Dr Blogs

An open blog enabling commentators from across secondary care to share their opinions. To contribute email editorial@hospitaldr.co.uk

Health Bill taking a pasting in the letters pages

By Mike Broad - 1st February 2012 2:51 pm

OK, so now I’m confused, are GPs in or out when it comes to commissioning. It’s not easy to tell from the letters pages of The Telegraph.

Hard on the heels of a letter from GPs saying they’re in favour of the Health and Social Care Bill, comes another saying they’re not.

The first one had 50-odd signatories; the second 360-ish. Nah Nany Nah Nah. Most GPs are opposed to the Bill it would appear. (Interesting how everyone now seems to write to The Telegraph instead of The Times - probably the old pay wall issue).

Here’s the second letter:

Dear Sir,

The Clinical Commissioning Group (CCG) leaders who support the Health and Social Care Bill (Letters, January 28) do not represent the majority of GPs, who believe that the Bill will seriously damage patient care. More than 90 per cent of GPs polled by the Royal College of General Practitioners said that the Bill should be withdrawn.

The NHS is not in peril if these reforms don’t go ahead. On the contrary, it is the Bill which threatens to derail and fragment the NHS into a collection of competing private providers. The Bill will result in hundreds of different organisations pulling against each other, leading to fragmentation, chaos and damage to the quality and availability of patient care.

As GPs, we agree that clinicians need more involvement in planning the NHS, and that the health service needs to improve. We don’t need a Bill to achieve that. Drop the Bill and let’s work on the real issues: improving safety, efficiency, and quality of care.

Dr David Jenner

Lead, Eastern Devon CCG

…and 364 other GPs.

“Health Bill opposition not representative of GPs”

By Mike Broad - 29th January 2012 10:19 am

In a letter to the Telegraph, a group of GPs challenged the growing perception that all doctors are opposed to the Health and Social Care Bill which is set to become law. A recent Royal College of GPs survey suggested the overwhelming majority of GPs were opposed to the government’s reforms:

Dear Sir,

The NHS faces a challenging few years. Clinical Commissioning Groups (CCGs) are already showing their ability to innovate and improve the care of patients despite difficult circumstances.

Blanket opposition to the NHS reforms by the British Medical Association and the Royal College of Nurses is not representative of the views of GPs who, like us, already lead CCGs, and the large number of GPs and nurses who support us. In many parts of England, CCGs are already showing effective leadership in their local health systems. This brings frontline clinical experience and the views of local people into the heart of the NHS.

Co-operation between hospitals, social services, GPs and community nurses is much stronger as a result – this can only benefit people who rely on these services.

The risks of derailing the development of clinical commissioning must not be underestimated. Previous health service reforms have failed to commit to clinical leadership and have paid the price of disengaging the frontline staff most needed to modernise the NHS. We cannot allow that to happen this time. Without strong clinical leadership and the coordinated efforts of local clinicians, the NHS itself may be in peril: local services can only be improved if we all pull together.

Yours sincerely,

Dr Shane Gordon

GP and CEO, North East Essex CCG

Dr Jonathan Marshall

Chairman, United Commissioning Group

Dr Amit Bhargava

Crawley CCG

Dr Dilip Acquilla

Vice-chairman, Easton CCG

Dr Shane Gordon

GP & CEO North East Essex CCG

Dr Jonathan Marshall

Chair, United Commissioning Group

Dr Tony Ainsworth

Chairman, Northeast Birmingham CCG

Dr A Ali

Vice-Chairman, Barnsley Peoples First Commissioning Consortium LLP

Dr Ken Aswani

GP/Medical Director, Waltham Forest Federated GP Consortium

Dr Nick Balac

Chairman, Barnsley Peoples First Commissioning Consortium LLP

Dr Barhey

Chairman, Luton CCG

Dr Sam Barrell

Clinical Director, Commissioning & Transition TCT

Chairman, Baywide CCG Ltd

Dr Kamal Bishai

West Essex CCG Board, Epping Forest Locality Lead

George Boulos

Deputy Lead, North & West Reading CCG

David Eyre-Brook

Chairman, Guildford and Waverley CCG

Charles Broomhead

Contract Lead, Northeast Birmingham CCG (NEB)

Dr Harry Byrne

Chairman, Darlington CCG

Mr Joseph Chandy

Chairman, Easington Locality Group, Durham Dales, Easington, Sedgefield Shadow CCG

