BMA

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

Call to get involved in consultant conference

By Richard Rawlins, chairman of the BMA's UK Consultants Conference - 7th March 2010 12:18 pm

The UK consultants conference, Standing up for Consultants, will be held at BMA House on Wednesday 2 June. Motions to be submitted from MSCs, or equivalent in the private sector, should be sent to the BMA by 29 March.

Motions on any topic will be considered, but this year there will be a focus on those under the headings of revalidation, SPAs, service reconfiguration, EWTD, and health policies. There will also be workshops on SPAs, CEA applications and working with the press and politicians.

All NHS MSCs and private hospital equivalents can send a representative, so if you do want the BMA to ‘do something’, please ensure your professional community is well represented. Apply by 1 April to the above website. The BMA will reimburse reasonable expenses. Non BMA members are welcome.

Additionally, it is essential that the BMA has its members’ details properly recorded, and that email addresses are registered. Members are asked to go to the BMA website and check under ‘My BMA Details’. Please ensure that if you do private practice, this fact is properly registered. Only by this means will the BMA be able to fairly determine and allocate resources towards lobbying and developing policies for issues in the independent sector.

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How ethical is your hospital’s purchasing?

By Dr Mahmood Bhutta, advisor on BMA’s medical fair and ethical trade group - 4th March 2010 6:43 pm

Most of the doctors I speak to are genuinely surprised to hear that some of the goods used in the NHS are made in sweats shops by children as young as seven.

It is this lack of awareness that the BMA is trying to address through the launch of an information campaign which aims to mobilise doctors in the NHS to show moral leadership and influence the purchasing decisions of the NHS organisations in which they work.

The campaign is a direct response to a BMA survey which found that only one in ten doctors was aware of fair trade medical supplies but when provided with information eight in ten were supportive.

Whilst there is clearly support amongst healthcare professionals, I am increasingly asked about ethical purchasing in the context of the current economic climate. Many seem conditioned to think that fair trade means more expensive goods however this is not the case.

Many of the supply chains in the NHS are unfathomably complex with goods from the developing world being processed, repackaged and rebadged in Europe before they are sold on to the NHS. At each link of the chain, a middle man skims off his fee often leaving little for the manufacturer, never mind the workers.

As a purchaser with huge buying power the NHS has the clout to put pressure on suppliers to provide more information about their products and how they are produced.

By bringing the manufacturers and the suppliers closer together - supply chains can become more streamlined. Removing the complexity of the supply chain will reduce some of the costs which could be used to fund improvements to working conditions and pay for workers without any additional cost to the NHS. Fair trade cotton scrubs are currently being trialled in my own hospital and these are actually cheaper than their conventionally produced counterparts so we know it can be done.

Many doctors will be involved with purchasing decisions at some point in their career and even if they aren’t, there are some simple things you can do to help. You can start by finding out whether your hospital has an ethical procurement policy, if not encourage your chief executive to adopt one. If you are involved in purchasing - ask questions of your current suppliers. Find out where their products are made and under what conditions.

Doctors can also form local interest groups within their institution to distribute leaflets and discuss the issues. It is also important to engage with other healthcare professionals and patient groups - it may even be worth talking to the local media.

If you want to learn more about the campaign visit the Fair Medical Trade website or show your support by joining the campaign Facebook group.

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How to help the humanitarian effort overseas

By Dr Abi Smith, deputy chair of the BMA's international committee - 27th January 2010 9:20 am

I find it difficult to watch the news coming out of Haiti without feeling like I want to use my clinical skills to help. I am not alone in feeling like this as Médecins Sans Frontières has been inundated with calls from doctors wanting to help.

The stark reality is, however, that most of us would be of little help without additional training or experience of working in the developing world in the aftermath of natural disasters. It got me thinking about the humanitarian work carried out by many British doctors, not only at times of crisis but, throughout the year and what organisations like the BMA can do to support them.

The BMA’s international committee runs a humanitarian fund supporting healthcare workers working in projects in the developing world. Looking through the list of projects it supported last year, it is humbling to see how ordinary doctors are using their time to make such a big difference.

