Saturday March 1, 2014
The voice of doctors
Contracts: share your views BY STEPHANIE JONES-BERRY
Ethics: find out about our latest guidance on FGM and decision-making in a military context PAGE 2
New BMA Scottish secretary Jill Vickerman looks forward to some interesting times ahead PAGE 5
We have a selection of your favourite
Doctors affected by contract negotiations are being urged to get involved to help progress formal talks between the BMA and NHS Employers. The BMA has written to the relevant doctors and medical students across the UK, encouraging them to join the debates. In their letter to consultants in England and Northern Ireland, BMA UK consultants and Northern Ireland committee chairs Paul Flynn and John Woods stress: ‘It is essential that your views help guide us through the difficult trade-offs that we face ahead.’ They tell doctors: ‘Your views have already had a major impact’, adding that in the build up to the negotiations, more than 4,000 doctors made their opinions known. They urge doctors to have their say in the association’s new online discussion area BMA Communities and at special events taking place in England and Northern Ireland, promising that those who do will directly influence the ongoing talks. The consultant negotiations have mainly focused on the facilitation of seven-day services and, to a lesser extent, pay progression. Other issues such as SPA (supporting professional activities) time and clinical excellence awards have yet to be discussed in detail.
Protecting pay and revamping rotas for juniors Junior doctors leaders are concerned that the negotiations could be used to squeeze salaries. BMA junior doctors committee co-chairs Andrew Collier and Kitty Mohan have written to UK juniors to assure them that, as a precondition for entering negotiations, it was agreed in the heads of terms document that the total pay available to the junior workforce should not decrease. ‘We have also agreed that additional funding will be allocated to cover any increased employer contributions into your pension,’ they add. ‘Now we have agreed how much money will be available, we have moved on to consider exactly
Dr Flynn says: ‘The BMA is committed to ensuring patients receive the same high quality of care — though not necessarily the same range of services — across the entire week. ‘Achieving common quality standards for all acutely ill patients is now likely to require changes over time to working patterns, including the increased presence of senior clinical staff in the evening and at the weekend, as well as the supporting resources we need to deliver that care.’ He insists this should not mean a greater workload for individuals, adding that many consultants already work beyond their contracted hours and that a healthy work-life balance was needed for
what pay will look like in the new contract. ‘Banding payments can cause wild fluctuations in salaries as juniors move from placement to placement, so we are determined to ensure that any new system makes it easier for juniors to plan their finances.’ The other key issue on which views are being sought is safe working hours. ‘Hundred-hour weeks are a thing of the past for most junior doctors, but some of you still work punishing rotas,’ write the co-chairs. ‘We are looking at ways that juniors can have more advance notice of their duties and the training opportunities in each post.’
the sake of the patients. ‘An essential aspect of any future deal would be agreement of fair rates of pay for consultants who work unsocial hours,’ he adds. ‘We are working with NHS Employers to model the impact of increased consultant presence on the consultant pay bill to feed into the wider contract negotiations.’ The government is committed to ending automatic pay progression across the whole public sector. The BMA is considering a number of alternatives, but is clear there must be fair ways of linking pay to responsibilities and performance in any revised system. On SPA time, NHS Employers is in agreement with the BMA on the significance of educational, training,
research and innovation activities. The association is also seeking to end pressure from individual employers to reduce SPAs.
Play your part Join the conversation at communities.bma.org.uk. Look for the My working life section, where you will find discussions on: what should determine pay progression if not time served; the fairness of clinical excellence awards; and seven-day services Attend one of five events across England and Northern Ireland to discuss your views with other doctors. Sign up at bma.org.uk/doctorsworth
medical mnemonics PAGE 6
BMA News is a supplement of BMJ Vol: 348 No.7947
Contract events: Find an innovative event near you and have your say on contract negotiations bma.org.uk/doctorsworth
GORY YARNS: Knitted drops of blood are appearing in public places to encourage people to become donors. The ‘yarnbombing’, or guerrilla knitting, exercise has been organised by the NHS Blood and Transplant service to appeal to young people, who make up just 15 per cent of active blood donors in the UK. The drops will appear on trees to highlight the fact that ‘blood doesn’t grow on trees … someone, somewhere must donate it before it can be used to save lives’. Register as a donor at www.blood.co.uk/trees
Caution urged over pharmacies The BMA has urged the Scottish government to consider applications to open pharmacies in rural areas carefully. In its response to a Scottish government consultation on pharmacy applications, BMA Scotland says changes to control-of-entry arrangements must protect the communities served by dispensing practices. BMA Scotland supports a suggested ‘prejudice test’, which would limit applications from pharmacies in areas where their presence would have a negative affect on services provided by dispensing practices. BMA Scottish GPs committee chair Alan McDevitt said the ability to run dispensing services helped remote areas retain and attract GPs.
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Saturday March 1, 2014
Special meeting for dissolved trust Doctors affected by changes at the Mid Staffordshire NHS Foundation Trust can debate the proposals at a special meeting later this month. BMA council chair Mark Porter will speak at the meeting organised by the BMA’s north and midStaffordshire division. The proposals suggest dissolving Mid Staffordshire with its services
taken over by the Royal Wolverhampton Hospitals NHS Trust and the University Hospital of North Staffordshire NHS Trust. The meeting takes place at 7pm on March 20 at the North Staffs Conference Centre, Stoke-on-Trent. Doctors can email Linda Scales at email@example.com to find out more and confirm their attendance.