Dr Jonathan Cockbain

Joint Chairman of Sutton CCG

Dr Rosemary Croft

Member of the management Exec, GP South Reading Consortium

Ms Jane Dempster

Clinical Lead, Farnham CCG

Dr Stewart Findlay

GP Chair, Durham Dales, Easington and Sedgefield CCG

Dr Colin Fleetcroft

Founder member of Guildford and Waverley CCG

Dr Annet Gamell

Chairman, Bucks Primary Care Collaborative

Dr Andy Harris

Chairman, Leeds South & East CCG

Dr John Havard

Board Member, Ipswich & East Suffolk CCG

Dr Mark Hayes

Shadow Clinical Accountable Officer, Vale of York CCG

Mr Ken Holton

Information & Data Lead, InSpires & Godiva CCGs (part of Arden Consortia)

Dr Derek Hooper

Chairman, NE Lincs Care Trust CCG Council

Dr Mark Jefford

Clinical Lead, Newark & Sherwood NHS CCG

Dr Elizabeth Johnston

Chairman, South Reading CCG

Dr Andrea Jones

GP/Associate Clinical Lead, Darlington CCG

Dr Mahesh Kamdar

Clinical Co-Chair, Castle Point CCG

Dr David Kelly

Chairman, North Kirklees Health Alliance

Dr Stephen Madgwick

Clinical Lead, Wokingham CCG

Dr Joanne Medhurst

Managing Director, Bexley BSU

Dr Joe McGilligan

Chairman, EsyDoc LLP

Dr Vaishali Nanda

Vice-chairman, Middlesborough CCG

Dr Steve Ollerton

Chairman, Greater Huddersfield CCG

Dr Ramila Patel

Chairman, South Birmingham Independent Commissioners

Dr Amal Paul

Chairman, Leeds Alliance CCG

Dr Boleslaw Posmyk

Chairman, Hartlepool Locality & Hartlepool & North Tees CCG

Ms Stephanie Poulter

Business Manager, Northeast Birmingham CCG

Mrs Jan Randall

Commissioning Manager, NHS Kirklees

Dr Hugh Reeve

Chairman, Cumbria CCG

Dr Stephen Richards

Consortium Lead, Oxfordshire CCG

Dr John Ribchester

Board Member, Canterbury & Coastal CCG

Dr John Rivers

Chairman, Isle of Wight CCG

Dr Dinah Roy

Chairman, Sedgefield Locality, Durham Dales, Sedgefield & Easington Shadow CCG

Dr Raian Sheikh

Clinical Lead, Mansfield & Ashfield CCG

Dr Gordon Sinclair

Chairman, Leeds West Commissioning Group

Dr Ramji Sinha

Deputy Chairman, Trans Walsall Independent Commissioners

Dr Rod Smith

Chairman, North & West Reading CCG

Dr Mark Spencer

GP/Chairman, Fleetwood CCG

Dr Koyih Tan

Clinical Lead & Chair, Fareham & Gosport CCG

Dr Helen Thomas

Associate Medical Director NHS Devon, SHA GP Lead South West

Board Member, Plymouth CCG

Dr Peter Wilczynski

Interim executive chair, Corby Healthcare CCG

Dr Martin Writer

GP Chair & GP Principal, Coastal Community Healthcare Consortium CCG

Royal colleges pull out of Health Bill opposition

By Mike Broad - 27th January 2012 10:27 am

The Academy of Medical Royal Colleges has performed an embarrassing U-turn on challenging the government’s Health and Social Care Bill.

It was due to release a statement saying it could not support the reform process on behalf of the 20 colleges it represents, but pulled out when the Royal College of Surgeons refused to support the move.

The academy also held talks with the three major unions - the British Medical Association, Royal College of Nursing and Royal College of Midwives - this week, all of whom are publicly opposing the Bill.

Here’s the statement the AMRC were going to release but didn’t:

“The medical royal colleges and faculties of the academy continue to have significant concerns over a number of aspects of the Health Bill and are disappointed that more progress has not been made in directly addressing the issues we have raised.

“The academy and medical royal colleges are not able to support the Bill as it currently stands.

“Unless the proposals are modified the Academy believes the bill may widen rather than lessen health inequalities and that unnecessary competition will undermine the provision of high quality integrated care to patients.”

Instead, it said that “there had been a useful exchange of information”.

What is the NHS going to look like post-reform?

