BMA

The British Medical Association (BMA) is a trade union and professional association for doctors and medical students

BMA’s letter to the papers over strike action

By Mike Broad - 1st June 2012 12:08 pm

So, the PR war starts. The BMA sent the following letter to the national newspapers following its announcement of industrial action:

It is with great regret that we, UK doctors, have been forced to take industrial action in order that our voice is heard by the government. We feel that it is important to explain why we are taking this action and what impact it is likely to have on your experience of the health service.

On Thursday 21 June, we will be holding a day of action.

On that day, doctors will be in their usual workplaces but providing urgent and emergency care only.

We will be postponing non-urgent cases and although this will be disruptive to the NHS, rest assured, doctors will be there when our patients need us most and our action will not impact on your safety. We feel this action is vital in order to address the unfair treatment of the NHS pension scheme.

Despite agreeing to major reforms in 2008, that made the NHS pension scheme fair and sustainable, doctors are now being asked to work much longer, up to 68 years of age, and to contribute much of their salary - up to 14.5% - for their pensions.

These contributions are up to twice as much as those of civil servants on the same pay, for the same pension. We are not looking for preferential treatment from the government but we do want fair treatment.

You do not need to do anything. We will work closely with NHS managers to ensure that anyone affected is able to receive as much notice as possible and to have non-urgent appointments rearranged. Anyone who needs urgent care on the day will receive that care.

For more information on this action go to www.bmaaction.org

Thank you for your understanding,

Hamish Meldrum

BMA chairman of council

Revalidation not yet fit for purpose, BMA warns

By Mike Broad - 16th April 2012 9:59 pm

The chairman of BMA council has written to the Department of Health warning them that the timescale for introducing revalidation - proposed for November 2012 - is unrealistic. Here’s the letter:

Dear Sir,

I am writing to highlight a number of concerns that we have in relation to England’s readiness to implement revalidation.

Supporting information for appraisal and revalidation

First, we remain concerned about the state of many employers’ clinical governance systems. The Organisational Readiness Self-Assessment exercise shows that many of these are still not sufficiently developed to support revalidation. As you know, this lack of progress is a significant risk and the prospect of relying solely on individual doctors to produce supporting evidence for their appraisal is not acceptable to us. We currently expect that a significant number of deferrals will be required for this reason.

The preparedness of designated organisations to support the introduction of revalidation is also variable. Some PCTs, for example, are attempting to implement the evidence requirements for revalidation before its start date and are preparing for revalidation in an inconsistent fashion, often not based on the GMC guidance, and before consideration of the business case and the enabling of relevant legislation.

Responsible Officers

The majority of doctors, particularly those working in managed environments, already have a connection with the appropriate Responsible Officer. There are however a significant number who do not and, to this end, the GMC is due to write out to around 70,000 doctors on the register to help them to identify a prescribed connection to a designated body. Further uncertainty has been caused by the Health and Social Care Bill as it is unclear who will provide the Responsible Officer function for GPs once PCTs have been abolished, or who will provide the relevant outcomes data on their performance. It would be useful to know when the DH consultation on Responsible Officers is expected, as this has been delayed for some time now.

Locum doctors

The conclusions of the largest revalidation pilots to date stated that locums had ‘particular difficulties obtaining supporting information, particularly information relating to the clinical governance of the practices or organisations within which they had worked.’ This remains the case, despite further piloting and general agreement that the proposed arrangements for locum doctors are inadequate.

For revalidation to work, all types of doctor need to be able to revalidate, irrespective of the nature of their practice or contractual status. As it stands, it remains unclear how locum doctors will be able to gather the supporting information they require in areas such as significant events, or obtain multi-source feedback from patients and colleagues. Whilst organisations, such as locum agencies, have a responsibility to develop their systems, only a very small minority have engaged with the ORSA exercise to date.

Multi-source feedback (MSF)

We had assumed that the proposals outlined in the GMC consultation from 2010, whereby the GMC would kite-mark questionnaires to ensure that they met the appropriate GMC standards, would be taken forward. Seventy nine percent of respondents to the consultation agreed that there should be a mechanism for accrediting questionnaires. It now seems that responsibility for ensuring that MSF questionnaires comply with the relevant GMC standards will rest with Responsible Officers.

