had to speak out bias in which ethnic-minority the Government tried on several and challenge policies doctors are referred at twice occasions to ease social distancing which I felt were likely the rate to disciplinary hearings. prematurely, he held firm, even if it He also strongly believes GMC risked a backlash from libertarian to increase illness investigations must always hold critics. A prime example of this and death’ accountable systemic root causes was in December 2020, when Dr rather than doctors in isolation.

Nagpaul pointed out the lack of On becoming chair of council, sense in a planned five days of Dr Nagpaul could not have foreseen he would lead mixing during the Christmas break amid rocketing the profession through the once-in-a-generation infection rates, only for the Government to bow to the crisis of the COVID pandemic. His was a constant inevitable at the last minute. position of leadership and challenge, representing the As council chair, Dr Nagpaul has demonstrably raised profession through countless media appearances, at the profile of the BMA in championing ethnic-minority Parliamentary inquiries, and in meetings with ministers. doctors and tackling race inequalities in medicine.

In April 2020, he was the first medical figure in the ‘For me, this was not about political point scoring.

My only purpose was to do right by the profession and media to call publicly on the Government to take action safeguard the health of the population. I had to speak in response to the disproportionate effects of COVID on ethnic minorities. ‘It was alarming that the first 10 out and challenge policies which I felt were likely to doctors who died of COVID – and almost 35 per cent increase illness and death,’ he says. of patients in intensive care at the time – were from ethnic minorities. I had to speak out.’ He subsequently wrote to every NHS trust in England to implement risk assessments to protect the most vulnerable doctors.

He feels a deep sense of duty to support IMGs (international medical graduates) who he describes as the ‘migrant architects of the NHS’.

‘The NHS could not have survived without them.

Over the decades they’ve taken on jobs with punishing rotas in hospitals that no one else would accept. GPs who worked in derelict, rundown premises serving their communities for decades. For me, they have been a source of immense inspiration, and the NHS owes them a deep debt of gratitude,’ he says.

Breaking down barriers GRADUATION DAY: Dr Nagpaul with wife Meena, daughter Aneeshka, and son Rahul

As chair of council, he set up an IMG champions group across all branches of practice, and led the creation of an international affiliate BMA membership to provide tailored support to IMGs while abroad, so they can be on thedoctor | August 2022

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the front foot before coming to the UK. ‘The biggest price I paid in being BMA council chair, He also set up the BMA forum for racial and after losing time with my family, was the pain of not ethnic equality, which has increased engagement of being in my practice. I was keeping my hand in by doing thousands more ethnic-minority members. two surgeries weekly, but missing out on continuity of Recently, Dr Nagpaul oversaw the publication of the care with people I’ve known for so long – with patients BMA’s landmark Racism in Medicine report, stating: ‘It asking me when I’m coming back.’ reveals that racism is not only wrecking doctors’ lives, but also threatening patient care and services, with Watershed moment one third of ethnic-minority doctors having left or are He continues to chair the BMA forum for racial and considering leaving work, and 16 per cent off sick due ethnic equality and is a board member of the NHS to racist experiences.’

Race and Health Observatory. He is also vice-chair He is clear equality must apply of his local medical committee, to all diversity strands. ‘You cannot representing his colleagues at a be unequal in your commitment local level, and he plans to take to equality. It must apply to all up a musical instrument – until ‘You cannot be characteristics from gender, sexual now, a source of regret, because unequal in your orientation to disability.’ music got side-lined during his commitment He comments that the BMA exceptionally studious youth. to equality’ has a network of elected women, His contribution and and has recently launched the achievements on behalf of the Disability, Long-term Conditions profession have received due and Neurodiversity Network. recognition. This includes a CBE for His ‘helicopter’ view as council chair reinforced services to primary care, and multiple awards as being to him the interdependence of the entire medical among the most influential figures in the NHS and profession. ‘We are one profession. You can’t sort out among Asians in Britain. He was also recently awarded any one part of the system without sorting out the an Honorary Fellowship of the Faculty of Public Health. whole.’