GPs oppose assisted dying law change GPs remain opposed to any change in the law on assisted dying, a consultation has confirmed. The RCGP (Royal College of GPs) consulted its members to discover whether views on the issue had changed since it last debated the issue in 2005. More than 1,700 college members responded, with 77 per cent backing the
college’s current opposition. Of the 28 RCGP bodies, such as local branches, which responded, 20 were opposed to changing the law. Doctors believed a change would be detrimental to the doctor-patient relationship and put vulnerable groups at risk. The BMA is opposed to changing the law on assisted dying.
Students welcome boost for women A group set up to help female medical students and doctors progress in their careers has been welcomed by student leaders. Sheffield Women in Medicine aims to inspire, nurture and support women at all stages of their medical careers across the Sheffield area. Founding member Alenka Brooks, an SpR in gastroenterology at Sheffield Teaching Hospitals NHS Foundation Trust, said there was a national need to understand the organisational and economic implications of increasing numbers of women in the medical profession. ‘There remains a significant under-representation of women in
senior leadership roles, academic positions and some medical and surgical specialties within the NHS and university systems,’ she said. BMA medical students committee Sheffield representative Kirsty Ward said: ‘Peer support and mentoring can help women fulfil their potential and are important for counteracting their under-representation at the top of the medical profession.’ The BMA launched a drive last month to encourage more women into leadership in the organisation. To read more about the BMA’s work go to bma.org.uk/bmawomen See www.womeninmedicine.co.uk
Concerns prompt data share delay The BMA has welcomed plans to delay extended patient data sharing in light of doctors’ concerns about a lack of public awareness. NHS England last week announced it was postponing the extraction of data from the medical records of general practice patients for six months. The decision follows talks between the BMA and NHS England over GPs’ concerns that their patients were unaware of the implications of the care.data scheme, which was due to be
implemented in April. The BMA supports the use of anonymised data to improve healthcare services but fears had been growing about the public awareness levels. Doctors said the decision to delay implementation would benefit patients and GPs by allowing NHS England more time to demonstrate the benefits of the scheme, including safeguards to protect anonymity and the right to opt out entirely. BMA GPs committee chair Chaand Nagpaul said: ‘We are
pleased that the decision has been taken to delay the roll out of extractions to care.data until the autumn. ‘It was clear from GPs on the ground that patients remained inadequately informed about the implications of care.data.’ NHS England national director for patients and information Tim Kelsey said: ‘We have been told very clearly that patients need more time to learn about the benefits of sharing information and their right to object to their information being shared.’ See bma.org.uk/confidentiality
BMA reassured health safe in free-trade talks BY STEPHANIE JONES-BERRY The BMA has been given further assurances that a free-trade agreement between the EU and the USA will not affect healthcare in the UK. Talks to develop the TTIP (transatlantic trade and investment partnership) started last July, with a fourth round of negotiations scheduled for next month. Letters to the BMA from the European Commission’s director general for trade and UK minister for trade and investment respond to its concerns about healthcare being opened up to greater market forces.
BMA lobbying has already won assurances from key UK and EU players that healthcare provision would not be part of the talks. BMA EU policy manager Paul Laffin said the correspondence was ‘good news’, as it reiterated what the organisation has been told to date. He said: ‘No matter what is eventually agreed for the final text of the TTIP, the European Parliament can vote to reject the treaty, just as it did — overwhelmingly — with the anti-counterfeiting trade agreement, back in 2012.’ This month, UK trade and investment minister Lord Livingston wrote to BMA council
chair Mark Porter to reassure him that the position on health services in the TTIP had not changed. He emphasises it is ‘for NHS commissioners’ to take decisions about which providers to contract with and the TTIP would not affect this policy. In a speech on the TTIP in London last week, European commissioner for trade Karel De Gucht said he wanted everybody to understand that the TTIP ‘does not endanger the NHS in any way’. He said trade agreements were used to create opportunities for service companies — not public services such as health. Go to bma.org.uk/europe OPINION
BMA Q&A BMA MEDICAL ETHICS COMMITTEE CHAIR TONY CALLAND
‘Doctors have a crucial role in
The government has announced measures to combat FGM (female genital mutilation). What role do you think doctors play?
The government said progress in tackling
asking the right
Athis issue would not have been possible
questions to help
without frontline professionals’ commitment. Doctors have a crucial role in asking the right questions to help identify girls at risk, and supporting those living with the resultant psychological and physical health problems. It is vital that doctors address this issue in their clinical practice. I would urge them to read the BMA’s guidance (bma.org.uk/ethics). Doctors can seek advice and support if they think a child is at risk of FGM from the NSPCC’s FGM helpline 0800 028 3550.
identify girls at risk of FGM’
The BMA launched a toolkit for armed forces doctors just over a year ago. How has this been used by doctors?
The toolkit was developed after a case in
Awhich military medical personnel were bma.org.uk/news-views-analysis
drawn into unprofessional practice. We have had requests for the toolkit from many doctors and health professionals working in the armed forces, in the UK and overseas. It has set an international benchmark for good practice. See bma.org.uk/ethics
The BMA lobbied for improvements to the original proposals and negotiated the right for patients to object to confidential data leaving the GP practice for care.data. Our negotiations have resulted in commissioners having access only to pseudonymised or anonymised data.
