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Archive for June, 2010

Stepping up to the mic at the BMA conference

By Mike Broad - 30th June 2010 4:25 pm

A lot of voices get heard at the BMA’s annual representatives meeting but, when it comes to the media, only the GPs and consultants tend to get any coverage.

So, in the interests of balance, it’s worth giving some of the views of juniors’ and the SAS doctors an airing.

Dr Shree Datta, chair of the JDC, stuck to her line that the problem with the working time regulations is their implementation rather than a restricted working week per se.

“Half-hearted compliance leads to half-filled rotas,” she insisted in her conference address.

She added: “It is time for employers to take up Temple’s challenge, and engage with junior doctors to create realistic rota solutions that balance training and service to our patients.”

Where all the additional ‘manpower’ will come from to fill these rotas she didn’t say. Maybe she feels, like Sir John, it’s up to consultants to fill the gap.

Training will clearly continue to be this year’s hot potato.

She said: “The many streams and rivers of NHS money are being diverted and dammed. The NHS prides itself on its highly trained workforce. But the quality of senior doctors in future depends on the quality of training now. The whole profession must unite against any suggestion of haphazard cuts to our training budgets.”

Dr Radhakrishna Shanbhag concurred. The chair of the SAS committee told the conference: “My job is not an easy one. It is no secret that the SAS grades include many varied and sometimes challenging needs and aspirations. We are a diverse group but that should be our strength. We need to improve access to training (for those that want it), provide some formal recognition of our competencies and skills and ensure that with this, the SAS grades are seen as a positive career choice for highly skilled and motivated specialists.”

But it’s not just about money, Shanbhag is after a bit of respect too. He complained about the slow implementation of the ‘new’ SAS contract. “Two years since it was introduced, I’m shocked that there are still many SAS doctors waiting for assimilation. I believe that this is a damning indictment of the lack of respect that employers have for our grade. We have continually pressed NHS Employers and devolved administrations to move things along and will continue to do so.”

And did I detect a desire for a bit more respect from within the ranks of the BMA?

In summation, he asked the conference to “take ownership of this grade, celebrate their achievements, acknowledge their vital role and let them be spoken to and about in the same breath as other senior medical professionals. Let us stand up for SAS doctors.”

While the slogan of the conference might have been ‘standing up for doctors’ - a line that the chairman of BMA council repeated at least 742 times - the real message was more one of ‘sticking together’, possibly alongside other public sector unions, to see out the gathering storm.

Tags: BMA, Training
Posted in Dr Blogs | 1 Comment »

Real personal budget pilots launched

Pulse - 12:25 pm

Patients will be given cash to purchase their own NHS care for the first time under a new government scheme.

The direct payments pilot, announced by health minister Paul Burstow, is to be rolled out across eight PCTs, who will directly hand patients the money for their care, allowing them to decide how, where and from whom they receive treatment.

Real personal budgets are already available to patients to purchase some forms of social care, but until now, personal health budgets have only been obtainable via PCTs or third parties.

The pilot scheme, which will run until 2012, is being developed to help patients with long term conditions such as diabetes, stroke, heart disease, end of life care and mental health conditions.

But the BMA has expressed concerns over the potential for the funding to be used to pay for ‘inappropriate and/or non-evidence based services or treatments’, including complementary therapies such as homeopathy.

My PDP objective: continue plodding along

By Bob Bury - 11:51 am

I’ve just been asked to write a report on the work of a committee I chair. They want me to provide three (not two, not four, but three) objectives for next year. Well I’m not going to, so there. In fact I’m getting a bit sick of this universal assumption that everyone needs to have objectives, over and above just continuing to do their job. Doesn’t matter what this particular committee does, just take my word for it that it has been fulfilling its purpose in a perfectly adequate fashion.

It’s the same with personal development plans (sorry, PD-bloody-Ps). Everyone has to have one of these, even the porters for all I know. It just makes no sense. Take me - I don’t need one. Not because, like Mary Poppins, I’m practically perfect in every way (although I’d be prepared to argue the case) but because I’m near the end of my career, and all the trust needs me to do is to carry on with my moderately lifelike impression of a competent radiologist, shifting the reporting without making too many actionable errors.

The same is true of many other members of staff, not just the old-timers like me. If it was really the case that everyone had an urgent and annually-recurring need to develop, it would mean that they had appointed a bunch of wasters who weren’t up to the job. If everyone has to have a PDP, it means that no-one is performing adequately. It’s just crap.

Of course, there are times in your career where you are actively learning and building up your practice, developing your service. But it’s not like that all the time, thank God, and for a large part of a career what you need to do is consolidate. There’s a lot to be said for plodding. And what’s the result of all this pressure to come up with ‘aims’ and ‘objectives’? I’ll tell you - the outcome is that everyone dreams up an aspirational and largely irrelevant wishlist, and then makes everyone else’s life a misery by trying to sign them up to providing ‘multi-source feedback’ to pad out their appraisal folders. Everyone is spending so much time examining their own and other people’s navels that nobody can find time to just do their bloody job.