By Dr Alex Scott-Samuel, senior lecturer in public health, Liverpool University - 23rd January 2012 11:26 am

One element missing from current discussions of the Health and Social Care Bill is a straightforward account of what will happen if it becomes law. From a detailed study of the Bill and the academic and policy literature about it, plus many discussions with experts, I have distilled this simple scenario of England a few years after the Bill’s enactment.

If the Health and Social Care Bill is passed and fully implemented, the NHS will no longer be a provider of services, as GPs, hospitals and community health services will all be outside the public sector. The NHS will simply be a publicly funded budget and a brand name for a subcontracting operation for competing private organisations, subject to European competition laws which will allow private companies to predominate over other (eg third sector) providers.

Since competition and collaboration are incompatible and in any case, cooperation between providers will be punishable by law as anti-competitive, coordinated services for people with chronic or complex conditions will break down and disappear except within the restricted framework of tied providers under the so-called “integrated care” model developed by the US health insurance industry.

Because the post-credit-crash health service has a more or less fixed budget it will increasingly be the case that services judged to be ‘of lower clinical priority’ will no longer be provided free and will be charged for (or alternatively people will go private). These increasingly common NHS charges will create a demand (i.e. a market) for health insurance, which will mainly be affordable by the most affluent and which will also drive up costs because of administration fees and private profits.

The trigger for the roll-out of top-up insurance will be the impending introduction of personal health budgets, which represent a first step towards user charges.

Clinical commissioning groups will operate on an individual basis so as to be compatible with the insurance companies, unlike the traditional GP service which is population-based and pools risk across the whole country. Illness will begin to cause bankruptcy as is common in the US. Inequalities will increase enormously. Large amounts of public funds raised through taxation will be redirected as profits for the private companies which will provide NHS services and NHS commissioning support, and direct NHS charges (or health insurance payments to cover these) will become a normal item of household expenditure.

This letter first appeared in The Guardian.

Does anyone understand the NHS reforms?

By Martin McKee, Professor of European Public Health, London School of Hygiene and Tropical Medicine - 18th January 2012 10:32 am

Despite 25 years of experience researching health systems, including writing over 30 books and 500 academic papers, Professor Martin McKee from the London School of Hygiene and Tropical Medicine says he still can’t understand the government’s plan for the NHS.

“I have tried very hard, as have some of my cleverer colleagues, but no matter how hard we try, we always end up concluding that the bill means something quite different from what the secretary of state says it does.”

McKee notes that even Malcolm Grant, the incoming chairman of the National Commissioning Board, has described the bill as “completely unintelligible.”

Each year Prof McKee teaches a course on health systems. This year, he knows his students will expect him to explain the changes proposed by the Department of Health in England, but he says: “If I am to do so, I need to understand them first. Here lies the problem.”

His first problem is in understanding what the changes are trying to solve. The government argues that reform is needed because the NHS is performing so badly in international terms. Yet the evidence it has produced, such as deaths from heart attacks, has been totally discredited, while independent reports show that the UK is now improving at a faster rate than almost anywhere else.

Furthermore, the Organisation for Economic Cooperation and Development (OECD) has argued that the UK would have done even better if it had not continually been reorganising the NHS.

His second problem is to understand what is being proposed. “The prime minister has reassured us that he will not privatise the NHS. Yet the management of one hospital has just been handed over to what is essentially a private equity consortium,” he writes on bmj.com.

The health secretary’s role is also a puzzle to McKee, who reads that he will no longer have a direct role in the management of the NHS, but sees “ever more examples, from waiting times to refusals to treatments, where he is actively intervening”.

His third problem concerns the rate and scale of change. Unlike the US, where the president cannot do anything without the approval of Congress, the Health and Social Care Bill is already being implemented even though it has not passed into law.

McKee concludes: “I realise that my bewilderment may simply be a consequence of my own failure to understand the insights that have been granted to wiser and more learned individuals than myself…But I’m also hoping that someone, somewhere, will be able to help me.”

Language testing: balancing safety and movement

By Richard Nelson - 17th January 2012 6:26 pm

Freedom of movement amongst member states is one of the cornerstones of European Union integration. However, the UK government is considering whether these freedoms should be restricted in the interests of public health, public policy and the delivery of services. Healthcare related services are an obvious target for this concern.

In October, a report of the House of Lords’ Select Committee on Social Policies and Consumer Protection, concluded that whilst “the concept of automatic recognition of the qualifications of health professionals is welcome, aiding mobility and helping to improve training standards” nevertheless “patient safety must be the overriding concern”.