We think that this is unfortunate, as the local interpretation of these requirements has already been shown to be inconsistent. For example, we are aware that the validity of some questionnaires has been challenged by those involved on the grounds that the development, implementation and/or administration of the questionnaires has not reflected the GMC guidance.

Remediation

It seems likely that the increased scrutiny arising from the appointment of Responsible Officers will lead to an increase in the number of cases requiring investigation. Remediation will be important part of supporting doctors in this situation and has been the subject of various working groups. Notable amongst these has been the Mascie-Taylor report, which provided a detailed insight into existing practices and outlined six recommendations, including the need to strengthen local processes and increase the capacity of staff within organisations to deal with performance concerns.

Despite all this work and despite the establishment of yet another working group, it is still far from clear how remediation will work in practice and who will be responsible for its delivery and funding. As we have said in the past, we cannot support the introduction of revalidation unless appropriate funding arrangements are in place to ensure consistency and equity between all types of doctor.

Time and resourcing for revalidation

The findings from the pilots have shown that doctors will require more time and resources to complete revalidation, at a time when they are already under pressure to deliver a more efficient service. With this in mind, the AoMRC has recommended that the minimum number of SPAs allowed for hospital doctors’ revalidation should be 1.5 per week, not including annual study leave.

However, this is being undermined by many employers, NHS Trusts and/or Boards reducing this allowance to 1 SPA. Trusts have reduced study leave budgets in their drive to make savings and in Wales, there is even a blanket restriction on all study leave. It is also currently unclear whether GPs will be provided with the extra resources and therefore time that they will need to complete the process. We therefore are sceptical that the climate is right for revalidation to succeed, both in terms of providing assurance to patients but also in being sufficiently robust to identify developmental opportunities for doctors.

All of these issues are fundamental to the successful introduction of revalidation and the lack of progress on them leads us to question whether the current timetable can be met. The assessment of readiness must take these factors into account. We would like to consider these issues at our next quarterly meeting, with a view to resolving them in advance of the ARM in late June. I also intend to raise them at the next meeting of the UK Revalidation Programme Board.

Dr Hamish Meldrum

Chairman of Council

Private healthcare investigation to be welcomed

By Derek Machin, chair of the BMA's private practice committee - 9:21 am

The BMA has for many years called for reform of the private healthcare market so that it can deliver a system which is fairer to patients and doctors.

Independent practitioners have had to deal with a number of imposed changes and restrictions to their practice, such as the introduction of so called open referral processes, and the increasing use of managed care initiatives which both limit the services and packages they can offer to patients.

There has also been a concerted effort by the major insurers to constrain consultants in private practice through changes to recognition criteria, efforts to limit consultants’ ability to set their own fees, and the expansion of partnership arrangements.

Our efforts to address these initiatives directly with the insurers proved futile. That is why we made representations to the Office of Fair Trading. This, along with submissions from other organisations, led to the OFT’s year-long investigation of the private healthcare market.

The OFT’s final report on the market proves interesting reading. There are a number of recommendations that we fully support such as the need for greater clarity to patients about when and why shortfalls occur.

Suggestions that the need for consultants to be recognised by PMI providers and that their terms of recognition may restrict private practice will divide opinion amongst consultants, providers and insurers.

Not all of the report’s findings are positive. Anaesthetic Groups come under scrutiny for potentially reducing price competition in local areas. If the Competition Commission decides to investigate this aspect of the market, then there are robust arguments about how the groups benefit patients.

Furthermore, while the report recognises that PMI providers “may adopt what appear to be a number of blunt and potentially distortitive policies in order to control costs”, it says these are necessary given the lack of quality information about consultants’ performance.

Despite these findings, we are pleased that our efforts have led to the OFT’s decision to refer the private healthcare market to the Competition Commission for a full market investigation. The Competition Commission is not constrained by the OFT’s recommendations and it does its own review of what aspects of the market it should investigate.

We will be lobbying hard for the investigation’s terms of reference to include the disproportionate power of large commercial insurers over doctors and the absence of any external regulation of that relationship. We think the simplest solution would be for the remit of the insurance ombudsman to be extended.