In Ghana, for example, a transplant surgeon and nephrologist have worked with local doctors with the long term aim of setting up a kidney transplant service. Kidney dialysis over a long period of time is prohibitively expensive and so it is critical that developing countries like Ghana can offer transplants.

Other projects have involved working in war torn countries like Afghanistan, Sudan, Ethiopia and Mozambique. Some of the projects are quite simple such as training community care workers to improve maternal health and infant mortality or supporting public health education programmes. What they all have in common is that they invest in local people making a sustainable difference long after the project teams have returned the UK.

Applications for this year’s Humanitarian Fund are now open. If you are looking to work on humanitarian projects in the developing world or know of colleagues embarking on this sort of work you should visit the BMA website.

If you want to find out a more about working overseas it is also worth having a look at Broadening Your Horizons, a comprehensive guide for doctors wanting to work overseas. For medical students interesting in getting work experience outside the UK the BMA has recently launched extensive guidance on medical electives.

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Where is the revalidation juggernaut heading?

By Dr Mark Porter, chair of the BMA's consultants committee - 19th January 2010 4:44 pm

It’s been delayed for so long that you could be forgiven for losing interest, but another major change to our working lives is heading towards us.

Following the issue of licences to practise in November, the second-phase pilots for revalidation in England (which, it would be fair to say, is more or less behind the other nations) are due to start shortly.

A huge amount remains unclear. One area we’ve called for the pilots to address concerns responsible officers (ROs) - to whom and for what precisely will they be responsible? The role is likely to fall to medical directors, which immediately presents obvious potential for conflicts of interest. Is their main duty to support you in navigating the process, is it to the GMC, or is it - given that all ROs are likely to have a position on the board of their trust - to senior management? Would it be as easy to raise a contentious issue with your medical director if he or she had a role in your revalidation?

There is clearly much room for improvement on the way the process is being communicated. Doctors remain largely in the dark not just on the amount of their time, energy, and money that will be taken up by revalidation but also on the standards that will be expected of them. To me this arises from a basic confusion about the purpose of the exercise. 

Is it to ensure doctors meet a basic minimum requirement, or is it to promote excellence? Much of the recent literature from the Revalidation Support Team defines standards which are aspirationally high. But, logically, the majority of doctors are not the very best, so there also needs to be a narrative for those who are a bare pass.

Our message to consultants is to be prepared. If you haven’t yet, and if you can find the time, start thinking about ‘evidence’ of your adherence to standards as early as possible. To the colleges, it is to be realistic in the standards expected. To trusts, it is to acknowledge that significant time will be required to complete the process - another reason not to cut consultants’ SPAs. And to the Department of Health, it’s to be clearer on what exactly is being asked of us.

The juggernaut is in motion but we need to know exactly where it’s heading.

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Encouragement will widen professional access

By Liz Denny, medical student in Liverpool and the BMA's lead on accessibility - 18th December 2009 1:34 pm

There will be many of you who will approach yet another report about equality and widening access to medicine in the same way that I approach the Peter Andre and Katie Price circus.

I don’t understand it, I don’t care about it and frankly I wouldn’t be that fussed if a gigantic foot dropped down on top of it.

I sympathise with this reaction as in recent months we have been deluged with reports, pronouncements and initiatives on this topic, not least from Alan Milburn’s summer report on widening access to the professions. Unfortunately much of this has been wrapped in the overbearing language of political correctness which makes you want to pull your hair out.

But, buried beneath this mountain of political spin lies a couple of serious points. It is true, as the BMA’s new report into the make up of medical school demonstrates, that as a profession we have an appalling track record of recruiting students from low income backgrounds.

Just one in seven medical students comes from this group, despite the government pouring £392 million into widening participation schemes in recent years. The glut of spending has resulted in an increase from the lowest groups of just 1.7% since 2003. Not exactly time for the party hats and the cava.

I imagine though that many of you again would have been left unmoved by this last paragraph, possibly because you suspect that what is coming next is a call for positive discrimination. Certainly our report suggests this view is filtering through to students, with a rising rate of applicants refusing to answer questions about their social status, possibly due to a fear they could end up being penalised if they are judged to be too wealthy.