Two weeks prior to this report, Andrew Lansley, the health secretary, told the Conservative Party conference that he intended to amend legislation requiring all doctors qualifying outside of the UK to undergo language tests: “We will make it mandatory for responsible officers to make sure that doctors are properly trained and qualified, with the right language skills for the job…We will also give the General Medical Council new powers to take action against doctors when there are concerns about their ability to speak English,” Mr Lansley said.

In time, this legislation will also apply to other professionals who have been trained in countries outside the UK, where languages other than English are spoken.

Despite this recommendation, under the EU’s Mutual Recognition of Professional Qualifications Directive, the language skills of those trained in Europe cannot be tested as this would restrict freedom of movement. The GMC has expressed concerns that it is required to accredit Europe-trained doctors, regardless of their English skills. No doubt other regulators feel the same way.

The controversial House of Lords committee recommends regulators such as the GMC, NMC and GPhC assess the language skills of professionals before permitting them to practise in the United Kingdom.

As well as testing language competence, the Select Committee recommended the sharing of fitness to practise data across EU member states to create alerts regarding pharmaceutical, medical and healthcare professionals against whom investigations have been brought. Mr Duncan Rudkin, chief executive of the GPhC stated that failing to share this data efficiently across the EU may pose a serious threat to the public.

The House of Lords Select Committee chair, Baroness Young, feels that it is unacceptable that European rules should put patient safety at risk by forcing regulators to accredit candidates who may not meet UK standards and by depriving prospective employers of the ability to be able to check an applicant’s disciplinary history.

So, do we need to be concerned about freedom of movement? The answer is yes. Whilst we need to ensure that those who provide pharmaceutical and healthcare services in the UK are trained to, and able to function at, appropriate levels, we also need to ensure that the rights of these pharmaceutical and healthcare professionals are not breached.

Regulatory defence law firms often deal with situations whereby professionals are erased or suspended in one member state and permitted to practise elsewhere by moving to work in another. Whilst the government may feel that this creates an obvious and serious risk to patients and the public throughout the EU, how can this be balanced with the legitimate rights of the individual professionals?

It is clear that patients require protection from healthcare professionals whose fitness to practise has been found to be impaired. However, this must be balanced with the need to promote equality within the European working market in a proportional and fair way.

The UK must not risk isolating itself from the European Treaty by using language assessments of migrant pharmaceutical, healthcare and medical professionals as a veil for discriminatory state behaviour. However, the current UK government clearly feels that public safety must take precedence.

Pharmacists and other healthcare professionals in the UK have an excellent reputation for protecting patient safety, whether they have been trained in the UK or elsewhere. So what happens when an investigation is launched by the regulator in relation to the standards of the professional who qualified outside the UK? What happens if a regulator will not allow the professional from an EU member state to register with them so as to be able to practise in the UK?

As pharmacy lawyers, we at Richard Nelson LLP are best placed to assist Pharmacists and other healthcare professionals in these situations. It is clear that enforcing high standards is central to the regulators’ role and the professionals must remain committed to promoting those high standards. However, it is equally important to protect the rights of the professionals and ensure that the regulators are not trying to discriminate against professionals who have trained in countries outside of the UK under a veil of protecting the safety of the public.

This article was written by the MD of Richard Nelson LLP Pharmacy Lawyers.

Private sector petulance damages NHS confidence

By Mike Broad - 14th January 2012 6:11 pm

God I’m fed up with the Health Bill. But then, just as I reached the point when I don’t care anymore, a flurry of unrelated stories this week has got me thinking again.

First things first, a quick shout out to Dr Clive Peedell, clinical oncologist, BMA council member, joint chair of the NHS Consultants Association and now professional jogger.

He’s started Bevan’s Run - a 160 mile run from Cardiff to London to protest at the government’s health reforms. Whether you agree with him or not, nuff respect.

The second story I spotted suggests that much of the profession actually agrees with Clive - they just can’t be arsed to pull their trainers on. According to a big survey by the Royal College of GPs, 98% of GPs would like the Health Bill withdrawn.

Bit of a problem this. The people its supposed to empower, and who are central to its success, have gone off the idea. It was going to be a challenge given the upheaval and timescales with significant buy in, what now?

The other two stories that made me think concerned the attitudes of private sector health providers, who are being invited in whole scale even before the health reforms become law.

First is the punch up between health insurer BUPA and private hospital group BMI which has led to the former ‘de-listing’ a swathe of the latter’s hospitals. A problem for them and the consultants who work in them.