BMA’s reaction to the passing of the Health Bill

By Hamish Meldrum - 21st March 2012 1:17 pm

Dear Colleague,

The Government’s proposals to reform the NHS in England have been the subject of intense public and parliamentary debate over the past eighteen months. Despite our best endeavours, the controversial Health and Social Care Bill has now completed its marathon passage through the Westminster Parliament.

The passing of this highly flawed Bill worries and saddens me. It has been an unnecessary distraction for NHS staff and caused instability and uncertainty on the ground at a time when the health service is trying to meet a considerable financial challenge. Longer term, there is a serious risk of damage to the NHS caused by further development of the market-based philosophy in the NHS.

The NHS does need to change to respond to the demands of an ageing population and advances in medical technology, but reform should be evidence-based, evolutionary not revolutionary, and undertaken in full partnership between policy-makers, NHS staff, patients and the wider public.

Even with the Bill becoming an Act, the future remains uncertain, and it is likely to be characterised by continued chaotic transition if proper planning and robust consultation are lacking.

What we have done

The BMA, and the many organisations across the health sector which later joined us, may not have achieved the ultimate aim of getting the Bill withdrawn, but we still had a significant impact.

From the very beginning, we lobbied MPs and Peers, engaged with other medical organisations and ensured that our members’ concerns had a high public profile. From our early position of “critical engagement”, where we sought to try to ensure that any potentially positive aspects of the reforms could be achieved in the most effective and least disruptive way, through to our call at our Special Representatives Meeting back in March 2011 for the Bill to be withdrawn or substantially amended, and even up to the final stages of the Bill’s passage through Parliament - when we were calling for the Bill to be dropped - we achieved some positive movement.

In April 2011 the Government, mindful of the professions’ concerns, was forced to pause the legislative process, create the Future Forum and “listen” - an event unprecedented in parliamentary history. On your behalf, we successfully lobbied for amendments such as the removal of the explicit tariff arrangements which would have allowed competition on price; the partial rebalancing of Monitor’s role away from promoting competition as an end in itself and towards ensuring better integration of services; the involvement of a wider group of clinicians in shaping services; new measures to protect patient information and confidentiality; and the reversal of plans to subject ‘failing’ NHS foundation trusts to a private-sector insolvency process.

We were successful in lobbying for an explicit duty for the Secretary of State for Health to have national oversight for education and training. Alongside others, we successfully argued for greater clarity about the Secretary of State’s accountability and responsibility to Parliament for the provision of the health service in England.

The Bill that has just passed has been subject to well over 1000 amendments, but I accept this was not enough and it would still be much better not to have had the Bill in the first place. The legislation is flawed; at its core, even with amendments, it places too much emphasis on market forces and risks greater fragmentation of our health service. I believe it was right to have spoken loudly and repeatedly about the risks inherent within it.

Looking ahead

The reality of the situation is that the legislation is now here. It is important that we face that and look ahead to what we, as a profession, can do to limit its more damaging aspects.

We cannot and will not let up, as there is still a lot of work to do; a huge amount of secondary legislation has still to be passed and much of that will dictate how doctors work in practice within the reformed NHS. There are still major question marks about the detailed operation of Clinical Commissioning Groups, the NHS Commissioning Board and Monitor’s role in the new system of economic regulation. We are concerned too about how the parallel reforms to public health and education and training will sensibly fit with new infrastructure.

Our efforts will continue to seek an evidence-based, sensible and practical approach to any implementation. We will be providing you with guidance and information throughout this process on what exactly the legislation will mean for you - look out for this on the NHS reform pages of the BMA website www.bma.org.uk/nhsreform and in our other regular communications.

The passing of this Bill marks a significant moment for the NHS. As clinicians directly involved in providing care in the NHS, there will still be opportunities to try and temper some of the worst potential consequences of the legislation and keep a health service which, despite this legislation, is still putting patients first in years to come. We may not have won this particular battle but we will still continue to fight to protect and preserve what is best about our NHS.