Well, this isn’t what the BMA or I believe in. Positive discrimination is as unfair as it sounds - there is nothing positive about discriminating against anyone.

What instead needs to happen is for us to remove the barriers holding back low income students. Many of these lie at school level, well before application forms are even filled in.

Pupils from low income areas receive worse grades than their counterparts in more affluent districts and, perhaps linked to this fact, many automatically think a career in medicine isn’t for them. Another issue may lie in the career advice students get, as there is evidence of an inconsistency in the quality of these services.

Certainly, in my own experience, I didn’t feel I got much encouragement to go for medicine despite my grades. There of course other barriers, not least the increasing cost of a medical degree which all politicians appear to have genetic pre-disposition to ignore - despite medical students now facing a £37,000 debt bill after graduation.

To tackle these problems we don’t need phony positive discrimination schemes. We need to look at the school system and how it interacts with medical schools, especially in terms of career advice services. We need no more increases in tuition fees and someone in Whitehall to wake up to the debt problem that threatens to bury the ambitions of thousands of students with the brains but not the wallet to get into medical school. And we also need a proactive set of mentoring schemes - an area the BMA is looking to work on - aimed at raising the sights of children so that they believe a career in medicine is within their reach.

Tackling the under representation of low income students is therefore not a flag to be raised in the cause of political correctness. It is about something more real, more practical and more important - making sure we get the best talent into our hospitals and that everyone gets the chance to fulfil their potential.

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Exempted deaneries need a code of practice

By Dr Shree Datta, chair of the BMA's JDC - 14th December 2009 1:03 pm

Can you imagine a job advert that doesn’t tell you where you will be working, the hours of work, what you will be paid, when you need to start or the length of the employment? Furthermore, when you call up to ask these questions your prospective employer refuses to give you an answer…

Well many of us don’t have to imagine, we just have to be junior doctors. Everybody from office temps to fruit pickers has the basic right to this information but, it seems, not junior doctors.

In 2008, the BMA challenged the Employment Agency Standards Inspectorate (EASI), the organisation responsible for regulating employment agencies, to find out whether deaneries were employment agencies in the eyes of the law. If they were, deaneries would have to comply with the requirements of the Employment Agencies Act and supply all the basic details about their jobs before they start.

Much to our satisfaction EASI confirmed that postgraduate medical deaneries appear to be employment agencies and as such would be required to comply with the requirements of the Employment Agencies Act. The BMA immediately began notifying EASI of deaneries failure to comply with the legislation.

Sadly, the costs of getting deaneries to provide junior doctors with the same basic rights as other workers caused the government machine to whirr into action and in

In May 2009, the Department of Business and Skills (BIS) published a consultation which detailed their intention to exempt deaneries from the employment agency regulations.

The BMA responded strongly to this consultation stating that deaneries should not be exempted. If BIS chooses to ignore the views of junior doctors and exempt deaneries then we must start the hard work of getting deaneries to sign up to a code of practice that raises standards.

Junior doctors are united on this issue and the JDC will do everything in its power to get what are basic employment rights for junior doctors. Should we not be satisfied with the terms of the code of practice for UK junior doctors, we will not be able to agree to them.

Our aim is to ensure that junior doctors are merely afforded the same rights to any other work seeker - no less. We will have a better idea of the direction of the code of practice early next year, so watch this space.

In the meantime, do get in touch with the deaneries and the BMA if you have trouble with applications for specialty training.

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Tis the season of new specialty training jobs

By Dr Shree Datta, chair of the BMA's junior doctors committee - 7th December 2009 5:45 pm

December is traditionally the time of year that most people get ready for Christmas.

Many junior doctors also face the additional pressure of applying for new jobs. But, with all the distractions of the festive season, it is important that everyone understands the recruitment process to maximise their chances of getting the training post they want.

Recruitment for specialty training officially began on the 4 December. And whilst the ill-conceived MTAS has been confined to the dustbin of history; we cannot be complacent.