BUPA claims BMI is charging 20% more than competing hospitals “despite offering no better quality or service”, and is all part of the insurers drive to reduce costs in private healthcare (which many other private practitioners will be only too aware of).

I don’t know who is ‘right’ or ‘wrong’ but it demonstrates a volatility that could be risky in a different, NHS setting.

Then there are those big, bouncy PIP implants. ”Replace our toxic time bombs for free,” say the ladies concerned.

However, a number of clinics are refusing to replace them for free with the Harley Medical Group being prominent among them. They are the victims of fraud, they say, a government agency - the MHRA - is to blame for authorising them, and the NHS is better placed to sort the problem out.

The government says the private clinics who fitted implants have a “moral duty” to remove them. But we all know that with continued media coverage the government will cave in and the local Nash surgeons will end up sorting  out this mess.

In another context, what happens when say an orthopaedic device fails and the private provider is under an NHS contract? Will it be acceptable in a competitive NHS market for private providers not to have to clean up their own mistakes? Surely we have learned from the ISTC contracts of the Labour government.

So there we have it - a flurry of stories that dent my confidence a little more that we can create a fair, harmonious and integrated healthcare landscape. There’s no chance of the Bill being scrapped now, and I’m not against the use of the independent sector per se, but one can only hope that commissioners think about more than the bottom line when inviting private sector health providers in.

“EU laws having unintended consequences in NHS”

By Mike Broad - 12th January 2012 3:12 pm

Two royal college presidents wrote a letter to The Telegraph this week calling for changes to the Working Time Regulations and the language testing of overseas doctors in order to promote patient safety in the UK:

Dear Sir,

The language competence of doctors from the EU working in Britain, and the stifling effect of the European Working Time Directive on the time that trainee doctors have to learn on the job, need urgent action. EU laws that apply to all sectors can have unintended consequences in healthcare that can put patients at risk, whether in Britain or other member states.

Our institutions’ key concern has always been to ensure the highest quality and standards of patient care, and we believe that EU rules for testing language competence should be strengthened.

It is also essential to ensure that doctors are competent. But the existing EU legal framework fails to recognise that periodic revalidation and requirements to participate in continuing professional development vary significantly across member states. The increased mobility of health professionals in the EU has highlighted huge variations both in the practical abilities of professionals of similar grades, and in the systems set up to ensure quality, in different member states.

We urge the European Commission to introduce a Mandatory Pro-active Alert System, which enables states to notify each other if a doctor has been struck off the medical register in one state.

We continue to be concerned about the future of medical training - acute medical training, in particular - and the effect of the European Working Time Directive on acute medical and surgical trainees, which reduces the number of hours available for them to train. We call for flexibility at a European and a national level with regard to how on-call time and compensatory rest for trainees are calculated.

Finding solutions to these problems will help ensure that future consultants have had training of the highest quality.

Yours sincerely,

Professor Norman Williams, president, Royal College of Surgeons

Sir Richard Thompson, president, Royal College of Physicians

If you’re concerned about a lack of training opportunities in acute medicine then register to attend Acute & General Medicine Conference 2012 - it’s free for many to attend.

Wires crossed over NHS whistleblowers’ hotline

By Mike Broad - 4th January 2012 11:19 am

Whenever a politician starts talking about setting up a ‘hotline’ to solve a problem, one cannot but remember John Major’s ‘Cone hotline’.

For those who have forgotten, it was a gimmicky, centralised attempt to solve a localised problem - and one that quickly descended into ridicule as traffic cones proliferated along our highways and byways.

It’s hard to dislike ‘hotlines’ as an idea - a sympathetic, readily available person on the other end of the phone who will seek to resolve your problem - and it goes a long way to explaining why politicians like them.

But, really, what is a whistleblowers’ hotline likely to achieve? Will people be able to track down the number? Who is going to be on the other end of the phone? How will they separate the malicious and misinformed callers from the genuine and oppressed? Who will they tell - the Care Quality Commission? If so, it’s already proved itself incapable of tackling such issues.

So, there are lots of questions, and too few answers. Maybe it will be become a useful ‘tip off’ service, but my prediction is that it will end in ‘FOI’ request embarrassment in a year or two when its ineffectiveness is exposed.

As Dr Kim Holt, a whistleblower in the Baby P case and representative of Patients First, said this week on Radio 5 Live many whistleblowers have approached the Department of Health in the past when they’ve feared local ramifications for whistleblowing only to be rebuffed - so why should they trust its hotline now?