Yours sincerely,

Dr Hamish Meldrum

Chairman of Council, BMA

Sign the e-petition to help protect the NHS pension

By Andy Blake, head of pensions at the BMA - 15th February 2012 10:11 am

Since BMA members overwhelmingly rejected the pensions proposals, we’ve been doing all we can to urge the government to come back to the table with a fairer offer. At the moment, they’re unwilling to change their position, but there is still time for the government to re-open meaningful negotiations with health unions - let’s hope that they see sense.

Last week BMA pensions committee chair Alan Robertson, with the help of the BMA parliamentary unit, launched an e-petition opposing the government’s pension proposals.

The e-petition says: “We urge the Department of Health, in conjunction with the governments of the devolved nations, to re-open meaningful negotiations with health unions to achieve a fair and amicable pension settlement. The NHS pension scheme is not an unfair burden on taxpayers - in fact it is providing a large positive cash flow to the Treasury. The settlement should reflect the fact that the NHS scheme underwent major changes only four years ago, with staff taking on responsibility for ensuring it is sustainable in the long term.”

MPs could be forced to debate the issue in the Commons if the petition gains 100,000 signatures - as I write we’ve passed 15,000. Please complete it HERE and ask your friends and colleagues to do likewise. We have to keep this issue at the forefront of all BMA members’ minds.

A huge amount of work is currently underway at the BMA; at each of the national offices and across our superb network of regional advisors and industrial relations officers. Preparations are being made for the emergency meeting of BMA council on 25 February and of course we are continuing to explain what the changes would mean to members and gather place of work details across the UK. Remember - it’s very easy to update your details here.

The emergency council meeting is of huge significance, as it will decide whether to ballot BMA members for industrial action and what that action might look like, should the government refuse to change its position.

The BMA will only take such steps as a last resort - we understand that for our members patient care will always be their main consideration. However, everyone has a line and judging by the results of our pensions survey the government has overstepped it for many doctors.

Stop feeling powerless - become a union rep

By Eleanor Draeger, deputy chair of the BMA's Junior Doctor Committee - 7th February 2012 12:41 pm

There is more to being a doctor than medicine. The really big things that affect patient care are often political. Issues like the Health and Social Care Bill and the quest to find £20 billion in efficiency savings will have a huge impact on the service patients will receive in the next few years.

There are also issues affecting our income, such as reform of the NHS pension scheme and the interminable pay freeze, both of which will have a bigger impact on junior doctors as we will still be working in the NHS when today’s consultants and GPs are long retired.

It is easy to feel powerless, especially when you are too busy to think beyond the next shift or set of exams, but it is possible for junior doctors to get their voices heard - by getting involved with the BMA. If you are the sort of person who finds yourself shouting at Andrew Lansley on Newsnight from the comfort of your armchair or explaining to your friend exactly why the Daily Mail article about young doctors being rubbish is a pile of tosh then perhaps you should consider getting more involved in medical politics.

Getting involved is easier than you think. The BMA’s junior doctor committee operates a visitor scheme that allows you to get a taste of the cut and thrust of medical politics without making a commitment to attend further meetings. It will show you how decisions are made and how the views of ordinary junior doctors can be used to solve problems ranging from banding appeals through to the government’s reforms of education and training.

If after attending your first junior doctors committee meeting you feel you have something to contribute then the next step would be to get involved with your regional junior doctors committee and stand for election to the JDC.

If you harbour serious ambitions to become a medico-political leader then you may want to consider standing for election to BMA Council. This is the main decision making body of the BMA and offers an opportunity to influence the direction of the whole association. Details of the elections can be found on the BMA website - you will have to be quick though as nominations have to be in by Friday 10 February.

The BMA often polarises opinion amongst junior doctors, but whatever your opinion, the only way to ensure your voice is heard is to get involved. So, if you are angry about the Health and Social Care Bill, apoplectic about the changes to the NHS pension scheme or frustrated at the way junior doctors are being treated in your own hospital - why not get involved with the BMA and make a difference.

Continued attacks on doctors will damage the NHS

By Dr Brian Keighley, chairman of the BMA in Scotland - 29th December 2011 12:31 pm

It is disappointing that over the course of the year, doctors have come under repeated attack on several fronts.

Their contracts are being devalued and undermined by NHS employers and now politicians are attacking the NHS pension scheme. It would appear that our political leaders perceive these to be the solution to the country’s national deficit. While this approach might deliver some savings in the short term, it will, in the longer term cause damage to patient care and the loss of doctors from the NHS as many may choose to retire early.