The BMA has been pressing to ensure patients are informed about the care.data system. What other involvement has the BMA had in these plans?
The Health and Social Care Act 2012
Acreates a statutory obligation for the
Health and Social Care Information Centre to require data from providers, including GPs. The first use of the new legal powers is care.data, the aim of which is to use information to inform commissioning decisions and improve health services. The BMA supports use of anonymised or pseudonymised data to improve patient care but is clear this must not undermine trust in the confidentiality of the health service.
Is the committee working on any new publications?
As part of the BMA’s work in upholding
Aand promoting health-related human
rights, we are producing a report on the health and human rights of children and young people in detention in the UK. The report has two main aims: supporting healthcare professionals in protecting and promoting the health-related rights of these children and young people, and highlighting aspects of the secure environment that are detrimental to health and, to this end, making recommendations for change to commissioners, youth justice agencies and policy-makers. We aim to publish the report this summer.
BMA News 3
Saturday March 1, 2014
Doctors press for more say in European policy BY GRAHAM CLEWS
said: ‘Whatever your view on the ongoing political debate over the UK’s relationship with Europe we cannot ignore the fact that the EU plays a vital role in setting public health policy. And while the BMA believes that healthcare should remain the primary responsibility of each member state, UK MEPs have a responsibility to secure a healthier Europe for their constituents. ‘Our manifesto sets out the vital policy areas MEPs must engage with over the next five years if we are to make a real difference to the health of all EU members.’ The BMA manifesto calls for this to be done in three key ways: championing a professional workforce, securing patients’ rights and safety, and improving public health. On championing a professional workforce, the BMA rejects any dilution of the European Working Time Directive on the grounds that this health and safety legislation is vital for patients and doctors.
OUT ON A LIMB: A charity is hoping to raise £5,500 by Monday to fund the delivery of 200 redundant prosthetic limbs to The Gambia. Legs 4 Africa estimates more than 2,000 limbs are disposed of each year in the UK as people grow, upgrade or replace their prosthetics. They cannot be reused in the UK but the charity is working with the Royal Victoria Teaching Hospital in The Gambia to recondition, customise and distribute the limbs to new owners. The charity is keen to hear from doctors who work with amputees who can donate used limbs. See more at legs4africa.org Donations can be made at crowdfunder.co.uk/legittoafrica
LEGS 4 AFRICA
Doctors should play a greater role in developing policies that affect the health of all Europeans, the BMA’s European election manifesto insists. The association has set out its priorities for a healthier Europe after May’s European Parliament elections: MEPs should work towards a safer, healthier Europe because of the importance of improving health; doctors’ expertise and professionalism must play a greater role in policy development; and all new EU legislative proposals must be evidence-based and accompanied by a full health impact assessment. In its manifesto, the BMA outlines its support for healthcare systems remaining the preserve of individual EU member states. But it says that Europe-wide political decisions affect the health of people across the continent. BMA council chair Mark Porter
The BMA would also like to see a set of EU-wide principles to ensure the fair recruitment of health professionals to protect vulnerable healthcare systems. On patients’ rights and safety, the BMA insists that the proposed transatlantic trade and investment partnership between Europe and the USA must not favour corporate interests over patients’ rights. On public health, the association calls for: New measures to lower alcohol consumption across the EU, rather than only tackling problem drinkers EU recognition that the benefits of minimum pricing for alcohol outweigh reductions in brewers’ profits A ‘rational debate’ about illegal drug use and options for change Regulation of the use of antimicrobials. Read the European election manifesto at bma.org.uk/lobbying
OFF THE RECORD NORTHERN IRELAND
‘Patients on the night in question described chaos, with nurses reduced to tears’ A crisis is a time of intense difficulty or danger, according to the Oxford English Dictionary, so it seems reasonable to conclude there is one in Northern Ireland’s emergency medicine service. A shortage of doctors has resulted in the closure of a number of emergency departments and restricted opening hours at others. BMA Northern Ireland has repeatedly warned of the dangers of staff shortages and called for action. In January, the Belfast Health and Social Care Trust declared a major incident at the Royal Victoria Hospital’s emergency department as staff struggled to cope with the number of people needing treatment. Patients on the night in question described chaos, with nurses reduced to tears. It has since emerged that senior doctors at the hospital had repeatedly informed trust management that conditions in the department meant they could not always guarantee patient safety. A report by the College of Emergency Medicine last year warned there were not enough consultants working in any of Northern Ireland’s emergency departments, including the Royal. Early findings of a review carried out by the healthcare watchdog the Regulation, Quality and Improvement Authority after the major incident were even more damning. Inspectors found, at times, that not enough medics were available to treat patients properly. About 100 staff who were interviewed raised concerns about staffing levels, bullying, intolerable pressure and a dysfunctional healthcare system. Most recently, health bosses admitted waiting times in the unit may have played a part in the deaths of five patients. Certainly, the evidence of a crisis is stacking up. So, why are health officials so scared of using the term? They have accused the media of whipping up concern and refused to acknowledge the Royal’s emergency department is unsafe at times. Speaking at Stormont, health, social services and public safety minister Edwin Poots said: ‘We should stop damning our emergency departments because they respond very, very well to people and they provide excellent care to people.’ Appearing in front of the health, social services and public safety committee, he said Northern Ireland hospitals were ‘performing safely’ and denied there was a crisis. No one is saying emergency department staff are not doing a good job. In fact, it is clear they are working above and beyond in awful conditions. BMA Northern Ireland has said doctors are being left frustrated that they cannot provide the level of service they would like. It is hardly surprising that trusts cannot recruit and retain enough doctors to work in Northern Ireland’s emergency departments. This is not a problem unique to Northern Ireland but it is compromising patient safety and creating intolerable working conditions. Despite everything, including the possibility that waiting times in Northern Ireland’s regional trauma unit could have contributed to the deaths of five patients, officials appear unwilling to acknowledge the extent of the problem. Lisa Smyth