So I’m going to give them just one objective for my committee - to carry on carrying on. And if they don’t like it, they can look for a more compliant chairman. They’ll have to soon, anyway, I’ll be in the garden, or fishing.

As Jerry Nelson would no doubt say (and probably has): continuous improvement, my arse!

Tags: appraisal
Posted in Bob Bury | 7 Comments »

Where’s the evidence for costly regulation?

By Tom Goodfellow - 29th June 2010 3:55 pm

Sporting matters may have recently pushed the BP Gulf oil leak off the front pages, but millions of gallons of the stuff are still being pumped into the sea with, as yet, unquantifiable consequences and no clear end in sight.

This may be the worst environmental disaster ever seen. Drilling for oil at that depth is very risky, yet to what extent did the international oil companies prepared for such an eventuality?

In June, senior executives of five of the other big companies appeared before US Congressmen on Capitol Hill to give an account of their own preparedness for a major disaster, and it was indeed a sorry spectacle by all accounts.

Each company blamed BP for making fatal errors, but insisted that they had robust contingency plans to deal with such an eventuality. In fact ExxonMobil’s plan contained 40 pages on dealing with the media but only nine pages on how to handle the leak itself. However it did contain information on how to protect walruses which, as it happens, are not found in Gulf waters.

Further probing revealed that the five companies drilling for oil in that region had virtually identical plans and that these were written by the same Texas sub-contractor. They were deemed largely to be “fantasy” documents.

This brings us to the heart of the matter which is that such risk management and regulatory policies are frequently aspirational and theoretical but are rarely grounded in practical experience.

All NHS trusts will have extensive risk management policies running to many pages, which will list detailed chains of responsibility right to the trust board level. Previously compliance has been regulated by a variety of bodies, the latest manifestation of which is the Care Quality Commission which is now the body with overarching responsibilities to regulate “all health and adult social care providers”. The aim is that “all providers must show they are meeting new essential standards of quality and safety across all of the regulated activities they provide”.

This seems a worthy aspiration. But when I try to read the CQC document, Essential standards of quality and safety (all 274 pages of it) why do I get that accustomed sinking feeling that this is yet another NHS behemoth? The work involved to demonstrate compliance, and indeed to assess it, will be vast and will generate further armies of managers and bureaucrats costing the NHS millions. For small organisations the work and costs could prove crippling. And the benefits? Largely unproven, like so many of the other costly regulatory systems which have proliferated over the last few years.

In 2002, Prof (now Lady) Onora O’Neill gave a brilliant series of BBC Reith lectures entitled, A question of trust. The third in the series, Called to Account, delivered at Addenbrookes Hospital, is worryingly prescient and should be read by all who have and interest in, or are concerned by such matters.

Tags: CQC, Regulation
Posted in Tom Goodfellow | 4 Comments »

Crisis will follow NHS pension meddling

By Mike Broad - 3:29 pm

The BMA has vowed at its annual representatives meeting to protect doctors’ pension scheme as a government commission starts examining the reform of public sector pensions.

Chancellor George Osborne announced a review of public sector pensions during the Emergency Budget, and is believed to be keen to extend the retirement age to 66 by 2016.

Dr Mark Porter, chair of the BMA’s consultants committee, called on the government to stand by the pension agreement reached in 2008.

In that agreement, higher earners pay more into their pensions and employers’ contributions will be capped at 14% of pensionable earnings.

Porter said that in recent years the NHS pension scheme has paid surpluses to the Treasury.

“The incomings of the pension scheme are now fixed with a two-year pay freeze. The outgoings are not fixed - over those two years the pension payments will rise in line with the cost and prices index, expected by the Treasury to be a 4% increase in those two years. So, incomings are static, and outgoings are rising.

“Let’s be clear - the greatest threat to the stability of the pension scheme is the government itself.”

The BMA’s strong stance follows rumours that the government is considering charging higher earning public sector professionals a one-off levy - of between £10,000 and £20,000 - to maintain their pension benefits. Trust chief executives are currently seeking advice on its implications.

The BMA feels that the NHS pension is in a strong position relative to other public sector pension schemes, such as the civil service and military, which have earlier retirement ages and lower employee contributions.

Dr Hamish Meldrum, chair of BMA council, was equally uncompromising on the issue of pensions.

“Only two years ago, we reached agreement which raised the age of retirement to 65, capped the contributions of the government, increased contributions by the higher paid and put the NHS scheme on a sensible and affordable footing for the future.

“I am not someone who easily resorts to threats, but I warn the government - in a spirit of cooperation and being helpful - if you really want a crisis in the NHS, start meddling with the NHS pension scheme.”