The NHS is nothing without its staff and right now with pending budget cuts, pressure on boards to make further savings, and staff cuts on hospital wards, doctors have less time to spend with patients and their goodwill is being pushed to breaking point.

Next year will see us surveying our members on the proposals for reform of the NHS pension scheme, and we have not ruled out a ballot for industrial action. Politicians should be wary of underestimating the strength of feeling amongst all members of the NHS pension scheme and listen to our concerns.

Maintaining a sustainable and high quality NHS in the current financial climate will require an open and informed dialogue about the true cost of delivering health services and the priorities for the allocation of NHS resources. Doctors working on the ground in both primary and secondary care are ideally placed to help the NHS provide the services that patients need. They are experts in delivering those services and must be engaged with both nationally and locally in making key decisions on where efficiencies can be made with the least impact to quality of care and patient safety.

Public Health

We in Scotland have always been progressive in tackling our public health challenges. Scotland led the way in tackling the blight of smoking on society by banning smoking in public places. The benefits of that legislation are clear for all to see.

Alcohol misuse is costing Scotland an estimated £3.6 billion a year. The cost of cheap drink is £900 for every adult in Scotland. If our politicians are serious about helping to change our Scots culture of heavy drinking, then they must support the government’s minimum pricing bill.

Sensible drinking begins with sensible pricing and I hope that minimum pricing will begin the cultural change we need to reduce the alcohol misuse epidemic in Scotland.

Pensions: don’t let someone else decide the future

By Dr Ian Wilson, deputy chairman of the BMA's Consultants Committee - 22nd December 2011 5:28 pm

Pensions. Traditionally one of the less scintillating dinner party conversation topics, but most consultants are aware of their importance (they are, after all, deferred salary), and of the radical, and damaging, changes the government is making.

Contrary to some of the media reports, the health unions, including the BMA, HAVE NOT agreed to the ‘final offer’ announced on 20 December. We are gauging the views of our members before we decide on the next step - which could be the first ballot of doctors on industrial action since the 70s.

To that end, BMA members will be receiving a postal survey in the first week in January. It is absolutely vital that you complete it, letting us know not just what you think of the offer, but also what action you would be prepared to take next.

In short, if you have a pension, you will be hit very hard indeed. It will cost you much, much, much more, with your monthly pension deductions going up sharply in April. If you’re currently contributing 8.5%, you would have to pay an incredible 14.5% by 2014. In most cases, you will have to work longer to get a full pension - up to 67 or 68.

And despite paying more for longer, you will probably get a worse deal over your retirement.   As well as being received for fewer years, you pension would be based on your Career Average Earnings, not your final salary. And it will be up-rated each year in line with the Consumer Price Index rather than the Retail Price Index, which sounds immeasurably dull until you take into account the fact that the change could cost you over £200,000 over 20 years of retirement.

To be fair, the deal before us is less bad than what had originally been proposed. Doctors within 10 years of their normal retirement would keep the current scheme, and those 10-13 years away would get partial protection.

However there is a further twist in the tail for consultants. First, our contract and salary scale are specifically tailored to a Final Salary Pension Scheme - we will be hit harder than most if it is taken away. And the pay review body has made a series of recommendations about our pay structure which may be significant and far reaching. We don’t yet know because the Secretary of State will not discuss them with us until the pensions issue is “sorted”.

The government has said this is the final offer and it is unlikely to be improved through further negotiations. It is obviously not something any of us would have sought. The decision is now with BMA members and whether they feel this is something to have the “ultimate” fight over. As a consultant you may very well think this is a fight worth having.

So what next? First you need to be aware how you will be affected - go to the BMA website and look at the Pensions Calculator, or go to one of our pension roadshows. Second, ensure your colleagues, especially trainees realise what’s heading their way. Finally, and most importantly, complete the BMA survey in January. If you don’t, you’re risking someone else making a decision about your future.