BMA lobbying wins pensions boost for locum GPs GP locum appraisers and salaried GPs are to benefit from improved pension arrangements following BMA lobbying. The changes mean that the income GP locums earn by conducting appraisals can count towards their pensions. Until now, this was only the case for salaried and partner GPs appraising other doctors. The NHSPA (NHS Pensions Authority) last month released guidance stating that freelance
GPs can now do the same. The move followed continued lobbying of NHS England by the GPC sessional GPs subcommittee. GPC sessional GPs subcommittee chair Vicky Weeks said: ‘The change to locum appraisers’ pensionable income is very welcome news for locums. The BMA has been helping to bring about this change. ‘It rectifies the nonsensical situation in which locums were discriminated against by reason
of their contractual status when all other appraisers were able to pension their income.’ The NHSPA has also announced changes that mean all the practice income of salaried GPs will be pensionable. Practice-based overtime was not pensionable for salaried GPs, which meant if they worked a Saturday morning, for example, the income was not pensionable. Find out more about pensions rights at bma.org.uk/pensions
BMA News BMA House Tavistock Square London WC1H 9JP Editorial Tel: (020) 7383 6122 Advertising Tel: (020) 7383 6386 Call a BMA adviser: 0300 123 123 3 Email: firstname.lastname@example.org Editor Caroline Winter-Jones Views and analysis editor Neil Hallows News editor Lisa Pritchard Senior writers Flavia Munn, Anita Wilkinson, Stephanie Jones-Berry Features and analysis writer Tammy Driver NI correspondent Lisa Smyth 07766 527604 Scotland correspondent Jennifer Trueland 07775 803795 Wales correspondent Richard Gurner 07786 035874 Social media manager Gordon Fletcher Social media officer Sara Kuhlman Production and publishing manager Rebecca Thomas Copy editors/Assistant production managers Kelly Spring, Anna Thomson Copy editor Chris Patterson Advertisement production Sean Johnson Content and engagement assistant Susan Godfrey BMA News 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 £112 (UK), €151 (Eurozone), $218 (USA) per 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 Polestar (Chantry) Limited. All advertisements in BMA News are subject to the standard conditions of acceptance of advertisement orders printed on the rate card. A copy may be obtained from the publishers on written request.
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Goldacre to speak at conference Doctor and journalist Ben Goldacre will be a keynote speaker at this month’s annual BMA public health medicine conference. He will explore the role of data in healthcare, along with NHS England chief data officer Geraint Lewis. London research fellow in epidemiology Dr Goldacre has been
battling ‘bad science’ including misleading use of data for many years. The conference, at BMA House, London, on March 21, will also examine public health’s new role within local government. Sign up at bma.org.uk/events/ 2014/march/conference-of-publichealth-medicine
Public more aware of organ opt out Awareness of Wales’s new opt-out organ donation law is on the increase, a new survey has revealed. In a Welsh government survey of 1,000 people, 59 per cent said they were aware of the legislation coming into effect in December 2015 when adults will be expected to opt out of the Organ Donor Register, rather than opt in. The survey was carried out in November last year and showed an increase of two percentage points against a similar survey
carried out in June. BMA Cymru Wales has welcomed the increase but said more work needed to be done to make sure the public were fully aware of the changes. BMA Welsh secretary Richard Lewis said: ‘It is important that further efforts are made to increase these figures significantly as time will quickly pass from now until the introduction date. The momentum of the public information campaign must be maintained.’
Swimmers show heart in channel Doctors who swam the English Channel have raised £26,000 for the Heart Research Fund for Wales. There were five doctors in the eight-strong Killer Whale team (pictured) who completed the swim last
September. Fundraising has closed. Team captain James Wrench, a Powys GP, said: ‘We made it despite 3ft waves, 40mph winds and “white horses” for three quarters of the crossing.’
‘Named GP’ role not too onerous The BMA has issued guidance on how having a ‘named GP’ will work for patients aged 75 and above. The change was agreed as part of the 2014/15 contract negotiations between the BMA GPs committee and NHS Employers and which come into effect in April. Under the changes, all practices will need to ensure that each patient aged 75 and over has a named, accountable GP.
The named GP’s responsibilities will include ensuring the physical and psychological needs of the patient are met and, where appropriate, working with other health and social care professionals to deliver a multidisciplinary care package. The GPC says this role should not prove particularly onerous and is in line with what many practices are already offering.
‘This is largely a role of oversight, with the requirements being introduced to reassure patients over 75 that they have one GP within the practice who is responsible for ensuring that this work is carried out on their behalf,’ the guidance says. Named GPs will not have 24hour responsibility for these patients. Read the BMA guidance at bma.org.uk/gpcontract and look for the FAQs section
Early registration may harm medical education BY GRAHAM CLEWS Plans to register doctors on graduation could threaten patient safety and harm UK medical education, the BMA warns. In a submission to HEE (Health Education England), the BMA medical students and junior doctors committees say the proposals, which would include a new selection process for the foundation programme, would have no effect on tackling foundation programme oversubscription. Under the proposals, UK medical graduates would be registered with the GMC on graduation but would need to score well in a new selection test to be given foundation posts.