There were glitches in the some of the application systems last year, but thankfully these were sorted out before any junior doctors were disadvantaged. However, they reminded us of the need to stay vigilant and proactive rather than reactive.

The principles of the Tooke Report should still be ringing in the ears of those responsible for recruitment. Change, although not unwelcome, must be evidence based. We must have robust piloting to find out how new systems operate in the real world and critically new computer systems must be rigorously tested.

The cost of getting selection for specialty training wrong is high, not merely financially, but in terms of affecting the public services our patients receive and the careers of individual doctors.

We have concerns over changes that may be on the horizon. There has been talk of introducing another knowledge-based test for specialty recruitment. The rationale for knowledge-based selection tests is not clear and the BMA has been critical of these tests as there is little evidence that they are a good way of selecting the best candidates.

Machine marked testing (MMT) is also looming. It has been mooted as a way of addressing the inconsistency of assessments which has caused problems for deaneries in national recruitment and has frustrated applicants.

Unless planned thoroughly, dissected microscopically and piloted, MMT will receive a hostile reception from junior doctors which it may not survive.

To maximise the chance of getting the job we want, it is critical that all applicants ensure they are familiar the process for 2010. The MMC website and Deanery websites are the main resources, although posts may also be advertised via BMJ Careers and NHS jobs.

If applicants encounter problems during the recruitment process they should contact the BMA on 0300 123 1233 so that we can put pressure on those responsible.

Doing your research thoroughly prior to applying or accepting a post is crucial as there are regional variations in the content of training programmes. Study leave and relocation allowances can also vary and the best way to find out what’s available is to speak to those in post currently.

This is the only way to avoid the Nightmare before Christmas. Good luck!

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Will immigration changes add to recruitment woe?

By Dr Shree Datta, chair of the BMA's junior doctor committee - 17th November 2009 12:55 pm

Last week saw Gordon Brown get tough on immigration.

In the Daily Mail, we heard that the government was cracking down on immigration starting with a curb on doctors. Self sufficiency should be the goal of workforce planning, but are we really there yet?

My previous blog on rota gaps highlighted the problems many junior doctors have working on understaffed rotas and the fact, which even the Department of Health acknowledges, that part of the rota gaps problem is due to a previous crackdown on immigration.

Predicting the numbers needed to staff the NHS is complicated and whilst we may have competition for jobs in some parts of the country, other parts may have problems recruiting the doctors they need to deliver services to patients.

Earlier last week I was talking on BBC Radio Cumbria about the North Cumbria University Hospitals NHS Trust. This trust is recruiting junior doctors and consultants from India because they can’t find home grown candidates, which clearly illustrates the problem with a heavy handed approach to immigration. My worry is that this will affect the quality of care patients in the NHS are getting and the amount of training that junior doctors are exposed to - leaving them ill-equipped to be the consultants of tomorrow.

Of course, as with most government announcements, there seems to be very little policy behind the rhetoric but in his effort to sound tough on immigration Gordon Brown must not ignore the fact we need a flexible system that does not leave the NHS short of doctors.

The BMA’s junior doctors committee is working to ensure that international doctors are able to take up the posts they are offered without being hindered by the red tape that surrounds visa applications. With 2010 around the corner, it’s very much a case of watch this space to see how the immigration changes on top of the European Working Time Directive affect junior doctor recruitment.

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Honesty needed from DH on juniors’ rota gaps

By Dr Shree Datta, chair of the BMA's junior doctors committee - 29th September 2009 2:50 pm

I was chairing my first meeting of the BMA’s junior doctors committee last week, when a copy of the Daily Telegraph was thrust under my nose. The article came as no great surprise as we had issued a press release highlighting the rota gap problem based on Department of Health figures we uncovered from 2008 recruitment. The figure was a 5% shortfall (or around 3,000 junior doctors in the UK).

What was surprising was the response from the DoH. Whilst I expected a public rebuttal, it came as a shock, as I’m sure it did to all junior doctors who read the article, to be told that: “The latest feedback from SHAs suggests the total numbers of vacancies for junior doctors in August this year was 1,055 which is only around 2% of posts.”