In the Emergency Budget, Osborne also announced that doctors would not receive a pay rise in the next two years.

Tags: Pensions
Posted in Hospital Dr News | 3 Comments »

Fees continue to go up while pay goes nowhere

By Mike Broad - 28th June 2010 2:18 pm

I couldn’t help but see some hypocrisy in the BMA’s representatives voting for a 2.5% increase in membership fees next year, when its very own junior doctors committee were last week banging on about how unfair increases in training charges were by the colleges.

A small but vocal minority wanted BMA membership fees to be tied to doctors’ pay increases from now on. “How can we sanction 2.5% when our pay will not increase for two years?” one said.

The JDC want to be involved in setting colleges’ training charges. Maybe the wider membership of the BMA should be involved in setting its fees?

Tags: Fees
Posted in Messy Business | No Comments »

Spirit of co-operation could falter over pensions

By Mike Broad - 12:00 pm

I’m at the BMA’s Annual Representatives Meeting in sunny Brighton. It’s a beautiful day and there’s a stunning view over the beach and the pier from the press room.

However, the 500 or so faithful members who’ve turned up are dutifully sat downstairs in a rather gloomy conference hall.

From my elevated position above the promenade I can see the odd one making a break for the beach but they’re being surprisingly dedicated to the cause.

That’s probably because there’s much to discuss - not least the threats to doctors’ pay and terms and conditions. As you’ll be aware, last week, Chancellor George Osborne pledged to freeze public sector pay for the next two years in his emergency budget.

Dr Hamish Meldrum, chair of BMA council, gave his big speech earlier. A key theme was the new spirit of cooperation between the coalition government and the union. He agreed with the government’s decision-making on the revalidation postponement, on seeking to reduce bureaucracy, cutting waste, streamlining management, and saying they want to put doctors in control.

However, while promising to be “reasonable and responsible in our pay demands”, he warned that doctors would “not be made the scapegoats for failures of speculators and marketers”.

In a direct message to the government Meldrum said “don’t underestimate us when it comes to protecting doctors’ jobs and pensions. On these, I will not be reasonable if, being reasonable means accepting cuts in the number of doctors or reneging on the recently agreed, revised pension arrangements for staff”.

He pointed to BMA research which suggests cuts are already being made to staffing numbers round the country. He described this as “madness”.

Rumours abound that doctors’ pensions are going to suffer following Osborne’s claim that public sector pensions will be reformed. One rumour is that doctors will have to pay a large one-off levy - in the region of £20,000 - next year to maintain their pension benefits.

It’s widely believed that the government will put back retirement age to 66 by 2016.

The BMA, however, feels that the NHS pension is in better shape than others within the public sector, such as the civil service and military. They claim doctors contribute more and retire later, and the NHS scheme should provide the model for other public pension schemes to follow.

Meldrum said: “Only two years ago, we reached agreement which raised the age of retirement to 65, capped the contributions of the government, increased contributions by the higher paid and put the NHS scheme on a sensible and affordable footing for the future.

I knew the love-in with the coalition government wouldn’t last long.

Tags: Pensions
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Interview: Dr Porter, chair of BMA’s consultants committee

By Mike Broad - 10:33 am

Hospital Dr invited Dr Mark Porter, chairman of the BMA’s consultants committee, and consultant anaesthetist in Coventry, to answer 13 questions and complete a half finished sentence.

1. What is the biggest challenge facing the profession?

“We’ve been used to continual increase in resources allocated to healthcare in the UK, with the biggest expansions being in the last ten years. Now the profession is being asked to manage a reduction as we all pay for the burst banking balloon. The challenge will be continuing to be effective advocates for our patients while feeling a justifiable sense of outrage at this.”

2. When did you last laugh and why?

“A few minutes ago at one of the idiocies of life. There are so many.”

3. What are the BMA’s priorities over the next year?

“To represent our members to the best of our ability, and to a high standard, both individually and as a profession. I expect that a significant part of my own time will be spent on ensuring that revalidation does not become a threat or a disproportionate burden on the profession.”

4. Which person influenced you the most and why?

“My family; Dr Sandy Macara, a BMA officer in the 1990s, who encouraged me to become involved; Dr John Elton, a colleague at work, who is an inspiration in his focus on patient care and multidisciplinary working.”

5. What is your favourite book?

“So many and too difficult to choose but one. In the last year, Direct Red by Gabriel Weston stands out; an elegantly written memoir of a surgeon’s journey through her career. Stunningly perceptive.”

6. Will revalidation be implemented as the GMC envisages?

“Yes and no. It will come, and it will be as the GMC envisages at that point, but to get from where we were to where we will be has involved significant change as the GMC and other organisations have been brought to accept that revalidation is unavoidable but it must not be oppressive.”