The BMA argues that the proposals are more likely to result in an increased number of UK medical graduates being unable to secure training posts because more applicants from Europe would be eligible for jobs. The association warns that medical school curricula would have to change to ensure students are ready for registration on graduation, meaning important elements of a doctor’s education may have to move to post-graduation. BMA medical students committee co-chair Harrison Carter said: ‘These proposals don’t address the central workforce question they were intended to address — oversubscription to the foundation programme — and they
could create a number of problems for patient safety, standards of medical education and the UK medical workforce.’ The HEE also suggests that removing the current year of preregistration employment would address reported patient safety concerns. However, the BMA says: ‘If there is a patient safety concern about the pre-registration year, we do not see how it can be resolved simply by moving the date of registration. ‘It should be resolved by greater emphasis on appropriate supervision, training and support.’ Read the submission to HEE and find out how the BMA is tackling oversubscription at bma.org.uk/news OPINION
FRONTLINE MEDICINE TA L E S F R O M T H E E M E R G E N C Y D E PA R T M E N T
‘Come April, the ambulances will still roll into the emergency department with blood and vomit dribbling from under their doors’
Charles Lamb is a pseudonym
I don’t know about you, but I’m a bit fed up with political dithering over minimum pricing for alcohol. It seems our leaders aren’t convinced about the harm cheap booze does, although half an hour spent observing any town centre on a Friday or Saturday night would dispel any doubt, and it would take even less than that in any emergency department. Maybe our leaders are concerned that fixing a price of 45p will push sensible drinkers into the arms of the opposition so close to their electoral departure. Or perhaps they’re worried about a loss of tax revenue, while ignoring the cost to their emergency services of patching people up. Behind our politicians, the real decisionmakers are doubtless at work. The financial equation has by now been the subject of complex mathematical modelling about death rates, pension uptake and NHS costs, and perhaps the Whitehall fixers have calculated that it’s cheaper to let a few alcoholics die young than to keep their
livers going until retirement age. Or could it be that some policy-makers are a little too close to the drinks industry and don’t really rate health promotion anyway, preferring the drinks industry’s own lurid cocktail of self-regulation at the front door and ‘pile ’em high, sell ’em cheap’ at the back. Somewhere in this mix there is actually some science, or as we now call it ‘evidence base’. But that has been conveniently brushed aside. Our leaders may have temporarily forgotten about health and hospital crises in their rush to stand in a flooded village for a photo opportunity in new wellies, looking serious, sympathetic and just a little wet. Possibly the evidence base on climate change hasn’t had the desired effect either. So rather than doing something useful, we are to have a new policy to keep lager cheap enough for everyone to buy with their paper-round pocket money. Currently, one can buy lager at 14p/100 mls, cider at 17p and vodka at £1.40 from my local supermarket, where ‘every little
(bit of profit) helps (our share price)’. Unfortunately, this won’t change at all in April when a minimum alcohol floor price is implemented, so it won’t be necessary to spend the next month stockpiling, unless you were going to anyway. And, reassuringly, come April the ambulances will still roll into the emergency department with blood and vomit dribbling from under the doors. There will still be unconscious teenagers with their clothes rearranged or missing, to be stretchered in for some R&R. Resuscitation and rehydration, that is. There will still be opportunities for some badly needed practice by the under-utilised junior whose life in emergency medicine is so bereft of excitement that one can find them sitting around the staff room drinking coffee while watching the latest celebrity ‘come dancing’ or ‘go swimming’ contest to occupy them on a Saturday night. Charles Lamb is a consultant in emergency medicine
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Saturday March 1, 2014
As a vote on independence looms, new BMA Scottish secretary Jill Vickerman, a former civil servant, is looking forward to meeting her former colleagues around the negotiating table. Jennifer Trueland reports
hese are interesting times for doctors in Scotland. Yes, there’s the not-so-small matter of the independence referendum in September, and its associated debates on subjects ranging from currency to EU membership. But for the health service, and for doctors in particular, there remain other pressing issues such as pensions, terms and conditions and, of course, the challenge of ensuring that patients receive high quality care as demand rises and budgets tighten. An exciting moment, then, for a new BMA Scottish secretary to start — and Jill Vickerman is relishing the chance. Before taking up her current post in December, Ms Vickerman was a senior civil servant with the Scottish government, latterly as policy director of the quality unit at the health and social care directorates. She was involved in drawing up the Scottish government’s 2020 Vision for Health and Social Care, which has quality at its heart. ‘It was a real privilege to work on the national strategy, and now I’m looking forward to working with doctors to translate that into a reality,’ she says. ‘Clinical leaders are key to making it happen.’