Shortly after stepping down from his BMA role, He has long believed in breaking down barriers Dr Nagpaul attended the graduation of his daughter between primary and secondary care, quoting the Aneeshka from Liverpool University Medical School. So when asked about the future of the profession he has Caring, supportive, collaborative finding that 60 per for so long represented, he cannot help but see it partly cent of doctors believe this is damaging patient care. through her eyes, which reinforces ‘Doctors should be part of one the BMA’s call for adequate pay for team, on the same side caring for junior doctors. patients – not have a tug of war ‘Doctors should It has to get better, he says. ‘I do across a hospital-primary care believe that we are at a watershed divide,’ he says. be part of one team, moment when the NHS just simply And the BMA has to be there on the same side cannot continue the way it has. And for all their needs. To achieve this, caring for patients’ I want Aneeshka, and the doctors of Dr Nagpaul is proud of the BMA’s the future, to have a belief that they unique position as a professional can be a part of a better future.’ association and trade union.

Reflecting on his career, Never was this more important there is a remarkable consistency. He was affected than during the pandemic when, as well as seeking and outraged by inequality from an early age, and a to protect members at work, he cites ‘medical demonstrable commitment to tackling it continues ethics guiding us on mandatory vaccinations, our to this day. He began to represent doctors because he board of science informing us about the science of saw that the NHS was at risk of being fragmented and the virus and its impact on our members, while the privatised, and still campaigns on these issues with international committee was instrumental in our calls equal passion. And there has always been a desire on for fair terms for IMGs coming to work in the UK’. his behalf to bring the profession together, something Dr Nagpaul came to the end of his term as BMA he displayed with great success during the pandemic. council chair in June, and was replaced by Philip Dr Nagpaul is a huge fan of Bob Dylan, who Banfield. He is now devoting more time to his GP once said: ‘People seldom do what they believe in.’ practice, where his wife Meena has been holding the Dr Nagpaul is someone who very much has. fort as the lead managing partner.

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Your BMA Junior doctors can often be treated badly during changeover. The BMA is here to help them In the last two years I have been writing this column I have been lucky enough to engage with people from across the health system.

I have had conversations with doctors and medical students from a range of specialties at different stages in their careers. I know our employers, regulators and the stakeholders who hold great influence and sway on our working lives have been reading, too.

I would like to address our members, stakeholders and employers at a particularly important time of the year. Across the country junior doctors have been going through the ‘changeover’ process in recent days and weeks. Starting a new job, working on a different ward or moving specialty can be incredibly challenging and daunting. For some this can mean moving cities or countries, struggling financially and we know the impact on friends and family is great, too.

To doctors who find themselves in this position I want to tell you that we know how difficult it can be – the BMA is here for you. And to employers and stakeholders I urge you to be as supportive as you possibly can and do the right thing, by doctors and patients.

I qualified in 2011 and have never worked in a fully staffed rota. I remember being in rooms where senior staff and managers were trying to fill gaps and have experienced being pressurised in those situations – being told I could be reported to the GMC if I don’t help and being told that they ‘can’t just knit doctors’ so I would have to fall into line.

Working in an NHS which is so under-resourced and under-staffed never becomes easier but in those early days of great change when you may feel vulnerable and uncertain these experiences are particularly difficult. And the truth is, that while many might say doing extra shifts or hours is necessary to ensure patient safety this is just a false economy. If patient safety is truly our concern then we must protect doctors from burnout and exhaustion. If patient safety is truly our concern then we must stop filling these gaps as a short-term fix and commit to retaining the

@drlatifapatel workforce and training and recruiting a sustainable future workforce.

Changeover can be a positive time for many people, when career progression is highlighted and when we have opportunities to form new teams.

However, I have heard countless examples already of doctors being taken advantage of or treated badly. The BMA will not stand for this sort of behaviour and will support junior doctors who face similar issues.

You are entitled to proper inductions, your employers must adhere to the code of practice and to six weeks’ notice for rotas and giving leave requested.