Top five tips for successful part-time working

By Sue Robertson, chair of the BMA's Scottish Staff, Associate Specialists and Specialty Doctors Committee - 22nd October 2011 7:55 am

Doctors are becoming increasingly interested in the possibility of working part-time or flexibly as they look to achieving a better work-life balance. Employers may even be more supportive at present as they look to make cost savings. As someone who has worked part -time for a significant chunk of my career, I want to share some of the pros and cons.

From the outset it is important to dispel a few myths about part-time working. You don’t need to be female and you don’t need to have children to work part-time. If you can afford the drop in income and you have other things you want to do with your life, why not give it some thought?

Working part-time presents its own challenges. Often the times that your team wants you to be there are the busiest times. It is likely that you will try to be more efficient and to “fit more in” to the time you spend at work. You may well feel that you have to work more hours than your job plan allows. It is important that you get the balance right, so that you can continue to work in a professional manner whilst having some time away from work.

The key to successful part-time working is innovative job planning. I have an associate specialist job in which I am encouraged to cover the whole variety of my specialty of renal medicine. Clinically I am challenged daily by clinics, ward rounds, referrals from within the hospital and from my colleagues in primary care. In order to do that, I have had to become better at handover. There are some tests or results that will come back when I am not at work and I need to make sure that someone else knows to look out for them. I still feel uncomfortable doing that as within myself it feels like I am not completing the job but I need to ensure that care of the patient is continuous.

Working part-time should not prevent you advancing in your career. I have been encouraged to take leadership roles both regionally and nationally and this adds a great deal to my job satisfaction. You need to be proactive though - nobody will offer you things on a plate. You will need to give good reasoned argument as to why you should have time in your job plan to fulfil these roles. I would recommend that you strive for variety and challenge in your working life as an SAS doctor because the rewards of job satisfaction are great.

For the first time with the 2008 contract, our need for SPA time has been recognised. We will continue to argue that most SAS doctors have too little time allocated in their job plans for Supporting Professional Activities (SPA) work but it was a start. If your SPA allocation is too small you should address that in your annual appraisal. You need to speak up though. A well trained appraiser should be able to help you work out what to do about this common problem.

My tips for success in part time working are:

1. Continue to set yourself new challenges

2. Job-plan carefully

3. Always maintain a high level of professionalism

4. Ensure that you have regular satisfactory appraisal and set out a personal development plan for the coming year so that time can be allocated to your needs for personal and professional development.

5. Enjoy the time you spend out of work doing the other things that life has to offer. You will take that enthusiasm back into your clinical role too.

You can find more information about improving your work life balance on the BMA’s electronic handbook webpage, including case studies from many other SAS doctors who have taken up this option.

Pensions: BMA not balloting members…yet

By Andy Blake, head of pensions at the BMA - 7th October 2011 10:18 am

There seems to be an impression that the BMA has decided not to ballot members on industrial action in respect of the threats to members’ pensions. Let me make it clear that that is absolutely not the case.

Our position is that we are not balloting members…yet.

The Royal College of Nursing and the Royal College of Midwives have taken exactly the same position as the BMA and of course we work closely with them and other health sector trades unions. In fact this week I am attending a meeting with TUC affiliates and non-affiliates to discuss communications and readiness for the pensions ‘day of action’ on November 30.

Recently BMA council discussed the threats to members’ pensions. The decision they took was, as I have said, not to ballot members as part of BMA activity on the ‘day of action’, but keeping open the option to do so in the future. We will fully support the day of action and we are currently working to provide guidance on legitimate action that you can take ahead of and on November 30.

It would be premature for us to be getting into the details of what action we might consider in the future, how a ballot would take place, or who would be balloted, especially as the government has not yet formally set out the full details of how it wants the NHS pension to change, let alone attempt to impose the changes.

The consultation on the proposed increases to employee contributions runs until October 21. A huge number of doctors have submitted responses to the Department of Health, making it clear what they think, not just of the proposed contribution hike but also more generally what they think about the wider proposals. Have you responded yet? If not then please do - we have some suggested text you can use.

We have made it absolutely clear that we do have the right to take industrial action (while being bound by the constraints of the law and of Good Medical Practice).

One thing is for sure though, if and when we ballot members we have to be absolutely certain that their place of work details are accurate  any inconsistencies would be challenged in court. So, please make sure that your details are up-to-date here.