Joining the other team Ms Vickerman doesn’t really like the term gamekeeper-turned-poacher, but it’s certainly true that in some respects she has ‘changed teams’. Although working in partnership on some issues is in doctors’ best interests, the BMA and Scottish government don’t always see eye to eye on everything. As the negotiator for doctors’ terms and conditions, obviously there are times when the BMA won’t agree with what the government wants to do — on pensions, for example. But asked how she will feel if she finds herself sitting across the table from her former colleagues, Ms Vickerman is quick to correct the wording. ‘I might be sitting around the table with them,’ she smiles. ‘I’ve worked hard to build up good relationships with ex-colleagues wherever they are. I think they all recognise that. ‘After all, while conversations will not always be easy, we all have the shared goal of working for a high quality, sustainable NHS. The conversations won’t always be entirely easy, but we’re looking for the best outcome for all of us.’ Ms Vickerman, who was born in Edinburgh but went to school in Glasgow,
From maths to medics was encouraged to think of medicine as a career. At the time, however, the lure of numbers was too great, and she ended up studying maths and statistics at Edinburgh University.
Change of direction ‘I loved maths, it was my favourite subject and I did an obscene amount of exams at school. I was always thinking about it,’ she laughs, adding that even when attending concerts she’d be using members of the audience as subjects in probability analysis. When she was close to graduating, however, she realised that it was the people behind the statistics that really grabbed her interest. ‘I always thought I’d be an actuary, but when I was offered a job as a government statistician I realised that was actually what I wanted to do. So rather than follow the big money, I went into public service.’ With a mother who was a nurse, and a sister who took up dentistry, it was perhaps no great surprise that Ms Vickerman found her niche in health, after a government career which started in transport and moved through education and macroeconomics. In many of these roles she worked with the UK Treasury and other government departments, as well as the administrations of the other devolved nations — a part of the job that she particularly liked. ‘I always really enjoyed that aspect of the role,’ she says. ‘It’s one of the things I missed as health became more and more devolved. I really think that when it comes to health policy you really need that [crossUK] contact because you need to have a shared understanding of how the different nations vary — in interpretation of data on waiting times, for example.’ Although health is largely devolved, and is diverging further regardless of whether Scotland votes for independence, there are areas of common interest, she says. For example, all four nations were studying the ramifications of care failings at Mid Staffordshire NHS Foundation Trust which led to a public inquiry, while the NHS in England had drawn on Scotland’s experience of patient safety when setting up the recent review led by Don Berwick. Although she sees an important part of her job with the BMA as making sure the Scottish voice is heard at a UK level within (and beyond) the organisation, she is also looking for ways in which the devolved
‘Clinical leaders are key to making the national strategy happen’ nations can benefit from, and contribute to, the BMA as a whole. ‘I’m looking forward to being part of BMA UK,’ she says.
Full steam ahead Although the polls still suggest that Scots will not choose independence come September, it’s important to consider the potential ramifications of the referendum, she says, at an organisational, as well as a policy level. ‘There will be a need to think very carefully about what that means for the BMA,’ Ms Vickerman says. ‘We’ll have to look at the various options for the association in the event of a yes or a no vote, because whatever happens in the referendum, we’re not standing still; things are changing.’ A big challenge facing the BMA in Scotland, and the wider organisation, is ensuring doctors’ position as professional leaders. ‘There’s a big focus on positioning
doctors so that they are having an influence on the planning and delivery of health services,’ she says. A keen golfer — at her best her handicap was 14, although she reckons it’s currently nearer to 20 because she hasn’t had much time to play recently — Ms Vickerman also relaxes by taking her two border terriers walking in the Pentland Hills near her home in Midlothian. Embo, 10, is named after a beach near Dornoch in the far north of Scotland, and Taupo, eight, after a place in New Zealand. So why these names? ‘They’re both beautiful places, and good names for dogs,’ she says. At the moment she is concentrating on the year ahead. ‘I think we have a window of opportunity to do some new, clear and ambitious thinking about the direction of health and care services. It’s early days, but I’m really enjoying it.’ bma.org.uk/news-views-analysis
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bma.org.uk/liveandlearnblog In the Live and Learn blog we asked for your favourite medical mnemonics. Blog readers commented:
Cranial nerves: Only overoptimistic twerps tell a fib after going very slowly home — olfactory, optic, oculomotor, trichlear, trigeminal, abducent, facial, auditory, glossopharyngeal, vagus, spinal accessory, hypoglossal. Jenny Gibson
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Blogs: bma.org.uk/thebmablog bma.org.uk/atworkblog bma.org.uk/liveandlearnblog
All comments: Please keep them brief and to the point. They may be edited for length and clarity.
I have a way to remember Reiter’s syndrome: Can’t wee, can’t see, can’t climb a tree. However, my all-time favourite is the one for the layers of the Scalp: Skin Connective tissue Aponeurosis Loose connective tissue Periosteum. Eleanor
Acute Emergency Headaches: STOP DAVeS Men S: Subarachnoid haemorrhage T: Temporal arteritis O: Obstruction (Chiari malformation, 3rd V colloid cyst)
P: Phaeochromocytoma D: Dissection (of cervical/cranial vessels) A: Apoplexy (pituitary) Ve: Vascular including Venous (stroke, ICH, CVST, vasculitis) S: Subdural and Epidural Men: Meningitis (bacterial, viral, aseptic, fungal, malignant)
your practice, think about how this could change the way you work or improve care and jot a few words down. However, if there is no real learning in something, it is not worth the effort of reflecting. John Sharvill MB BS MRCGP Deal, Kent
ABCs of anaesthesia, as told to me by an anaesthetist: Airway Breathing Crossword
Europeans and alcohol
Reflecting as you go In her letter ‘Reflection not natural’ (February 15, 2014, page 6), Fiona Toolis echoes the way many people feel about reflection, including me. I work as a GP but also as a trainer and appraiser. Both roles require me to ‘score’ reflection. My message is: don’t let it get in the way of learning. If you learn something that may change
Communities chat In response to the #donateandnominate campaign:
An easy way to remember the ‘Sepsis Six’ (set of early interventions to reduce mortality in sepsis) is O2 FLUID: O2 Oxygen high flow F Fluid challenge 20-30mls/kg L Lactate measurement U Urine output I Infection screen D Drug therapy (prompt antibiotics).