Instead of wasting millions on a phone line, the government should ‘invest’ in making the existing legislation and policies work within local settings.

NHS employers are already obliged to have a formal whistleblowing policy and employees who feel compelled to raise concerns are protected by the Public Interest Disclosure Act 1998 - as long as they disclose information in the public interest in a reasonable and responsible manner.

The challenge is to create a culture where clinicians no longer fear for their careers if they raise concerns. Most doctors - and indeed managers - appreciate that a clinician’s primary responsibility is to their patient, not their employer. So, local systems of reporting have to take partisanship out of the process. They must be confidential and rigorous. A senior, independent figure must be accountable locally. It can’t be left to clinical directors and HR to sort out, where personalities hold such sway.

Imagine if the government put as much priority on this as say emergency readmission rates, with a similar fining system, you can bet that trusts would comply. Trust boards must record all expressions of concern and present their responses on an annual basis to a dedicated assessor with powers to ‘audit’ and investigate.

I liked the suggestion of Dr David Drew, another wronged whistleblower, who wrote in the pages of Hospital Dr that where concerns are upheld by an independent body the trust CEO should personally present the whistleblower with an award at a public ceremony. Now that would change the culture around whistleblowing!

As the Mid Staffs Inquiry draws to a climax, one hopes that there will finally be recognition of the importance of whistleblowing - and the need to support whistleblowers - to prevent such disasters happening in the future. And, as the traffic cones continue to proliferate around the M25, I’d suggest it’s going to take more than a phone line.

Time for doctors’ representatives to trim their fees

By Mike Broad - 14th December 2011 12:52 pm

I hear there’s been a bit of a spontaneous campaign on DNUK, the online doctors’ forum, calling on the medical institutions to freeze their annual fees to correspond with the stagnation in doctors’ wages.

For those of you who have been living in a cave, Chancellor George Osborne recently capped public sector pay rises at 1% for two years - this will follow the ending of a three year pay freeze for consultants in 2013/2014.

The call for fee freezes is not new. It happens most years. Every time I attend the BMA’s annual shin dig the argument is the same. The group, which includes the BMA and BMJ, announce big returns - on the basis of membership fees, the BMJ’s significant recruitment revenue, and their investments.

Some doctors then jump up and say they would like to see a freezing in membership fees. Normally the auditorium murmurs some initial agreement only for the Treasurer to stand up and guilt them all into voting through the membership rises because “if we don’t the BMA won’t be able to achieve so much”.

I’m sure variations of this argument are played out time and time again within our fee charging medical institutions - whether it’s royal colleges or medical indemnifiers.

I appreciate that ‘the people in charge’ are duty bound to run successful organisations, but surely enough is enough. This year there is a bigger picture - with industrial action over pensions starting to look more likely - and there is more to be gained for the branding of your institution if you have some empathy with your members.

Now one institution looks like it is going to actually cut it’s fees. Have a guess which one? No. Choose the one that was at the bottom of your list.

Yes, amazingly, the GMC is going to be the first.

Hospital Dr is not always very friendly to the GMC (with good reason), but credit where credit is due: in cutting its fees, it has taken an important step. And it follows a freeze the previous year.

I could start banging on about why doctors shouldn’t pay anything towards their regulation any more because they are no longer in a self-regulatory system, but I won’t.

The £30 reduction signifies more than just a saving for doctors. It suggests there is some understanding of its membership, and the pressures they are operating under. Not sure I’d go so far as to say ‘empathy’ but we shouldn’t disparage this move - it could be the start of a relationship with the profession rather than a minor dictatorship.

So, who is going to be next?

I hope they all put their hands up and offer reductions - not just freezes. When it comes to reward the profession is being battered.

There was an underrated piece of research recently (and slightly ironically) by the BMA’s junior doctors committee which revealed the mean cost of training to juniors across nine hospital specialties. The total? £18,257. And this at a time when they’re carrying record debt into their careers, with the advent of tuition fees, and their earning capacity has been compromised through reduced work hours.

For the record, it showed that general practice is the least expensive specialty to train in (from FY1 to CCT) at £6,825. While anaesthetics was the most expensive specialty at £24,912, closely followed by gastroenterology and acute medicine.

What more evidence do our representative bodies need to show a bit of Christmas spirit?

In this vein, Hospital Dr is offering FREE training to consultants in acute and advanced general medicine in 2012 in London. Register to attend early HERE not to miss out. Juniors are welcome too!