Given that this apparent reduction in rota gaps came at a time when most hospitals were trying desperately to prepare for the introduction the European Working Time Directive such a large drop seems almost miraculous.

Last year the DoH stated in a document on the WTD that: “Patient safety can be put at risk if critical rotas cannot be filled and in extreme circumstances, specific services may be need to be closed.” This suggests they are, or at least were, aware of the seriousness of the problem.

In the same document they acknowledged the reasons behind for the problem were Modernising Medical Careers and the changes to the immigration system. It is all there on page 9.

Yet their view is seems somewhat different now, according to their unnamed spokesman in the Daily Telegraph: “It is not true to say that as international recruitment has been stopped there will be gaps in rotas.”

They go on to dismiss our concerns about rota gaps: “The BMA are using old data…”

Has the rota gaps problem gone away? Dr Alan Axford, Hywel Dda NHS Trust’s medical director thought not when he took the unprecedented step of publicly highlighting the rota gap problems in West Wales in July. In Northern Ireland, the Erne and Tyrone County hospitals have suspended some gynaecological services due to a shortage of junior doctors and in Scotland it was recently reported that 23% paediatric trainees were on maternity leave.

The fact is that hospitals rely on junior doctors working extra unpaid hours to prop up our healthcare system. This is not a suitable or sustainable way to solve the problem. The DoH needs to stop hiding behind statistics and pretending the problem has gone away. We work on these rotas - we know it hasn’t.

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Time to prioritise SAS contract implementation

By Dr Radhakrishna Shanbhag, chair of the SAS committee - 1st September 2009 12:22 pm

I got into medico-politics to improve the lives of staff grade and associate specialist grade doctors. What I didn’t fully appreciate was the how painfully slow the process would be.

The BMA first sat down to negotiate a new contract with NHS employers over four years ago and this was after many years of calling for a new deal for non-consultant career grade doctors - as we were described then. When SAS doctors voted to accept the new contract the suggested timetable for implementation was for the majority to have transferred to the new contract by June 2009.

It was even written into the terms and conditions that it was anticipated that the job planning process would be completed within three months of a doctor expressing an interest. I am disappointed but not altogether surprised to learn that this has not happened.

Since the implementation of the new SAS contracts in April 2008, we have monitored progress closely. The whole process has felt a little like wading through treacle. The first step for trusts was to send out letters inviting doctors to express an interest in switching to the new contract. Now sending a letter to the staff grade doctors in a trust does not seem like a huge undertaking, yet according to our recent reports five trusts have not even managed to do this. We have followed this up directly and I believe that they have now finally done so.
 
Critical to the implementation of the new contract is the process of job planning. There is a wide range of online resources available on the BMA website to help doctors with the job planning process. However, this is contingent on employers getting the ball rolling. Our monitoring shows that only 13% of employers have concluded the job planning process and offered the new contract.

Now that we have the full picture of the sluggish nature of implementation, we have challenged NHS employers to put pressure on NHS trusts to properly implement the contract. It is not acceptable for trusts to drag their feet on this process. We are particularly keen to ensure that SAS doctors who move to the new contract get the back pay owed to them. It seems that only 7% of employers have reached this stage of implementation.

I am confident that back pay will be paid but the delays are still an unnecessary imposition and further evidence of the lack of value many employers seem to put on those in our grade.  

The proliferation of non-standard grades has been a bugbear of mine. Our research has shown that 7 out of 10 employers are offering the new contract to doctors in non-standard grades. I would like to see all non-standard posts offered the new contract. Non-standard posts create confusion for other healthcare workers and patients and should be consigned to the dustbin.

After intense pressure at our last negotiating meeting, NHS Employers has put a message out to all employers in England asking for their progress and for detail of any challenges they are facing. Perhaps a case of ‘too little, too late’ but at least a sign that they acknowledge the problem.

I have also just written to the chairs of local negotiating committees to urge them to support us in ensuring the speedy completion of implementation. We will continue the pressure both locally and nationally. The DoH has consistently said how important SAS doctors are to the NHS. This is their chance to prove their commitment to us. Contract implementation needs to be a priority, not an afterthought.

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