As someone living in a ‘student area’, I fear for the health of today’s university students and despair of the inaction of the council and universities whose complex relationship mirrors that between the central government and the alcohol industry. Any positive action by the EU has to be welcomed.
bma.org.uk/thebmablog In the BMA blog, we stressed the importance of the EU having an effective alcohol strategy.·
We’ve been doing this as well but calling it #needleandnominate. #donateandnominate is a much better name. I hope this spreads. Anonymous
Blog readers commented:
This is an excellent (if very depressing) piece because it doesn’t sound to me as if we’re going to get any positive action out of the EU at all. Do they still sponsor a ‘wine lake’ along with the butter mountain? What is certain is that they will always put French farmers (and big business) ahead of the patients I see with liver disease and psychiatric problems.
Twitter talk On care.data:
@TheBMA better they demonstrate they can convince people how important it is than include an opt in form. @Snyberwiz
@TheBMA good to see the BMA getting this right. Puts the doctors in a dodgy position. @BenGrabham
Let’s not forget the hidden costs due to loss of sleep for those whose residential streets are blighted by drunkenness.
Well done @rcgp and @TheBMA upholding key #nhs principles of confidentiality, consent and trust. @lancsgp OPINION
SEE ONE, DO ONE WORKING AND SURVIVING AS A JUNIOR DOCTOR
‘It’s the kind of mistake I hope I would make again — putting patient care before administrative correctness’
As a GP registrar I made more than a few mistakes, from simple data entry errors and spelling mistakes to blunders that incurred the wrath of practice managers. There are two that stand out, and they share a theme of patient-centredness. The first time I upset a practice manager was when I changed a patient’s address on the computer system, and then referred them. Unfortunately for me, the move made something complicated happen with funding, which exercised the practice manager. Fortunately for the patient, it was a twoweek-wait referral for a
suspected melanoma that turned out to be a melanoma. I wonder if the patient’s treatment would have been delayed if I had instead told them to register with a different practice, and seek a referral from there. He was taken off the list, but my mistake may have saved his life. It is the kind of ‘mistake’ I hope I would make again — putting patient care before the needs of administrative correctness. In truth, I felt smug. The second mistake, at a different practice, was partly my fault and partly the fault of a patient. She was a young woman who had just got a job with a small care agency, and was in need of a hepatitis C vaccine. ‘A hepatitis C vaccine? Are you sure? I didn’t think there was such a thing,’ I questioned her as my mind whirred. Had I missed something in the latest edition of the BNF or countless email alerts that I was signed up to? ‘I think so, I’m sure it was hepatitis C,’ she
didn’t look that sure. ‘I think you mean hepatitis B, don’t you?’ I asked throwing her a lifeline. Her face brightened, ‘Yes, that must be the one!’ And in my pleasure at working out what this patient actually wanted, I forgot to check with anyone that it was OK to give a course of hepatitis B vaccinations to a patient for work. The nurse who gave the course didn’t question my judgement either. So a few weeks later my trainer took me aside and explained that my induction hadn’t been thorough enough; he blamed himself. For a storm had been whipped up when the practice had billed the care agency for the vaccinations, which were after all an occupational health service. Perhaps naively I had again put patient care ahead of administrative correctness, except this time it wasn’t life or death but a matter of money. I’m not likely to be in a rush to repeat that mistake. Samir Dawlatly is a GP in Birmingham
See One, Do One is a 450-word column about life as a junior doctor. If you would like to submit an article for this column, use the contact details above. Payment is made for those published.
BMA News 7
Saturday March 1, 2014
The 2014 @TheBMA Council elections have 23 per cent fewer candidates than 2012 (59 vs 77). Does this reflect apathy or poor publicity to BMA members? @Flattliner
@TheBMA interesting. Some definite ‘yes’ candidates. Pleased to see some young leaders coming through the system. @sidhuGP
Too many juniors? Heidi Phillips asks in ‘Horrible histories make for a never-ending tale’ (February 1, 2014, page 7) whether the system needs mending. Maybe to answer her question we need to think the unthinkable — perhaps there are too many junior doctors in hospital. If one day someone in the government were to compare the increase in the number of doctors with the increase in (acknowledged an ageing) population over the last 10, 20 and 30 years, the comments and answers might be interesting. Alan Padwell MB ChB FRCPath Rochdale, Greater Manchester
Medical slavery is rife I would like to refer to the BMJ Careers editorial ‘Subconsultant posts: watching for harm’ (BMJ Careers, February 15, 2014, page 1). It concludes that: ‘…
there is a need to keep a watchful eye on the situation and to continue to raise concerns whenever evidence shows that subconsultant posts are harming doctors’ careers and patient care.’ I wonder whether the BMA could have been keeping ‘a watchful eye’ on the destruction of the careers of hundreds of doctors employed in associate specialist, specialty doctor, staff grade and trust fellow positions, who for years have been made to work under similar circumstances, despite being fully trained and on the specialist register like their consultant colleagues. It is time to recognise that lawful medical slavery has been going on for a long time while the dreaded subconsultant grade doesn’t even officially exist.