7. What is your guiltiest pleasure?

“The DVD box set of Battlestar Galactica.”

8. What can doctors do to protect services in the face of cuts?

“Make sure that we have a strong voice in decisions; that we bring our experience, our advocacy and our evidence to bear in those decisions.”

9. What was your most embarrassing professional moment?

“Entering the main hall at a BMA conference and being immediately called to speak, having forgotten that I had submitted a speaking request or what the debate was about. It was a long walk to the podium as I tried to work out what the preceding speaker had been exhorting the conference to do.”

10. Of what achievement are you most proud?

“Being part of the team that put the present consultant contracts into place.”

11. Is the downturn going to compromise the 2003 consultant contract for many?

“For some, perhaps. There has always been accountability in any employment contract, and some consultants are still less able to give a meaningful account of what they spend their SPA time on - time that costs their employers in cash terms. In some trusts this brings the role of SPAs into question and challenge. I’m quite clear what they are for - quality assurance and quality improvement for our roles as doctors in looking after patients.”

12. When were you most in danger?

“At 60 mph ten metres from a car that had pulled out in front of me.”

13. The government are keen to extend the role of the private sector in delivering NHS services. What progress has the BMA’s Look After Our NHS campaign made?

“We were never under the illusion that the Prime Minister would smack his head and say ‘of course’ - we set out to raise awareness about an insidious process occurring alongside fine slogans about patient choice and creating spare capacity. And we have done that with the support of many doctors.”

Finish this sentence: juniors working a 48-hour week will have their training opportunities improved by… careful attention to their needs instead of an assumption that given more time it will just happen.

Tags: Interview
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Can’t believe the feedback on the quality of my teaching

By Jerry Nelson - 8:35 am

Bloody arsing students. Is it me, or are they all useless whingeing crybabies who reckon they need to be spoonfed everything on a plate?

Teaching students used to be fun. They’d be so keen to suck up to you that you could tell them any old crap and they’d be grateful, then they’d all get squiffy at the firm party and the pretty ones would sit on your knee. You could humiliate them on ward rounds, cancel teaching sessions, leave them to finish the clinic, and they’d love you for it.

But as with so much of the world, it’s all become completely arse about face. Can you believe that the Middle Bit of England Medical School now routinely asks them for feedback? I mean, asks THEM!!? What the arsing hell is that all about? As if anyone gives a flying badger’s rectum what they think about anything, let alone the ‘quality of their teaching’.

Here’s a few examples of ‘feedback’:

“Mr Nelson frequently failed to turn up for appointed tutorials and was frequently rude to patients on ward rounds.”

“At first I thought Mr Nelson was trying hard to memorise my name badge, but I soon realised he was just staring at my chest.”

“The only thing Mr Nelson said to me during my entire eight-week attachment was that radiologists are all gay. My father is a radiologist.”

And I’m like: where are they getting this nonsense from?

Any students reading this? Right - here’s the deal. I supply the gems of wisdom honed through years of experience at the very highest level in the greatest profession on God’s earth, and you supply the gratitude. That’s it. Class dismissed!

Tags: Humour
Posted in Nelson's Column, Bolg, Blog, whatever... | 3 Comments »

Services are already being cut, survey reveals

By Mike Broad - 8:18 am

The economic downturn is already having a significant and haphazard impact on NHS services, despite government reassurances that frontline services will be protected.

A BMA survey of its local negotiating committees reveals widespread plans for redundancies, recruitment freezes and service cutbacks.

Nearly three quarters of the 92 LNC chairs who responded said clinical services or infrastructure developments were being postponed for financial reasons. Two in five said that access to treatments or therapies were being limited.

Nearly two thirds of respondents said that there was a freeze on recruitment, with the overwhelming majority saying it covered clinical posts.

A quarter said there were redundancies planned in their trusts.

While the government has guaranteed growth in spending, in real terms, on the NHS, it’s also under pressure to make efficiencies of up to £20bn over the next four years.

Dr Hamish Meldrum, chair of BMA council, said: “There may be areas where there is a genuine need to examine ways of working and services being offered to ensure they are delivered in the most cost-effective manner. But all too often we see blanket bans, indiscriminate cost-cutting and decisions seemingly taken for political and financial expediency rather than because of good clinical evidence.

“Patients, local populations and health professionals should be actively involved in decision-making processes involving change and there should be genuine devolution of decision –making to the local level. We urge the government and NHS organisations to focus on those areas where they can truly eliminate waste.”

Nearly half of responding LNCs were being consulted on cost and efficiency savings. The amount of savings being sought averaged 6%.

Meldrum added that the survey’s findings, which were launched at the start of the BMA’s Annual Representatives Meeting, also suggested that consultants’ SPAs are being squeezed.

Tags: Cuts, Funding
Posted in Hospital Dr News | No Comments »