There are so many other things, things that may seem small but can really have an effect, too. For example, having car-parking permits available and ready, sorting ID quickly, making sure there are sufficient and appropriate places to rest, particularly during or after shift work. Again – we know this isn’t happening.

To doctors rotating – and particularly if you are starting foundation year 1 – you should not be threatened with GMC referral, told that you are breaking your contract, or that you simply have to deal with whatever your employer says. This is where we can help you. And to people in senior positions applying this sort of pressure – stop now. We know from our members this is happening and it is not acceptable. While I appreciate there can be stress involved in dealing with rotas it is incumbent on you to make sure situations are being dealt with fairly and doctors are not damaged by your actions.

The BMA is here for you – our members. And membership is free until October 2022. Join us, allow us to support you. We will protect you.

If anyone subjects you to treatment that doesn’t feel or sound right, contact us at @DrLatifaPatel or RBChair@bma.org.uk Dr Latifa Patel is chair of the BMA representative body thedoctor | August 2022

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on the ground thedoctor

Highlighting practical help given to BMA members in difficulty

A consultant was told his contract would be ending, but some in his trust may have been ignorant of his employment rights A retired consultant went back to his former trust and was working 11 PAs (programmed activities) a week.

That should be a sentence to warm the cockles, given the NHS faces its biggest backlog in history, and is desperately short of doctors.

But his employer did not treat him well.

Out of the blue, he was told his contract would be ending. The reason was not that the role was disappearing, or there was no longer a need for it. Instead, his employer had recruited a new consultant. Our doctor was offered four PAs a week on what would probably be a short-term basis while his successor shadowed him and settled in.

He came to the BMA with a question – how could it be a redundancy situation if the role hadn’t disappeared? He was right, but what the employment adviser also quickly established was that the trust had no right to dispose of him so easily.

The doctor had been on a two-year, fixedterm contract, which had been allowed to roll over for almost another three years. His duration of service was very important because, as the adviser knew, but perhaps some in the trust did not, employees on fixed-term contracts gain

extra rights after four years.

Under the Fixed Term Employees (Prevention of Less Favourable Treatment) Regulations 2002, workers have a right to treat their contracts as permanent if they are successively renewed for more than four years, unless employers can come up with reasonable justifications for ending it.

The adviser raised this with the trust and was ready to also tell them that their actions may have breached equalities legislation because of age discrimination, but fortunately the trust quickly saw sense.

It meant the conversation between the trust and the doctor completely shifted. As it happened, the doctor wanted a better worklife balance, and instead of having to hang on to a job that was being unfairly taken away, he successfully negotiated, with the BMA’s help, a reduction in PAs with a permanent contract.

The doctor said the adviser was ‘absolutely great’ – he explained the doctor’s rights to him, what the outcomes might be, and liaised effectively with the HR department.

The doctor said: ‘In these uncertain times I think hospital doctors would be mad not to have the backing of the BMA.’

The Doctor

Editor: Neil Hallows (020) 7383 6321

BMA House, Tavistock Square, London, WC1H 9JP. Tel: (020) 7387 4499

Chief sub-editor: Chris Patterson

Email thedoctor@bma.org.uk Call a BMA adviser 0300 123 1233

Senior staff writer: Peter Blackburn (020) 7874 7398

@TheDrMagazine @theBMA The Doctor is published by the British Medical Association. The views expressed in it are not necessarily those of the BMA. It is available on subscription at £160 (UK) or £225 (non-UK) a year from the subscriptions department. All rights reserved. Except as permitted under current legislation, no part of this work may be photocopied, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical or otherwise without the written permission of the editor. Printed by William Gibbons. A copy may be obtained from the publishers on written request.

The Doctor is a supplement of The BMJ. Vol: 378 issue no: 8349 ISSN 2631-6412

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Staff writers: Tim Tonkin (020) 7383 6753 and Ben Ireland Scotland correspondent: Jennifer Trueland Feature writer: Seren Boyd Senior production editor: Lisa Bott-Hansson Design: BMA creative services Cover: Charlie Birchmore Read more from The Doctor online at bma.org.uk/thedoctor

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