PRIZE COMMENT FELIX BENNETT
On BMA council elections:
Show some wartime spirit The letter about on-call duties and resultant illnesses (‘Not so sweet dreams’, February 8, 2014, page 6) was interesting. In 1949, aged 22, I was a general medicine and neurology house physician, one of three house physicians at the very busy Nottingham General Hospital. I spent one week in three on call (24 hours a day for seven days) and did the routine ward and outpatients work. There was only one medical registrar (resident) and we tried our best not to call him at night. Quite outrageous of course but this was normal for that time and medicine was less complicated. The experience was great but looking back I realise I must have carried out blood transfusions (haematemeses were very common) and lumbar punctures half asleep. There were no divorces because we were very nearly all unmarried and I think most of us survived. Maybe this was due to our wartime diet and experiences.
Erman Melikyan MD FRCS Southampton The BMA staff, associate specialists and specialty doctors committee replies: The BMA is opposed to the creation of subconsultant posts and recognises the skills and experience already provided by doctors in the SAS grades. This senior service must be appropriately recognised and the SASC will continue to lobby for this at every opportunity. SASC are currently working with the GMC and NHS Employers to ensure that SAS work is recognised both in IT systems (such as patient coding) and through appraisal and will also provide input to any developments coming out of the Shape of Training Report.
Melvin Ross MB FRCGP London
VOICEBOX ‘Life is changing and we need a more flexible training scheme to reflect that’
It’s all anyone is asking me at the moment: what are you going to do after this year? Having just survived my F1 (foundation doctor 1) year I am faced with a sudden, potentially career defining decision: what do I do after my F2 year? There are some of us who are career-focused and born to be a cardiothoracic surgeon or dermatologist, but many who aren’t. The junior doctor training reforms known as MMC (Modernising Medical Careers) were meant to structure the previously unstructured wasteland known as the SHO (senior house officer) years. The SHO grade was abolished for a supposedly streamlined and structured approach to training, moving from the two-year foundation programme into runthrough training that would take a doctor all the way to consultant or GP level. But the UK Foundation
Programme’s annual report reveals not all those who complete the foundation programme go straight into higher training. In 2010, 83 per cent of F2s went directly on to training schemes, 71 per cent in 2011, dropping to 67 per cent in 2012. So given this information and the general lack of enthusiasm among my fellow F2s (maybe Devon is just not a very enthusiastic place), maybe this direct route into specialty training is not the optimum for all aspiring consultants or GPs? The possibilities of trust jobs, working abroad or further education offer the newly qualified junior doctor a broader spectrum of working possibilities and possibly a more attractive lifestyle at this point in their lives. The format of life is changing. The current generation does not dream of a dog, a family and a house by the age of 25 so we need a more flexible and accepting training scheme to adapt to these changes.
So why doesn’t the medical establishment support this new wave of doctors who want to expand their experiences and education to ultimately become well-rounded and accomplished doctors? Is it time for the emergence of an F3 doctor, who takes the time to do locum jobs or work abroad, before entering a formalised training scheme? This could become an increasingly popular option. It seems doctors do not want to be pigeonholed prematurely and if the issue is not addressed, the UK medical system could risk losing trainees to other countries or even other professions. Paul Heron is a foundation doctor 2 in Exeter See our guide to working abroad at bma.org.uk/developing-your-career/
For more about broadening your horizons at bma.org.uk/developing-your-career/ career-progression/broaden-your-horizons
Voicebox is your 450-word forum to raise issues affecting today’s doctors. Submit articles for consideration using the details in ‘contact us’ on page 6. Payment is made for those published.
Making the most of
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Save up to £50 off the full fee with your BMA membership discount at all BMJ Masterclasses: • before early bird deadline: £195 per day • after early bird deadline: £220 per day
Not only will you earn 6 CPD credits by attending, you will also receive: • the comprehensive course handbook and materials to take away and refer back to • dedicated Q&A time with the leading experts in their ﬁeld • complimentary six month access to BMJ Best Practice • BLS refresher course and pre and post attendance tests from onExamination to identify your learning gaps (GP General Update only) • certiﬁcate of attendance, two course lunch and refreshments, and ample networking opportunities
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BMA Careers Skills: Workshops The medical workplace is increasingly competitive and highly pressured –– we’re here to ensure you fulﬁl your true potential without having to spend a fortune or waste any of your valuable time. Our workshops provide the essential tools you need to build on your career successes. You can learn the top tips that can make all the difference to your career with our workshops on key topics.
Workshops around the UK
Management essentials • Monday 31 March – Birmingham • Friday 25 April – Manchester • Thursday 1 May – Nottingham • Monday 19 May – Edinburgh • Friday 23 May – Leeds • Monday 30 June – Edinburgh
Management essentials • Thursday 13 March 2014 • Tuesday 8 April 2014
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Presenting skills • Wednesday 9 April 2014 Negotiating skills • Tuesday 18 March 2014
Don’t forget! We limit the number of attendees so that you receive focused attention from an experienced medical careers consultant and BMA members save £150 on each workshop. Not only does it count towards your continued professional development but it’s also excellent value for money. Cost:
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